Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management
Липопротеины, богатые триглицеридами, и холестерин липопротеинов высокой плотности у пациентов с высоким риском сердечно-сосудистых заболеваний: доказательные данные и рекомендации по лечению
2011-04-29
SCID: 54.1/sbacez43
Discuss with AI
cardiovascular riskdyslipidaemia managementhigh-density lipoprotein cholesterollifestyle interventionstriglyceride-rich lipoproteins
Figures from the paper
Abstract (AI)
Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density lipoprotein cholesterol (HDL-C) as cardiovascular risk factors, and (ii) to advise on therapeutic strategies for management. Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic studies for TRL and remnants, together with the epidemiological data suggestive of the association for circulating triglycerides and cardiovascular disease. For HDL, epidemiological, mechanistic, and clinical intervention data are consistent with the view that low HDL-C contributes to elevated cardiovascular risk; genetic evidence is unclear however, potentially reflecting the complexity of HDL metabolism. The Panel believes that therapeutic targeting of elevated triglycerides (≥ 1.7 mmol/L or 150 mg/dL), a marker of TRL and their remnants, and/or low HDL-C (<1.0 mmol/L or 40 mg/dL) may provide further benefit. The first step should be lifestyle interventions together with consideration of compliance with pharmacotherapy and secondary causes of dyslipidaemia. If inadequately corrected, adding niacin or a fibrate, or intensifying LDL-C lowering therapy may be considered. Treatment decisions regarding statin combination therapy should take into account relevant safety concerns, i.e. the risk of elevation of blood glucose, uric acid or liver enzymes with niacin, and myopathy, increased serum creatinine and cholelithiasis with fibrates. These recommendations will facilitate reduction in the substantial cardiovascular risk that persists in patients with cardiometabolic abnormalities at LDL-C goal.
Key Findings
1
Elevated triglyceride-rich lipoproteins (TRLs) and their remnants are causally associated with increased cardiovascular risk, supported by mechanistic and genetic evidence.
2
Low HDL-C is consistently associated with higher cardiovascular risk in epidemiological, mechanistic, and intervention studies, although genetic evidence remains unclear because of complex HDL metabolism.
3
Management should begin with lifestyle intervention, assessment of pharmacotherapy adherence, and evaluation of secondary dyslipidaemia causes before adding niacin, fibrates, or intensifying LDL-C lowering.
4
Niacin and fibrate combination strategies require safety assessment because niacin may raise blood glucose, uric acid, or liver enzymes, while fibrates may cause myopathy, increased creatinine, or cholelithiasis.
5
Targeting triglycerides ≥1.7 mmol/L (150 mg/dL) and/or HDL-C <1.0 mmol/L (40 mg/dL) may provide additional cardiovascular benefit in high-risk patients at LDL-C goal.
Research Object
Patients with cardiometabolic abnormalities at LDL-C goal, characterized by elevated triglyceride-rich lipoproteins and/or low HDL-C
Research Subject
The cardiovascular-risk contribution of elevated triglyceride-rich lipoproteins and low HDL-C, and therapeutic strategies for managing these abnormalities
Publication Details
Publication Date
2011-04-29
Journal
Publisher
ISSN
Open access PDF
Access Type
Author Information
Download PDF
Subscribe to digest