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Statin therapy in athletes and patients performing regular intense exercise - Position paper from the International Lipid Expert Panel (ILEP).

Identifieur interne : 000653 ( Main/Merge ); précédent : 000652; suivant : 000654

Statin therapy in athletes and patients performing regular intense exercise - Position paper from the International Lipid Expert Panel (ILEP).

Auteurs : Niki Katsiki [Grèce] ; Dimitri P. Mikhailidis [Royaume-Uni] ; Gani Bajraktari [Suède] ; Andre R. Miserez [Suisse] ; Arrigo F G. Cicero [Italie] ; Eric Bruckert [France] ; Maria-Corina Serban [Roumanie] ; Erkin Mirrakhimov [Kirghizistan] ; Fahad Alnouri [Arabie saoudite] ; Željko Reiner [Croatie] ; György Paragh [Hongrie] ; Amirhossein Sahebkar [Iran] ; Maciej Banach [Pologne]

Source :

RBID : pubmed:32087236

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English descriptors

Abstract

Acute and chronic physical exercises may enhance the development of statin-related myopathy. In this context, the recent (2019) guidelines of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) for the management of dyslipidemias recommend that, although individuals with dyslipidemia should be advised to engage in regular moderate physical exercise (for at least 30 min daily), physicians should be alerted with regard to myopathy and creatine kinase (CK) elevation in statin-treated sport athletes. However it is worth emphasizing that abovementioned guidelines, previous and recent ESC/EAS consensus papers on adverse effects of statin therapy as well as other previous attempts on this issue, including the ones from the International Lipid Expert Panel (ILEP), give only general recommendations on how to manage patients requiring statin therapy on regular exercises. Therefore, these guidelines in the form of the Position Paper are the first such an attempt to summary existing, often scarce knowledge, and to present this important issue in the form of step-by-step practical recommendations. It is critically important as we might observe more and more individuals on regular exercises/athletes requiring statin therapy due to their cardiovascular risk.

DOI: 10.1016/j.phrs.2020.104719
PubMed: 32087236

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pubmed:32087236

Le document en format XML

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<term>Exercise (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Hydroxymethylglutaryl-CoA Reductase Inhibitors (adverse effects)</term>
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<term>Humains (MeSH)</term>
<term>Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase (effets indésirables)</term>
<term>Inhibiteurs de l'hydroxyméthylglutaryl-CoA réductase (usage thérapeutique)</term>
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<div type="abstract" xml:lang="en">Acute and chronic physical exercises may enhance the development of statin-related myopathy. In this context, the recent (2019) guidelines of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) for the management of dyslipidemias recommend that, although individuals with dyslipidemia should be advised to engage in regular moderate physical exercise (for at least 30 min daily), physicians should be alerted with regard to myopathy and creatine kinase (CK) elevation in statin-treated sport athletes. However it is worth emphasizing that abovementioned guidelines, previous and recent ESC/EAS consensus papers on adverse effects of statin therapy as well as other previous attempts on this issue, including the ones from the International Lipid Expert Panel (ILEP), give only general recommendations on how to manage patients requiring statin therapy on regular exercises. Therefore, these guidelines in the form of the Position Paper are the first such an attempt to summary existing, often scarce knowledge, and to present this important issue in the form of step-by-step practical recommendations. It is critically important as we might observe more and more individuals on regular exercises/athletes requiring statin therapy due to their cardiovascular risk.</div>
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<PMID Version="1">32087236</PMID>
<DateCompleted>
<Year>2021</Year>
<Month>03</Month>
<Day>29</Day>
</DateCompleted>
<DateRevised>
<Year>2021</Year>
<Month>03</Month>
<Day>29</Day>
</DateRevised>
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<Journal>
<ISSN IssnType="Electronic">1096-1186</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>155</Volume>
<PubDate>
<Year>2020</Year>
<Month>05</Month>
</PubDate>
</JournalIssue>
<Title>Pharmacological research</Title>
<ISOAbbreviation>Pharmacol Res</ISOAbbreviation>
</Journal>
<ArticleTitle>Statin therapy in athletes and patients performing regular intense exercise - Position paper from the International Lipid Expert Panel (ILEP).</ArticleTitle>
<Pagination>
<MedlinePgn>104719</MedlinePgn>
</Pagination>
<ELocationID EIdType="pii" ValidYN="Y">S1043-6618(20)30581-8</ELocationID>
<ELocationID EIdType="doi" ValidYN="Y">10.1016/j.phrs.2020.104719</ELocationID>
<Abstract>
<AbstractText>Acute and chronic physical exercises may enhance the development of statin-related myopathy. In this context, the recent (2019) guidelines of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) for the management of dyslipidemias recommend that, although individuals with dyslipidemia should be advised to engage in regular moderate physical exercise (for at least 30 min daily), physicians should be alerted with regard to myopathy and creatine kinase (CK) elevation in statin-treated sport athletes. However it is worth emphasizing that abovementioned guidelines, previous and recent ESC/EAS consensus papers on adverse effects of statin therapy as well as other previous attempts on this issue, including the ones from the International Lipid Expert Panel (ILEP), give only general recommendations on how to manage patients requiring statin therapy on regular exercises. Therefore, these guidelines in the form of the Position Paper are the first such an attempt to summary existing, often scarce knowledge, and to present this important issue in the form of step-by-step practical recommendations. It is critically important as we might observe more and more individuals on regular exercises/athletes requiring statin therapy due to their cardiovascular risk.</AbstractText>
<CopyrightInformation>Copyright © 2020. Published by Elsevier Ltd.</CopyrightInformation>
</Abstract>
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<Author ValidYN="Y">
<LastName>Katsiki</LastName>
<ForeName>Niki</ForeName>
<Initials>N</Initials>
<AffiliationInfo>
<Affiliation>First Department of Internal Medicine, Division of Endocrinology and Metabolism, Diabetes Center, Medical School, AHEPA University Hospital, Thessaloniki, Greece. Electronic address: nikikatsiki@hotmail.com.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Mikhailidis</LastName>
<ForeName>Dimitri P</ForeName>
<Initials>DP</Initials>
<AffiliationInfo>
<Affiliation>Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Bajraktari</LastName>
<ForeName>Gani</ForeName>
<Initials>G</Initials>
<AffiliationInfo>
<Affiliation>Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo, Serbia; Medical Faculty, University of Prishtina, Prishtina, Kosovo, Serbia; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Miserez</LastName>
<ForeName>Andre R</ForeName>
<Initials>AR</Initials>
<AffiliationInfo>
<Affiliation>Diagene Research Institute, Reinach, Switzerland; University of Basel, Basel, Switzerland.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Cicero</LastName>
<ForeName>Arrigo F G</ForeName>
<Initials>AFG</Initials>
<AffiliationInfo>
<Affiliation>Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Bruckert</LastName>
<ForeName>Eric</ForeName>
<Initials>E</Initials>
<AffiliationInfo>
<Affiliation>Pitié-Salpêtrière Hospital and Sorbonne University, Cardio Metabolic Institute, Paris, France.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Serban</LastName>
<ForeName>Maria-Corina</ForeName>
<Initials>MC</Initials>
<AffiliationInfo>
<Affiliation>Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Mirrakhimov</LastName>
<ForeName>Erkin</ForeName>
<Initials>E</Initials>
<AffiliationInfo>
<Affiliation>Kyrgyz State Medical Academy, Named after Akhunbaev I.K., Bishkek, Kyrgyzstan.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Alnouri</LastName>
<ForeName>Fahad</ForeName>
<Initials>F</Initials>
<AffiliationInfo>
<Affiliation>Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre Riyadh, Saudi Arabia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Reiner</LastName>
<ForeName>Željko</ForeName>
<Initials>Ž</Initials>
<AffiliationInfo>
<Affiliation>Department of Internal Diseases University Hospital Center Zagreb School of Medicine, Zagreb University, Zagreb, Croatia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Paragh</LastName>
<ForeName>György</ForeName>
<Initials>G</Initials>
<AffiliationInfo>
<Affiliation>Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Sahebkar</LastName>
<ForeName>Amirhossein</ForeName>
<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<LastName>Banach</LastName>
<ForeName>Maciej</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland. Electronic address: maciejbanach77@gmail.com.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y">
<CollectiveName>International Lipid Expert Panel (ILEP)</CollectiveName>
</Author>
</AuthorList>
<Language>eng</Language>
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<PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D016454">Review</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic">
<Year>2020</Year>
<Month>02</Month>
<Day>19</Day>
</ArticleDate>
</Article>
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<Country>Netherlands</Country>
<MedlineTA>Pharmacol Res</MedlineTA>
<NlmUniqueID>8907422</NlmUniqueID>
<ISSNLinking>1043-6618</ISSNLinking>
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<ChemicalList>
<Chemical>
<RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D019161">Hydroxymethylglutaryl-CoA Reductase Inhibitors</NameOfSubstance>
</Chemical>
</ChemicalList>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList>
<MeshHeading>
<DescriptorName UI="D056352" MajorTopicYN="Y">Athletes</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D032921" MajorTopicYN="N">Consensus</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D050171" MajorTopicYN="N">Dyslipidemias</DescriptorName>
<QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D015444" MajorTopicYN="Y">Exercise</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D019161" MajorTopicYN="N">Hydroxymethylglutaryl-CoA Reductase Inhibitors</DescriptorName>
<QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName>
<QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName>
</MeshHeading>
<MeshHeading>
<DescriptorName UI="D009135" MajorTopicYN="N">Muscular Diseases</DescriptorName>
<QualifierName UI="Q000139" MajorTopicYN="N">chemically induced</QualifierName>
</MeshHeading>
</MeshHeadingList>
<KeywordList Owner="NOTNLM">
<Keyword MajorTopicYN="Y">Athleths</Keyword>
<Keyword MajorTopicYN="Y">Exercises</Keyword>
<Keyword MajorTopicYN="Y">Management</Keyword>
<Keyword MajorTopicYN="Y">Mylagia</Keyword>
<Keyword MajorTopicYN="Y">Statin intolerance</Keyword>
</KeywordList>
<CoiStatement>Declaration of Competing Interest NK has given talks, attended conferences and participated in trials sponsored by Amgen, Astra Zeneca, Bausch Health, Boehringer Ingelheim, Elpen, MSD, Mylan, Novo Nordisk, Sanofi and Servier; GB has given talks and attended conferences sponsored by KRKA, Trepharm, Bosnalijek, Akaloid and Novartis; AC has received honoraria as scientific consultant from Meda-Mylan, Menarini International and Sharper; EB - consulting/presentation: Amgen, Genfit, MSD, Sanofi-Regeneron, Aegerion, Chiesi, Rottapharm, Lilly, Ionis pharmaceuticals, Servier, Mylan and Akcea; FA has given talks, attended conferences and participated in trials sponsored by Amgen, AMRYT Pharma and Sanofi; MB - speakers bureau: Abbott/Mylan, Abbott Vascular, Actavis, Akcea, Amgen, Biofarm, KRKA, MSD, Polpharma, Sanofi-Aventis, Servier and Valeant; consultant to Abbott Vascular, Akcea, Amgen, Daichii Sankyo, Freia Pharmaceuticals, Esperion, Lilly, MSD, Polfarmex, Resverlogix, Sanofi-Aventis; Grants from Sanofi and Valeant; All other authors have nothing to declare. #International Lipid Expert Panel (ILEP) Experts (alphabetically): Fahad Alnouri (Cardiovascular Prevention Unit, Adult Cardiology Department. Prince Sultan Cardiac Centre Riyadh, Saudi Arabia), Fahma Amar (Unit of Diabetes &Metabolism, Alexandria University, Alexandria, Egypt), Atanas G. Atanasov (Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, Poland; Department of Pharmacognosy, University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria; Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria), Gani Bajraktari (Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo), Maciej Banach (Department of Hypertension, Medical University of Lodz, Poland; Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland, Cardiovascular Research Centre, University of Zielona-Gora, Zielona-Gora, Poland), Marcin A. Bartlomiejczyk (Department of Hypertension, Medical University of Lodz, Poland; Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland), Bojko Bjelakovic (Clinic of Pediatrics, Clinical Center, Nis, Faculty of Medicine, University of Nis, Serbia), Eric Bruckert (Pitié-Salpetrière Hospital and Sorbonne University, Cardio metabolic Institute, Paris, France), Agata Bielecka-Dabrowa (Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland), Alberto Cafferata (Facultad de Medicina, Instituto Universitario de Ciencias de la Salud, Fundación H.A. Barceló, Argentina), Richard Ceska (Third Department of Medicine - Department of Endocrinology and Metabolism of the First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic), Arrigo F.G. Cicero (Atherosclerosis and Hypertension Research Group, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy), Xavier Collet (Institute of Metabolic and Cardiovascular Diseases, Inserm, Toulouse, France), Olivier Descamps (Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine Saint-Paul, Belgium; Department of Cardiology, Cliniques Universitaires Saint-Luc, Bruxells, Belgium), Nair Devaki (Department of Clinical Biochemistry, the Royal Free London NHS Foundation Trust, Pond Street, London, UK), Dragan Djuric (Institute of Medical Physiology "Richard Burian" Faculty of Medicine, University of Belgrade, Belgrade, Serbia), Ronen Durst (Cardiology Department, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel), Marat V. Ezhov (National Cardiology Research Center, Moscow, Russia), Zlatko Fras (Preventive Cardiology Unit, Department of Vascular Medicine, Division of Medicine, University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia), Dan Gaita (Institutul de Boli Cardiovasculare, Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Romania), Stephan von Haehling (Department of Cardiology and Pneumology, Heart Center Göttingen, University of Göttingen Medical Center, Georg-August-University, Göttingen, Germany), Adrian V. Hernandez (Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT, USA; Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru), Steven R. Jones (the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA), Jacek Jozwiak (Department of Family Medicine and Public Health Faculty of Medicine University of Opole, Opole, Poland), Nona Kakauridze (Department of Internal Medicine, Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia), Niki Katsiki (Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece), Amit Khera (Division of Cardiology, UT Southwestern, Dallas, TX, USA), Karam Kostner (Mater Hospital, University of Queensland, St Lucia, QLD, Australia), Raimondas Kubilius (Department of Rehabilitation, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania), Gustavs Latkovskis (Institute of Cardiology and Regenerative Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia; Pauls Stradins Clinical University Hospital, Riga, Latvia), G.B. John Mancini (Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada), A. David Marais (Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa), Seth S. Martin (Ciccarone Center for Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA), Julio Acosta Martinez (Medico Cardiologo de la Policlinica Metropolitana, Carcass, Venezuela), Mohsen Mazidi (Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital, Strand, London, UK), Dimitri P. Mikhailidis (Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK), Erkin Mirrakhimov (Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan), Andre R. Miserez (diagene Research Institute, Reinach, Switzerland; President of Swiss Society of Familial Forms of Hypercholesterolemia (SSFH), Breitenbach, Switzerland; University of Basel, Basel, Switzerland), Olena Mitchenko (Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Ukraine; Ukrainian Atherosclerosis Society), Patrick Moriarty (Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA), Seyed Mohammad Nabavi (Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran), Demosthenes B. Panagiotakos (School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece), György Paragh (University of Debrecen Faculty of Medicine, Department of Internal Medicine, Debrecen, Hungary), Daniel Pella (1 st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia), Peter E. Penson (School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK), Zaneta Petrulioniene (Vilnius University Faculty of Medicine, Vilnius, Lithuania; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania), Matteo Pirro (Department of Medicine, University of Perugia, Perugia, Italy), Arman Postadzhiyan (Bulgarian Society of Cardiology, Medical University of Sofia, Sofia, Bulgaria), Raman Puri (I P Apollo Hospital, New Delhi, India), Ashraf Reda (Menoufia University, President of EAVA), Željko Reiner (University Hospital Center Zagreb, Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia), Jemaa Riadh (Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar, Tunis, Tunisia), Dimitri Richter (Cardiac Department, Euroclinic, Athens, Greece), Manfredi Rizzo (Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy), Massimiliano Ruscica (Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy), Amirhossein Sahebkar (Biotechnology Research Center, Pharmaceutical Technology Institute, Neurogenic Inflammation Research Center, and School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran), Naveed Sattar (Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK), Maria-Corina Serban (Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania), Abdulla M.A Shehab (Medical Education Department, United Arab Emirates University, Al Ain, United Arab Emirates), Aleksandr B. Shek (Department of Ischemic Heart Disease and Atherosclerosis, Republican Specialised Center of Cardiology, Tashkent, Uzbekistan), Cesare R. Sirtori (Dipartimento di Scienze Farmacologiche e Biomolecolari, Università di Milano Centro Dislipidemie, Grande Ospedale Metropolitano, Niguarda Ca'Granda President, Fondazione Carlo Sirtori), Claudia Stefanutti (Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy), Tomasz Tomasik (Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland), Peter P. Toth (The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA), Margus Viigimaa (Tallinn University of Technology, North Estonia Medical Centre, Tallinn, Estonia), Dragos Vinereanu (Cardiology Department, University and Emergency Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania), Branislav Vohnout (Institute of Nutrition, Faculty of Nursing and Health Professional Studies and Coordination Centre for Familial Hyperlipoproteinemias, Slovak Medical University in Bratislava, Bratislava, Slovakia; Institute of Epidemiology, School of Medicine, Comenius University, Bratislava, Slovakia), Michal Vrablik (1 st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic), Nathan D. Wong (Department of Medicine, School of Medicine University of California, Irvine, CA, USA; Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California, USA), Hung-I Yeh (Department of Medicine, Mackay Medical College, Taipei, Taiwan; Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan), Jiang Zhisheng (Institute of Cardiovascular Disease, University of South China, Hengyang, Hunan, China), Andreas Zirlik (University Heart Centre Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany). With the official endorsement of: Association of Cardiologists of the Republic of Uzbekistan, Baltic Society of Atherosclerosis, Chinese Atherosclerosis Society, College of Family Physicians in Poland, Croatian Atherosclerosis Society, Czech Society for Atherosclerosis, Egyptian Association for Endocrinology, Diabetes and Atherosclerosis (EAEDA), French Atherosclerosis Society, Hellenic Atherosclerosis Society, Hellenic Lipidology Society, Hungarian Atherosclerosis Society, International Natural Product Sciences Taskforce (INPST), Israeli Society for Treatment and Prevention of Atherosclerosis, Italian Nutraceuticals Society (SINut), Italian Society for Cardiovascular Prevention (SIPREC), Kosovo Society of Cardiology, Kyrgyz Atherosclerosis Society, Latvian Society of Cardiology, Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, Lithuanian Heart Association, Mighty Medic, Polish Lipid Association (PoLA), Romanian National Forum for Prevention, Romanian Society of Cardiology, Russian National Atherosclerosis Society, Saudi Group for Cardiovascular Prevention and Rehabilitation of the Saudi Heart Association, Serbian Association for Arteriosclerosis, Thrombosis and Vascular Biology Research (SAATVBR), Slovak Association of Atherosclerosis, Slovenian Society of Cardiology, Society of Endocrine and Metabolic Disease of South Africa, Society on Sarcopenia, Cachexia and Wasting Disorders, South African Heart Association, Swiss Society for Familial forms of Hypercholesterolemia (SSFH), Tunisian Association of Study and Research on Atherosclerosis, Ukrainian Atherosclerosis Society, Very Large Database of Lipids (VLDL).</CoiStatement>
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<ForeName>Fahad</ForeName>
<Initials>F</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Amar</LastName>
<ForeName>Fahma</ForeName>
<Initials>F</Initials>
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<Investigator ValidYN="Y">
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<ForeName>Atanas G</ForeName>
<Initials>AG</Initials>
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<LastName>Bajraktari</LastName>
<ForeName>Gani</ForeName>
<Initials>G</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Banach</LastName>
<ForeName>Maciej</ForeName>
<Initials>M</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Bartlomiejczyk</LastName>
<ForeName>Marcin A</ForeName>
<Initials>MA</Initials>
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<LastName>Bjelakovic</LastName>
<ForeName>Bojko</ForeName>
<Initials>B</Initials>
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<Investigator ValidYN="Y">
<LastName>Bruckert</LastName>
<ForeName>Eric</ForeName>
<Initials>E</Initials>
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<Investigator ValidYN="Y">
<LastName>Bielecka-Dabrowa</LastName>
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<Initials>A</Initials>
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<Initials>N</Initials>
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<Initials>D</Initials>
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<LastName>Ezhov</LastName>
<ForeName>Marat V</ForeName>
<Initials>MV</Initials>
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<LastName>Fras</LastName>
<ForeName>Zlatko</ForeName>
<Initials>Z</Initials>
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<ForeName>Dan</ForeName>
<Initials>D</Initials>
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<LastName>von Haehling</LastName>
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<Initials>S</Initials>
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<LastName>Hernandez</LastName>
<ForeName>Adrian V</ForeName>
<Initials>AV</Initials>
</Investigator>
<Investigator ValidYN="Y">
<LastName>Jones</LastName>
<ForeName>Steven R</ForeName>
<Initials>SR</Initials>
</Investigator>
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<LastName>Jozwiak</LastName>
<ForeName>Jacek</ForeName>
<Initials>J</Initials>
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<Initials>N</Initials>
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<Initials>N</Initials>
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<LastName>Martinez</LastName>
<ForeName>Julio Acosta</ForeName>
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<ForeName>Mohsen</ForeName>
<Initials>M</Initials>
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<Initials>E</Initials>
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<ForeName>Andre R</ForeName>
<Initials>AR</Initials>
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