How to control residual cardiovascular risk despite statin treatment: focusing on HDL-cholesterol

Area of Science:

• Cardiology
• Metabolic Disorders
• Pharmacology

Background:

• Lowering low-density lipoprotein-cholesterol (LDL-C) is primary for cardiovascular disease (CVD) risk reduction.
• Residual CVD risk persists despite LDL-C targets, often due to high triglycerides (TG) and low high-density lipoprotein-cholesterol (HDL-C).
• Atherogenic dyslipidemia, characterized by low HDL-C, high TG, and small, dense LDL particles, is linked to insulin resistance and metabolic syndrome.

Purpose of the Study:

• To review the rationale and importance of increasing HDL-C and lowering TG levels.
• To discuss their role as secondary therapeutic targets in managing dyslipidemia and preventing cardiovascular events.
• To explore the ongoing debate on HDL-C function versus levels in CHD reduction.

Main Methods:

• Review of current literature on dyslipidemia management and cardiovascular risk factors.
• Discussion of the role of TG and HDL-C in residual risk after LDL-C lowering.
• Analysis of ongoing clinical trials investigating combination therapies.

Main Results:

• Elevated TG and low HDL-C are independent risk factors for cardiovascular morbidity and mortality.
• Raising HDL-C and lowering TG are potential secondary targets for patients with residual risk.
• Efficacy of increasing HDL-C alone in reducing coronary heart disease (CHD) requires further confirmation.

Conclusions:

• Targeting both LDL-C and non-HDL-C/TG/HDL-C parameters is essential for comprehensive cardiovascular risk management.
• Further research and large clinical trials are needed to confirm the benefits of raising HDL-C and lowering TG.
• Combination therapies are being investigated to address residual risk in patients with dyslipidemia.