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RESEARCH PRODUCT
How to assess and manage cardiovascular risk associated with lipid alterations beyond LDL
Maurizio AvernaErik StroesMasatsune OguraArman PostadzhiyanMiha CercekPaolo Calabro'Patrizia SuppressaPatrizia SuppressaPatrizia Suppressasubject
medicine.medical_specialtyApolipoprotein BType 2 diabetes030204 cardiovascular system & hematologyRisk AssessmentTriglyceride03 medical and health scienceschemistry.chemical_compound0302 clinical medicineHigh-density lipoprotein cholesterolRisk FactorsInternal medicinemedicineInternal MedicineHumans030212 general & internal medicineAtherogenic dyslipidaemiaHypolipidemic AgentsbiologyCholesterolbusiness.industryDisease Managementnutritional and metabolic diseasesGeneral MedicineLipoprotein(a)Cholesterol LDLmedicine.diseaseCardiovascular diseaseCardiovascular riskResidual riskNon-high-density lipoprotein cholesterolEndocrinologychemistryCardiovascular DiseasesPractice Guidelines as Topicbiology.proteinlipids (amino acids peptides and proteins)Metabolic syndromeHydroxymethylglutaryl-CoA Reductase InhibitorsbusinessRisk assessmentCardiology and Cardiovascular MedicineApolipoprotein BBiomarkersLipoproteinLipoprotein(a)description
Background and aims: The maintenance of clinically recommended levels of low-density lipoprotein cholesterol (LDL-C) through a statin therapy is a gold standard in the management of patients with dyslipidaemia and cardiovascular disease (CVD). However, even when LDL-C levels are at or below clinically recommended target levels, residual cardiovascular (CV) risk still remains. Therefore, assessing lipoproteins beyond LDL-C in managing CV risk is imperative. Methods: A working group of clinical experts have assessed the role of lipoproteins other than LDL-C in identifying the CV risk in patients with dyslipidaemia and CVD and in the management of atherogenic dyslipidaemia associated with a number of other diseases. The recommendations, in line with the European guidelines, are presented. Results: A thorough evaluation of clinical data by the expert working group resulted in recommendations to consider non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (apoB), remnant cholesterol and lipoprotein(a) (Lp[ a]) as biomarkers of residual CV risk in patients with CVD. Elevated Lp(a) levels were also suggested to be a causal factor. The experts highlighted the significance of nonHDL-C and triglycerides (TG) in atherogenic dyslipidaemia associated with type 2 diabetes, metabolic syndrome, chronic kidney disease (CKD) and familial combined hyperlipidaemia (FCH). The working group recommended combinatorial therapeutic approaches in high-risk patients, including agents impacting on TG and HDL-C levels. Conclusions: Evaluation of a lipoprotein landscape when LDL-C levels remain low strongly supports the role of non-HDL-C, Lp(a) and TGs in identifying patients with increased residual risk of CV and in selecting their treatment strategy. (C) 2017 Elsevier B.V. All rights reserved
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-01-01 |