Beyond LDL cholesterol: the role of elevated triglycerides and low HDL cholesterol in residual CVD risk remaining after statin therapy.
Managed care initiatives to reduce cardiovascular disease (CVD) risk have, to date, focused almost exclusively on statins, which are primarily low-density lipoprotein cholesterol-lowering agents and have limited effects on triglycerides and high-density lipoprotein (HDL) cholesterol at commonly used doses. Significant residual CVD risk (ie, risk of recurrent CVD events) remains after treatment with statins and may stem, at least partially, from low HDL cholesterol and/or elevated triglycerides. Consequently, national treatment guidelines suggest that combination therapy may be necessary to address multiple lipid targets and adding niacin or a fibrate to a statin is a strategy to be considered. Recent clinical trial evidence has demonstrated the efficacy of niacin/statin and fenofibric acid/statin combination therapies in treating multiple lipid abnormalities.
The Milton S. Hershey Medical Center, Pennsylvania State Heart and Vascular Institute, H047, 500 University Dr, Hershey, PA 17033, USA. palagona@hmc.psu.edu
Peter
P
Alagona
D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000187:drug effects*; D008078:Cholesterol, LDL / Q000187:drug effects*; D011345:Fenofibrate / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015228:Hypertriglyceridemia / Q000175:diagnosis / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D009525:Niacin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D040242:Risk Reduction Behavior
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D009525:Niacin; D011345:Fenofibrate