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Managing the residual cardiovascular disease risk associated with HDL-cholesterol and triglycerides in statin-treated patients: a clinical update.
Nutr Metab Cardiovasc Dis 2013; 23(9):799-807NM

Abstract

Cardiovascular disease (CVD) is a significant cause of death in Europe. In addition to patients with proven CVD, those with type 2 diabetes (T2D) are at a particularly high-risk of CVD and associated mortality. Treatment for dyslipidaemia, a principal risk factor for CVD, remains a healthcare priority; evidence supports the reduction of low-density lipoprotein cholesterol (LDL-C) as the primary objective of dyslipidaemia management. While statins are the treatment of choice for lowering LDL-C in the majority of patients, including those with T2D, many patients retain a high CVD risk despite achieving the recommended LDL-C targets with statins. This 'residual risk' is mainly due to elevated triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) levels. Following statin therapy optimisation additional pharmacotherapy should be considered as part of a multifaceted approach to risk reduction. Fibrates (especially fenofibrate) are the principal agents recommended for add-on therapy to treat elevated TG or low HDL-C levels. Currently, the strongest evidence of benefit is for the addition of fenofibrate to statin treatment in high-risk patients with T2D and dyslipidaemia. An alternative approach is the addition of agents to reduce LDL-C beyond the levels attainable with statin monotherapy. Here, addition of fibrates and niacin to statin therapy is discussed, and novel approaches being developed for HDL-C and TG management, including cholesteryl ester transfer protein inhibitors, Apo A-1 analogues, mipomersen, lomitapide and monoclonal antibodies against PCSK9, are reviewed.

Authors+Show Affiliations

Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Kispaticeva 12, 10 000 Zagreb, Croatia. Electronic address: zreiner@kbc-zagreb.hr.

Pub Type(s)

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

Language

eng

PubMed ID

23932901

Citation

Reiner, Z. "Managing the Residual Cardiovascular Disease Risk Associated With HDL-cholesterol and Triglycerides in Statin-treated Patients: a Clinical Update." Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, vol. 23, no. 9, 2013, pp. 799-807.
Reiner Z. Managing the residual cardiovascular disease risk associated with HDL-cholesterol and triglycerides in statin-treated patients: a clinical update. Nutr Metab Cardiovasc Dis. 2013;23(9):799-807.
Reiner, Z. (2013). Managing the residual cardiovascular disease risk associated with HDL-cholesterol and triglycerides in statin-treated patients: a clinical update. Nutrition, Metabolism, and Cardiovascular Diseases : NMCD, 23(9), pp. 799-807. doi:10.1016/j.numecd.2013.05.002.
Reiner Z. Managing the Residual Cardiovascular Disease Risk Associated With HDL-cholesterol and Triglycerides in Statin-treated Patients: a Clinical Update. Nutr Metab Cardiovasc Dis. 2013;23(9):799-807. PubMed PMID: 23932901.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Managing the residual cardiovascular disease risk associated with HDL-cholesterol and triglycerides in statin-treated patients: a clinical update. A1 - Reiner,Z, Y1 - 2013/08/09/ PY - 2012/11/02/received PY - 2013/04/16/revised PY - 2013/05/09/accepted PY - 2013/8/13/entrez PY - 2013/8/13/pubmed PY - 2014/4/29/medline KW - ACCORD KW - AIM-HIGH KW - ARBITER KW - Action to Control Cardiovascular Risk in Diabetes KW - Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol KW - Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides and Impact on Global Health Outcomes KW - BIP KW - Bezafibrate Infarction Prevention KW - CTT KW - Cardiovascular diseases KW - Cholesterol Treatment Trialists KW - EAS KW - ERASE KW - ESC KW - Effect of reconstituted HDL on Atherosclerosis-Safety and Efficacy KW - European Atherosclerosis Society KW - European Society of Cardiology KW - FIELD KW - Fenofibrate Intervention and Event Lowering in Diabetes KW - Fibrates KW - HPS2-THRIVE KW - Heart Protection Study 2: Treatment of HDL to Reduce the Incidence of Vascular Events KW - Hypertriglyceridaemia KW - ILLUMINATE KW - Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events KW - Nicotinic acid KW - SCORE KW - Statins KW - Study of the Effect of Dalcetrapib on Atherosclerotic Disease in Patients with Coronary Artery Disease KW - Systemic Coronary Risk Estimation KW - Triglycerides KW - dal-OUTCOMES SP - 799 EP - 807 JF - Nutrition, metabolism, and cardiovascular diseases : NMCD JO - Nutr Metab Cardiovasc Dis VL - 23 IS - 9 N2 - Cardiovascular disease (CVD) is a significant cause of death in Europe. In addition to patients with proven CVD, those with type 2 diabetes (T2D) are at a particularly high-risk of CVD and associated mortality. Treatment for dyslipidaemia, a principal risk factor for CVD, remains a healthcare priority; evidence supports the reduction of low-density lipoprotein cholesterol (LDL-C) as the primary objective of dyslipidaemia management. While statins are the treatment of choice for lowering LDL-C in the majority of patients, including those with T2D, many patients retain a high CVD risk despite achieving the recommended LDL-C targets with statins. This 'residual risk' is mainly due to elevated triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) levels. Following statin therapy optimisation additional pharmacotherapy should be considered as part of a multifaceted approach to risk reduction. Fibrates (especially fenofibrate) are the principal agents recommended for add-on therapy to treat elevated TG or low HDL-C levels. Currently, the strongest evidence of benefit is for the addition of fenofibrate to statin treatment in high-risk patients with T2D and dyslipidaemia. An alternative approach is the addition of agents to reduce LDL-C beyond the levels attainable with statin monotherapy. Here, addition of fibrates and niacin to statin therapy is discussed, and novel approaches being developed for HDL-C and TG management, including cholesteryl ester transfer protein inhibitors, Apo A-1 analogues, mipomersen, lomitapide and monoclonal antibodies against PCSK9, are reviewed. SN - 1590-3729 UR - https://www.unboundmedicine.com/medline/citation/23932901/Managing_the_residual_cardiovascular_disease_risk_associated_with_HDL_cholesterol_and_triglycerides_in_statin_treated_patients:_a_clinical_update_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0939-4753(13)00120-8 DB - PRIME DP - Unbound Medicine ER -