Strategies for optimizing lipid management.
The currently recommended low-density lipoprotein cholesterol (LDL-C) goal of < 100 mg/dL in high-risk patients is a reasonable target of lipid-lowering therapy. Indeed, recent studies have suggested that the optimal level of LDL-C level may be < 70 mg/dL. However, there is considerable evidence that lipid measures other than LDL-C may be more accurate predictors of cardiovascular risk and thus may be useful in addition to LDL-C in guiding treatment to reduce cardiovascular risk. Non-high-density lipoprotein cholesterol (non-HDL-C) provides a measure of all atherogenic, apolipoprotein (apo) B-containing lipoproteins and can be calculated from a standard lipid panel. Baseline non-HDL-C level has been found to be superior to LDL-C level in predicting cardiovascular risk. Currently, non-HDL-C is recommended as a secondary target of lipid-lowering therapy in patients with elevated triglycerides. Apo B may also be useful in risk assessment and determining optimal therapy; apo B level and apo B/apo A-I ratio on 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor ("statin") therapy have been found to be strong predictors of risk of acute vascular events. Available data indicate that optimal apo B levels may not be achieved even with what has been considered intensive lipid-lowering therapy. Identification of optimal lipid targets and increased efforts to achieve those targets may help reduce the cardiovascular risk that remains despite lipid-lowering therapy that is currently considered adequate or even aggressive.
Ballantyne
Christie M
CM
Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Baylor College of Medicine, Houston, TX 77030, USA. cmb@bcm.tmc.edu
D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use
D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors