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. 2024 Mar 29:29:18.
doi: 10.4103/jrms.jrms_318_23. eCollection 2024.

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults

Fahimeh Bagheri Kholenjani  1 , Shahla Shahidi  1 , Golnaz Vaseghi  2 , Vahid Ashoorion  3 , Nizal Sarrafzadegan, Mansour Siavash  4 , Maryam Heidarpour  4 , Shahrzad Shahidi  5 , Masoumeh Sadeghi  6 , Noushin Mohammadifard  7 , Masoumeh Jorjani  8 , Majid Ghayour Mobarhan  9 , Davood Shafie  10 , Hossein Farshidi  11 , Fariborz Khorvash  12 , Mojdeh Ghabaei  13 , Zahra Teimouri-Jervekani  1 , Mojgan Mortazavi  14 , Valiollah Hajhashemi  15 , Neda Roshanravan  16 , Leila Yazdanpanah  17 , Majid Davari  18 , Behzad Fatemi  18 , Elaheh Khorasani  19 , Ramesh Hoseinkhani  20 , Elaheh Zarean  21 , Alireza Ahmadi  22 , Maryam Eghbali Babadi  23 , Ahmadreza Assareh  24 , Mehdi Shadmani  25 , Javad Kojuri  26 , Farimah Shirani  23 , Mojgan Sanjari  27 , Fahimeh Haghighatdoost  28 , Razieh Hassannejad  1 , Elham Hashemi  29 , Mohammad Hassan Moaddab  30 , Alaleh Gheisari  31 , Bahar Dehghan  22 , Mitra Naseri  32 , Nosrat Ghaemi  33 , Fereidoun Noohi  34   35 , AliAkbar Haghdoost  36 , Amin Salehi-Abargouei  37 , Sara Beigrezaie  38 , Amin Doosti-Irani  39 , Nahid Ramezani-Jolfaie  40 , Bijan Eraj  41 , Mahin Hashemipour  29 , Ebrahim Nematipour  42 , Mahmoud Rafieian Kopaei  43
Affiliations

First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults

Fahimeh Bagheri Kholenjani et al. J Res Med Sci. .

Abstract

This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.

Keywords: Adult; Iran; clinical practice guideline; hyperlipidemia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Analytical framework for the management of dyslipidemia in adults. LDL-C = Low-density lipoprotein cholesterol; CVDs = Cardiovascular diseases; TG = Triglyceride
Figure 2
Figure 2
The algorithm for the diagnosis, management, and treatment of adult with high low-density lipoprotein cholesterol. LDL-C = Low-density lipoprotein cholesterol
Figure 3
Figure 3
The algorithm for the diagnosis, management, and treatment of adult with high triglyceride. *In this guideline, diabetes (type 1 and 2), cardiovascular diseases, ischemic stroke, familial hypercholesterolemia, and non-alcoholic fatty liver have been considered. CVDs = Cardiovascular diseases; TG = Triglyceride; ALT = Alanine transaminase
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