Figure 1.
Figure 2.
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Figure 5.
Classification of statins by LDL-C reduction efficacy
| High-intensity statin | Moderate-intensity statin | Low-intensity statin |
|---|---|---|
| Reduces LDL-C by >50% before treatment | Reduces LDL-C by approximately 30%–50% before treatment | Reduces LDL-C by <30% before treatment |
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Behavior and risk factors associated with cardiovascular disease from atherosclerosis
| Lifestyles | Biochemical characteristics | Personal characteristics |
|---|---|---|
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Classes of recommendations
| Class | Definition |
|---|---|
| I | The evidence and/or consensus suggest that the treatment or measure is beneficial, useful, and effective for patients. |
| IIa | The evidence or opinion tends to support the idea that the measure is beneficial and potentially effective for patients. |
| IIb | The evidence or opinion regarding the benefit and potential effectiveness of the measure is still unclear. |
| III | The evidence or overall consensus suggests that the treatment or measure is not useful, not effective, and in some cases, may be harmful to patients. |
Medications for dyslipidemia treatment
| Medications | Recommended dosage | Efficacy | Side effects |
|---|---|---|---|
| LDL-C lowering medications | |||
| Statins |
|
|
|
| Ezetimibe (cholesterol absorption inhibitor) | Ezetimibe 10 mg/d (Take once daily) | Lowers plasma LDL-C by 10%–18% and apoB by 11%–16%. Combined with statins, reduces LDL-C by an additional 25% [69]. |
|
| Bile acid sequestrants | Cholestyramine 8–16 mg/d | Lowers plasma LDL-C levels by 15%–25% |
|
| PCSK9 monoclonal antibody |
| Lowers plasma LDL-C levels by 50%–60% |
|
| PCSK9 siRNA | Inclisiran 248 mg SC at 0, 3, then every 6 months | Lowers plasma LDL-C levels by 40%–60% |
|
| Bempedoic acid | 180 mg/d | Lowers plasma LDL-C levels by 23% when used as monotherapy, 36% when combined with ezetimibe, and 12.6%–16.5% when combined with statins |
|
| Triglyceride-lowering medications | |||
| Fibrates |
|
|
|
| Omega-3 fatty acids |
| Lower plasma TG by 20%–50% |
|
The strength of recommendations in the context of clinical practice in Thailand
| Symbol | Definition |
|---|---|
| ++ | “Strongly recommend” indicates a high level of confidence in the recommendation, as the measure is highly beneficial to patients and cost-effective. |
| + | “Recommend” indicates a moderate level of confidence in the recommendation, as the measure may be beneficial to patients and may be cost-effective in specific situations (it may be optional depending on the circumstances and appropriateness). |
| +/− | “Neither recommend nor against” indicates an uncertain level of confidence in providing the recommendation, as there is insufficient evidence to support or oppose the measure. It may or may not be beneficial to patients and may not be cost-effective, but it does not increase harm to patients. Therefore, the decision to proceed depends on other factors (it may or may not be done). |
| − | “Not recommend” indicates a moderate level of confidence in advising against the measure, as it is not beneficial to patients and is not cost-effective unless necessary. |
| −− | “Strongly not recommend/against” indicates a high level of confidence in advising against the measure, as it may cause harm or pose a danger to patients. |
Maximum recommended doses of lipid-lowering drugs in CKD patients
| Drug group and name | Maximum recommended dose by CKD stage | |||
|---|---|---|---|---|
| Stage 1–2 (GFR ≥60 mL/min/1.73 m2)) | Stage 3a (GFR 45–59 mL/min/1.73 m2) | Stage 3b–5 (GFR <45 mL/min/1.73 m2) | Kidney transplant | |
| Statin (mg/day) | ||||
| Atorvastatin | 40–80 | 40–80 | 20–40 | 20 |
| Fluvastatin | 80 | 80 | No data | 80 |
| Pitavastatin | 4 | 4 | 2 | No data |
| Pravastatin | 40 | 40 | 20 | 20 |
| Rosuvastatin | 40 | 20 | 10 | 5 |
| Simvastatin | 40 | 40 | 20–40 | 20 |
| Simvastatin/ezetimibe | 40/10 | 40/10 | 20/10 | 20/10 |
| Bile acid sequestrants (g/day) | ||||
| Cholestyramine | 16 | 16 | 16 | 16 |
| Fibric acid derivatives (mg/day) | ||||
| Fenofibrate | 300 | 100 | Not recommended | Not recommended |
| Fenofibrate (micronized form) | 200 | 100 | Not recommended | Not recommended |
| Fenofibrate (micronized and microcoated form) | 160 | 80 | Not recommended | Not recommended |
| Fenofibrate (nano-technology form) | 145 | 72.5 | Not recommended | Not recommended |
| Gemfibrozil | 1,200 | 1,200 | 600 | 600 |
| Pemafibrate | 0.4 | 0.4 | 0.2 | No data |
| Others (mg/day) | ||||
| Ezetimibe | 10 | 10 | 10 | 10 |
| Niacin | 2,000 | 2,000 | 1,000 | No data |
| Omega-3 fatty acids (EPA/DHA) | 4,000 | 4,000 | 4,000 | 4,000 |
| Pure EPA | 4,000 | 4,000 | 4,000 | 4,000 |
| Alirocumab | 75–150 | 75–150 | 75–150 | 75–150 |
| Evolocumab | 140–420 | 140–420 | 140–420 | 140–420 |
| Inclisiran | 284 | 284 | 284 | 284 |
Diagnostic criteria for albumin in urine
| Stage | AER (mg/24 h) | ACR (mg/mmol) | ACR (mg/g) | Definition |
|---|---|---|---|---|
| A1 | <30 | <3 | <30 | Normal or slightly increased |
| A2 | 30–300 | 3–30 | 30–300 | Moderately increased |
| A3 | >300 | >30 | >300 | Severely increased |
Stages of CKD
| CKD stage | eGFR (mL/min/1.73 m2) | Definition |
|---|---|---|
| Stage 1 | >90 | Normal or high |
| Stage 2 | 60–89 | Mild decrease |
| Stage 3a | 45–59 | Mild to moderate decrease |
| Stage 3b | 30–44 | Moderate to severe decrease |
| Stage 4 | 15–29 | Severe decrease |
| Stage 5 | <15 | End-stage kidney failure |
Levels of evidence
| Level | Definition |
|---|---|
| A | Data derived from multiple randomized clinical trials or meta-analyses. |
| B | Data derived from a single randomized clinical trial or large non-randomized studies. |
| C | Consensus of the experts and/or small studies, retrospective studies, and registries |