TEST DIRECTORY

Excerpt from the Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022

Diagnostic Criteria for Dyslipidemia

• * Basically, 10 hours or more of fasting shall be deemed "fasting". However, intake of non-caloric fluids such as water or tea shall be permitted. If unable to be confirmed as "fasting", it shall be deemed "at any time".
• ** If the screening shows borderline hyper-LDL-cholesterolemia or borderline hyper-non-HDL-cholesterolemia, consider whether there are high-risk pathologies and consider the need for treatment.

• LDL-C shall be calculated using the Friedewald formula (TC - HDL-C - TG/5) (however, only for fasting blood sampling) or using the direct method.
• If TG is 400 mg/dL or higher or blood is sampled at any time, use non-HDL-C (= TC - HDL-C) or the direct LDL-C method. However, when using non-HDL-C for the screening, risk should be evaluated keeping in mind that in the absence of hypertriglyceridemia, the difference from LDL-C may be less than +30 mg/dL.
• The TG reference range differs depending on fasting blood sampling or blood sampling at any time.
• HDL-C alone is not subjected to drug intervention.

Flowchart for Setting Lipid Control Targets from the Viewpoint of Arteriosclerotic Disease Prevention

• Calculate based on the scores by the Hisayama Study (Figure 3-2).
• * Stenosis in 50% or more of the intracranial or extracranial arteries, or aortic arch atheroma (maximum thickening of 4 mm or more).
• Note: If diagnosed with familial hypercholesterolemia and familial type III hyperlipidemia, do not use this chart, and see Chapter 4 "Familial Hypercholesterolemia" and Chapter 5 "Primary Dyslipidemia", respectively.

Lipid Control Targets by the Risk Classification

• * It shall be taken into consideration in diabetes mellitus with PAD, microangiopathy (retinopathy, nephropathy, neuropathy) complications or smoking (see Section 5.2 of Chapter 3).
• ** It shall be taken into consideration when complicated by any of the following four pathologies: "acute coronary syndrome", "familial hypercholesterolemia", "diabetes mellitus", and "coronary artery disease and atherothrombotic cerebral infarction (including other cerebral infarction with overt atheroma)".
• While non-drug therapy is the basic means of achieving control targets in primary prevention, drug treatment shall be taken into consideration for 180 mg/dL or more of LDL-C in any of the control classification. The possibility of familial hypercholesterolemia shall also be taken into consideration (see Chapter 4).
• Achieve the LDL-C control target first, followed by the non-HDL-C target. Even if the LDL-C control target is achieved, high non-HDL-C is often associated with hypertriglyceridemia, of which control is important. Low HDL-C should be addressed basically by lifestyle improvement.
• These values are only targets to be achieved. For primary prevention (low to intermediate risks), an LDL-C reduction of 20-30% can also be a target.
• *** Ten hours or more of fasting shall be deemed "fasting". However, intake of non-caloric fluids such as water or tea shall be permitted. If unable to be confirmed as "fasting", it shall be deemed "at any time".
• **** Stenosis in 50% or more of the intracranial or extracranial arteries, or aortic arch atheroma (maximum thickening of 4 mm or more). - See Chapter 7 for elderly people.