Residual macrovascular risk in 2013: what have we learned?
Creators: name: Fruchart, Jean-Charles
name: Davignon, Jean
name: Hermans, Michel
name: Al-Rubeaan, Khalid
name: Amarenco, Pierre
name: Assmann, Gerd
name: Barter, Philip
name: Betteridge, John
name: Bruckert, Eric
name: Cuevas, Ada
name: Farnier, Michel
name: Ferrannini, Ele
name: Fioretto, Paola
name: Genest, Jacques
name: Ginsberg, Henry N.
name: Gotto, Antonio
name: Hu, Dayi
name: Kadowaki, Takashi
name: Kodama, Tatsuhiko
name: Krempf, Michel
name: Matsuzawa, Yuji
name: Núñez-Cortés, Jesús
name: Monfil, Carlos
name: Ogawa, Hisao
name: Plutzky, Jorge
name: Rader, Daniel
name: Sadikot, Shaukat
name: Santos, Raul
name: Shlyakhto, Evgeny
name: Sritara, Piyamitr
name: Sy, Rody
name: Tall, Alan R.
name: Tan, Chee
name: Tokgözoğlu, Lale
name: Toth, Peter
name: Valensi, Paul
name: Wanner, Christoph
name: Zambon, Alberto
name: Zhu, Junren
name: Zimmet, Paul
Publisher: name: Columbia University
Year: 2014
Subjects: Non-insulin-dependent diabetes
Cardiovascular system--Diseases
Medicine
Epidemiology

description: 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.