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Pemafibrate to Treat and Prevent Diabetic Foot Ulceration: An Unmet Clinical Need Requiring Formal Evaluation
Chairman: Prof. Jean-Charles Fruchart (Lille, France)
Speaker: Prof. Paul Ridker (Boston, USA)
watch now...
R3i Upcoming Events
October 31, 2024
R3i symposium
What does it mean "Residual Risk" ?
Prof. Michel Hermans (Brussels, Belgium)
How to manage atherogenic/diabetic DLP
Prof. Alberto Zambon (Padova, Italy)
See the program...
Latest R3i Booklet and Slidekit
PCSK9 as Therapeutic Target
This booklet/slidedeck, the second in the series, focuses on evidence from clinical trials with PCSK9-targeted therapeutics.

Elevated LDL cholesterol is established as causal for atherosclerotic cardiovascular disease. Statin treatment, although effective in lowering LDL cholesterol, still leaves an unacceptably high residual cardiovascular risk, underlining the need for additional therapies.
R3i Editorial
20 May 2024
Reducing residual risk: lower cholesterol and inflammation is better
Prof. Jean Charles Fruchart, Prof. Michel Hermans, Prof. Pierre Amarenco
Cardiovascular disease continues its position as the leading cause of morbidity, disability, and death worldwide, despite important advances in acute management and therapy over the last 30 years. Much of the focus of preventive strategies has been on low-density lipoprotein cholesterol (LDL-C), as the major driver of cardiovascular risk . However, even when LDL-C is well managed, patients continue to experience cardiovascular events, implying the need to identify and target other modifiable risk factors...
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Landmark studies
20 May 2024
Non-HDL cholesterol: an accessible marker of high residual risk
This study including more than 23,000 statin-treated patients with ischaemic heart disease and well controlled low-density lipoprotein cholesterol (LDL-C) levels, confirms non-high-density lipoprotein cholesterol (non-HDL-C) as a simple and robust measure to identify patients who have a high residual risk.
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Focus on...
20 May 2024
Insights from CLEAR-Outcomes trial: Targeting LDL cholesterol alone is not enough
According to this trial analysis, high-sensitivity C-reactive protein (hsCRP) predicts cardiovascular events more strongly than low-density lipoprotein cholesterol (LDL-C) in high-risk statin-intolerant patients.
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R3i Booklets / Slidekits Educational Library
Created by Prof. Jean-Charles Fruchart and R3i Members
More than 6.000 downloadable slides
Including printable extensive comments booklets
Differentiating SPPARMα and fibrates
(PPARα agonists)
This booklet/slidekit discusses the evidence for the novel SPPARMα agonist, pemafibrate, that differentiates it as a distinct therapeutic class from traditional fibrates.
SSPARMα at the Crossroads of Obesity,
Diabetes and Cardiovascular Diseases
This library discusses the rationale and therapeutic opportunities for SPPARαMs in the future management of cardiovascular diseases, including the latest information on the role of triglyceride-rich lipoproteins and their remnants in residual vascular risk.
PCSK9 and Atherosclerosis
Authors review the discovery and structure of PCSK9, PCSK9 levels in health and disease, PCSK9-drug interactions focusing on statin trials, current approaches to PCSK9 inhibition, and recent results from anti-PCSK9 mAb pre-clinical and clinical trials.
Other Slidekits
The R3i Educational Library also contains numerous commented slides concerning micro and macrovascular residual risk as well as the detailed analysis of the most important clinical studies related to it.
Triglyceride-rich lipoproteins and atherosclerotic cardiovascular disease
This booklet provides a critical background to triglyceride-rich lipoproteins and their role in ASCVD, concluding with discussion of the trials.
PCS9 as a therapeutic target
Insights from clinical trials
This booklet/slidedeck, the second in the series, focuses on evidence from clinical trials with PCSK9-targeted therapeutics.
Recent publications
Remnant cholesterol: a residual risk factor for aortic valve calcium progression

Results from the MESA (Multi-Ethnic Study of Atherosclerosis) study show that elevated remnant cholesterol was associated with an increased risk...
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Lipoprotein(a) and residual cardiovascular risk

Findings from the BiomarCaRE project show that residual inflammatory risk influences the association of lipoprotein(a) [Lp(a)] with risk for recurrent...
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NHANES: Heterogeneity of dyslipidaemia in diabetes

Diabetic dyslipidaemia, typically characterised by the combination of elevated triglycerides (TG) and low plasma levels of high-density lipoprotein cholesterol (HDL-C),...
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High long-term residual risk: Act earlier

This recent review highlights the high long-term residual cardiovascular risk that persists in secondary prevention patients treated with statins, and...
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NEW The R3i International Steering Committee Meeting, Marrakech 2023
Reducing vascular complications of type 2 diabetes: New targets, new treatments
▷ Watch all 8 sessions Webcasts
➤ Selective Peroxisome Proliferator–Activated Receptor Alpha Modulators (SPPARMα): New Opportunities to Reduce Residual Cardiovascular Risk in Chronic Kidney Disease?
➤ Residual vascular risk in diabetes: Will the SPPARMα concept hold the key?
➤ SPPARMα – the Lazarus effect
NEW MOVIE - Understanding how pemafibrate acts
What's Residual Risk?
Residual risk of vascular events persisting in patients at treatment goals according to current standards of care or failing to meet goals, including risk related to dyslipidemia, high blood pressure, hyperglycemia, systemic inflammation and unhealthy lifestyles.
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What is the Initiative?
The R3i, a worldwide, academic, multidisciplinary non-profit organization, aims to successfully address the excessively high risk of macro- and micro-vascular complications in patients with atherogenic dyslipidemia, characterised by elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol and unaddressed by current standards of care.
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