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R3i EDITORIAL

5 October 2012

Call to action: re-emphasising the importance of targeting residual vascular risk

Prof. JC Fruchart, Prof. J. Davignon, Prof. M Hermans

Board of the R3i turstees
Prof. JC Fruchart, Prof. J. Davignon, Prof. M Hermans The timely Call to Action: ‘Our Time, A Call to Save Preventable Death From Cardiovascular Disease,’(1) jointly authored by the World Heart Federation, American Heart Association, American College of Cardiology Foundation, European Heart Network and European Society of Cardiology, re-emphasizes the importance of multifactorial intervention to reduce the burden of cardiovascular disease (CVD).

In addition to taking action to reduce physical inactivity, high blood pressure, salt intake and smoking, this paper also highlights the need for action on other targets specifically among those individuals at high CV risk:
  • Saturated fat intake
  • Obesity
  • Alcohol
  • Elevated cholesterol
In particular, multidrug drug therapy to prevent and treat CVD is regarded as a priority.

It is clear that there is much to do, especially in individuals at higher CV risk. While lowering LDL cholesterol remains the cornerstone of dyslipidemia management, the increasing epidemic of obesity, metabolic syndrome and type 2 diabetes highlights the need to address other modifiable cardiometabolic risk factors not highlighted in this Call to Action. The evidence supports atherogenic dyslipidemia as a key driver of CV risk in individuals with high cardiometabolic risk.(2) The R3i believes that targeting atherogenic dyslipidemia should be included as a clinical priority especially in those individuals at high CV risk, despite controlled LDL cholesterol levels.

This is the mission of the R3i.

Moreover, targeting atherogenic dyslipidemia, a condition readily identifiable from routine lipid profiles, is not only an appropriate clinical strategy in the higher risk individual, but also makes good economic sense. Studies have shown that nearly 17.9 million deaths could be avoided over a 10-year period by implementing multidrug therapy in individuals at higher CV risk.(3) The mindset that reducing one component will suffice to prevent CVD is wrong and needs to change. This is consistent with the R3i mission.

Undoubtedly, changing practice and adopting targets, both those highlighted in the Call to Action,(1) as well as other important contributors to CV risk is supported by consideration of the economic implications. There are particular issues in emerging economic regions such as Asia, where there is a high prevalence of atherogenic dyslipidemia driven by increasing urbanization, adoption of Western diets and sedentary lifestyle. Thus Asia would clearly benefit from strategies targeting this modifiable risk factor to reduce residual vascular risk. Such an approach makes good clinical and economic sense and should therefore be a key investment strategy to reduce the burden of CVD.


References

1. Smith SC, Collins A, Ferrari R et al. Our time: a call to save preventable death from cardiovascular disease (heart disease and stroke). J Am Coll Cardiol 2012; 60: Epub ahead of print.

2. Chapman MJ, Ginsberg HN, Amarenco P et al; European Atherosclerosis Society Consensus Panel. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J 2011;32:1345-61.

3. World Economic Forum and World Health Organization. From burden to ‘best buys’: reducing the economic impact of non-communicable disease in low- and middle-income countries. September 2011. http://www.who.int/nmh/publications/best_buys_summary/en/index.html. Accessed 18 September 2012.