Too Many Competing Interests

The Treatment of Disorders of Lipid Metabolism by Prof. Dr. med. Klaus G. Parhofer in issue 15/2016

The review article on the treatment of dyslipidemias (1) unfortunately mentions the clinical practice guideline NVL-KHK (2), which is definitive in Germany, in one sentence only. Instead, what follows is the therapeutic recommendations of the European Society of Cardiology (ESC) and the pharmaceutical industry: “LDL—the lower, the better.” The NVL-KHK guideline (S3 level, 2016) clarifies, however, that an LDL target value is not supported by the available evidence: “The LDL target value <100 mg/dl is therefore based on expert opinion” (2).

In the meantime, the transparency portal Leitlinienwatch.de [guideline watch] has drawn attention to a neglected aspect: the 2011 ESC dyslipidemia guideline that is used by all those in favor of “treating to target” is subject to numerous conflicting interests and therefore does not meet the quality criteria of the Association of the Scientific Medical Societies in Germany (AWMF) (3, 4):

• 17 out of a total of 18 authors have competing interests, 12 of these relating directly to the subject of the guideline.
• 22 of 29 document reviewers reported conflicts of interest, 15 of these relating directly to the subject of the guideline.
• The guideline documentation does not contain any mention of abstentions regarding competing interests.
• No public review has taken place (2).

On this background, the therapeutic algorithm suggested in Deutsches Ärzteblatt, using ezetemibe and PCSK9-inhibitors, is questionable, not least because the authors also reported financial ties to the manufacturers of the recommended products.

DOI: 10.3238/arztebl.2016.0643b

Dr. med. Niklas Schurig

Board member of MEZIS e. V., Member of leitlinienwatch.de

Kuppenheim

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Parhofer KG: The treatment of disorders of lipid metabolism. Dtsch Arztebl Int 2016; 113: 261–8

2. Nationale Versorgungsleitlinie: Chronische KHK 2016, S. 59. www.leitlinien.de/mdb/downloads/nvl/khk/khk-4aufl-vers1-lang.pdf (last accessed on 1 May 2016).

3. Leitlinienwatch.de: European Society of Cardiology Clinical Practice Guidelines: Managment of Dyslipidaemias. www.leitlinienwatch.de/dyslipidaemias-management-of-european-society-of-cardiology-clinical-practice-guidelines/ (last accessed on 1 May 2016).

4. AWMF: Empfehlungen der AWMF zum Umgang mit Interessenkonflikten bei Fachgesellschaften. www.awmf.org/fileadmin/user_upload/Leitlinien/Werkzeuge/empf-coi.pdf (last accessed on 1 May 2016).