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Title: Residual macrovascular risk in 2013: What have we learned?
Authors: Jean Charles Fruchart
Jean Davignon
Michel P. Hermans
Khalid Al-Rubeaan
Pierre Amarenco
Gerd Assmann
Philip Barter
John Betteridge
Eric Bruckert
Ada Cuevas
Michel Farnier
Ele Ferrannini
Paola Fioretto
Jacques Genest
Henry N. Ginsberg
Antonio M. Gotto
Dayi Hu
Takashi Kadowaki
Tatsuhiko Kodama
Michel Krempf
Yuji Matsuzawa
Jesús M. Núñez-Cortés
Carlos C. Monfil
Hisao Ogawa
Jorge Plutzky
Daniel J. Rader
Shaukat Sadikot
Raul D. Santos
Evgeny Shlyakhto
Piyamitr Sritara
Rody Sy
Alan Tall
Chee E. Tan
Lale Tokgözoǧlu
Peter P. Toth
Paul Valensi
Christoph Wanner
Alberto Zambon
Junren Zhu
Paul Zimmet
R3i Foundation
Fondation coeur et arteres
Institut de Recherches Cliniques de Montreal
Cliniques Universitaires Saint-Luc, Brussels
King Saud University
Hopital Bichat-Claude-Bernard AP-HP
Assmann-Stiftung für Prävention
University of New South Wales (UNSW) Australia
Hopital Universitaire Pitie Salpetriere
Clinica Las Condes
Point Medical
Universita di Pisa
Universita degli Studi di Padova
McGill University Health Centre, Royal Victoria Hospital
Columbia University in the City of New York
Weill Cornell Medical College
Peking University
University of Tokyo
Centre Hospitalier Universitaire de Nantes
Osaka University
Hospital General Universitario Gregorio Maranon
University of Concepcion
Kumamoto University
Brigham and Women's Hospital and Harvard Medical School
Penn Cardiovascular Institute
Jaslok Hospital and Research Centre
Instituto do Coracao do Hospital das Clinicas
Almazov National Medical Research Centre
Mahidol University
University of the Philippines Manila
Columbia University, College of Physicians and Surgeons
Gleneagles Hospital
Hacettepe Universitesi
University of Illinois
Universite Paris 13
Universitatsklinikum Wurzburg
Fudan University
Baker Heart and Diabetes Institute
Keywords: Medicine
Issue Date: 24-Jan-2014
Citation: Cardiovascular Diabetology. Vol.13, No.1 (2014)
Abstract: 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. © 2014 Fruchart et al.; licensee BioMed Central Ltd.
ISSN: 14752840
Appears in Collections:Scopus 2011-2015

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