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1 November 2008

Treated dyslipidemic patients remain at high residual risk of vascular events

Pr Jean-Charles Fruchart

President of the R3i International Steering Committee
Pr Jean-Charles Fruchart Despite current standards of care including achievement of LDL-C goals and control of blood pressure and glycemia, dyslipidemic patients remain at high residual risk of vascular events. In patients with type 2 diabetes or metabolic syndrome, there is an excess of both macro- and microvascular risk despite intensive multifactorial intervention.

Atherogenic dyslipidemia, characterized by elevated triglycerides, low HDL C and an increased proportion of small, dense LDL, is common in high-risk patients, including those with established cardiovascular disease (CVD), type 2 diabetes or metabolic syndrome, and contributes to both macrovascular and microvascular residual risk.

However, atherogenic dyslipidemia is largely undertreated in clinical practice. Therapeutic intervention aimed at all components of this atherogenic dyslipidemia may help reduce residual vascular risk in high-risk patients.

Vascular inflammation also appears to be an important factor of both macro- and microvascular risk. Therapeutic intervention aiming to reduce vascular inflammation may contribute to reduce vascular residual risk.

Lifestyle modification is an important first step in reducing vascular residual risk. However, it is recognized that this may be difficult to achieve and maintain in the longer-term. Evidence supports optimal therapeutic intervention aimed at achievement of all lipid targets and control of blood pressure and glycemia with pharmacotherapy, adjunctive to lifestyle intervention.

However, these data have not been disseminated enough to be translated into current clinical practice. This is why about twenty experts from various background and countries have created a new worldwide physician educational initiative against vascular residual risk.

The ambitious objective of the Residual Risk Reduction Initiative (R3i) is, through knowledge dissemination and with active participation of primary care physicians, to achieve substantial reduction of vascular residual risk in the years to come.