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Open Access Highly Accessed Review

Residual macrovascular risk in 2013: what have we learned?

Jean-Charles Fruchart12*, Jean Davignon3, Michel P Hermans4, Khalid Al-Rubeaan5, Pierre Amarenco6, Gerd Assmann7, Philip Barter8, John Betteridge9, Eric Bruckert10, Ada Cuevas11, Michel Farnier12, Ele Ferrannini13, Paola Fioretto14, Jacques Genest15, Henry N Ginsberg16, Antonio M Gotto17, Dayi Hu18, Takashi Kadowaki19, Tatsuhiko Kodama20, Michel Krempf21, Yuji Matsuzawa22, Jesús Millán Núñez-Cortés23, Carlos Calvo Monfil24, Hisao Ogawa25, Jorge Plutzky26, Daniel J Rader27, Shaukat Sadikot28, Raul D Santos29, Evgeny Shlyakhto30, Piyamitr Sritara31, Rody Sy32, Alan Tall33, Chee Eng Tan34, Lale Tokgözoğlu35, Peter P Toth36, Paul Valensi37, Christoph Wanner38, Alberto Zambon14, Junren Zhu39, Paul Zimmet40 and for the Residual Risk Reduction Initiative (R3i)

Author Affiliations

1 R3i Foundation, St. Alban-Anlage 46, Basel, CH 4010, Switzerland

2 Fondation Cœur et Artères, Lille, France

3 Institut de recherches cliniques de Montréal; Centre Hospitalier de l’Université de Montréal and Department of Experimental Medicine, McGill University, Montreal, Canada

4 Cliniques Universitaires Saint-Luc, Brussels, Belgium

5 University Diabetes Center, King Saud University, Riyadh, Saudi Arabia

6 Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France

7 Assmann-Stiftung für Prävention, Münster, Germany

8 Centre for Vascular Research, University of New South Wales, Sydney, Australia

9 University College London, London, UK

10 Department of Endocrinology and Cardiovascular Disease Prevention, Institut of CardioMetabolism and Nutrition (ICAN) Hôpital Pitié-Salpêtrière, Paris, France

11 Nutrition Center, Clínica Las Condes, Santiago, Chile

12 Point Medical, Dijon, France

13 University of Pisa School of Medicine, and Metabolism Unit of the National Research Council (CNR) Institute of Clinical Physiology, Pisa, Italy

14 Department of Medical and Surgical Sciences, University of Padova, Padova, Italy

15 McGill University and Center for Innovative Medicine, McGill University Health Center/Royal Victoria Hospital, Montreal, Canada

16 Department of Medicine and Irving Institute for Clinical and Translational Research, Columbia University, New York, USA

17 Weill Cornell Medical College, Cornell University, New York, USA

18 Heart Institute, People Hospital of Peking University, Beijing, China

19 Department of Diabetes and Metabolic Diseases Unit, The University of Tokyo, Tokyo, Japan

20 Department of Systems Biology and Medicine, The University of Tokyo, Tokyo, Japan

21 Human Nutritional Research Center and Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Nantes, Nantes, France

22 Sumitomo Hospital and Osaka University, Osaka, Japan

23 University Hospital Gregorio Marañón, Universidad Complutense, Madrid, Spain

24 University of Concepción, Concepción, Chile

25 Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan

26 Brigham and Women’s Hospital and Harvard Medical School, Boston, USA

27 Division of Translational Medicine and Human Genetics, Smilow Center for Translational Research, Penn Cardiovascular Institute, Philadelphia, PA, USA

28 Jaslok Hospital and Research Center, Mumbai, India

29 Unidade Clínica de Lipides InCor-HCFMUSP, Sao Paulo, Brazil

30 Federal Almazov Heart Blood Endocrinology Centre, St Petersburg, Russia

31 Mahidol University, Bangkok, Thailand

32 University of the Philippines-Philippine General Hospital, Manila, The Philippines

33 Specialized Center of Research (SCOR) in Molecular Medicine and Atherosclerosis, Columbia University, College of Physicians & Surgeons, New York, USA

34 Gleneagles Medical Centre, Singapore

35 Hacettepe University, Ankara, Turkey

36 Sterling Rock Falls Clinic, CGH Medical Center, Sterling and University of Illinois School of Medicine, Peoria, IL, USA

37 Hôpital Jean Verdier, Department of Endocrinology Diabetology Nutrition, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France

38 University Hospital Würzburg, Würzburg, Germany

39 Zhongshan Hospital, Fudan University, Shanghai, China

40 Baker IDI Heart and Diabetes Institute, Melbourne, Australia

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Cardiovascular Diabetology 2014, 13:26  doi:10.1186/1475-2840-13-26

Published: 24 January 2014

Abstract

Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.

Keywords:
Residual cardiovascular risk; Atherogenic dyslipidaemia; Type 2 diabetes; Therapeutic options