Vnitr Lek 2011, 57(3):313-316

Residual risk of cardiovascular complications and its reduction with a combination of lipid lowering agents

V. Soška1,2
1 Oddělení klinické biochemie FN u sv. Anny v Brně, přednosta doc. MUDr. Vladimír Soška, CSc.
2 II. interní klinika Lékařské fakulty MU, Brno, přednosta prof. MUDr. Miroslav Souček, CSc.

Most patients treated with statins die due to cardiovascular events. The risk of cardiovascular event during statin treatment is called residual risk. The source of residual risk are some risk factors including dyslipidemia, characterized by low HDL-cholesterol, elevated triglycerides and apolipoprotein B, small dense LDL and sometimes also high lipoprotein(a). High residual risk is common in patients with metabolic syndrom, type 2 diabetes mellitus, insulinoresistance and abdominal obesity. Residual risk can be decreased by combination therapy statins with fibrates or statins with niacin; niacin can affect almost all lipids and lipoproteins that participate in residual risk. There are evidences from clinical trials that combinations statin with fibrates or statin with niacin are safe.

Keywords: cardiovascular diseases; rezidual risk; apolipoprotein B; HDL-cholesterol; triglycerides; statins; fibrates; niacin

Received: December 8, 2010; Published: March 1, 2011  Show citation

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Soška V. Residual risk of cardiovascular complications and its reduction with a combination of lipid lowering agents. Vnitr Lek. 2011;57(3):313-316.
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    References

    1. Baigent C, Keech A, Kearney PM et al. Cholesterol Treatment Trialist (CTT) Collaborators. Efficacy and safety of cholesterol lowering treatment: Prospective meta-anylysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005; 366: 1267-1278. Go to original source... Go to PubMed...
    2. Gordon DJ, Probstfield JL, Garrison RJ et al. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation 1989; 79: 8-15. Go to original source... Go to PubMed...
    3. Castelli WP, Garrison RJ, Wilson PWF et al. Incidence of coronary heart disease and lipoprotein cholesterol levels: The Framingham Study. JAMA 1986; 256: 2835-2838. Go to original source... Go to PubMed...
    4. Pedersen TR, Olsson AG, Faergeman O et al. Lipoprotein changes and reduction in the incidence of major coronary events in the Scandinavian Simvastatin Survival Study (4S). Circulation 1998; 97: 1453-1460. Go to original source... Go to PubMed...
    5. Sacks FM, Tonkin AM, Shepherd J et al. Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors: the Prospective Pravastatin Pooling Project. Circulation 2000; 102: 1893-1900. Go to original source... Go to PubMed...
    6. Ballantyne CM, Herd JA, Ferlic LL et al. Influence of low HDL on progression of coronary artery disease and response to fluvastatin therapy. Circulation 1999; 99: 736-743. Go to original source... Go to PubMed...
    7. Rubins HB, Robins SJ, Collins D et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med 1999; 341: 410-418. Go to original source... Go to PubMed...
    8. Cífková R, Býma S, Češka R et al. Prevence kardiovaskulárních onemocnění v dospělém věku. Společné doporučení českých odborných společností. Vnitř Lék 2005; 51: 1021-1036.
    9. Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 1998; 81: 7B-12B. Go to original source... Go to PubMed...
    10. Hokanson JE, Austin MA. Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 1996; 3: 213-219. Go to original source... Go to PubMed...
    11. Freiberg JJ, Tybjaerg-Hansen A, Jensen JS et al. Nonfasting triglycerides and risk of ischemic stroke in the general population. JAMA 2008; 300: 2142-2152. Go to original source... Go to PubMed...
    12. Nordestgaard BG, Benn M, Schnohr P et al. Nonfasting Triglycerides and Risk of Myocardial Infarction, Ischemic Heart Disease, and Death in Men and Women. JAMA 2007; 298: 299-308. Go to original source... Go to PubMed...
    13. Stampfer MJ, Krauss RM, Ma J et al. A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA 1996; 276: 882-888. Go to original source...
    14. Griffin BA, Freeman DJ, Tait GW et al. Role of plasma triglyceride in the regulation of plasma low density lipoprotein (LDL) subfractions: relative contribution of small, dense LDL to coronary heart disease risk. Atherosclerosis 1994; 106: 241-253. Go to original source... Go to PubMed...
    15. Watts GF, Mandalia S, Brunt JN et al. Independent associations between plasma lipoprotein subfraction levels and the course of coronary artery disease in the St. Thomas' Atherosclerosis regression study (STARS). Metabolism 1993; 42: 1461-1467. Go to original source... Go to PubMed...
    16. Walldius G, Jungner I. The apoB//apoA-1 ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy - a review of the evidence. J Intern Med 2006; 259: 493-519. Go to original source... Go to PubMed...
    17. Walldius G, Jungner I, Holme I et al. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 2001; 358: 2026-2033. Go to original source... Go to PubMed...
    18. Barter PJ, Ballantyne CM, Carmena R et al. Apo B versus cholesterol in estimating cardiovascular risk and in quiding therapy: report of the thirty-person/ten country panel. J Intern Med 2006; 259: 247-258. Go to original source... Go to PubMed...
    19. Vaverková H, Soška V, Rosolová H et al. Doporučení pro diagnostiku a léčbu dyslipidémií v dospělosti, vypracované výborem České společnosti pro aterosklerózu. Vnitř Lék 2007; 53: 181-197. Go to PubMed...
    20. Loscalzo J, Weinfeld M, Fless GM et al. Lipoprotein(a), fibrin binding and plasminogen activation. Arteriosclerosis 1990; 10: 240-245. Go to original source... Go to PubMed...
    21. Assmann G, Schulte H, von Eckardstein A. Hypertriglyceridemia and elevated lipoprotein(a) are risk factors for major coronary events in middle-aged men. Am J Cardiol 1996; 77: 1179-1184. Go to original source... Go to PubMed...
    22. Dahlen GH, Guyton JR, Attar M et al. Association of levels of lipoprotein Lp(a), plasma lipids and other lipoproteins with coronary artery disease documented by angiography. Circulation 1986; 74: 758-765. Go to original source... Go to PubMed...
    23. Danesh J, Collins R, Peto R. Lipoprotein(a) and coronary heart disease. Metaanalysis of prospective studies. Circulation 2000; 102: 1082-1085. Go to original source... Go to PubMed...
    24. Filippatos T, Milionis HJ. Treatment of hyperlipidemia with fenofibrate and related fibrates. Expert Opin Invest Drugs 2008; 17: 1599-1614. Go to original source... Go to PubMed...
    25. Tonkin AM, Chen L Effects of combination lipid therapy in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Circulation 2010; 122: 850-852. Go to original source... Go to PubMed...
    26. Wierzbicki AS, Morrell J, McMahon Z et al. The effect of fibrate-statin combination therapy on cardiovascular events: a retrospective cohort analysis. Curr Med Res Opin 2010; 26: 2141-2146. Go to original source... Go to PubMed...
    27. Berge KG, Canner PL. Coronary drug project: experience with niacin. Eur J Pharmacol 1991; 40 (Suppl 1): S49-S51. Go to original source...
    28. Canner PL, Berge KG, Wenger NK et al. Fifteen year mortality in coronary drug project patients: long term benefit with niacin. J Am Coll Cardiol 1986; 8: 1245-1255. Go to original source... Go to PubMed...
    29. Brown BG, Zhao XQ, Chait A et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med 2001; 345: 1583-1592. Go to original source... Go to PubMed...
    30. Taylor AJ, Sullenberger LE, Lee HJ et al. Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) 2: a double-blind, placebo-controlled study of extended-release niacin on atherosclerosis progression in secondary prevention patients treated with statins. Circulation 2004; 110: 3512-3517. Go to original source... Go to PubMed...
    31. Villines TC, Stanek EJ, Devine PJ et al. The ARBITER 6-HALTS Trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies in Atherosclerosis): final results and the impact of medication adherence, dose, and treatment duration. J Am Coll Cardiol 2010; 55: 2721-2726. Go to original source... Go to PubMed...

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