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R3i EDITORIAL

3 May 2010

Lipids and residual risk of coronary heart disease in statin-treated patients

Prof. Jean Ferrieres

Department of Cardiology, Toulouse University Hospital,Toulouse, France
Prof. Jean Ferrieres Cardiovascular diseases will continue to be a major cause of morbidity due to improved in-hospital prognosis of acute coronary syndromes, better secondary preventive therapy and increased incidence of abdominal obesity and diabetes.

Statin therapy is the cornerstone of the treatment of dyslipidemia. Every reduction in LDL-cholesterol (LDL-C) level is associated with decreased risk of all-cause and coronary heart disease mortality. In international guidelines, statins are considered as first-line lipid-lowering drugs in patients in primary and secondary cardiovascular prevention.

Even though major coronary heart disease risk reductions are observed in randomized controlled trials and in the “real world”, a substantial number of coronary heart disease events are not prevented by statin therapy. Some patients do not reach the recommended therapeutic goals for LDL-C despite their treatment. Furthermore, in a significant number of patients treated with statins, residual risk remains. This may be due to the presence of other modifiable risk factors and also to residual LDL-cholesterol abnormalities, as well as low HDL-cholesterol (HDL-C) and/or high triglycerides levels. Low HDL-C is an established independent cardiovascular risk factor. High triglycerides and coronary heart disease risk is still a controversial issue. This residual risk is a call for new therapies to provide comprehensive lipid management.

The Dyslipidemia International Study (DYSIS)1 objective was to assess prevalence and types of persistent lipid abnormalities in patients receiving statin therapy, across both primary and secondary care settings. DYSIS was an epidemiological cross-sectional study and evaluated the patient characteristics of 22,063 consecutive statin-treated patients during a single visit to their primary care physicians or specialists on an outpatient basis in Europe and Canada. More than three quarters of patients included in DYSIS were at very high cardiovascular risk. Half of DYSIS patients had pre-existing cardiovascular diseases, two-thirds had metabolic syndrome, and 40% were diabetics.

DYSIS showed a high prevalence of lipid abnormalities in statin-treated patients. In particular, two thirds to three quarters of those with diabetes had LDL-C levels not at goal and/or elevated TG levels and/or low HDL-C levels.
Overall, the DYSIS results demonstrate the gap between guidelines and clinical practice and the need for a more intensive and comprehensive lipid management in high-risk populations.



References

1. Leiter L, Feely J, Ferrieres J., et al. Characteristics of statin-treated patients with diabetes mellitus in Europe and Canada: results of the Dyslipidemia International Study. 20th World Diabetes Congress, Montreal, Canada, October 2009 (Abstract D-0812).