PoLA/CFPiP/PCS/PSLD/PSD/PSH guidelines on diagnosis and therapy of lipid disorders in Poland 2021

Abstract

In Poland there are still nearly 20 million individuals with hypercholesterolaemia, most of them are unaware of their condition; that is also why only ca. 5% of patients with familial hypercholesterolaemia have been diagnosed; that is why other rare cholesterol metabolism disorders are so rarely diagnosed in Poland. Let us hope that these guidelines, being an effect of work of experts representing 6 main scientific societies, as well as the network of PoLA lipid centers being a part of the EAS lipid centers, certification of lipidologists by PoLA, or the growing number of centers for rare diseases, with a network planned by the Ministry of Health, improvements in coordinated care for patients after myocardial infarction (KOS-Zawał), reimbursement of innovative agents, as well as introduction in Poland of an effective primary prevention program, will make improvement in relation to these unmet needs in diagnostics and treatment of lipid disorders possible.

Omega-6 fatty acids and the Risk of Cardiovascular Disease: Insights from a Systematic Review and Meta-Analysis of Randomized Controlled Trials and a Mendelian Randomization Study.

“…A Cochrane review ( n = 660 participants) also found no significant association between either increased or decreased omega-6 PUFA intake and CVD risk factors [ 15 ]. In accordance with our results, a previous systematic review reported that replacement of saturated fats with cis-PUFA (which was equivalent to omega-6 PUFAs) significantly lowered TC levels, as we reported in the present study [ 48 – 56 ].…”

Which patients at risk of cardiovascular disease might benefit the most from inclisiran? – The expert opinion of the Polish experts. The compromise between EBM and possibilities in healthcare.

“…Despite some differences in the PROFICIO, ODYSSEY and (VICT)ORION programs, for the most part, we observe similarities, especially in the group of patients being investigated (FH, ASCVD, special populations) [ 11 , 15 , 20 ];…”

“…The analyses also showed that inclisiran effectively reduced non-HDL-C, apolipoprotein B, and lipoprotein(a) (Lp(a)) by 42.8, 40.2, and 20%, respectively, thereby demonstrating good efficacy in the management of residual risk [ 12 – 14 ]. This is especially important now, as in the recent Polish guidelines, non-HDL is considered as an equal important lipid parameter to LDL-C, and strong recommendations were also suggested for Lp(a) measurement (for all ASCVD and FH patients with IIbC level of recommendations), which is still assessed very rarely in Poland (mostly in patients at borderline CVD risk and in those with premature myocardial infarction) [ 15 ].…”

“…Also, patients with chronic kidney disease (CKD) stage 4 (with eGFR within 15–29 ml/min/1.73 m 2 ), based on the data from the ORION-7 study, might benefit from inclisiran [ 21 ]. This is a group which is one of the greatest challenges for cardiologists and lipidologists in the effective management of lipid disorders, as there is currently no indicated lipid-lowering therapy [ 15 , 22 ].…”

Design and rationale of a nationwide screening analysis from the LIPIDOGRAM2015 and LIPIDOGEN2015 studies

“…In populations from various countries it was shown that no more than 30% of patients reach LDL target levels both in primary and secondary prevention of CAD [ 44 – 47 ]. This type of epidemiological data may influence dyslipidaemia treatment guidelines for PHC, but are also of great importance not only for Polish family physicians, but also for cardiologists to whom patients are referred for consultations [ 48 ]. Furthermore, public health specialists, medical care administrators, and the public health care payer (NFZ – Polish National Health Fund) managing and financing the health care system will also benefit.…”