June 20, 2018Journal of the American College of Cardiology195 citationsOpen Access
View Full PaperUnmet Need for Adjunctive Dyslipidemia Therapy in Hypertriglyceridemia Management
Structured PICO
Does adjunctive triglyceride-lowering therapy reduce residual atherosclerotic cardiovascular disease risk in high-risk patients optimally treated with statins?
P
Population
High-risk patients with type 2 diabetes mellitus, metabolic syndrome, and obesity with elevated triglycerides and residual atherosclerotic cardiovascular disease risk despite statin therapy
I
Intervention
Adjunctive dyslipidemia therapy (fibrates, niacin, CETP inhibitors, omega-3 fatty acids)
C
Comparator
Statin therapy alone (optimal control of LDL-C)
O
Outcome
Atherosclerotic cardiovascular disease events
There remains an unmet need for adjunctive therapies targeting hypertriglyceridemia to reduce residual cardiovascular risk in statin-treated patients, with ongoing trials of omega-3 fatty acids expected to provide further evidence.
Abstract
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.