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

Uchechukwu K Sampson1, Sergio Fazio, MacRae F Linton

  • 1Department of Medicine, Vanderbilt University Medical Center, Atherosclerosis Research Unit, 383 PRB - 2220 Pierce Avenue, Nashville, TN 37232-6300, USA. u.sampson@vanderbilt.edu

Current Atherosclerosis Reports
|November 22, 2011
PubMed

Insights

Residual cardiovascular risk persists despite lowering LDL-C. Modulating HDL-C and triglycerides shows uncertain benefits, emphasizing lifestyle changes for managing metabolic syndrome and diabetes.

Area of Science:

  • Cardiovascular Medicine
  • Lipid Metabolism
  • Pharmacotherapy

Background:

  • Residual cardiovascular risk (CVR) is a significant concern even after achieving low-density lipoprotein cholesterol (LDL-C) reduction targets.
  • Low high-density lipoprotein cholesterol (HDL-C) and high triglycerides (TG) are implicated as key contributors to this residual CVR.

Purpose of the Study:

  • To review the challenges in treating residual CVR after intensive LDL-C lowering.
  • To evaluate the role of HDL-C and TG modulation in managing persistent CVR.

Main Methods:

  • Review of scientific evidence and clinical trial data, including ACCORD, ILLUMINATE, and AIM-HIGH studies.
  • Analysis of lipid-modifying therapies and their impact on CVR.

Main Results:

  • Clinical trials (ACCORD, ILLUMINATE, AIM-HIGH) did not consistently demonstrate risk reduction through HDL-C/TG modulation.
  • The optimal long-term strategy for lipid modification to reduce CVR remains unclear.

Conclusions:

  • Lifestyle modifications are crucial for addressing the physiological drivers of CVR, particularly in patients with diabetes and metabolic syndrome.
  • Absolute risk reduction through lifestyle remains a cornerstone strategy for managing residual CVR.

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