The Residual Risk Reduction Initiative

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The R3I website is dedicated to inform and educate physicians about Residual Vascular Risk.
It provides with the latest information and interactive educational tools promoting the concept of Residual Vascular Risk.

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Editorial

Prof. JC Fruchart, Prof. F Sacks, Prof. M Hermans
Board of the R3i trustees

ARBITER 6-HALTS (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies) is the first trial to show that a treatment strategy aimed at raising HDL-C in high-risk statin-treated patients at LDL-C goal (<100 mg/dL or 2.6 mmol/L) produces regression of atherosclerosis compared with an intensive LDL-C lowering strategy. These results are supportive of the residual cardiovascular risk concept per se, of a lipid-related modifiable component to this risk, and of the value of targeting non-LDL lipids to reduce this risk.

In a previous position statement, the Residual Risk Reduction Initiative (R3i) has argued for consideration of treatment strategies to address the high level of residual cardiovascular risk due to non-LDL lipids in statin-treated patients. This is supported by initial data from the REALIST (REsiduAl risk Lipids and Standard Therapies) macrovascular survey showing that low HDL-C and/or elevated triglycerides, components of atherogenic dyslipidemia, are strong indicators of residual macrovascular risk. Whether raising HDL-C and/or lowering triglycerides, against a background of statin therapy, reduces this risk is more contentious...

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News

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Epicardial endothelial dysfunction correlates with LDL and HDL particle size

Coronary endothelial function was assessed in 490 patients of both genders and endothelial dysfunction (epicardial constriction >20% or increase in coronary blood flow <50% in response to intracoronary acetylcholine) was diagnosed in 273 patients. Measurement of lipoprotein particle subclasses using nuclear magnetic resonance revealed that epicardial endothelial dysfunction was significantly correlated with total (p=0.03) and small LDL particles (p<0.01) and inversely correlated with total and large HDL particles (p<0.01).

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High plasma HDL-C levels protect against risk of stroke

Owing to follow-up data collected from 93 695 persons aged 19 to 77 years in 8 European countries (1 234 252 total observation-years), the risk of stroke was increased by 9% in men and by 10% in women with each year of age, and by 28% in men and 25% in women with each 10-mm Hg increase in systolic blood pressure. Smoking increased the risk of stroke by 104% in women and 82% in men. Conversely, high HDL-C levels decreased risk of stroke by 42% in women and 20% in men.

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A meta-analysis of 32 studies shows that elevated triglycerides are an independent risk factor for coronary heart disease

A systematic review of 32 population-based studies investigating the association between baseline serum levels of triglycerides and HDL-C and the development of coronary heart disease (CHD: coronary events or coronary death) was carried out. The independent association between elevated triglycerides and risk of CHD was statistically significant in 16 out of of 30 populations without pre-existing CHD. Triglycerides and HDL-C were mutually exclusive predictors of coronary events in 12 out of 20 analyses of patients without pre-existing CHD. The association between triglycerides and primary CHD independently of HDL-C makes the authors suggest that both lipid abnormalities may be considered in cardiovascular risk prediction and as targets for preventive cardiocascular intervention.

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Significant reduction of non-fatal stroke but nonsignificant decrease in primary end point of cardiovascular events in peripheral artery disease patients on aspirin

To investigate the effect of aspirin on cardiovascular event rates in secondary prevention patients with peripheral artery disease, data were extracted from 18 prospective randomized controlled trials involving 5269 patients, among whom 8.9% of those treated with aspirin and 11% of those in the control groups experienced a cardiovascular event (non-fatal myocardial infarction, stroke or cardiovascular death). Odds ratio calculation yielded a 12% reduction in cardiovascular events, which was not significant. Aspirin was not associated with significant reductions in all-cause or cardiovascular mortality, myocardial infarction or major bleeding. However, there was a 34% reduction in non-fatal stroke events.

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High prevalence of hypertriglyceridemia but low use of TG-lowering medications in the US

Among 5610 individuals aged 20 years or older participating in the National Health and Nutrition Examination Survey conducted from 1999 to 2004, 33.1% had a triglycerides (TG) concentration =150 mg/dL, and 17.9% had TG concentration =200 mg/dL. Only 2.6% of participants with a TG concentration =150 mg/dL and 3.6% of those with a TG concentration =200 mg/dL used a prescription medication primarily aimed at reducing hypertriglyceridemia (fenofibrate, gemfibrozil, or niacin).

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Ethnic differences in lipid profile changes associated with physical activity

Levels of activity were measured in 8764 African-American and white Caucasian participants of the Atherosclerosis Risk in Communities (ARIC) study aged 45-64 years at baseline. After 9 years of follow up, increases in the level of activity were associated with increases in HDL cholesterol in all participants and decreases in triglycerides among white participants. LDL cholesterol decreased in women of both ethnicities, while the association with total cholesterol was limited to African-American women.