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Review
. 2012 Feb;14(1):1-10.
doi: 10.1007/s11883-011-0219-7.

Residual cardiovascular risk despite optimal LDL cholesterol reduction with statins: the evidence, etiology, and therapeutic challenges

Uchechukwu K Sampson  1 , Sergio Fazio, MacRae F Linton
Affiliations
Review

Residual cardiovascular risk despite optimal LDL cholesterol reduction with statins: the evidence, etiology, and therapeutic challenges

Uchechukwu K Sampson et al. Curr Atheroscler Rep. 2012 Feb.

Abstract

This review captures the existence, cause, and treatment challenges of residual cardiovascular risk (CVR) after aggressive low-density lipoprotein cholesterol (LDL-C) reduction. Scientific evidence implicates low high-density lipoprotein cholesterol (HDL-C) and high triglycerides (TG) in the CVR observed after LDL-C lowering. However, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial with fenofibrate, the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) study with torcetrapib, and the recently terminated Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study with niacin, do not clearly attribute risk reduction value to HDL-C/TG modulation. The optimum approach to long-term lipid-modifying therapies for CVR reduction remains uncertain. Consequently, absolute risk modulation via lifestyle changes remains the centerpiece of a strategy addressing the physiologic drivers of CVR associated with HDL-C/TG, especially in the context of diabetes/metabolic syndrome.

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Figures

Figure 1
Figure 1. Presence of Residual CV Risk in Large Prospective Studies of Optimal Statin Therapy
4S = Scandinavian Simvastatin Survival Study[6]; CARE = Cholesterol and Recurrent Events trial[10]; LIPID = Long-term Intervention with Pravastatin in Ischaemic Disease[7]; HPS = Heart Protection Study[8]; PROSPER = Prospective Study of Pravastatin in the Elderly at Risk[101]; ASCOT-LLA = Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm[102]; ALLHAT-LLT = Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial[103]; ASPEN = Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in Non-Insulin-dependent Diabetes Mellitus[104]; WOSCOPS = West of Scotland Coronary Prevention Study[11]; AFCAPS/TexCAPS = Air Force/Texas Coronary Atherosclerosis Prevention Study[9]; CARDS = Collaborative Atorvastatin Diabetes Study[105]; TNT = Treating to New Targets study[14]
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References

    1. Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–1681. ** The strongest available meta-analysis on the value of intensive LDL-C lowering in reducing cardiovascular risk.

    1. Smith SC, Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2006;47:2130–2139. - PubMed
    1. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227–239. - PubMed
    1. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) JAMA. 2001;285:2486–2497. - PubMed
    1. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts) Eur Heart J. 2007;28:2375–2414. - PubMed

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