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What is residual Risk
Position Paper
The Residual Risk Reduction Initiative:
A call to action to reduce residual vascular risk in dyslipidemic patients
Jean-Charles Fruchart PhD, Frank Sacks MD, Michel P. Hermans MD PhD, Gerd Assmann MD, W. Virgil Brown MD FACC, Richard Ceska MD PhD, M. John Chapman PhD DSc, Paul M. Dodson MD, Paola Fioretto MD, Henry N. Ginsberg MD, Takashi Kadowaki MD, Jean-Marc Lablanche MD, Nikolaus Marx MD, Jorge Plutzky MD FACC, Ċ½eljko Reiner MD PhD, Robert S. Rosenson MD FACC, Bart Staels PhD, Jane K. Stock PhD, Rody Sy MD, Christoph Wanner MD, Alberto Zambon MD PhD, Paul Zimmet MD PhD

A condensed version is published in Diabetes & Vascular Disease Research

The aims of this position paper are :

  • - to highlight the evidence associating atherogenic dyslipidemia with residual macrovascular and microvascular risk in patients at high CV risk despite current standards of care for hyperlipidemia and diabetes,
  • - to recommend therapeutic intervention for reducing this Residual vascular Risk, supported by evidence and expert consensus.
 
Key Messages
  • Dyslipidemic patients remain at high Residual vascular Risk despite treatment for high LDL cholesterol and diabetes in accordance with current standards of care.

  • Macrovascular residual risk is present in both diabetic and non-diabetic patients, but diabetic patients are particularly affected.

  • Despite intensive multifactorial therapy, including antidiabetics and antihypertensives as well as statins, type 2 diabetic patients remain exposed to a high risk of microvascular complications (retinopathy, nephropathy, neuropathy).

  • Atherogenic dyslipidemia, i.e, high TG and low HDL cholesterol, often with elevated apolipoprotein B and non HDL cholesterol, is a key factor associated with Residual vascular Risk. Atherogenic dyslipidemia is largely under-diagnosed and under-treated in clinical practice.

  • Statin therapy does not:
    • - eliminate the CV risk associated with low HDL-C levels and high TG
    • - significantly affect mortality in diabetic patients
    • - significantly affect microvascular residual risk in patients with diabetes

  • The R3i recommends multifactorial intervention involving combination therapy targeting all lipid goals, intensive control of blood pressure and glycemia, and lifestyle modification as the optimal approach to reducing Residual vascular Risk in dyslipidemic patients.

  • Ongoing outcomes studies, i.e., ACCORD, AIM-HIGH and HPS2-THRIVE, will provide important information about the use of combination lipid-modifying treatments.