eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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Lipid lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel

Arrigo F.G. Cicero, Alessandro Colletti, Gani Bajraktari, Olivier Descamps, Dragan M. Djuric, Marat Ezhov, Zlatko Fras, Niki Katsiki, Michel Langlois, Gustavs Latkovskis, Demosthenes B. Panagiotakos, Gyorgy Paragh, Dimitri P. Mikhailidis, Olena Mitchenko, Bernhard Paulweber, Daniel Pella, Christos Pitsavos, Željko Reiner, Kausik K. Ray, Manfredi Rizzo, Amirhossein Sahebkar, Maria-Corina Serban, Laurence S. Sperling, Peter P. Toth, Dragos Vinereanu, Michal Vrablík, Nathan D. Wong, Maciej Banach

Arch Med Sci 2017; 13, 5: 965–1005


1.1. Cardiovascular disease and dyslipidemia: prevalence and global economic impact

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, reaching 31% of deaths in 2012 [1]. In particular, atherosclerosis and ischemic heart disease (IHD) are the main causes of premature death in Europe and are responsible for 42% of deaths in women and 38% in men under 75 years old [2]. The global economic impact of CVD is estimated to have been US $906 billion in 2015 and is expected to rise by 22% by 2030 [3]. Cardiovascular diseases also represent the major cause of disability in developed countries. It has been estimated that their growing burden could lead to a global increase in loss of disability-adjusted life years (DALYs), from a loss of 85 million DALYs in 1990 to a loss of ~150 million DALYs in 2020, becoming a major non-psychological cause of lost productivity [4].
Several risk factors contribute to the etiology and development of CVD; they are divided into those modifiable through lifestyle changes or by taking a pharmacologic treatment (e.g. for hypertension, smoking, diabetes mellitus, hypercholesterolemia) and those that are not modifiable (age, male gender, and family history) [5]. Elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) blood concentrations are the major modifiable risk factors for coronary heart disease (CHD), whereas high concentrations of plasma high-density lipoprotein cholesterol (HDL-C) in certain conditions are considered protective [6]. Moreover, LDL-C remains a fundamental CV risk factor (and a main target of therapy) even when statins are largely used in the general population [7].
An examination of the data of 18 053 participants aged ≥ 20 years who participated in the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2006 showed that the unadjusted prevalence of hypercholesterolemia ranged from 53.2% to 56.1% in United States adults [8]. Differences related to gender and race or ethnicity were observed; in particular, a lower rate of control was found among women than men and lower rates of having a cholesterol check and being told about hypercholesterolemia were reported by African Americans and Mexican Americans than whites [8].
A recent report from the American Heart Association confirmed that in the US only 75.7% of children and 46.6% of adults present targeted TC levels (TC < 170 mg/dl for children and...

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