Treatment of dyslipidemia in diabetes. Should the lipid-management protocol which the ADA 2015 guideline recommends be used for Japanese as a reference?

Abstract

This ADA guideline followed the concept of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline [3], which had been settled in accordance with ‘‘the 2011 report of the Institute of Medicine on the development of trustworthy clinical guidelines’’ [4]. Briefly, the expert panels had asked critical questions, chosen and reviewed high-quality randomized controlled trials (RCTs) and reliable meta-analyses, and resolved the critical questions. Their precise analyses had identified ‘‘four statin benefit groups’’ which would benefit from management with statins, and diabetic patients were included among these groups. This identification of ‘‘four statin benefit groups’’ is a great advance in that physicians can easily identify patients requiring treatment for dyslipidemia. Besides this identification, the panels recommended administration of a fixed dose of the appropriate statin, leaving behind the ‘‘treat-to-target’’ protocol in which titration of agents is performed to achieve target lipid levels. The theoretical framework for this recommendation was: fixed doses of specific statins were used in the analyzed RCTs; and these RCTs did not utilize protocols in which agent dose titration was performed to target specific LDL-C or nonHDL-C levels.