Article type
Abstract
"Background: Non-communicable diseases (NCDs) are responsible for most global deaths, particularly in low- and middle-income countries. These diseases are driven by various risk factors including smoking, hypertension, obesity, and family history. Additionally, imbalances in low-density lipoprotein cholesterol (LDL-c) and triglyceride levels, known as dyslipidemias, contribute significantly to their progression. In 2019, high levels of LDL cholesterol were directly linked to approximately 4.4 million deaths globally and contributed to 98.62 million DALYs.
Objectives: We critically assessed the methodological quality of available CPG on pharmacological treatments for dyslipidemia and compared their recommendations for primary dyslipidemia.
Methods: A systematic review (CRD42023481886) was performed in PubMed, Scopus, Web of Science, Tripdatabase and grey literature (Dez-2023). Eligible records were appraised by two reviewers using AGREE-II and the complementary tool for assessing on recommendations' quality and certainty, AGREE-REX. Both instruments were applied following the original user manual, and descriptive statistics were used to summarize data (SPSS v.28). The recommendations were qualitatively compared.
Results: Overall, 66 guidelines, mainly developed in North America (33%), Asia (27%), and Europe (17%) and authored by professional societies (71%) and governmental parties (21%) were identified. Guidelines presented a moderate overall quality (scores of 72% - AGREE II and 52% - AGREE-REX, respectively). Slight differences in favor of governmental organizations were noted for the overall AGREE II score and domains 2 and 3. European guidelines provided higher scores than Asians and Africans AGREE II overall score, and Asians and North American AGREE II domain 5. The highest scores were identified to AGREE II ' Scope and Purpose' (89%) and 'Presentation Clarity' (97%) domains. The items related to rigor of development (46% score on AGREE II), scarcely report systematic methods to obtain evidence, expert external review and update methodological processes. Initial treatment is mainly statins for all guidelines; however, care is advised in using statins for primary care, considering lack of studies on Asian people.
Conclusions: Methodological weaknesses are common among guidelines addressing dyslipidemia treatment, especially regarding scientific rigor, stakeholders' values and preferences, and facilitators and barriers to implementability. Special attention must be given to recommendations for statins for Asian people and food supplements."
Objectives: We critically assessed the methodological quality of available CPG on pharmacological treatments for dyslipidemia and compared their recommendations for primary dyslipidemia.
Methods: A systematic review (CRD42023481886) was performed in PubMed, Scopus, Web of Science, Tripdatabase and grey literature (Dez-2023). Eligible records were appraised by two reviewers using AGREE-II and the complementary tool for assessing on recommendations' quality and certainty, AGREE-REX. Both instruments were applied following the original user manual, and descriptive statistics were used to summarize data (SPSS v.28). The recommendations were qualitatively compared.
Results: Overall, 66 guidelines, mainly developed in North America (33%), Asia (27%), and Europe (17%) and authored by professional societies (71%) and governmental parties (21%) were identified. Guidelines presented a moderate overall quality (scores of 72% - AGREE II and 52% - AGREE-REX, respectively). Slight differences in favor of governmental organizations were noted for the overall AGREE II score and domains 2 and 3. European guidelines provided higher scores than Asians and Africans AGREE II overall score, and Asians and North American AGREE II domain 5. The highest scores were identified to AGREE II ' Scope and Purpose' (89%) and 'Presentation Clarity' (97%) domains. The items related to rigor of development (46% score on AGREE II), scarcely report systematic methods to obtain evidence, expert external review and update methodological processes. Initial treatment is mainly statins for all guidelines; however, care is advised in using statins for primary care, considering lack of studies on Asian people.
Conclusions: Methodological weaknesses are common among guidelines addressing dyslipidemia treatment, especially regarding scientific rigor, stakeholders' values and preferences, and facilitators and barriers to implementability. Special attention must be given to recommendations for statins for Asian people and food supplements."