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J Am Coll Cardiol. 2018 Jul 17;72(3):330-343. doi: 10.1016/j.jacc.2018.04.061. Epub 2018 Jun 20.

Unmet Need for Adjunctive Dyslipidemia Therapy in Hypertriglyceridemia Management.

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Clinical Research and Adult Diabetes Sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts. Electronic address:
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Cardiovascular Division, Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
VA New England Healthcare System, Boston University School of Medicine, Boston, Massachusetts.


Despite the important role of high-intensity statins in reducing atherosclerotic cardiovascular disease events in secondary and primary prevention, substantial residual risk persists, particularly among high-risk patients with type 2 diabetes mellitus, metabolic syndrome, and obesity. Considerable attention is currently directed to the role that elevated triglycerides (TGs) and non-high-density lipoprotein cholesterol levels play as important mediators of residual atherosclerotic cardiovascular disease risk, which is further strongly supported by genetic linkage studies. Previous trials with fibrates, niacin, and most cholesterol ester transfer protein inhibitors that targeted high-density lipoprotein cholesterol raising, and/or TG lowering, have failed to show conclusive evidence of incremental event reduction after low-density lipoprotein cholesterol levels were "optimally controlled" with statins. Although omega-3 fatty acids are efficacious in lowering TG levels and may have pleiotropic effects such as reducing plaque instability and proinflammatory mediators of atherogenesis, clinical outcomes data are currently lacking. Several ongoing randomized controlled trials of TG-lowering strategies with an optimal dosage of omega-3 fatty acids are nearing completion.


clinical trials; dyslipidemia and residual risk; hypertriglyceridemia; omega-3 fatty acids

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