SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

Chapman, MJ; Ginsberg, HN; Amarenco, P; Andreotti, F; Borén, J; Catapano, AL; Descamps, OS; Fisher, E; Kovanen, PT; Kuivenhoven, JA; et al. Chapman, MJ; Ginsberg, HN; Amarenco, P; Andreotti, F; Borén, J; Catapano, AL; Descamps, OS; Fisher, E; Kovanen, PT; Kuivenhoven, JA; Lesnik, P; Masana, L; Nordestgaard, BG; Ray, KK; Reiner, Z; Taskinen, MR; Tokgözoglu, L; Tybjærg-Hansen, A; Watts, GF; European Atherosclerosis Society Consensus Panel, (2011) Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. EUROPEAN HEART JOURNAL, 32 (11). 1345 - 1361. ISSN 0195-668X https://doi.org/10.1093/eurheartj/ehr112
SGUL Authors: Ray, Kausik Kumar

[img]
Preview
PDF Published Version
Available under License St George's repository terms & conditions.

Download (806kB) | Preview

Abstract

Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density lipoprotein cholesterol (HDL-C) as cardiovascular risk factors, and (ii) to advise on therapeutic strategies for management. Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic studies for TRL and remnants, together with the epidemiological data suggestive of the association for circulating triglycerides and cardiovascular disease. For HDL, epidemiological, mechanistic, and clinical intervention data are consistent with the view that low HDL-C contributes to elevated cardiovascular risk; genetic evidence is unclear however, potentially reflecting the complexity of HDL metabolism. The Panel believes that therapeutic targeting of elevated triglycerides (≥1.7 mmol/L or 150 mg/dL), a marker of TRL and their remnants, and/or low HDL-C (<1.0 mmol/L or 40 mg/dL) may provide further benefit. The first step should be lifestyle interventions together with consideration of compliance with pharmacotherapy and secondary causes of dyslipidaemia. If inadequately corrected, adding niacin or a fibrate, or intensifying LDL-C lowering therapy may be considered. Treatment decisions regarding statin combination therapy should take into account relevant safety concerns, i.e. the risk of elevation of blood glucose, uric acid or liver enzymes with niacin, and myopathy, increased serum creatinine and cholelithiasis with fibrates. These recommendations will facilitate reduction in the substantial cardiovascular risk that persists in patients with cardiometabolic abnormalities at LDL-C goal.

Item Type: Article
Additional Information: Published on behalf of the European Society of Cardiology. All rights reserved. Copyright: The Author 2011 The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed.
Keywords: Cardiovascular Diseases, Cholesterol, HDL, Clinical Trials as Topic, Dyslipidemias, Fatty Acids, Omega-3, Fibric Acids, Forecasting, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypolipidemic Agents, Life Style, Lipid Metabolism, Lipoproteins, Niacin, Risk Factors, Triglycerides, Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, CARDIAC & CARDIOVASCULAR SYSTEMS, TYPE-2 DIABETES-MELLITUS, CORONARY-HEART-DISEASE, RANDOMIZED CONTROLLED-TRIAL, EXTENDED-RELEASE NIACIN, ESTER TRANSFER PROTEIN, APOLIPOPROTEIN-A-I, INTIMA-MEDIA THICKNESS, HEALED MYOCARDIAL-INFARCTION, HUMAN ATHEROSCLEROTIC PLAQUE, LIFE-STYLE INTERVENTION, High-density lipoprotein cholesterol, Triglycerides, Triglyceride-rich lipoproteins, Remnants, Cholesterol, Atherogenic dyslipidaemia, Cardiovascular disease, Atherosclerosis, Guidelines, Cardiovascular System & Hematology, 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: EUROPEAN HEART JOURNAL
ISSN: 0195-668X
Related URLs:
Dates:
DateEvent
1 June 2011Published
Web of Science ID: WOS:000295678800015
URI: http://openaccess.sgul.ac.uk/id/eprint/107138
Publisher's version: https://doi.org/10.1093/eurheartj/ehr112

Actions (login required)

Edit Item Edit Item