‘Trig-onometry’: non-high-density lipoprotein cholesterol as a therapeutic target in dyslipidaemia
| Autor: | T. A. Jacobson |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Very low-density lipoprotein Statin business.industry medicine.drug_class Cholesterol nutritional and metabolic diseases General Medicine Fibrate Gastroenterology chemistry.chemical_compound Endocrinology Ezetimibe chemistry Internal medicine Medicine lipids (amino acids peptides and proteins) Risk factor business Niacin medicine.drug Lipoprotein |
| Zdroj: | International Journal of Clinical Practice. 65:82-101 |
| ISSN: | 1368-5031 |
| DOI: | 10.1111/j.1742-1241.2010.02547.x |
| Popis: | Targeting elevations in low-density lipoprotein cholesterol (LDL-C) remains the cornerstone of cardiovascular prevention. However, this fraction does not adequately capture elevated triglyceride-rich lipoproteins (TRLs; e.g. intermediate-density lipoprotein, very low density lipoprotein) in certain patients with metabolic syndrome or diabetic dyslipidaemia. Many such individuals have residual cardiovascular risk that might be lipid/lipoprotein related despite therapy with first-line agents (statins). Epidemiological evidence encompassing > 100,000 persons supports the contention that non-high-density lipoprotein cholesterol (non-HDL-C) is a superior risk factor vs. LDL-C for incident coronary heart disease (CHD) in certain patient populations. In studies with clinical end-points evaluated in the current article, a 1:1 to 1:3 relationship was observed between reductions in non-HDL-C and in the relative risk of CHD after long-term treatment with statins, niacin (nicotinic acid) and fibric-acid derivatives (fibrates); this relationship increased to 1:5 to 1:10 in smaller subgroups of patients with elevated triglycerides and low HDL-C levels. Treatment with statin-, niacin-, fibrate-, ezetimibe-, and omega 3 fatty acid-containing regimens reduced non-HDL-C by approximately 9-65%. In a range of clinical trials, long-term treatment with these agents also significantly decreased the incidence of clinical/angiographic/imaging efficacy outcome variables. For patients with dyslipidaemia, consensus guidelines have established non-HDL-C treatment targets 30 mg/dl higher than LDL-C goals. Ongoing prospective randomised controlled trials should help to resolve controversies concerning (i) the clinical utility of targeting non-HDL-C in patients with dyslipidaemia; (ii) the most efficacious and well-tolerated therapies to reduce non-HDL-C (e.g. combination regimens); and (iii) associations between such reductions and clinical, angiographic, and/or imaging end-points. |
| Databáze: | OpenAIRE |
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