TY - JOUR
T1 - Residual macrovascular risk in 2013
T2 - What have we learned?
AU - Fruchart, Jean Charles
AU - Davignon, Jean
AU - Hermans, Michel P.
AU - Al-Rubeaan, Khalid
AU - Amarenco, Pierre
AU - Assmann, Gerd
AU - Barter, Philip
AU - Betteridge, John
AU - Bruckert, Eric
AU - Cuevas, Ada
AU - Farnier, Michel
AU - Ferrannini, Ele
AU - Fioretto, Paola
AU - Genest, Jacques
AU - Ginsberg, Henry N.
AU - Gotto, Antonio M.
AU - Hu, Dayi
AU - Kadowaki, Takashi
AU - Kodama, Tatsuhiko
AU - Krempf, Michel
AU - Matsuzawa, Yuji
AU - Núñez-Cortés, Jesús M.
AU - Monfil, Carlos C.
AU - Ogawa, Hisao
AU - Plutzky, Jorge
AU - Rader, Daniel J.
AU - Sadikot, Shaukat
AU - Santos, Raul D.
AU - Shlyakhto, Evgeny
AU - Sritara, Piyamitr
AU - Sy, Rody
AU - Tall, Alan
AU - Tan, Chee E.
AU - Tokgözoǧlu, Lale
AU - Toth, Peter P.
AU - Valensi, Paul
AU - Wanner, Christoph
AU - Zambon, Alberto
AU - Zhu, Junren
AU - Zimmet, Paul
PY - 2014/1/24
Y1 - 2014/1/24
N2 - 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.
AB - 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.
KW - Atherogenic dyslipidaemia
KW - Residual cardiovascular risk
KW - Therapeutic options
KW - Type 2 diabetes
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U2 - 10.1186/1475-2840-13-26
DO - 10.1186/1475-2840-13-26
M3 - Review article
C2 - 24460800
AN - SCOPUS:84892772956
VL - 13
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
SN - 1475-2840
IS - 1
M1 - 26
ER -