Current Atherosclerosis Reports

, Volume 14, Issue 1, pp 1–10

Residual Cardiovascular Risk Despite Optimal LDL Cholesterol Reduction with Statins: The Evidence, Etiology, and Therapeutic Challenges

  • Uchechukwu K. Sampson
  • Sergio Fazio
  • MacRae F. Linton
Statin Drugs (M Clearfield, Section Editor)

DOI: 10.1007/s11883-011-0219-7

Cite this article as:
Sampson, U.K., Fazio, S. & Linton, M.F. Curr Atheroscler Rep (2012) 14: 1. doi:10.1007/s11883-011-0219-7

Abstract

This review captures the existence, cause, and treatment challenges of residual cardiovascular risk (CVR) after aggressive low-density lipoprotein cholesterol (LDL-C) reduction. Scientific evidence implicates low high-density lipoprotein cholesterol (HDL-C) and high triglycerides (TG) in the CVR observed after LDL-C lowering. However, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial with fenofibrate, the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) study with torcetrapib, and the recently terminated Atherothrombosis Intervention in Metabolic Syndrome with Low HDL Cholesterol/High Triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study with niacin, do not clearly attribute risk reduction value to HDL-C/TG modulation. The optimum approach to long-term lipid-modifying therapies for CVR reduction remains uncertain. Consequently, absolute risk modulation via lifestyle changes remains the centerpiece of a strategy addressing the physiologic drivers of CVR associated with HDL-C/TG, especially in the context of diabetes/metabolic syndrome.

Keywords

Statins LDL cholesterol CV risk reduction Residual CV risk 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Uchechukwu K. Sampson
    • 1
    • 2
    • 3
  • Sergio Fazio
    • 1
    • 2
  • MacRae F. Linton
    • 1
    • 4
  1. 1.Department of MedicineVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of PathologyVanderbilt University Medical CenterNashvilleUSA
  3. 3.Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of PharmacologyVanderbilt University Medical CenterNashvilleUSA

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