Unmet Need for Hypertriglyceridemia Management
- Ganda OP, Bhatt DL, Mason RP, Miller M, Boden WE.
- Unmet Need for Adjunctive Dyslipidemia Therapy in Hypertriglyceridemia Management. J Am Coll Cardiol 2018;72:330-343.
The following are key points to remember from this review article on the unmet need for adjunctive dyslipidemia therapy in the management of hypertriglyceridemia:
- Despite the use of high-intensity statins to reduce the risk of atherosclerotic cardiovascular events, substantial risk remains. This is particularly true among patients with type 2 diabetes mellitus (DM2), metabolic syndrome, and obesity.
- Epidemiologic studies have demonstrated that, in addition to elevated low-density lipoprotein cholesterol (LDL-C) levels, elevation in both triglycerides (TGs) and high-density lipoprotein cholesterol (HDL-C) are independent predictors of coronary heart disease (CHD).
- Hypertriglyceridemia is a highly prevalent lipid disorder. More than 25% of the adult population has TG levels of ≥150 mg/dl. This is likely to continue increasing with the epidemics of obesity, metabolic syndrome, and DM2.
- Two prior randomized trials of statins plus extended-release niacin or placebo failed to show a reduction in CHD events. Three other large randomized trials evaluating cholesteryl ester transfer protein inhibitors also failed to show reductions in atherosclerotic cardiovascular disease risk despite increasing HDL-C levels.
- Fibrates, niacin, and omega-3 fatty acids are available therapies that treat elevated TG and/or HDL-C levels. Results have been mixed. Two studies each of omega-3 fatty acid therapy and fibrate therapy have shown reductions in important cardiovascular outcomes (e.g., death, nonfatal myocardial infarction). However, eight other studies of these agents have failed to show benefit.
- Inflammation remains an important potential target for therapies aimed at reducing CHD risk. Omega-3 fatty acids may have anti-inflammatory properties, likely via leukotriene-mediated effects. Canakinumab (a monoclonal antibody targeting IL-1β) improved CHD risk among patients with an elevated baseline C-reactive protein.
- Several large randomized trials are currently evaluating the role of omega-3 fatty acid therapy for statin-treated patients. Two of these include patients with a baseline LDL-C level <100 mg/dl.
- Other potential therapies to address the residual CHD risk include antibody-based antisense oligonucleotides and small interfering ribonucleic acid. These targets are still early in development for cardiovascular patients.
Keywords: Antibodies, Monoclonal, Atherosclerosis, Cholesterol Ester Transfer Proteins, Cholesterol, HDL, Cholesterol, LDL, Coronary Disease, C-Reactive Protein, Diabetes Mellitus, Type 2, Dyslipidemias, Fatty Acids, Omega-3, Fibric Acids, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypertriglyceridemia, Inflammation, Interleukin-1, Leukotrienes, Metabolic Syndrome X, Myocardial Infarction, Niacin, Obesity, Primary Prevention, Triglycerides, Vascular Diseases
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