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The Residual Risk Reduction Initiative: a call to action to residual vascular risk in dyslipidaemic patients

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Fruchart, Jean-Charles Hermans, Michel [UCL] Sacks, Frank M. Assmann, Gerd Brown, W. Virgil Zimmet, Paul

Despite current standards of care aimed at achieving targets for low-density lipoprotein (LDL) cholesterol, blood pressure and glycaemia, dyslipidaemic patients remain at high residual risk of vascular events. Atherogenic dyslipidaemia, specifically elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, often with elevated apolipoprotein B and non-HDL cholesterol, is common in patients with established cardiovascular disease, type 2 diabetes, obesity or metabolic syndrome and is associated with macrovascular and microvascular residual risk. The Residual Risk Reduction Initiative (R(3)i) was established to address this important issue. This position paper aims to highlight evidence that atherogenic dyslipidaemia contributes to residual macrovascular risk and microvascular complications despite current standards of care for dyslipidaemia and diabetes, and to recommend therapeutic intervention for reducing this, supported by evidence and expert consensus. Lifestyle modification is an important first step. Additionally, pharmacotherapy is often required. Adding niacin, a fibrate or omega-3 fatty acids to statin therapy improves achievement of all lipid risk factors. Outcomes studies are evaluating whether these strategies translate to greater clinical benefit than statin therapy alone. In conclusion, the R3i highlights the need to address with lifestyle and/or pharmacotherapy the high level of residual vascular risk among dyslipidaemic patients who are treated in accordance with current standards of care.

Document type Article de périodique (Journal article) – Journal Article, Research Support, Non-U.S. Gov't, Review
Publication date 2008
Language Anglais
Journal information "Diabetes and Vascular Disease Research" - Vol. 5, no. 4, p. 319-35 (2008)
Peer reviewed yes
Publisher Sherborne Gibbs Ltd (Edgbaston)
issn 1479-1641
e-issn 1752-8984
Publication status Publié
Affiliations UCL - Cliniques universitaires Saint-Luc
UCL - MD/MINT - Département de médecine interne
MESH Subject Treatment Outcome ; Risk Reduction Behavior ; Practice Guidelines as Topic ; Microcirculation ; Hypolipidemic Agents - therapeutic use ; Humans ; Health Promotion ; Health Knowledge, Attitudes, Practice ; Evidence-Based Medicine ; Dyslipidemias - complications - physiopathology - therapy ; Combined Modality Therapy ; Cardiovascular Diseases - etiology - physiopathology - prevention & control ; Atherosclerosis - etiology - physiopathology - therapy
Keywords lifestyle ; macrovascular ; microvascular ; pharmacotherapy ; residual risk
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Permanent URL http://hdl.handle.net/2078.1/35943