Background: Health Insurance and General Practitioners (GPs) Society asked HAS’ for recommendations on the use of lipid-lowering drugs for hypercholesterolemia management, mainly for GPs due to the obsolescence of the national clinical practice guideline (CPG) and publication of international CPGs with different positions.

Objectives: To develop an ADG on lipid-lowering drugs for hypercholesterolemia management.

Methods:The process consisted of an analysis and synthesis of international CPGs internally conducted with the help of a restricted working group (WG) to draft recommendations and consultation of stakeholders.

Results: Even with the notion of a restricted WG, we had difficulty recruiting cardiologists without conflicts of interest. It slowed down the process and may have somewhat limited the expertise.
The scope of the guideline was enlarged to combined hyperlipidaemia, hypertriglyceridaemia, and heterozygous familial hypercholesterolemia for covering the main dyslipidaemias. Furthermore, emphasis was placed on the assessment and management of overall cardiovascular risk.
The data analysed were numerous: about fifteen CPGs, a few meta-analysis, and studies about risk estimation in French population. There were some differences between CPGs on certain aspects of the management, and controversy, especially on the interest of lipid-lowering drugs in subjects with lower cardiovascular risk.
Otherwise, some medical societies did not play their role in reviewing texts.
In total, the development of this ADG required four WG meetings, which is relatively low, but lasted two years, which is comparable to the theoretical period of a standard CPG.

Conclusions: The need to produce quickly a guideline about a controversial subject led us to produce an ADG. Despite the reluctance of key stakeholders and the extent of the topic, we succeeded in producing it, in particular through a high implication in the internal development of an evidence report summarising existing recent guidelines. The time of development of this CPG would probably have been longer with the standard method.