Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

M John Chapman; Henry N Ginsberg; Pierre Amarenco; Felicita Andreotti; Jan Borén; Alberico L Catapano; Olivier S Descamps; Edward Fisher; Petri T Kovanen; Jan Albert Kuivenhoven; Philippe Lesnik; Luis Masana; Børge G Nordestgaard; Kausik K Ray; Zeljko Reiner; Marja-Riitta Taskinen; Lale Tokgözoglu; Anne Tybjærg-Hansen; Gerald F Watts; European Atherosclerosis Society Consensus Panel

doi:http://dx.doi.org/10.1093/eurheartj/ehr112

Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

M John Chapman, Henry N Ginsberg, Pierre Amarenco, Felicita Andreotti, Jan Borén, Alberico L Catapano, Olivier S Descamps, Edward Fisher, Petri T Kovanen, Jan Albert Kuivenhoven, Philippe Lesnik, Luis Masana, Børge G Nordestgaard, Kausik K Ray, Zeljko Reiner, Marja-Riitta Taskinen, Lale Tokgözoglu, Anne Tybjærg-Hansen, Gerald F Watts, European Atherosclerosis Society Consensus Panel

803 Citations (Scopus)

Abstract

Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density lipoprotein cholesterol (HDL-C) as cardiovascular risk factors, and (ii) to advise on therapeutic strategies for management. Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic studies for TRL and remnants, together with the epidemiological data suggestive of the association for circulating triglycerides and cardiovascular disease. For HDL, epidemiological, mechanistic, and clinical intervention data are consistent with the view that low HDL-C contributes to elevated cardiovascular risk; genetic evidence is unclear however, potentially reflecting the complexity of HDL metabolism. The Panel believes that therapeutic targeting of elevated triglycerides (<1.7 mmol/L or 150 mg/dL), a marker of TRL and their remnants, and/or low HDL-C (<1.0 mmol/L or 40 mg/dL) may provide further benefit. The first step should be lifestyle interventions together with consideration of compliance with pharmacotherapy and secondary causes of dyslipidaemia. If inadequately corrected, adding niacin or a fibrate, or intensifying LDL-C lowering therapy may be considered. Treatment decisions regarding statin combination therapy should take into account relevant safety concerns, i.e. the risk of elevation of blood glucose, uric acid or liver enzymes with niacin, and myopathy, increased serum creatinine and cholelithiasis with fibrates. These recommendations will facilitate reduction in the substantial cardiovascular risk that persists in patients with cardiometabolic abnormalities at LDL-C goal.

Original language	English
Journal	European Heart Journal (English Edition)
Volume	32
Issue number	11
Pages (from-to)	1345-61
Number of pages	17
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehr112
Publication status	Published - Jun 2011

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Chapman, M. J., Ginsberg, H. N., Amarenco, P., Andreotti, F., Borén, J., Catapano, A. L., Descamps, O. S., Fisher, E., Kovanen, P. T., Kuivenhoven, J. A., Lesnik, P., Masana, L., Nordestgaard, B. G., Ray, K. K., Reiner, Z., Taskinen, M-R., Tokgözoglu, L., Tybjærg-Hansen, A., Watts, G. F., & European Atherosclerosis Society Consensus Panel (2011). Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. European Heart Journal (English Edition), 32(11), 1345-61. https://doi.org/10.1093/eurheartj/ehr112

Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. / Chapman, M John; Ginsberg, Henry N; Amarenco, Pierre et al.

In: European Heart Journal (English Edition), Vol. 32, No. 11, 06.2011, p. 1345-61.

Research output: Contribution to journal › Journal article › Research › peer-review

Chapman, MJ, Ginsberg, HN, Amarenco, P, Andreotti, F, Borén, J, Catapano, AL, Descamps, OS, Fisher, E, Kovanen, PT, Kuivenhoven, JA, Lesnik, P, Masana, L, Nordestgaard, BG, Ray, KK, Reiner, Z, Taskinen, M-R, Tokgözoglu, L, Tybjærg-Hansen, A, Watts, GF & European Atherosclerosis Society Consensus Panel 2011, 'Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management', European Heart Journal (English Edition), vol. 32, no. 11, pp. 1345-61. https://doi.org/10.1093/eurheartj/ehr112

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title = "Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management",

abstract = "Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density lipoprotein cholesterol (HDL-C) as cardiovascular risk factors, and (ii) to advise on therapeutic strategies for management. Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic studies for TRL and remnants, together with the epidemiological data suggestive of the association for circulating triglycerides and cardiovascular disease. For HDL, epidemiological, mechanistic, and clinical intervention data are consistent with the view that low HDL-C contributes to elevated cardiovascular risk; genetic evidence is unclear however, potentially reflecting the complexity of HDL metabolism. The Panel believes that therapeutic targeting of elevated triglycerides (<1.7 mmol/L or 150 mg/dL), a marker of TRL and their remnants, and/or low HDL-C (<1.0 mmol/L or 40 mg/dL) may provide further benefit. The first step should be lifestyle interventions together with consideration of compliance with pharmacotherapy and secondary causes of dyslipidaemia. If inadequately corrected, adding niacin or a fibrate, or intensifying LDL-C lowering therapy may be considered. Treatment decisions regarding statin combination therapy should take into account relevant safety concerns, i.e. the risk of elevation of blood glucose, uric acid or liver enzymes with niacin, and myopathy, increased serum creatinine and cholelithiasis with fibrates. These recommendations will facilitate reduction in the substantial cardiovascular risk that persists in patients with cardiometabolic abnormalities at LDL-C goal.",

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T1 - Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

AU - Chapman, M John

AU - Ginsberg, Henry N

AU - Amarenco, Pierre

AU - Andreotti, Felicita

AU - Borén, Jan

AU - Catapano, Alberico L

AU - Descamps, Olivier S

AU - Fisher, Edward

AU - Kovanen, Petri T

AU - Kuivenhoven, Jan Albert

AU - Lesnik, Philippe

AU - Masana, Luis

AU - Nordestgaard, Børge G

AU - Ray, Kausik K

AU - Reiner, Zeljko

AU - Taskinen, Marja-Riitta

AU - Tokgözoglu, Lale

AU - Tybjærg-Hansen, Anne

AU - Watts, Gerald F

AU - European Atherosclerosis Society Consensus Panel

PY - 2011/6

Y1 - 2011/6

N2 - Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density lipoprotein cholesterol (HDL-C) as cardiovascular risk factors, and (ii) to advise on therapeutic strategies for management. Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic studies for TRL and remnants, together with the epidemiological data suggestive of the association for circulating triglycerides and cardiovascular disease. For HDL, epidemiological, mechanistic, and clinical intervention data are consistent with the view that low HDL-C contributes to elevated cardiovascular risk; genetic evidence is unclear however, potentially reflecting the complexity of HDL metabolism. The Panel believes that therapeutic targeting of elevated triglycerides (<1.7 mmol/L or 150 mg/dL), a marker of TRL and their remnants, and/or low HDL-C (<1.0 mmol/L or 40 mg/dL) may provide further benefit. The first step should be lifestyle interventions together with consideration of compliance with pharmacotherapy and secondary causes of dyslipidaemia. If inadequately corrected, adding niacin or a fibrate, or intensifying LDL-C lowering therapy may be considered. Treatment decisions regarding statin combination therapy should take into account relevant safety concerns, i.e. the risk of elevation of blood glucose, uric acid or liver enzymes with niacin, and myopathy, increased serum creatinine and cholelithiasis with fibrates. These recommendations will facilitate reduction in the substantial cardiovascular risk that persists in patients with cardiometabolic abnormalities at LDL-C goal.

AB - Even at low-density lipoprotein cholesterol (LDL-C) goal, patients with cardiometabolic abnormalities remain at high risk of cardiovascular events. This paper aims (i) to critically appraise evidence for elevated levels of triglyceride-rich lipoproteins (TRLs) and low levels of high-density lipoprotein cholesterol (HDL-C) as cardiovascular risk factors, and (ii) to advise on therapeutic strategies for management. Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk. This interpretation is based on mechanistic and genetic studies for TRL and remnants, together with the epidemiological data suggestive of the association for circulating triglycerides and cardiovascular disease. For HDL, epidemiological, mechanistic, and clinical intervention data are consistent with the view that low HDL-C contributes to elevated cardiovascular risk; genetic evidence is unclear however, potentially reflecting the complexity of HDL metabolism. The Panel believes that therapeutic targeting of elevated triglycerides (<1.7 mmol/L or 150 mg/dL), a marker of TRL and their remnants, and/or low HDL-C (<1.0 mmol/L or 40 mg/dL) may provide further benefit. The first step should be lifestyle interventions together with consideration of compliance with pharmacotherapy and secondary causes of dyslipidaemia. If inadequately corrected, adding niacin or a fibrate, or intensifying LDL-C lowering therapy may be considered. Treatment decisions regarding statin combination therapy should take into account relevant safety concerns, i.e. the risk of elevation of blood glucose, uric acid or liver enzymes with niacin, and myopathy, increased serum creatinine and cholelithiasis with fibrates. These recommendations will facilitate reduction in the substantial cardiovascular risk that persists in patients with cardiometabolic abnormalities at LDL-C goal.

U2 - http://dx.doi.org/10.1093/eurheartj/ehr112

DO - http://dx.doi.org/10.1093/eurheartj/ehr112

M3 - Journal article

SN - 0195-668X

VL - 32

SP - 1345

EP - 1361

JO - European Heart Journal

JF - European Heart Journal

IS - 11

ER -

Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management

Abstract

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