Residual cardiovascular risk of lipid origin. Components and pathophysiological aspects

Area of Science:

• Cardiology
• Lipidology
• Preventive Medicine

Background:

• Low-density lipoprotein cholesterol (LDL-c) reduction via statins is proven effective for cardiovascular risk management.
• Residual risk, a persistent high cardiovascular risk despite achieving LDL-c targets, is a significant clinical concern.
• Atherogenic dyslipidemia, characterized by elevated triglycerides and altered LDL particles, underlies residual lipid risk.

Purpose of the Study:

• To review the concept of residual cardiovascular risk in the context of atherogenic dyslipidemia.
• To discuss diagnostic measures for identifying atherogenic dyslipidemia.
• To evaluate current treatment strategies for managing residual risk.

Main Methods:

• Literature review of studies on LDL-c, residual risk, and atherogenic dyslipidemia.
• Analysis of diagnostic markers including total cholesterol, triglycerides, HDL-c, non-HDL cholesterol, remnant cholesterol, apolipoprotein B100, and lipoprotein (a).
• Evaluation of lifestyle and pharmacological interventions for atherogenic dyslipidemia.

Main Results:

• Despite optimal LDL-c levels, residual cardiovascular risk remains a challenge.
• Atherogenic dyslipidemia is identified through specific lipid and lipoprotein measurements.
• Weight loss and exercise are foundational treatments; fenofibrate shows potential efficacy in specific cases.

Conclusions:

• Residual risk management requires addressing atherogenic dyslipidemia beyond LDL-c reduction.
• Comprehensive lipid profiling is crucial for identifying patients at risk.
• While lifestyle changes are primary, targeted pharmacological approaches like fenofibrate may play a role in managing residual risk.