ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Table 2.3 – Diagnostic criteria for familial hypercholesterolemia (based on the Dutch Lipid Clinic Network criteria – Dutch MEDPED) Parameter Score Family history First degree relative with premature vascular/coronary disease (men < 55 years, women < 60 years) OR First or second degree relative with TC > 290 mg/dL* First degree relative with tendon xanthoma and/or corneal arcus OR First degree relative < 16 years with TC > 260 mg/dL* 1 2 Clinical history Patient with premature CAD (men < 55 years, women < 60 years) Patient with premature cerebral or peripheral arterial disease (men < 55 years, women < 60 years) 2 1 Physical examination Tendon xanthoma Corneal arcus < 45 years 6 4 LDL-c Levels (mg/dL) ≥ 330 mg/dL 250 - 329 mg/dL 190 - 249 mg/dL 155 - 189 mg/dL 8 5 3 1 DNA analysis Functional mutation in the LDL receptor, the ApoB100, or the PCSK9* gene 8 FH diagnosis Confirmed if Potential if Possible if Not FH > 8 points 6 - 8 points 3 - 5 points < 3 points CAD: coronary artery disease; DNA: deoxyribonucleic acid; FH: familial hypercholesterolemia; LDL-c: low-density lipoprotein-cholesterol; TC: total cholesterol. * Modified from the Dutch MEDPED, adopting a criterion from the Simon Broome Register Group proposal. Adapted from the Updated Guideline for Dyslipidemia and Atherosclerosis Prevention (5) and the I Brazilian Guidelines for Familial Hypercholesterolemia. 19 Table 2.4 – Dietary recommendations for the treatment of dyslipidemia Recommendations LDL-c Triglycerides Within the target and without comorbidities* (%) Above the target or with comorbidities* (%) Borderline 150-199 mg/dL (%) High 200-499 mg/dL (%) Very high† > 500 mg/dL (%) Weight loss Maintaining a healthy weight 5-10 Up to 5 5-10 5-10 Carbohydrate (%TEV) 50-60 45-60 50-60 50-55 45-50 Added sugars (%TEV) < 10 < 10 < 10 5-10 < 5 Protein (%TEV) 15 15 15 15-20 20 Fat (%TEV) 25-35 25-35 25-35 30-35 30-35 Trans fatty acids (%TEV) Exclude from diet Saturated fatty acids (%TEV) < 10 < 7 < 7 < 5 < 5 Monounsaturated fatty acids (%TEV) 15 15 10-20 10-20 10-20 Polyunsaturated fatty acids (%TEV) 5-10 5-10 10-20 10-20 10-20 Linolenic acid, g/day 1.1-1.6 EPA and DHA, g - - 0.5-1.0 > 2.0 > 2.0 Fiber 25 g, with 6 g of soluble fiber DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; TEV: total energy value. The reassessment period after implementing lifestyle modification measures should be 3 to 6 months. Adapted from the Updated Brazilian Guideline for Dyslipidemia and Atherosclerosis Prevention. 7 801