Achieving Optimal Lipid Goals in Patients With Coronary Artery Disease

Karalis, Dean G.; Subramanya, Raghunandan Dudda; Hessen, Scott E.; Liu, Longjian; Victor, Mark F.

doi:10.1016/j.amjcard.2010.11.006

Cited by 42 publications

(26 citation statements)

References 18 publications

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“…The authors concluded that clinicians should consider more intense lipidlowering therapy with combination lipid-lowering drugs in patients with the metabolic syndrome to better target their lipid goals and further reduce CV risk. These findings are not a surprise and are consistent with other studies that have shown that most high-risk patients do not achieve their optimal LDL and non-HDL cholesterol goals in clinical practice [16,17]. The strengths of this study are the large patient number and that the analysis was performed not just by the Chinese guidelines, but also by the American NCEP ATP III guidelines.…”

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confidence: 89%

Achieving optimal lipid goals in the metabolic syndrome: A global health problem

Karalis

2014

Atherosclerosis

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The metabolic syndrome is defined by a constellation of cardiometabolic risk factors that include abdominal obesity, elevated blood sugar, high blood pressure, low high-density lipoprotein (HDL) cholesterol and elevated triglycerides. The metabolic syndrome is diagnosed when 3 of these 5 risk factors are present [1]. Underlying these metabolic risk factors is adipose tissue dysfunction and insulin resistance which leads to an increase in circulating free fatty acids (FFA). Increased FFA delivery to the liver increases hepatic secretion and triglyceride enrichment of very-low density lipoprotein (VLDL) cholesterol. Incomplete lipolysis of VLDL particles leads to an accumulation of triglyceride-rich remnant lipoproteins and triglyceride enrichment of HDL cholesterol via cholesteryl ester transfer protein (CETP) results in smaller HDL particles and low levels of HDL cholesterol [2]. Although lowdensity lipoprotein (LDL) cholesterol is not specifically part of the metabolic syndrome, individuals with the metabolic syndrome have a high concentration of small dense LDL cholesterol particles. The atherogenic dyslipidemia associated with the metabolic syndrome is an important risk factor for atherosclerosis and cardiovascular (CV) disease. The presence of the metabolic syndrome is associated with a 2-fold increased risk of CV disease and a 5-fold increased risk of diabetes [3].The prevalence of the metabolic syndrome worldwide is on the rise. This is due to an increase in the rates of obesity in both adults and children, especially in developing countries [4]. Most deaths related to the metabolic syndrome are attributable to CV disease and this is mediated in large part by the hypertension and dyslipidemia associated with the metabolic syndrome. First-line management of the metabolic syndrome is lifestyle intervention; however when lifestyle changes alone are unsuccessful, pharmacologic therapy to target the high blood pressure and dyslipidemia associated with the metabolic syndrome is recommended. Statins are the drug of choice to target the dyslipidemia associated with the metabolic syndrome and are effective in lowering not only LDL cholesterol, but also lower triglyceride-rich remnant lipoproteins and have favorable effects on the size and concentration of LDL cholesterol particles [5]. Post-hoc analyses from several clinical outcome studies have shown that statin therapy reduces major CV event in patients with the metabolic syndrome [6,7] and subgroup analyses from other clinical trials suggest that fibrates, niacin and omega-3 fatty acids may further reduce CV risk in statin treated patients with high triglycerides and low HDL cholesterol [8e10]. Although the new ACC/AHA cholesterol lowering guidelines [11] do not specifically address the metabolic syndrome nor set cholesterol goals for treatment, most individuals who have the metabolic syndrome will have a high CV risk score or other indications that would warrant statin therapy. The National Lipid Association [12] and several international societies [13,14] also ...

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confidence: 89%

Achieving optimal lipid goals in the metabolic syndrome: A global health problem

Karalis

2014

Atherosclerosis

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“…Given the high risk population involved, it is 168 noteworthy that 87 % of patients with proven CHD were on 169 lipid-lowering therapy and over 80 % had achieved LDLc 170 levels \3.00 mmol/L with 54 % achieving LDLc levels 171 below 2.50 mmol/l. These findings are not as good as pre-172 vious studies where 73 and 79 % of patients achieved target 173 LDLc levels (\ 2.50 mmol/L) [8,9]. However it must be 174 noted that patient data recorded for the present study was 175 based on older LDLc guidelines (\ 3.00 mmol/L).…”

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confidence: 50%

Lipid targets in clinical practice: successes, failures and lessons to be learned

et al. 2013

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“…(24,25) Although the guidelines recommend a goal of LDL-C < 70 mg/dL for patients with EAD, LDL-C goal attainment rates remain low worldwide and have been reported to be in the range of 17%-35%. (3)(4)(5)(26)(27)(28)(29) Some studies (3,8,26) that were conducted when the recommended guideline was based on the 2004 updated National Cholesterol Education Program III (30) have suggested setting LDL-C goals of 100 mg/dL before considering the use of a non-statin drug, such as ezetimibe. Similar to these other studies, (3,8,26) our patients with EAD had a high undertreatment rate in terms of LDL-C reduction even though most patients received statins.…”

Section: Discussionmentioning

confidence: 99%

Management of atherosclerosis risk factors for patients at high cardiovascular risk in real-world practice: a multicentre study

Phrommintikul

Krittayaphong

Wongcharoen

et al. 2017

smedj

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Achieving Optimal Lipid Goals in Patients With Coronary Artery Disease

Cited by 42 publications

References 18 publications

Achieving optimal lipid goals in the metabolic syndrome: A global health problem

Achieving optimal lipid goals in the metabolic syndrome: A global health problem

Lipid targets in clinical practice: successes, failures and lessons to be learned

Management of atherosclerosis risk factors for patients at high cardiovascular risk in real-world practice: a multicentre study

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