Residual cardiovascular risk: Dyslipidaemia criteria need to be tighter
A new review makes the case for stricter control of eligibility criteria, particularly among patients with elevated triglycerides, when testing novel therapeutics in the setting of residual cardiovascular risk. The authors make the point that recruitment of an inappropriate patient population likely explains the failure of past cardiovascular outcomes studies. For example, in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid study testing the effect of fenofibrate in statin-treated type 2 diabetes patients, there were no specific inclusion criteria for elevated triglycerides. The failure to show impact on residual cardiovascular risk is therefore a direct consequence of enrolling high-risk patients with normal or near normal lipid levels and not patients with "true" dyslipidaemia. The authors conclude that future trials of novel lipid-modifying drugs should have stringent lipid selection criteria for eligible patients to be a true test of intervention against lipid-related residual cardiovascular risk.
Trials in "True" dyslipidemic patients are urged to reconsider comprehensive lipid management as a means to reduce residual cardiovascular risk
Werba JP, Vigo LM, Veglia F et al.