Despite the important role of high-intensity statins in reducing atherosclerotic cardiovascular disease (ASCVD) events, substantial residual risk persists, according to a state-of-the-art review article published July 9 in the Journal of the American College of Cardiology.

Om P. Ganda, MD, et al., discuss how even after intensive statin therapy has been initiated and as defined by current guidelines, ASCVD risk continues and the prevalence of atherogenic dyslipidemia increases with the global epidemics of type 2 diabetes mellitus, metabolic syndrome and obesity.

The authors point out that prior trials with fibrates, niacin and most cholesterol ester transfer protein inhibitors that targeted high-density lipoprotein cholesterol-raising and triglyceride-lowering have failed to demonstrate conclusive evidence of incremental event reduction after "optimally controlled" low-density lipoprotein (LDL-C) levels on statins. While fibrates are effective in reducing elevated triglyceride levels, the authors note that evidence for reducing residual risk when combined with statins remains uncertain.

Furthermore, even though omega-3 fatty acids have been found to be efficacious in lowering triglyceride levels and may have pleiotropic effects such as reducing plaque instability and pro-inflammatory mediators of atherogenesis, the authors state that clinical outcomes data are currently lacking. Currently, several ongoing randomized trials of triglyceride-lowering strategies with optimal dosage of omega-3 fatty acids are nearing completion.

"If triglyceride reduction improves cardiovascular disease risk beyond LDL-C, the potential added benefit of omega-3 fatty acids may be considerable, especially in diabetic patients at high ASCVD residual-risk burden and frequently high triglyceride levels, in addition to elevated LDL-C," the authors conclude.

Keywords: Fibric Acids, Cholesterol, HDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Niacin, Cholesterol Ester Transfer Proteins, Diabetes Mellitus, Type 2, Fatty Acids, Omega-3, Hypertriglyceridemia, Dyslipidemias, Atherosclerosis, Triglycerides, Lipoproteins, LDL, Inflammation Mediators

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