R3i Editorials
R3i editorials, created by members of the R3i board, focus on addressing the persistent challenges of residual cardiovascular risk. These editorials serve to educate healthcare professionals about emerging insights and therapeutic strategies related to lipid-related risk factors, such as triglyceride-rich lipoproteins and lipoprotein(a).
Latest Editorial
March 2026
Lessons for future trials of triglyceride-lowering therapy
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco, Prof. Lale Tokgözoglu
For decades, evidence from population studies linked higher triglycerides (indicative of higher levels of triglyceride-rich lipoproteins and remnant cholesterol) with increased cardiovascular risk (1). Genetic studies further supported this relationship (2). Together, these data catalysed testing whether lowering elevated triglycerides reduced cardiovascular events in high-risk patients managed with contemporary preventive therapies. However, trials to date have largely disappointed (3-6). REDUCE-IT did show a significant reduction in cardiovascular events with high-dose icosapent ethyl (a pharmaceutical grade formulation of eicosapentaenoic acid) (7), although this may relate to the effects of high achieved plasma eicosapentaenoic acid levels, rather than just triglyceride reduction (8,9). Thus, the premise for targeting elevated triglycerides to lower residual cardiovascular risk remains unproven. Given the escalating burden of hypertriglyceridemia – currently affecting more than one in four individuals globally (10) – new thinking on trial design is urgently needed.
A recent report from the SWEDEHEART registry of patients hospitalized with myocardial infarction (MI) provides new insights (11). As discussed in this month’s Landmark report, a key aim was to investigate the magnitude of triglyceride lowering required for cardiovascular benefit, to define which patients might benefit most. This observational registry included 51,719 MI patients who had triglyceride measurements at admission and 1 year follow-up. These patients were stratified by quartiles of change in triglyceride levels between these timepoints. The cohort did not undergo systematic intervention to target triglycerides. Over a median follow-up of 5.6 years, 9008 (17%) patients had a major adverse cardiovascular event (MACE), 5148 (10%) died, and 3696 (7%) had a non-fatal MI. Patients in the top quartile of triglyceride reduction (≥0.6 mmol/L) had the lowest rates for MACE and all-cause mortality. Overall, patients who achieved at least 1.0 mmol/L reduction in baseline triglycerides (equating to at least 46% reduction from baseline) had a 13% reduction in risk for MACE, 9% reduction in all-cause mortality, and 16% reduction in non-fatal MI. However, only 27% of patients in the registry, of whom most were in the top quartile, achieved this magnitude of triglyceride reduction (11).
These findings offer explanations into why previous trials of triglyceride lowering therapies did not demonstrate significant cardiovascular benefit. First, baseline triglycerides of the trial populations were too conservative, mostly in the range of 1.7–4.9 mmol/L (3-6). Second, although the treatments resulted in significant percentage reductions in triglycerides, the absolute reductions were insufficient to achieve relevant biological changes. Thus, future trials should ensure inclusion of patients with higher triglyceride
levels, and test more efficacious triglyceride-lowering therapies. These take-home messages align with previous calls for inclusion of patients with higher triglycerides in clinical outcomes studies testing the triglyceride hypothesis (12).
With the advent of RNA-based therapeutics, the future appears positive. A raft of novel therapies targeting other hepatic proteins that regulate lipid metabolism, notably apolipoprotein CIII (APOC3) or angiopoietin like 3 protein (ANGPTL3), are in development. Clinical trials in the setting of mixed dyslipidemia have shown substantial triglyceride reductions, in excess of 50% and even 70% for ANGPTL3-directed therapies (13-17). In addition, there may be other favourable lipid changes; APOC3-directed treatments primarily reduce triglycerides but also raise high-density lipoprotein cholesterol, whereas those targeting ANGPTL3- offer broader lipid modulation, including substantial reductions in low-density lipoprotein cholesterol (13-17). Other members of the ANGPTL family, notably ANGPTL4 (18) are also in the pipeline.
These novel RNA therapeutics have promise to offer a true test of the relevance of triglyceride lowering to residual cardiovascular risk.
References
- Ginsberg HN, Packard CJ, Chapman MJ, et al. Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies-a consensus statement from the European Atherosclerosis Society. Eur Heart J 2021;42:4791–806.
2. Nordestgaard BG. Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease: new insights from epidemiology, genetics, and biology. Circ Res 2016;118:547–63.
3. ACCORD Study Group; Ginsberg HN, Elam MB, Lovato LC, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010;362:1563–74.
4. Scott R, O’Brien R, Fulcher G, et al; Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study Investigators. Effects of fenofibrate treatment on cardiovascular disease risk in 9,795 individuals with type 2 diabetes and various components of the metabolic syndrome: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetes Care 2009;32:493–8.
5. Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of high-dose omega-3 fatty acids vs corn oil on major adverse cardiovascular events in patients at high cardiovascular risk: the STRENGTH randomized clinical trial. JAMA 2020;324:2268–80.
6. Das Pradhan A, Glynn RJ, Fruchart JC, et al. Triglyceride lowering with pemafibrate to reduce cardiovascular risk. N Engl J Med 2022;387:1923-34.
7. Bhatt DL, Steg PG, Miller M, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 2019;380:11–22.
8. Szarek M, Bhatt D, Miller M, et al. Eicosapentaenoic acid, arachidonic acid, and triglyceride levels mediate most of the benefit of icosapent ethyl in REDUCE-IT. Eur Heart J 2023; doi: 10.1093/eurheartj/ehad655.1309.
9. Sherratt SCR, Mason RP, Libby P, Steg PG, Bhatt DL. Do patients benefit from omega-3 fatty acids? Cardiovasc Res 2024; 119:2884–901.
10. Ballena-Caicedo J, Zuzunaga-Montoya FE, Loayza-Castro JA, et al. Global prevalence of dyslipidemias in the general adult population: a systematic review and meta-analysis. J Health Popul Nutr 2025; 44: 308.
11. Schubert J, Hagström E, Westerbergh J, et al. Triglyceride reduction after MI and major adverse outcomes in SWEDEHEART—insights for future trials. Eur J Prev Cardiol 2026; doi: 10.1093/eurjpc/zwag076.
12. Nordestgaard AT, Pradhan AD, Everett BM, et al. Expanding the triglyceride range in clinical trials: therapeutic opportunities. Eur Heart J 2025;46:1835-48.
13. Bergmark BA, Marston NA, Bramson CR, et al. Effect of vupanorsen on non–high-density lipoprotein cholesterol levels in statin-treated patients with elevated cholesterol: TRANSLATE-TIMI 70. Circulation 2022;145:1377–86.
14. Rosenson RS, Gaudet D, Hegele RA, et al. Zodasiran, an RNAi therapeutic targeting ANGPTL3, for mixed hyperlipidemia. N Engl J Med 2024;391:913–25.
15. Tardif J-C, Karwatowska-Prokopczuk E, Amour ES, et al. Apolipoprotein C-III reduction in subjects with moderate hypertriglyceridaemia and at high cardiovascular risk. Eur Heart J 2022;43:1401–12.
16. Ballantyne CM, Vasas S, Azizad M, et al. Plozasiran, an RNA interference agent targeting APOC3, for mixed hyperlipidemia. N Engl J Med 2024;391:899–912.
17. Gao Y, Bai Y, Mu X. Pang X. Efficacy and safety of small interfering RNA (siRNA) therapies for hypertriglyceridemia and mixed dyslipidemia: an updated systematic review and meta-analysis. Front Pharmacol 2026;17:1736821. doi: 10.3389/fphar.2026.1736821
18. Cummings BB, Joing MP, Bouchard PR, et al. Safety and efficacy of a novel ANGPTL4 inhibitory antibody for lipid lowering: results from phase 1 and phase 1b/2a clinical studies. Lancet 2025;405:1923-34. - Key words: Triglycerides; clinical trials; residual cardiovascular risk; APOC3; ANGPTL3
More Editorials
2025
Is personalized residual risk the future?
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco, Prof. Lale Tokgözoglu
Despite advances in interventional strategies and pharmacological treatments, residual cardiovascular risk remains a major clinical challenge. Novel insights reinforce the interplay of multiple contributing pathways, and…
Looking back at 2025: What made the news
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco, Prof. Lale Tokgözoglu
As we say farewell to 2025, what did we learn this year about residual cardiovascular risk? Crucially, our knowledge of lipid-related residual risk continues to…
What’s new in lipid research? Insights from AHA 2025
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco, Prof. Lale Tokgözoglu
The 2025 American Heart Association (AHA) Scientific Sessions did not disappoint, premiering exciting new data in the lipid field. One of the stars was VESALIUS-CV with the PCSK9 inhibitor evolocumab (1), a…
Lipoprotein(a) is a residual cardiovascular risk factor: identify and manage
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco, Prof. Lale Tokgözoglu
Recognition of lipoprotein(a) [Lp(a)] as a residual cardiovascular risk factor is gaining momentum. Already clear evidence supports the causality of high Lp(a) levels in increased risk for atherosclerotic….
Clinical trials need to represent the wider population
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco
Inclusivity in clinical trials matters. This is because randomized clinical trials represent the primary evidence base that shapes guidelines and clinical practice. Yet cardiovascular outcomes studies tend to be conducted in….
Update to the 2019 ESC/EAS guidelines clarifies lipid management
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco
Guidelines are not static but evolve as evidence dictates. Thus, it is not surprising that updated guidance to the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines has been recently published (1,2). This update has been…
New approaches to triglyceride-lowering: back to the future with ANGPTL4?
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality world-wide (1). Moreover, with escalating obesity, particularly among younger individuals (2), ASCVD will continue to be a global challenge….
Triglyceride levels in clinical trials – should we aim higher?
Prof. Peter Libby, Prof. Michel Hermans, Prof. Pierre Amarenco
There is a wealth of evidence from observational studies over the decades linking elevated plasma triglycerides (TG), a surrogate for TG-rich lipoproteins and their remnants, with increased cardiovascular risk (1)….
2024
PROMINENT trial suggests new hope for diabetes-related lower-extremity complications
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Diabetes-related complications (both macrovascular and microvascular) have a devastating impact on people with diabetes. As diabetes prevalence escalates worldwide, projected to increase by almost 50% by 2045 (1), the…
New kids on the block for triglyceride lowering
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Recent times have seen a resurgence of interest in triglycerides (TG), a surrogate for atherogenic TG-rich lipoproteins which are now considered to contribute to residual cardiovascular risk…
Action needed on peripheral artery disease – any hints from PROMINENT?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Peripheral artery disease (PAD) is an escalating challenge. Global estimates suggest that >200 million individuals worldwide are living with PAD, with over 40% of this burden in low to middle income countries (1,2)…
New options for residual vascular risk on the horizon?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Despite optimal risk factor control, residual cardiovascular risk remains a persistent challenge for clinicians managing patients with or at high risk of atherosclerotic cardiovascular disease (ASCVD). Attention has therefore focused on targeting other drivers of this risk….
Reducing residual risk: lower cholesterol and inflammation is better
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Within the lipid focus, there has been considerable effort to address non-LDL-lipids implicated in this risk. Following disappointment with HDL-targeted therapies, attention was re-directed to elevated triglycerides (TG, a marker for TG-rich lipoproteins and their remnants) as a potential therapeutic target 4….
The microvascular-macrovascular interplay: the next target?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
To date, cholesterol and inflammation are the main targets for managing residual vascular risk. Added to this, important findings from cardiovascular outcome trials with novel glucose-lowering therapies,….
Targeting residual cardiovascular risk: what’s in the pipeline?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Individuals with atherosclerotic cardiovascular disease remain at high risk of recurrent events. Some of this risk may be ascribed to practical factors such as clinical inertia or cross-country disparities in access to effective lipid lowering therapies, as highlighted by the EU-wide DA VINCI study….
2023
Remnant cholesterol – evolving evidence
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Remnant cholesterol continues to attract attention as a target to reduce residual cardiovascular risk. Conventionally, remnant cholesterol is defined as the cholesterol contained in remnant lipoprotein particles, i.e. metabolized very-low-density lipoprotein and…
Call to action on residual stroke risk
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Stroke is the leading cause of disability worldwide and the second leading cause of death. According to latest data from the Global Burden of Disease Study, the absolute number of strokes has increased by 70% over the last three decades (1990 to 2019),…
Residual risk in 2023: where to?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Residual cardiovascular risk has evolved from a concept 1 to become an established target in cardiovascular disease research. Recent studies, particularly those focused on lipids, have shown that targeting a lower level of low-density lipoprotein cholesterol (LDL-C)…
2022
Lipid-related residual risk: lessons from PROMINENT?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Triglyceride-rich lipoproteins have attracted much attention as a likely therapeutic target to reduce residual cardiovascular risk, supported by evidence from extensive epidemiologic, genetic, and mechanistic studies 1….
Residual cardiovascular risk: is apolipoprotein B the preferred marker
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Beyond LDL-C, guidelines recommend non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein (apo)B as key secondary targets 4. These parameters can remain elevated even when LDL-C goal is attained…
Residual vascular risk in chronic kidney disease: new options on the horizon
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Chronic kidney disease (CKD) is increasingly recognized as a worldwide health concern. Whereas there has been a general decline in rates of death and disability-adjusted life years due to non-communicable diseases, such favourable trends do not exist for CKD 1…
Looking back at 2021 – what made the news?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
2021 was an exciting time in the lipid field, especially with increased recognition of the importance of triglyceride (TG)-rich lipoproteins and their remnants to atherosclerotic cardiovascular disease (ASCVD) risk…
2021
New ACC guidance addresses unmet clinical needs for high-risk patients with mild to moderate hypertriglyceridemia
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
For too long, triglycerides (TG) have been the forgotten player in atherosclerotic cardiovascular disease (ASCVD). Times are now changing. Substantive evidence from epidemiologic surveys and Mendelian randomization studies supports a role for TG-rich lipoproteins and their remnants in the causal pathway of ASCVD 1,2…
Residual vascular risk: What matters?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
The Residual Risk Reduction Initiative (R3i) has led the field in highlighting the importance of residual vascular risk 1,2. This risk encompasses both macrovascular and microvascular residual risk,…
Understanding vein graft failure: a role for PPARalpha in pathobiology
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Peripheral artery disease (PAD) is a common but often underdiagnosed and undertreated condition. Recent estimates indicate that PAD affects more than 230 million people globally 1,…
Residual cardiovascular risk: how to identify?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Despite best evidence-based treatment, patients with atherosclerotic cardiovascular disease are at high risk of recurrent events. While targeting inflammation (as in CANTOS),…
Metabolic syndrome and COVID-19
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Since report of the first cases of SARS-CoV-2 infection associated with the severe respiratory disease COVID-19 in Wuhan, China, the world has been enduring uniquely uncertain times…
Elevated triglyceride: linking ASCVD and dementia
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
The connection between the heart and brain has been long recognised. Epidemiological studies show that an adverse profile of cardiovascular risk factors, including hypercholesterolaemia, hypertension,…
Does SPPARMα offer new opportunities in metabolic syndrome and NAFLD?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
We are in the midst of an epidemic of metabolic disease. Already the metabolic syndrome, as defined by a joint statement from expert groups 1, affects about one-third of the adult world population 2…
Omega-3 fatty acids for residual cardiovascular risk: more questions than answers
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Omega-3 fatty acids have long been considered for a potential role in reducing residual cardiovascular risk. Meta-analyses have evaluated this issue; among the most recent, omega-3 supplementation significantly reduced the risk…
2020
Targeting triglycerides: Novel agents expand the field
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Guidelines have long recognised that elevated triglycerides (TG) are a marker of cardiovascular risk 1. Indeed, TG and TG-rich lipoproteins are among the atherogenic lipids and lipoproteins believed…
Why multidrug approaches are needed in NASH: insights with pemafibrate
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Nonalcoholic fatty liver disease (NAFLD) is a major challenge for the 21st century. Already more than 25% of the global population is affected 1, with similar rates among industrialised and less developed countries 2…
Triglyceride-rich remnant lipoproteins: a new therapeutic target in aortic valve stenosis?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Given that aortic valve stenosis is a chronic and multifactorial process, initiated many years before the onset of clinical symptoms, implies an atherosclerotic-like evolution with the involvement of…
Lowering triglycerides or low-density lipoprotein cholesterol: which provides greater clinical benefit?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Treatment guidelines prioritise low-density lipoprotein cholesterol (LDL-C) as the primary lipid target for intervention to prevent atherosclerotic cardiovascular disease (ASCVD).1…
The omega-3 fatty acid conundrum
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Omega-3 fatty acids have seen a resurgence of interest over the last couple of years. This has been largely driven by the landmark study REDUCE-IT (Reduction of Cardiovascular Events with…
2019
Focus on stroke: more input to address residual cardiovascular risk
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Stroke is a leading cause of death worldwide, second only to ischaemic heart disease. Yet, while there has been a decline in stroke mortality over the last three decades, stroke prevalence has increased,…
International Expert Consensus on Selective Peroxisome Proliferator-Activated Receptor Alpha Modulator (SPPARMα): New opportunities for targeting modifiable residual cardiovascular risk
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Atherogenic dyslipidaemia has long been recognised as a contributor to modifiable residual cardiovascular risk.1 To date, however, definitive evidence on how best to target this to reduce…
2018
Residual cardiovascular risk: triglyceride metabolism and genetics provide a key
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Understanding the major contributors to residual cardiovascular risk has been a tedious business. With the failure of major studies such as AIM-HIGH with niacin, and dal-OUTCOMES and ACCELERATE…
The clinical gap for managing residual cardiovascular risk: will new approaches make the difference?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
In 2013, the Residual Risk Reduction Initiative published a second ‘call to action’ on residual cardiovascular risk, following the initial paper in 2008.1,2 Five years later, are we any closer to…
Residual cardiovascular risk: refocus on a multifactorial approach
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Guidelines focus on reducing low-density lipoprotein cholesterol (LDL-C), given indisputable evidence that this is a key driver of both clinical and subclinical atherosclerotic cardiovascular disease (ASCVD)…
Optimizing treatment benefit: the tenet of personalized medicine
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Cardiovascular disease (CVD) poses an increasing global burden. While novel therapeutic approaches have undoubtedly reduced morbidity and mortality in the acute coronary setting, the corresponding increase…
Addressing residual cardiovascular risk – back to basics?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
While 2017 has certainly been a ‘rollercoaster of a year’ for lipid research, it has also provided important insights for the management of residual cardiovascular risk. The FOURIER…
2017
Residual risk of heart failure: how to address this global epidemic?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Heart failure affects more than 26 million people worldwide 1, and poses a huge economic burden to society. In 2012, the annual costs of heart failure management were estimated at $108 billion,…
Remnants and residual cardiovascular risk: triglycerides or cholesterol?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Non-high-density lipoprotein cholesterol (non-HDL-C) is recognized as a key therapeutic target, especially in subjects with a lipid profile characterized by elevated triglycerides and low HDL-C levels (atherogenic dyslipidaemia),…
Targeting residual cardiovascular risk: lipids and beyond…
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Accumulation of cholesterol from atherogenic apolipoprotein B-containing lipoproteins in the arterial wall has long been considered the instigator of atherosclerosis 1…
Residual cardiovascular risk in the Middle East: a perfect storm in the making
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Continuing our theme of residual cardiovascular risk in developing regions we turn our attention to countries in the Middle East and North Africa (MENA), a region in critical health flux. Already in 2010, ischaemic…
A global call to action on residual cardiovascular risk
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
The developed world has seen substantial improvement in the management of cardiovascular disease (CVD), particularly in the acute setting. Indeed, in Western and Central Europe, these gains in…
2016
SPPARM?: more than one way to tackle residual risk
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
TAtherogenic dyslipidaemia, the combination of elevated triglycerides and low plasma concentration of high-density lipoprotein cholesterol (HDL-C), is a contributing factor to residual cardiovascular risk 1…
Remnants linked with diabetic myocardial dysfunction
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Cholesterol-rich remnants are the products of the degradation of very low-density lipoproteins (secreted from the liver) and chylomicrons (secreted from the intestine). Plasma level of remnant cholesterol, …
New study links elevated triglycerides with plaque progression
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Genetic studies show that elevated triglycerides (a marker for triglyceride-rich lipoproteins and their remnants) are causal for atherosclerotic cardiovascular disease1,2…
Atherogenic dyslipidaemia: a risk factor for silent coronary artery disease
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Clinical trials aim to assess the impact of treatments on risk for cardiovascular events, hard clinical endpoints which can be readily and objectively evaluated. However, this month’s Focus article 1 raises…
SPPARM?: a concept becomes clinical reality
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Peroxisome proliferator-activated receptor alpha (PPAR?) agonists – fibrates – are perhaps the best option among available agents for managing atherogenic dyslipidaemia, a key contributor to lipid-related…
Remnant cholesterol back in the news
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Despite emphasis on low-density lipoprotein cholesterol (LDL-C) as the primary lipid target, reinforced by publication of the Sixth Joint Task Force European Guidelines for Cardiovascular Disease Prevention in Clinical Practice this…
Back to the future: triglycerides revisited
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Whether elevated triglycerides represent a causal risk factor has been much debated. However, increasing recent evidence provides a strong case for support. This month’s Landmark article adds to this story…
Unravelling the heritability of triglycerides and coronary risk
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Driven by genetics, elevated triglycerides, a marker of triglyceride-rich lipoproteins and their remnants have regained the focus of attention. Since 2013, studies have provided consistent evidence for specific loci with an…
Will residual cardiovascular risk meet its nemesis in 2016?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Lowering low-density lipoprotein (LDL) cholesterol is indisputably the cornerstone of dyslipidaemia management for cardiovascular disease prevention. However, it is also evident that attaining LDL cholesterol goal does…
Tackling residual cardiovascular risk: a case for targeting postprandial triglycerides?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Statin therapy is undoubtedly the cornerstone of dyslipidaemia management, and effective in reducing the risk of cardiovascular events in both diabetic and non-diabetic patients by 20-30% per mmol/L reduction in low-density…
Looking back at 2015: lipid highlights
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
The last 12 months has been an exciting time for lipid research, led by the advance of proprotein convertase subtilisin/kexin type 9 (PCSK9) targeted therapy. Indeed, the American Heart Association (AHA) has cited the PCSK9…
2015
Legacy effects in cardiovascular prevention
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
It is increasingly clear that the benefits of pharmacotherapeutic intervention on the atherosclerotic process may extend beyond the period of active treatment. Such an effect has already been demonstrated for statins…
Residual cardiovascular risk: it’s not just lipids!
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
What contributes to residual cardiovascular risk? Certainly, lipid and lipoproteins risk factors are important. Much of the focus of the Residual Risk Reduction Initiative (R3i) has been on the management…
Addressing residual vascular risk: beyond pharmacotherapy
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Reducing residual vascular risk in statin-treated patients who have achieved evidence-based lipid goals remains an ongoing mission of the Residual Risk Initiative (R3i). Much attention has focused on…
Back to basics: triglyceride-rich lipoproteins, remnants and residual vascular risk
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
This month we focus on triglyceride-rich lipoproteins (TRLs) as a contributor to lipid-related residual vascular risk. These TRLs are comprised of intestinally-derived chylomicrons remnants, and very-low-density lipoprotein…
Beyond the PCSK9 decade: what’s next?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
The last decade in lipid research has been widely regarded as the ‘PCSK9 decade’. Genetic studies have driven the development of novel therapies targeting the enzyme proprotein convertase subtilisin/kexin…
Targeting triglycerides: what lies on the horizon for novel therapies?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco
Accumulating evidence strengthens the case for consideration of an appropriate marker of triglyceride (TG)-rich lipoproteins in guidelines for the management of dyslipidaemia.1 The consensus of…
Do we need new lipid biomarkers for residual cardiovascular risk?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco, Prof. Jean Davignon
Cardiovascular disease burden continues to escalate, despite advances in diagnosis, management and pharmacotherapy over the last few decades. The latest news from the Global Burden of Disease 2013,1…
The Residual Risk Debate Hots Up: Lowering LDL-C or lowering remnant cholesterol?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco, Prof. Jean Davignon
Has PCSK9 inhibition clouded other considerations?
This month’s editorial brings together both sides of the debate surrounding the optimal approach for targeting residual cardiovascular risk…
Call for action on stroke
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco, Prof. Jean Davignon
Stroke, predominantly ischaemic stroke, is a leading cause of mortality, morbidity and serious long-term disability. Moreover, the fact that one in four strokes occur in individuals who have previously had a stroke…
Triglycerides: the tide has turned
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco, Prof. Jean Davignon
The Residual Risk Reduction Initiative (R3i) has long been an advocate of targeting atherogenic dyslipidaemia, elevated triglycerides and low high-density lipoprotein cholesterol (HDL-C), a driver of lipid-related…
Post IMPROVE-IT: Where to now for residual risk?
Prof. Jean-Charles Fruchart, Prof. Michel P. Hermans, Prof. Pierre Amarenco, Prof. Jean Davignon
Well, the relief from IMPROVE-IT, reported at the recent American heart Association Scientific Sessions, was palpable (see Landmark trial). We now have evidence that lowering low-density lipoprotein cholesterol…
