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Eur Heart J Suppl. 2016 Apr 12;18(Suppl C):C2-C12. doi: 10.1093/eurheartj/suw009.

Current practice in identifying and treating cardiovascular risk, with a focus on residual risk associated with atherogenic dyslipidaemia.

Author information

1
Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy.
2
Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Carnaxide, Portugal.
3
Cardiology Department, Policlínica Gipuzkoa, San Sebastián, Spain.
4
Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Parma and Azienda Ospedaliera Universitaria of Parma, Parma, Italy.
5
Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
6
Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece.
7
Lipid Clinic, Point Médical, Dijon, France.
8
Cardiovascular Preventive Department, Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France.
9
Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
10
Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
11
Department of Cardiology, Ege University Medical School, İzmir, Turkey.
12
Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal.
13
Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.
14
Internal Medicine Service, Hospital General Universitario Gregorio Marañón, Facultad de Medicina de la Universidad Complutense, Madrid, Spain.
15
Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.
16
Hacettepe University, Ankara, Turkey.
17
Department of Endocrinology Diabetology Nutrition, Jean Verdier Hospital, APHP, Paris Nord University, CRNH-IdF, CINFO, Bondy, France.
18
Institute of Cardiovascular Medicine, North Estonia Medical Centre, Tallinn University of Technology, Tallinn, Estonia.
19
Third Department of Internal Medicine, First Medical Faculty, Charles University, Prague, Czech Republic.
20
Clinica Medica, Department of Medicine, University of Padova, Padova, Italy.
21
Head of Cardiology, University Alcala de Henares, Hospital Ramón y Cajal, Madrid, Spain.
22
Department of Pharmacological and Biomolecular Sciences, University of Milan, IRCCS Multimedica, Milan, Italy.

Abstract

A panel of European experts on lipids and cardiovascular disease discussed clinical approaches to managing cardiovascular risk in clinical practice, including residual cardiovascular risk associated with lipid abnormalities, such as atherogenic dyslipidaemia (AD). A simplified definition of AD was proposed to enhance understanding of this condition, its prevalence, and its impact on cardiovascular risk. Atherogenic dyslipidaemia can be defined by high fasting triglyceride levels (≥2.3 mmol/L) and low high-density lipoprotein cholesterol (HDL-c) levels (≤1.0 and ≤1.3 mmol/L in men and women, respectively) in statin-treated patients at high cardiovascular risk. The use of a single marker for the diagnosis and treatment of AD, such as non-HDL-c, was advocated. Interventions including lifestyle optimization and low-density lipoprotein (LDL)-lowering therapy with statins (±ezetimibe) are implemented by all experts. Treatment of residual AD can be performed with the addition of fenofibrate, since it can improve the complete lipoprotein profile and reduce the risk of cardiovascular events in patients with AD. Specific clinical scenarios in which fenofibrate may be prescribed are discussed, and include patients with very high triglycerides (≥5.6 mmol/L), patients who are intolerant or resistant to statins, and patients with AD and at high cardiovascular risk. The fenofibrate-statin combination was considered by the experts to benefit from a favourable benefit-risk profile. Cardiovascular experts adopt a multifaceted approach to the prevention of atherosclerotic cardiovascular disease, with lifestyle optimization, LDL-lowering therapy, and treatment of AD with fenofibrate routinely used to help reduce a patient's overall cardiovascular risk.

KEYWORDS:

Atherogenic dyslipidaemia; Cardiovascular risk; Fenofibrate; Fenofibrate–statin combination therapy; Residual cardiovascular risk; Statin

PMID:
28533705
DOI:
10.1093/eurheartj/suw009

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