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Published on: October 12, 2017
Modification of high-density lipoprotein cholesterol in the management of cardiovascular risk
Jim Koeller1, Robert L Talbert
1College of Pharmacy, University of Texas at Austin, USA.
Insights
Cardiovascular disease remains a leading cause of death. Addressing low high-density lipoprotein cholesterol (HDL) and high triglycerides is crucial for patient risk management and improved outcomes.
Area of Science:
- Cardiology
- Metabolic Disorders
- Pharmacology
Background:
- Cardiovascular disease (CVD) persists as the primary cause of mortality in the US, despite clinical trial evidence of reduced morbidity and mortality.
- Clinician-reported practices suggest under-identification and undertreatment of at-risk patients according to national guidelines.
- Low high-density lipoprotein cholesterol (HDL) and hypertriglyceridemia are significant risk factors for CVD, particularly in patients with type 2 diabetes and men.
Purpose of the Study:
- To review current evidence and guidelines for managing dyslipidemia, focusing on low-density lipoprotein cholesterol (LDL), HDL, and triglycerides.
- To evaluate therapeutic strategies for lipid disorders, emphasizing lifestyle changes and pharmacologic interventions.
- To discuss the role of niacin and fibrates in managing low HDL and hypertriglyceridemia, including advancements in niacin formulation.
Main Methods:
- Review of clinical trial data and practice surveys.
- Analysis of National Cholesterol Education Program Adult Treatment Panel III guidelines.
- Examination of epidemiologic data on lipid levels and cardiovascular risk.
- Comparison of therapeutic effects of niacin and fibrates.
Main Results:
- Low-density lipoprotein cholesterol (LDL) is the primary target for intervention in CVD risk reduction.
- Low HDL levels, especially with hypertriglyceridemia, significantly increase cardiovascular risk.
- Extended-release niacin demonstrates efficacy in improving lipid profiles while minimizing adverse effects compared to other niacin formulations.
Conclusions:
- Effective management of dyslipidemia requires addressing LDL, HDL, and triglyceride levels according to established guidelines.
- Therapeutic lifestyle changes are the initial step, followed by pharmacologic intervention when necessary.
- Extended-release niacin offers a favorable risk-benefit profile for managing low HDL and hypertriglyceridemia.
Abstract:
Although several clinical trials clearly demonstrate a decrease in mortality and morbidity rates for various patient populations with cardiovascular disease, this disease continues to be the leading cause of death in the United States. Based on various practice surveys and descriptive reports, clinicians apparently are not identifying patients at risk or not treating them to established goals set by national guidelines. Most evidence, including the updated National Cholesterol Education Program Adult Treatment Panel III guidelines, support low-density lipoprotein cholesterol (LDL) as the principal target for intervention. The guidelines also emphasize that a low level of high-density lipoprotein cholesterol (HDL) alone or in association with hypertriglyceridemia increases the risk of cardiovascular disease; also, epidemiologic data taken as a whole signify that a 1% decrease in HDL levels is associated with a 2-3% increase in risk of coronary heart disease. Low HDL levels occur more frequently than once thought, especially in selected populations such as patients with type 2 diabetes and men. Therapeutic lifestyle changes should be implemented first for any lipid disorder. In patients for whom this approach is not adequate, LDL levels need to be lowered to goals based on risk assessment. In addition, low HDL levels and/or hypertriglyceridemia should be managed with a niacin or fibrate product. However, increases in HDL levels and reductions in triglyceride levels are modest with fibrates compared with the dose-related changes seen with niacin products. Reformulation of niacin into an extended-release form minimizes common adverse effects seen with crystalline or sustained-release niacin, and the beneficial effects on the lipid profile are maintained.
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