There is ongoing debate as to whether public health guidelines should advocate reducing SFA consumption as much as possible to reduce the risk of chronic diseases, especially cardiovascular disease (CVD). In considering both sides of this question, we identified a number of points of agreement, most notably that the overall dietary patterns in which SFAs are consumed are of greater significance for cardiometabolic and general health than SFA intake alone. Nevertheless, there remained significant disagreements, centered largely on the interpretation of evidence bearing on 4 major questions: 1) does reducing dietary SFAs lower the incidence of CVD, 2) is the LDL-cholesterol reduction with lower SFA intake predictive of reduced CVD risk, 3) do dietary SFAs affect factors other than LDL cholesterol that may impact CVD risk, and 4) is there a sufficient rationale for setting a target for maximally reducing dietary SFAs? Finally, we identified specific research needs for addressing knowledge gaps that have contributed to the controversies.

The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline for management of dyslipidemia in chronic kidney disease (CKD) was published in 2003. Since then, considerable evidence, including randomized controlled trials of statin therapy in adults with CKD, has helped better define medical treatments for dyslipidemia. In light of the new evidence, KDIGO (Kidney Disease: Improving Global Outcomes) formed a work group for the management of dyslipidemia in patients with CKD. This work group developed a new guideline that contains substantial changes from the prior KDOQI guideline. KDIGO recommends treatment of dyslipidemia in patients with CKD primarily based on risk for coronary heart disease, which is driven in large part by age. The KDIGO guideline does not recommend using low-density lipoprotein cholesterol level as a guide for identifying individuals with CKD to be treated or as treatment targets. Initiation of statin treatment is no longer recommended in dialysis patients. To assist US practitioners in interpreting and applying the KDIGO guideline, NKF-KDOQI convened a work group to write a commentary on this guideline. For the most part, our work group agreed with the recommendations of the KDIGO guideline, although we describe several areas in which we believe the guideline statements are either too strong or need to be more nuanced, areas of uncertainty and inconsistency, as well as additional research recommendations. The target audience for the KDIGO guideline includes nephrologists, primary care practitioners, and non-nephrology specialists such as cardiologists and endocrinologists. As such, we also put the current recommendations into the context of other clinical practice recommendations for cholesterol treatment.

The dyslipidaemias are conditions that are still under-diagnosed, under-treated, and poorly controlled. This condition is common to the rest of the risk factors considered fundamental. Within the dyslipidaemias, the data that we have available, generally refer to the hypercholesterolaemias or in particular to the dyslipidaemias not dependent on LDL in patients who are already being treated with statins. However, there is only limited data available on atherogenic dyslipidaemia, characterised by the elevation of triglycerides and/or a decrease in HDL-cholesterol. However, given its profile, to determine the particularities of this atherogenic dyslipidaemia could help to control this anomaly more effectively. The present study, conducted in accordance with the Delphi method, has as its purpose to demonstrate the level of agreement or disagreement of an expert group, made up from different scientific societies, on what atherogenic dyslipidaemia is and represents, as well as what is the most suitable diagnostic and therapeutic approach. It has been concluded that the level of knowledge of the epidemiological aspects, its association with cardiovascular risks, of clinical identification, and specific treatment, has reached a significant level of agreement between the experts consulted. However, some aspects have been detected that, even today, are still subject to controversy: the role of isolated hypertriglyceridaemia as a risk factor, and its consideration as a therapeutic objective both in primary and secondary prevention, the effects linked to HDL-cholesterol, and that are strictly associated with the capacity to produce cholesterol efflux, the appropriateness of the therapeutic objectives to individual particularities, as well as the need to employ - frequently - combined treatment to correctly approach the correction of the lipid profile as a whole.