Reducing vascular events risk in patients with dyslipidaemia: an update for clinicians

Area of Science:

• Cardiovascular Medicine
• Lipidology
• Metabolic Disorders

Background:

• Cardiovascular disease (CVD) risk reduction in dyslipidaemia necessitates risk stratification and intervention on modifiable factors.
• Statins effectively lower low-density lipoprotein cholesterol (LDL-C) but a significant residual vascular risk (RvR) often remains, particularly in patients with diabetes.
• Increasing global rates of obesity, type 2 diabetes, and metabolic syndrome contribute to a growing burden of atherogenic dyslipidaemia, characterized by low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides.

Purpose of the Study:

• To address the unquantified residual vascular risk (RvR) in patients with dyslipidaemia, especially those with atherogenic dyslipidaemia.
• To explore the potential of combination lipid-lowering therapies targeting atherogenic dyslipidaemia to reduce RvR.
• To evaluate the efficacy of specific combination therapies in high-risk populations, such as patients with diabetes.

Main Methods:

• Review of current clinical practices for cardiovascular disease risk stratification and management of modifiable risk factors in dyslipidaemia.
• Analysis of the role of atherogenic dyslipidaemia as a component of residual vascular risk.
• Examination of evidence from clinical trials, including the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, on combination lipid-lowering therapies.

Main Results:

• Residual vascular risk (RvR) in dyslipidaemia is often linked to suboptimal attainment of lipid targets (LDL-C, non-HDL-C, apolipoprotein B) and atherogenic dyslipidaemia.
• Atherogenic dyslipidaemia, prevalent in metabolic syndrome and diabetes, involves VLDL overproduction and impaired cholesterol transport.
• The ACCORD trial demonstrated that combination therapy (simvastatin plus fenofibrate) reduced macrovascular risk in diabetic patients with atherogenic dyslipidaemia and retinopathy risk.

Conclusions:

• Addressing residual vascular risk requires comprehensive management beyond LDL-C reduction, including targeting atherogenic dyslipidaemia.
• Combination therapies, such as statins with fibrates, show promise in reducing cardiovascular events in high-risk patients with specific lipid profiles.
• Further research and clinical practice integration are needed to quantify and manage residual vascular risk effectively, particularly in the context of metabolic disorders.