How to assess and manage cardiovascular risk associated with lipid alterations beyond LDL

Area of Science:

• Cardiology
• Lipidology
• Preventive Medicine

Background:

• Statin therapy aims to maintain recommended low-density lipoprotein cholesterol (LDL-C) levels for cardiovascular disease (CVD) management.
• Residual cardiovascular risk persists even with optimal LDL-C levels, necessitating further assessment.
• Evaluating lipoproteins beyond LDL-C is imperative for comprehensive CV risk management.

Purpose of the Study:

• To assess the role of non-LDL-C lipoproteins in identifying and managing CV risk in dyslipidaemia and CVD.
• To provide expert recommendations aligned with European guidelines for managing atherogenic dyslipidaemia.
• To highlight biomarkers for residual CV risk in patients with existing CVD.

Main Methods:

• A working group of clinical experts evaluated existing clinical data.
• The assessment focused on lipoproteins other than LDL-C.
• Recommendations were formulated in accordance with European guidelines.

Main Results:

• Non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (apoB), remnant cholesterol, and lipoprotein(a) (Lp[a]) are recommended biomarkers for residual CV risk.
• Elevated Lp(a) is identified as a potential causal factor for CVD.
• Non-HDL-C and triglycerides (TG) are significant in atherogenic dyslipidaemia associated with type 2 diabetes, metabolic syndrome, CKD, and FCH.
• Combinatorial therapeutic approaches targeting TG and HDL-C are recommended for high-risk patients.

Conclusions:

• Evaluating the lipoprotein profile beyond LDL-C is essential for identifying patients at increased residual risk.
• Non-HDL-C, Lp(a), and TG are key biomarkers for risk stratification and treatment selection.
• Comprehensive lipoprotein assessment aids in tailoring treatment strategies for optimal cardiovascular risk reduction.