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Optimal pharmacotherapy to combat the atherogenic lipid triad.
Curr Opin Cardiol. 2011 Sep; 26(5):403-11.CO

Abstract

PURPOSE OF REVIEW

A lipid triad involving an atherogenic dyslipidemia characterized by moderate/high LDL-C, low HDL-C, and elevated triglyceride (TG) occurs in numerous clinical settings associated with high cardiovascular risk. This article focuses on optimizing treatment of atherogenic dyslipidemias involving this lipid triad, emphasizing niacin-based or fibrate-based therapies.

RECENT FINDINGS

Niacin-based therapies comprehensively improve the atherogenic lipid profile, lead to atherosclerosis regression, and exert benefits across a spectrum of cardiovascular endpoints in studies based on limited patient numbers. Fibrates impact TG, HDL-C, and LDL-C according to lipid phenotype and underlying metabolic abnormality. In a recent meta-analysis, fibrates significantly reduced major cardiovascular events (-10%) and coronary events (-13%) across a wide range of lipid phenotypes, but had no impact on stroke, sudden death, or mortality. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial in type 2 diabetic patients similarly showed no significant effect of fenofibrate + simvastatin (vs. simvastatin) on nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death; a subgroup (17%) with marked atherogenic dyslipidemia trended toward benefit. Both niacin and fibrates attenuate vascular inflammation but the potential clinical relevance is indeterminate.

SUMMARY

Optimal cardiovascular risk reduction in patients exhibiting the lipid triad requires integrated pharmacotherapy to normalize LDL-C, HDL-C, TGs, and potentially lipoprotein(a). Ongoing studies may provide definitive evidence of the impact of niacin plus statins on cardiovascular outcomes.

Authors+Show Affiliations

Dyslipidemia, Inflammation and Atherosclerosis Research Unit, UMR-S939, National Institute for Health and Medical Research, Hôpital de la Pitié-Salpetriere, Paris, France. john.chapman@upmc.frNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

21730827

Citation

Chapman, M John, et al. "Optimal Pharmacotherapy to Combat the Atherogenic Lipid Triad." Current Opinion in Cardiology, vol. 26, no. 5, 2011, pp. 403-11.
Chapman MJ, Redfern JS, McGovern ME, et al. Optimal pharmacotherapy to combat the atherogenic lipid triad. Curr Opin Cardiol. 2011;26(5):403-11.
Chapman, M. J., Redfern, J. S., McGovern, M. E., & Giral, P. (2011). Optimal pharmacotherapy to combat the atherogenic lipid triad. Current Opinion in Cardiology, 26(5), 403-11. https://doi.org/10.1097/HCO.0b013e32834965e9
Chapman MJ, et al. Optimal Pharmacotherapy to Combat the Atherogenic Lipid Triad. Curr Opin Cardiol. 2011;26(5):403-11. PubMed PMID: 21730827.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimal pharmacotherapy to combat the atherogenic lipid triad. AU - Chapman,M John, AU - Redfern,Jan S, AU - McGovern,Mark E, AU - Giral,Philippe, PY - 2011/7/7/entrez PY - 2011/7/7/pubmed PY - 2011/12/22/medline SP - 403 EP - 11 JF - Current opinion in cardiology JO - Curr. Opin. Cardiol. VL - 26 IS - 5 N2 - PURPOSE OF REVIEW: A lipid triad involving an atherogenic dyslipidemia characterized by moderate/high LDL-C, low HDL-C, and elevated triglyceride (TG) occurs in numerous clinical settings associated with high cardiovascular risk. This article focuses on optimizing treatment of atherogenic dyslipidemias involving this lipid triad, emphasizing niacin-based or fibrate-based therapies. RECENT FINDINGS: Niacin-based therapies comprehensively improve the atherogenic lipid profile, lead to atherosclerosis regression, and exert benefits across a spectrum of cardiovascular endpoints in studies based on limited patient numbers. Fibrates impact TG, HDL-C, and LDL-C according to lipid phenotype and underlying metabolic abnormality. In a recent meta-analysis, fibrates significantly reduced major cardiovascular events (-10%) and coronary events (-13%) across a wide range of lipid phenotypes, but had no impact on stroke, sudden death, or mortality. The Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial in type 2 diabetic patients similarly showed no significant effect of fenofibrate + simvastatin (vs. simvastatin) on nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death; a subgroup (17%) with marked atherogenic dyslipidemia trended toward benefit. Both niacin and fibrates attenuate vascular inflammation but the potential clinical relevance is indeterminate. SUMMARY: Optimal cardiovascular risk reduction in patients exhibiting the lipid triad requires integrated pharmacotherapy to normalize LDL-C, HDL-C, TGs, and potentially lipoprotein(a). Ongoing studies may provide definitive evidence of the impact of niacin plus statins on cardiovascular outcomes. SN - 1531-7080 UR - https://www.unboundmedicine.com/medline/citation/21730827/Optimal_pharmacotherapy_to_combat_the_atherogenic_lipid_triad_ L2 - http://dx.doi.org/10.1097/HCO.0b013e32834965e9 DB - PRIME DP - Unbound Medicine ER -