Atherogenic dyslipidemia – a new target in cardiovascular prevention


Authors: Ľubomíra Fábryová
Authors‘ workplace: Metabol KLINIK s. r. o., Ambulancia pre diabetológiu, poruchy látkovej premeny a výživy, Bratislava
Published in: AtheroRev 2016; 1(3): 126-137
Category: Reviews

Overview

Despite the huge success achieved through statin therapy in reducing LDL-C (primary endpoint) together with the reduction of cardio-cerebrovascular morbidity and mortality still remains high cardiovascular risk. This reflects the rise in obesity, increased metabolic syndrome and type 2 diabetes, which is characterized by high prevalence of atherogenic dyslipidemia. Atherogenic dyslipidemia is characterized by a cluster of quantitative and qualitative changes in the meta­bolism of lipids and lipoproteins, leading to increased aterogenicity of plasma: increased concentration of the triglycerides and apo C-III-rich VLDL particles, the quality modified small dense LDL particles, quantitative and qualitative changes in HDL-C particles with loss of cardioprotectivity, increased concentration of remnant lipoprotein particles and the presence of postprandial hyperlipidemia. Targeting the atherogenic dyslipidemia complex is a next extension of the therapeutic targets. From the existing lipid-lowering agents, we should review the effect of fibrates in combination therapy in patients with atherogenic dyslipidemia. Near future are selective PPARα modulators, a little further ahead is therapy directly targeting the metabolism of triglyceride-rich lipoproteins. These options represent a new opportunity to reduce cardiovascular risk by influencing the complex atherogenic dyslipidemia (fig, tab. 3) [68].

Key words:
atherogenic dyslipidaemia – residual cardiovascular risk – indicators of plasma atherogenicity – statins – fibrates – selective PPARα modulators – CETP inhibitors – niacin – PCSK9 inhibitors – omega 3 fatty acids – apo C-III inhibitors


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