Residual cardiovascular risk in secondary prevention.
Despite substantial progress in the characterization and pharmacological treatment of risk factors associated with cardiovascular disease (CVD), residual cardiovascular risk represents a challenge to an effective CVD primary and secondary prevention. A multifactorial approach aimed at controlling all risk factors present in each individual patient is of paramount importance to effectively reduce the risk of CV events. While aggressive as compared to conventional LDL-cholesterol lowering provides further CV events reduction in secondary prevention patients, significant residual cardiovascular risk remains even after intensive statin therapy and an LDL-C levels of <70 mg/dL. Combination lipid-lowering strategies with a statin and fenofibrate or a statin and nicotinic acid may provide significant residual CV risk reduction in selected subgroups of patients (i.e. patients with diabetes on statin therapy and persistently low HDL-C and/or high triglycerides). Intensive risk factor management approaches aimed at controlling plasma LDL-C, glucose metabolism and blood pressure may significantly reduce residual CV risk; they should however be implemented based on individual cardiovascular risk profiles and clinical phenotypes, following the footsteps of personalized medicine.
Clinica Medica 1, Department of Medicine, School of Medicine, University of Padova, Via Giustiniani 2, Padua, Italy. alberto.zambon@unipd.it
Alberto
A
Zambon
D050197:Atherosclerosis; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000187:drug effects; D005260:Female; D058607:Fibric Acids; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009525:Niacin; D012307:Risk Factors; D055502:Secondary Prevention; D014665:Vasodilator Agents
D008078:Cholesterol, LDL; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014665:Vasodilator Agents; D009525:Niacin