Residual macrovascular risk in 2013: what have we learned?
Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.
R3i Foundation, St, Alban-Anlage 46, Basel, CH 4010, Switzerland. jean-charles.fruchart@r3i.org.
Jean-Charles
JC
Fruchart
Jean
J
Davignon
Michel P
MP
Hermans
Khalid
K
Al-Rubeaan
Pierre
P
Amarenco
Gerd
G
Assmann
Philip
P
Barter
John
J
Betteridge
Eric
E
Bruckert
Ada
A
Cuevas
Michel
M
Farnier
Ele
E
Ferrannini
Paola
P
Fioretto
Jacques
J
Genest
Henry N
HN
Ginsberg
Antonio M
AM
Gotto
Dayi
D
Hu
Takashi
T
Kadowaki
Tatsuhiko
T
Kodama
Michel
M
Krempf
Yuji
Y
Matsuzawa
Jesús Millán
JM
Núñez-Cortés
Carlos Calvo
CC
Monfil
Hisao
H
Ogawa
Jorge
J
Plutzky
Daniel J
DJ
Rader
Shaukat
S
Sadikot
Raul D
RD
Santos
Evgeny
E
Shlyakhto
Piyamitr
P
Sritara
Rody
R
Sy
Alan
A
Tall
Chee Eng
CE
Tan
Lale
L
Tokgözoğlu
Peter P
PP
Toth
Paul
P
Valensi
Christoph
C
Wanner
Alberto
A
Zambon
Junren
J
Zhu
Paul
P
Zimmet
D000818:Animals; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D050171:Dyslipidemias / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007858:Learning; D012307:Risk Factors