Document Type : Original Article

Authors

1 Humber River Hospital, Toronto, ON Canada

2 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, Canada

10.48305/arya.2023.41868.2904

Abstract

INTRODUCTION: The prevention and control of dyslipidemia, as an important risk factor for cardiovascular diseases (CVDs), is a priority for the healthcare system to reduce the burden of these diseases. The purpose of this protocol is to outline the key steps of the first Iranian Dyslipidemia Clinical Practice Guideline development, which can be used by other researchers as a guide to design a standard, comprehensive, evidence-based, and local context-based guideline.
METHOD: This guideline will be developed and reported according to the format of the World Health Organization (WHO) Handbook for Guideline Development. All members of the guideline development team will sign the declaration-of-competing-interests (DOI) forms. The development of the authors’ guideline will be supported by five groups: the steering committee (SC), the Guideline Developing Group (GDG), the systematic review (evidence synthesis) group, and the external review group. The authors will also establish a patient advisory group to inform guideline development by patients’ values and preferences. The SC and GDG will determine the scope of the guideline and will design PICO questions. The systematic review group will systematically search Embase, PubMed, Scopus, Web of Sciences, Cochrane Library, and Google Scholar from inception. The systematic review group will assess the risk of bias and create evidence summaries using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The recommendations of this guideline will be divided into strong recommendations and weak or conditional recommendations or suggestions.
CONCLUSION: This clinical practice guideline will provide clinicians and healthcare professionals with new evidence-based recommendations for the diagnosis, management, and treatment of dyslipidemia in children and adults.
 

Keywords

1. Tabatabaei-Malazy O, Qorbani M, Samavat T, Sharifi F, Larijani B, Fakhrzadeh H. Prevalence of dyslipidemia in Iran: a systematic review and meta-analysis study. Int J Prev Med 2014; 5(4): 373-93. 
2. Hovsepian S, Kelishadi R, Djalalinia S, Farzadfar F, Naderimagham S, Qorbani M. Prevalence of dyslipidemia in Iranian children and adolescents: A systematic review. J Res Med Sci 2015; 20(5): 503-21.https://doi.org/10.4103/1735-1995.163979
3. Daniels SR. Screening and treatment of dyslipidemias in children and adolescents. Horm Res Paediatr 2011; 76 Suppl 1: 47-51. https://doi.org/10.1159/000329163
4. Psaty BM, Rivara FP. Universal screening and drug treatment of dyslipidemia ‎in children and adolescents. JAMA 2012; 307(3): 257-8. https://doi.org/10.1001/jama.2011.1916
5. Hatami M, Tohidi M, Mohebi R, Khalili D, Azizi F, Hadaegh F. Adolescent lipoprotein classifications according to National Health and Nutrition Examination Survey (NHANES) vs. National Cholesterol Education Program (NCEP) for predicting abnormal lipid levels in adulthood in a Middle East population. Lipids Health Dis 2012; 11(1): 1-7. https://doi.org/10.1186/1476-511X-11-107
6. Toori MA, Kiani F, Sayehmiri F, Sayehmiri K, Mohsenzadeh Y, Ostovar R, et al. Prevalence of hypercholesterolemia, high LDL, and low HDL in Iran: a systematic review and meta-analysis. Iran J Med Sci 2018; 43(5): 449.
7. Sarrafzadegan N, Kelishadi R, Sadri G, Malekafzali H, Pourmoghaddas M, Heidari K, et al. Outcomes of a comprehensive healthy lifestyle program on cardiometabolic risk factors in a developing country: the Isfahan Healthy Heart Program. Arch Iran Med 2013; 16(1): 4-11.
8. Harrison MB, Légaré F, Graham ID, Fervers B. Adapting clinical practice guidelines to local context and assessing barriers to their use. CMAJ 2010; 182(2): E78-E84. https://doi.org/10.1503/cmaj.081232
9. Motlagh ME, Kelishadi R, Amirkhani MA, Ziaoddini H, Dashti M, Aminaee T, et al. Double burden of nutritional disorders in young Iranian children: findings of a nationwide screening survey. Public Health Nutr 2011; 14(4): 605-10. https://doi.org/10.1017/S1368980010002399
10. Sayarifard A, Nazari M, Bahmanziari N, Mehrdad N, Ghadirian L. Challenges of Clinical Practice Guidelines Adaptation in Iran: Lesson learned for Low and Middle-Income Countries. Med J Islam Repub Iran 2022; 36. https://doi.org/10.47176/mjiri.36.71
11. Format of clinical practice guideline Iran Ministry of Health and Medical Education 2020. Available from: https://Hetas.behdasht.gov.ir.
12. Glenton C, Lewin S, Norris S. World health organization handbook for guideline development. Geneva: WHO. 2016.
13. Chen Y, Yang K, Marušić A, Qaseem A, Meerpohl JJ, Flottorp S, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med 2017; 166(2): 128-32. https://doi.org/10.7326/M16-1565
14. Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Developing guidelines. BMJ 1999; 318(7183): 593-6.https://doi.org/10.1136/bmj.318.7183.593
15. Armstrong MJ, Mullins CD, Gronseth GS, Gagliardi AR. Recommendations for patient engagement in guideline development panels: a qualitative focus group study of guideline-naïve patients. PLoS One 2017; 12(3): e0174329. https://doi.org/10.1371/journal.pone.0174329
16. Guyatt GH, Oxman AD, Kunz R, Atkins D, Brozek J, Vist G, et al. GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol 2011; 64(4): 395-400. https://doi.org/10.1016/j.jclinepi.2010.09.012
17. Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, et al. 2021 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in adults. Can J Cardiol 2021; 37(8): 1129-50.‎ https://doi.org/10.1016/j.cjca.2021.03.016
18. Jellinger PS. American association of clinical endocrinologists/american ‎college of endocrinology management of dyslipidemia and prevention of cardiovascular disease clinical practice guidelines. Diabetes Spectr 2018; 31(3): 234. https://doi.org/10.2337/ds18-0009
19. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2019; 290: 140-205. https://doi.org/10.15829/1560-4071-2020-3826
20. Rhee E-J, Kim HC, Kim JH, Lee EY, Kim BJ, Kim EM, et al. 2018 Guidelines for the management of dyslipidemia in Korea. J Lipid Atheroscler 2019; 8(2): 78-131. https://doi.org/10.12997/jla.2019.8.2.78
21. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA ‎guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139(25): e1082-e143. https://doi.org/10.1161/CIR.0000000000000698
22. Lim JS, Kim EY, Kim JH, Yoo J-H, Yi KH, Chae HW, et al. 2017 Clinical practice guidelines for dyslipidemia of Korean children and adolescents. Ann Pediatr Endocrinol Metab 2020; 25(4): 199. https://doi.org/10.6065/apem.2040198.099
23. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017; 358. https://doi.org/10.1136/bmj.j4008
24. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355. https://doi.org/10.1136/bmj.i4919
25. Higgins JP, Savović J, Page MJ, Elbers RG, Sterne JA. Assessing risk of bias in a randomized trial. Cochrane Handbook Syst Rev Interv 2019: 205-28. https://doi.org/10.1002/9781119536604.ch8
26. Bigby M, Williams HC. Appraising systematic reviews and meta‐analyses. Evid Based Dermatol 2014:33-8.https://doi.org/10.1002/9781118357606.ch8
27. Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. Available from guidelinedevelopment org/handbook. 2019.
28. Alonso-Coello P, Sola I, Ferreira-Gonzalez I. Formulating recom-mendations with GRADE: A matter of confidence. Rev Esp Cardiol 2013; 66(3): 163-7.https://doi.org/10.1016/j.rec.2012.07.015
29. Grundy SM, Barter P, Bersot TP, Betteridge DJ, Carmena R, et al. An International Atherosclerosis Society position paper: global recommendations for the management of dyslipidemia: executive summary. Atherosclerosis 2014; 2 (2):32. https://doi.org/10.1016/j.atherosclerosis.2013.11.031