Effective Lipid-lowering Therapy in High-risk Patients

REVIEW, December 2010, VOL I ISSUE III, ISSN 2042-4884
10.5083/ejcm.20424884.211 , Cite or Link Using DOI
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Benoit J Arsenault, PhD, John J.P. Kastelein, MD, PhD and Jean-Claude Tardif, MD

ABSTRACT

Cardiovascular disease (CVD) is the primary cause of mortality in developed and developing societies. Identifying patients at high CVD risk is important but challenging. Measurement of classical risk factors is crucial for this assessment. Also, next to traditional factors such as lipids or lipoprotein levels, apolipoproteins or Lp(a) plasma levels may be important for such purposes. Moreover, the use of emerging biomarkers such as C-reactive protein is likely to gain importance in upcoming years in an attempt to better identify subgroups of patients that may be at increased cardiovascular risk. Our review will focus on novel tools that are, or will become available to identify patients at high CVD risk; and to discuss the potential usefulness of statins in these patients, with a particular focus on potent statin therapy.

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death in the world according to the World Health Organization. Each year, more deaths occur from CVD than from any other disease. Although low- and middle-income countries are proportionally more affected by CVD as a result of access to treatment, the risk factors for CVD are similar across gender, ethnicity and region of the world.

Most of these risk factors have been identified in the 1950s by the investigators of the Framingham Heart Study and include age, male gender, elevated blood pressure, smoking, blood lipid levels, poor diet and physical inactivity; the last two being the root causes of chronic conditions such as metabolic syndrome, systemic inflammation, insulin resistance and diabetes, which are also important risk factors for CVD. Over the past decade, numerous genetic variants have also been linked to the development of CVD and the role of genetics in CVD risk prevention and treatment is expected to receive more consideration in the future.