Relationship between Atherogenic Dyslipidemia and Target Lesion Revascularization Post Everolimus-Eluting Stent Implantation

Hypercholesterolemia, an increase in the lowdensity lipoprotein cholesterol (LDL-C) level, is one of the most important causal risk factors for cardiovascular (CV) diseases.At present, lowering the LDL-C level is considered to be the most effective strategy for preventing CV events; thus, we are using statins, ezetimibe, and PCSK9 inhibitors to achieve further reduction in this level.In the recent guidelines of the Japan Atherosclerosis Society (JAS), an optimal LDL-C goal for secondary prevention is 70 mg/dL in patients with acute coronary syndrome, familial hypercholesterolemia, diabetes, and both coronary artery disease (CAD) and atherothrombotic strokes 1) .However, not all patients, with 70 mg/dL LDL-C level, treated with statins are preventable to CV events.Fasting and non-fasting triglyceride (TG) levels are associated with CV events among the Japanese 1) .Recently, non-fasting measurement of TG levels was recommended for CV risk assessment by the European Atherosclerosis Society and JAS 1) .High TG levels are affected by the accumulation of TG-rich lipoproteins and their remnant lipoproteins; remnant lipoproteins' accumulation enhanced atherogenicity in patients with hypertriglyceridemia 2) .In this issue of the journal, Kimura et al. retrospectively evaluate the relationship between atherogenic dyslipidemia (AD) and target lesion revascularization (TLR) in 3,014 lesions from 2,022 consecutive patients who underwent everolimuseluting stent (EES) implantation 3) .The authors defined AD as a combination of non-fasting TG 175 mg/dL and high-density lipoprotein cholesterol (HDL-C) 40 mg/dL based on the new JAS guidelines.They found important evidence; AD was associated with a significantly increased incidence of