title: The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia.
abstract: Despite achieving targets for low-density lipoprotein (LDL) cholesterol, blood pressure, and glycemia in accordance with current standards of care, patients with dyslipidemia remain at high residual risk of vascular events. Atherogenic dyslipidemia, characterized by elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, often with elevated apolipoprotein B and non-HDL cholesterol, is common in patients with established cardiovascular disease (CVD), type 2 diabetes mellitus, or metabolic syndrome and contributes to both macrovascular and microvascular residual risk. However, atherogenic dyslipidemia is largely underdiagnosed and undertreated in clinical practice. The Residual Risk Reduction Initiative (R3i) was established to address this highly relevant clinical issue. The aims of this position paper are (1) to highlight evidence that atherogenic dyslipidemia is associated with residual macrovascular and microvascular risk in patients at high risk for CVD, despite current standards of care for dyslipidemia and diabetes; and (2) to recommend therapeutic intervention for reducing this residual vascular risk supported by evidence and expert consensus. Lifestyle modification with nutrition and exercise is an important, effective, and underutilized first step in reducing residual vascular risk. Therapeutic intervention aimed at achievement of all lipid targets is also often required. Combination lipid-modifying therapy, with the addition of niacin, a fibrate, or omega-3 fatty acids to statin therapy, increases the probability of achieving all lipid goals. Outcomes studies are in progress to evaluate whether these combination treatment strategies translate to a clinical benefit greater than that achieved with statins alone. The R3i highlights the need to address with lifestyle and/or pharmacotherapy the high level of residual risk of CVD events and microvascular complications among patients with dyslipidemia receiving therapy for high levels of LDL cholesterol and for diabetes in accordance with current standards of care.
authors.affiliation: INSERM UR 545, Institut Pasteur de Lille, Université Lille 2, Lille, France. Jean-Charles.Fruchart@pasteur-lille.fr
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Fruchart
authors.forename: Frank
authors.initials: F
authors.lastname: Sacks
authors.forename: Michel P
authors.initials: MP
authors.lastname: Hermans
authors.forename: Gerd
authors.initials: G
authors.lastname: Assmann
authors.forename: W Virgil
authors.initials: WV
authors.lastname: Brown
authors.forename: Richard
authors.initials: R
authors.lastname: Ceska
authors.forename: M John
authors.initials: MJ
authors.lastname: Chapman
authors.forename: Paul M
authors.initials: PM
authors.lastname: Dodson
authors.forename: Paola
authors.initials: P
authors.lastname: Fioretto
authors.forename: Henry N
authors.initials: HN
authors.lastname: Ginsberg
authors.forename: Takashi
authors.initials: T
authors.lastname: Kadowaki
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Lablanche
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Jorge
authors.initials: J
authors.lastname: Plutzky
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Reiner
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rosenson
authors.forename: Bart
authors.initials: B
authors.lastname: Staels
authors.forename: Jane K
authors.initials: JK
authors.lastname: Stock
authors.forename: Rody
authors.initials: R
authors.lastname: Sy
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.forename: Alberto
authors.initials: A
authors.lastname: Zambon
authors.forename: Paul
authors.initials: P
authors.lastname: Zimmet
mesh_terms: D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D014943:Global Health; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D008055:Lipids / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000960:Hypolipidemic Agents; D008055:Lipids