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The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in dyslipidaemic patientsInserm UR 545; Université Lille2; Lille, France.
Nutrition Department, Harvard School of Public Health, Department of Medicine, Harvard Medical School, and Cardiovascular Division and Channing Laboratory, Brigham and Women's Hospital, Boston, MA, US.
Cliniques Universitaires St-Luc, Service d'Endocrinologie et Nutrition, Brussels, Belgium.
Assmann-Stiftung für Prävention, Münster, Germany.
Emory University School of Medicine and Veterans Affairs Medical Center, Decatur, GA, US.
Center of Preventive Cardiology, University General Hospital, Prague, Czech Republic.
Dyslipidemia and Atherosclerosis Research Unit, INSERM (U. 551), Hôpital de la Pitié, Paris, France.
Medical Ophthalmology, and Diabetes, Heart of England Foundation Trust, Birmingham, UK.
Department of Medical and Surgical Sciences, University of Padova, Padova, Italy.
Department of Medicine and Irving Institute for Clinical and Translational Research, Columbia University, New York, US.
Department of Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Service de Cardiologie B et Hémodynamique, Hôpital Cardiologique, Lille, France.
Department of Internal Medicine II, University of Ulm, Ulm, Germany.
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, US.
University Hospital Center Zagreb, Zagreb, Croatia.
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, US.
U.545 Inserm; Institut Pasteur de Lille Université Lille2; Lille, France.
London, UK.
Lipid Research Unit, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
Department of Medicine, Division of Nephrology, University Hospital Würzburg, Würzburg, Germany.
Department of Medical and Surgical Sciences, University of Padova, Padova, Italy.
International Diabetes Institute, Caulfield, Victoria, Australia. 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 (R3I) 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.
Key Words: lifestyle • macrovascular • microvascular • pharmacotherapy • residual risk
Diabetes and Vascular Disease Research, Vol. 5, No. 4,
319-335 (2008) |
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