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Reducing residual vascular risk in patients with atherogenic dyslipidemia: Where do we go from here?

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Hermans, Michel [UCL] Fruchart, Jean Charles

Residual vascular risk (RvR) represents risk of incident vascular events or progression of established vascular damage persisting on current standards of care. RvR is best captured by cardiovascular risk calculators or the presence of a metabolic syndrome. A substantial proportion of RvR can be reduced by addressing modifiable risk factors, including atherogenic dyslipidemia (AD). The hallmarks of AD are raised triglycerides and decreased levels of HDL-C, driven by VLDL overproduction from insulin resistance/hyperinsulinemia. AD can be targeted by lifestyle intervention, fibrates or nicotinic acid. AD contributes to RvR of micro- and macro-vascular disease in Type 2 diabetes mellitus, even when LDL-C is controlled. The ACCORD Lipid trial demonstrated that macrovascular RvR, high in Type 2 diabetes mellitus, was decreased after the addition of fenofibrate in patients with AD. Fenofibrate also decreased the RvR of retinopathy, irrespective of baseline non-LDL lipids. Ongoing trials will establish whether targeting low HDL-C with niacin reduces RvR in high-risk patients. © 2010 Future Medicine Ltd.

Document type Article de périodique (Journal article)
Publication date 2010
Language Anglais
Journal information "Clinical Lipidology" - Vol. 5, no.6, p. 811-826 (2010)
Peer reviewed yes
Publisher Future Medicine Ltd. ((United Kingdom) London)
issn 1758-4299
e-issn 1758-4302
Publication status Publié
Affiliations UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
UCL - (SLuc) Service d'endocrinologie et de nutrition
Keywords ApoB ; VLDL ; Apolipoprotein A1 ; Apolipoprotein B100 ; Ezetimibe ; Fenofibrate ; Fibric acid derivative ; High density lipoprotein cholesterol ; Hydroxymethylglutaryl coenzyme A reductase inhibitor ; Insulin ; Laropiprant plus nicotinic acid ; Cardiovascular ; Low density lipoprotein cholesterol ; Nicotinic acid ; Simvastatin ; Triacylglycerol ; Very low density lipoprotein cholesterol ; Atherosclerosis ; Cardiovascular risk ; Diabetic angiopathy ; Diabetic microangiopathy ; Diabetic nephropathy ; Diabetes ; Diabetic retinopathy ; Diet therapy ; Disease severity ; Dyslipidemia ; Exercise ; High risk patient ; Human ; Hypercholesterolemia ; Hyperinsulinemia ; Hypertriglyceridemia ; HDL-C ; Insulin resistance ; Lifestyle modification ; Metabolic syndrome X ; Non insulin dependent diabetes mellitus ; Priority journal ; Randomized controlled trial (topic) ; Review ; Risk reduction ; Insulin resistance ; Metabolic syndrome ; Microangiopathy ; Residual risk ; Triglyceride
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Bibliographic reference Hermans, Michel ; Fruchart, Jean Charles. Reducing residual vascular risk in patients with atherogenic dyslipidemia: Where do we go from here? . In: Clinical Lipidology, Vol. 5, no.6, p. 811-826 (2010)
Permanent URL http://hdl.handle.net/2078.1/132173