Dyslipidemia and cardiovascular risk: the importance of early prevention

Abstract

Strategies aimed at primary prevention provide an outstanding opportunity for reducing the onset and burden of cardiovascular (CV) disease. Lipid abnormalities, including high levels of low-density lipoprotein cholesterol (LDL-C), elevated triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C), are associated with an increased risk of CV events, thereby serving as contributors to this process. By consensus, lowering LDL-C, generally with statin therapy, is the primary target of lipid-lowering therapy. However, statin therapy may be insufficient for patients with mixed dyslipidemia, especially those with insulin resistance syndromes. While the addition of niacin, fibrate or omega-3 fatty acids may be useful in this setting, outcomes data are lacking. Therefore, data from ongoing prospective studies will hopefully resolve this issue and facilitate identification of optimal strategies to augment CV risk reduction.

Figure 1.

Effect of fibrate treatment on clinical outcomes. Results from four major studies with (a) gemfibrozil (b) fenofibrate and (c) gemfibrozil or bezafibrate. HHS,^, FIELD, VA-HIT: Veterans Affairs HDL Intervention Trial;^, BIP,^, CHD: coronary heart disease; CVD: CV disease; TG: triglycerides.