Original Title: Ajustement des hypolipémiants (statines et ézétimibe) dans la prise en charge du risque cardiovasculaire

Authors' objectives: Since the revision of the national medical protocol (NMP) on the adjustment of lipidlowering agents in 2019, new guidelines have been published, such as those of the Canadian Cardiovascular Society (CCS) and the Patient, Experience, Evidence, Research (PEER) group on lipid management. These new recommendations introduce changes to certain clinical practices, thus creating inconsistencies with the current version of the NMP and causing confusion regarding the optimal approach to adopt on the ground. To ensure consistent, up-to-date cardiovascular risk management, the MSSS’s Direction nationale des soins et services infirmiers has mandated INESSS to update the NMP and all the related documents.

Authors' results and conclusions: RESULTS (#1 IMPORTANCE OF OPTIMIZING LIFE HABITS IN CARDIOVASCULAR RISK MANAGEMENT): The optimization of life habits is the cornerstone of cardiovascular risk management, this both before considering initiating pharmacological treatment and to support such treatment. In addition, when lipid-lowering therapy is considered advisable, adopting healthy life habits is crucial for optimizing the long-term clinical outcomes. (#2 IMPORTANCE OF QUICKLY ACHIEVING THE TARGETED TREATMENT INTENSITY): In addition, the NMP now contains a visual representation (in the form of a nomogram) of the expected reduction in LDL-C levels based on the different statin doses and the possible addition of ezetimibe, this to facilitate the choice of the appropriate dose according to the individual's clinical condition. The purpose of this tool is to streamline clinical decision-making and foster a uniform approach for quickly achieving therapeutic goals. (#3 LIPID PROFILE NECESSARY AFTER THE START OF TREATMENT IN CERTAIN SITUATIONS ONLY): It was found that, although some studies show an association between achieving a lower LDL-C level and a greater decrease in cardiovascular risk, none of the primary prevention data analyzed directly show a cardiovascular risk reduction when intensifying lipid-lowering therapy in persons who do not reach a certain LDL-C cutoff. (#4 AN ALGORITHM FOR ASSISTING IN THE MANAGEMENT OF STATIN INTOLERANCE): Adverse effects can occur when initiating lipid-lowering therapy, some of which, mainly those involving muscles and the liver, can have sometimes serious consequences. To explain how to proceed in such situations, an algorithm has been included in the national medical protocol. CONCLUSION : This updating of the national medical protocol and the individual adjustment prescription template for lipid-lowering agents (statins and ezetimibe) is based on clinical data and clinical practice recommendations from the literature, which have been enhanced with experiential knowledge from different experts and clinicians and with contextual information.

Authors' methods: A systematic review of the literature concerning best clinical practices for the pharmacological management of cardiovascular risk was conducted in accordance with INESSS’s usual standards. The information was analyzed with a vew to contextualizing the practice in Québec, using mainly legislative, regulatory and organizational contextual information specific to Québec, and the perspectives of the different stakeholders consulted. An advisory committee consisting of clinicians from different specialties and areas of expertise was created to gather the stakeholders’ perspectives. Lastly, the overall quality of the work and its acceptability and applicability were assessed by external reviewers who are specialists in the field of interest and by future users who did not participate in the project.

Authors' identified further research: The advisability of updating the recommendations in this guide will be determined 4 years from the date of publication of this work on the basis of the advances in the scientific data, changes in clinical practices, the inclusion of new drugs in the formularies, or the health and social services system’s needs.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/protocole-medical-national-ajustement-des-hypolipemiants-statines-et-ezetimibe-dans-la-prise-en-charge-du-risque-cardiovasculaire.html

URL for protocol: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Ordonnances_collectives/Hypolipemiants/INESSS_PMN_hypolipemiants.pdf

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/protocole-medical-national-ajustement-des-hypolipemiants-statines-et-ezetimibe-dans-la-prise-en-charge-du-risque-cardiovasculaire.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)