The lipid triad, or how to reduce residual cardiovascular risk?

Since the first interventional studies on cholesterol, many large prospective trials have demonstrated that the statins can reduce the risk of a major cardiovascular event by 25 to 35%. But, in spite of the overall decrease in LDL-cholesterol in the general population over the last 20 years and treatments with statins, the persistence of a high residual vascular risk is observed in some patients. This residual risk is observed mainly in patients with atherogenic dyslipidaemia with low HDL-cholesterol, elevated triglycerides and a preponderance of small and dense LDL-cholesterol particles, a profile frequently found in patients with non-insulin dependent diabetes mellitus (N1DDM), obesity or metabolic syndrome and which has been called thee lipid triad. The frank increase in the prevalence of these metabolic abnormalities in populations worldwide casts doubt on the benefits acquired over the last few years in cardiovascular prevention. Not only does it appear essential to improve the treatment of all risk factors (hypertension, smoking, etc.), but it now seems necessary to manage all lipid parameters by decreasing LDL and also triglycerides and by increasing HDL. The development of new pathways of research and the introduction of novel compounds, which have demonstrated their clinical effectiveness, with regard to HDL in particular, are awaited. (C) 2010 Elsevier Masson SAS. All rights reserved.