IJCS | Volume 33, Nº4, July and August 2020

DOI: https://doi.org/10.36660/ijcs.20200131 Chronic noncommunicable diseases (NCDs) comprise the world's leading group of causes of death, accounting for premature deaths, loss of quality of life, and adverse economic and social impacts. They represent about 70% of global deaths, close to 38 million deaths annually, significantly exceeding deaths from external causes and infectious diseases, such as COVID-19. Almost 45% of the deaths, more than 17 million, occur as a result of cardiovascular disease (CVD). 1 The same happens in Brazil, where 72% of the deaths are due to NCDs, and about 30%, to CVD. 1 Dyslipidemia is a significant risk factor for CVD, particularly coronary artery disease (CAD) and stroke. Prospective and long-term epidemiological studies have shown that individuals with healthier lifestyles and fewer risk factors for CAD could improve their life expectancy by decreasing cardiovascular morbidity and mortality. 2 The Framingham Offspring Study, which followed 3501 participants from 1987 to 2011, has demonstrated that low levels of high-density lipoprotein (HDL) or high levels of low-density lipoprotein (LDL) and triglycerides, alone or in any combination, are associated with increased risk for CVDs. 3 Therefore, intervention measures are necessary to reduce morbidity and mortality, as well as the cost of hospitalizationdue to thosediseases. Inaddition, improving the quality of life and health of the population is essential. Lifestyle changes, such as the adoption of a healthy diet and physical activity, can favorably affect plasma lipid concentrations. However, many patients need medication to achieve their therapeutic goals. 2 In recent years, lipid-lowering therapy, in particular statins, has been one of the most used interventions for primary and secondary prevention of atherosclerotic cardiovascular diseases, since studies have shown their efficacy in reducing both future events and CVD mortality. 4,5 In this sense, to identify individuals at risk for CVD, guidelines have been developed, recommending the use of lipid-lowering therapy for the prevention/treatment of those diseases. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) used the Framingham score to assess the risk of CAD for ten years. The NCEP-ATP III classified individuals into three categories, high risk (> 20%), moderate risk (10-20%) and low risk (<10%), suggesting the use of lipid-lowering therapy to reduce LDL (<100 mg/dl) in patients at high risk for CAD, whose LDL concentrations are ≥130 mg/dl. The HDL targets were considered secondary objectives in patients with high levels of triglycerides (> 200 mg/dl). 6 An observational and retrospective study, evaluating the adherence of internal medicine residents inWorcester, Massachusetts, to the NCEP-ATP III guidelines for the treatment of patients with dyslipidemia, has shown better adherence to drug therapy (44% - 77%) and changes in lifestyle (44% - 83%) as compared to the recommendations for follow-up (22% - 31%), evidencing the difficulties of adherence over time. 7 The American College of Cardiology (ACC) and the American Heart Association (AHA) developed in 2013 a guideline on cardiovascular risk assessment and hypercholesterolemia management. The guideline established new perspectives on LDL treatment goals, using a new tool to assess cardiovascular risk, the pooled cohort equations (PCE). The guideline suggested the use of statin to individuals aged 40 to 75 years, without 377 EDITORIAL International Journal of Cardiovascular Sciences. 2020; 33(4):377-379 Mailing Address: Gláucia Maria Moraes de Oliveira Universidade Federal do Rio de Janeiro - R. Prof. Rodolpho P. Rocco, 255 - 8°. Andar - Sala 6, UFRJ. Postal Code: 21941-913, Cidade Universitária, RJ - Brazil. E-mail: glauciam@cardiol.br , glauciamoraesoliveira@gmail.com Are we Improving Adherence to Cardiovascular Guidelines? Luciana Nicolau Aranh a a nd Gláucia Maria Moraes de Oliveir a Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ – Brazil Editorial related to the article: Treatment Eligibility and Therapeutic Responses of an Ecuadorian Population at High Cardiovascular Risk Based on the ATP III Guidelines Cardiovascular Diseases/complications, Mortality; Cardiovascular Diseases/prevention and control; COVID-19; Dyslipidemias; Triglycerides; Life Style; Tabagism; Hydroxymethylglutaryl-CoA Reductase Inhibition/therapeutic use; Patient Compliance. Keywords