Residual macrovascular risk in 2013: what have we learned?

被引:129
作者
Fruchart, Jean-Charles [1 ,2 ]
Davignon, Jean [3 ,4 ]
Hermans, Michel P. [5 ]
Al-Rubeaan, Khalid [6 ]
Amarenco, Pierre [7 ,8 ]
Assmann, Gerd [9 ]
Barter, Philip [10 ]
Betteridge, John [11 ]
Bruckert, Eric [12 ]
Cuevas, Ada [13 ]
Farnier, Michel [14 ]
Ferrannini, Ele [15 ,16 ]
Fioretto, Paola [17 ]
Genest, Jacques [18 ,19 ]
Ginsberg, Henry N. [20 ,21 ]
Gotto, Antonio M., Jr. [22 ]
Hu, Dayi [23 ]
Kadowaki, Takashi [24 ,25 ]
Kodama, Tatsuhiko [26 ]
Krempf, Michel [27 ,28 ]
Matsuzawa, Yuji [29 ,30 ]
Nunez-Cortes, Jesus Millan [31 ]
Monfil, Carlos Calvo [32 ]
Ogawa, Hisao [33 ]
Plutzky, Jorge [34 ,35 ]
Rader, Daniel J. [36 ]
Sadikot, Shaukat [37 ,38 ]
Santos, Raul D. [39 ]
Shlyakhto, Evgeny [40 ]
Sritara, Piyamitr [41 ]
Sy, Rody [42 ]
Tall, Alan [43 ]
Tan, Chee Eng [44 ]
Tokgozoglu, Lale [45 ]
Toth, Peter P. [46 ,47 ]
Valensi, Paul [48 ]
Wanner, Christoph [49 ]
Zambon, Alberto [17 ]
Zhu, Junren [50 ]
Zimmet, Paul [51 ]
机构
[1] R3i Fdn, CH-4010 Basel, Switzerland
[2] Fondat Coeur & Arteres, Lille, France
[3] Univ Montreal, Ctr Hosp, Inst Rech Clin Montreal, Montreal, PQ, Canada
[4] McGill Univ, Dept Expt Med, Montreal, PQ, Canada
[5] Clin Univ St Luc, B-1200 Brussels, Belgium
[6] King Saud Univ, Univ Diabet Ctr, Riyadh, Saudi Arabia
[7] Hop Xavier Bichat, Dept Neurol, Paris, France
[8] Hop Xavier Bichat, Stroke Ctr, Paris, France
[9] Assmann Stiftung Prevent, Munster, Germany
[10] Univ New S Wales, Ctr Vasc Res, Sydney, NSW, Australia
[11] UCL, London, England
[12] Hop La Pitie Salpetriere, Inst CardioMetab & Nutr ICAN, Dept Endocrinol & Cardiovasc Dis Prev, Paris, France
[13] Clin Las Condes, Ctr Nutr, Santiago, Chile
[14] Point Med, Dijon, France
[15] Univ Pisa, Sch Med, I-56100 Pisa, Italy
[16] Natl Res Council CNR, Inst Clin Physiol, Metab Unit, Pisa, Italy
[17] Univ Padua, Dept Med & Surg Sci, Padua, Italy
[18] McGill Univ, Montreal, PQ, Canada
[19] McGill Univ, Royal Victoria Hosp, Ctr Hlth, Ctr Innovat Med, Montreal, PQ H3A 1A1, Canada
[20] Columbia Univ, Dept Med, New York, NY USA
[21] Columbia Univ, Irving Inst Clin & Translat Res, New York, NY USA
[22] Cornell Univ, Weill Cornell Med Coll, New York, NY 10021 USA
[23] Peking Univ, People Hosp, Inst Heart, Beijing 100871, Peoples R China
[24] Univ Tokyo, Dept Diabet, Tokyo, Japan
[25] Univ Tokyo, Metab Dis Unit, Tokyo, Japan
[26] Univ Tokyo, Dept Syst Biol & Med, Tokyo, Japan
[27] Univ Hosp Nantes, Human Nutrit Res Ctr, Nantes, France
[28] Univ Hosp Nantes, Dept Endocrinol Metab Dis & Nutr, Nantes, France
[29] Sumitomo Hosp, Osaka, Japan
[30] Osaka Univ, Osaka, Japan
[31] Univ Complutense, Univ Hosp Gregorio Maranon, E-28040 Madrid, Spain
[32] Univ Concepcion, Concepcion, Chile
[33] Kumamoto Univ, Dept Cardiovasc Med, Kumamoto, Japan
[34] Brigham & Womens Hosp, Boston, MA 02115 USA
[35] Harvard Univ, Sch Med, Boston, MA 02115 USA
[36] Penn Cardiovasc Inst, Smilow Ctr Translat Res, Div Translat Med & Human Genet, Philadelphia, PA USA
[37] Jaslok Hosp, Mumbai, Maharashtra, India
[38] Res Ctr, Mumbai, Maharashtra, India
[39] Lipides InCor HCFMUSP, Unidade Clin, Sao Paulo, Brazil
[40] Federal Almazov Heart Blood Endocrinol Ctr, St Petersburg, Russia
[41] Mahidol Univ, Bangkok 10700, Thailand
[42] Univ Philippines, Philippine Gen Hosp, Manila, Philippines
[43] Columbia Univ Coll Phys & Surg, Specialized Ctr Res SCOR Mol Med & Atheroscl, New York, NY 10032 USA
[44] Gleneagles Med Ctr, Singapore, Singapore
[45] Hacettepe Univ, Ankara, Turkey
[46] Univ Illinois, Sterling Rock Falls Clin, CGH Med Ctr, Sterling, IL USA
[47] Univ Illinois, Sch Med, Peoria, IL USA
[48] Univ Paris Nord, AP HP, Dept Endocrinol Diabetol Nutr,CINI O, Hop Jean Verdier,CRNH IdF, Bondy, France
[49] Univ Hosp Wurzburg, Wurzburg, Germany
[50] Fudan Univ, Zhongshan Hosp, Shanghai 200433, Peoples R China
关键词
Residual cardiovascular risk; Atherogenic dyslipidaemia; Type; 2; diabetes; Therapeutic options; HIGH-DENSITY-LIPOPROTEIN; CORONARY-ARTERY-DISEASE; TRIGLYCERIDE-RICH LIPOPROTEINS; COMBINATION LIPID THERAPY; TYPE-2; DIABETES-MELLITUS; TERM FENOFIBRATE THERAPY; PHOSPHOLIPID FATTY-ACIDS; STATIN-TREATED PATIENTS; SUBTILISIN/KEXIN TYPE 9; CHRONIC KIDNEY-DISEASE;
D O I
10.1186/1475-2840-13-26
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R(3)i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R(3)i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R(3)i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptor alpha agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R(3)i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.
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页数:17
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