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Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation
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Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation
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Journal Article
Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation
2021
Overview
Abstract
Background
Current guidelines target low-density lipoprotein cholesterol (LDL-C) concentrations to reduce atherosclerotic cardiovascular disease (ASCVD) risk, and yet clinical trials demonstrate persistent residual ASCVD risk despite aggressive LDL-C lowering.
Content
Non–LDL-C lipid parameters, most notably triglycerides, triglyceride-rich lipoproteins (TGRLs), and lipoprotein(a), and C-reactive protein as a measure of inflammation are increasingly recognized as associated with residual risk after LDL-C lowering. Eicosapentaenoic acid in statin-treated patients with high triglycerides reduced both triglycerides and ASCVD events. Reducing TGRLs is believed to have beneficial effects on inflammation and atherosclerosis. High lipoprotein(a) concentrations increase ASCVD risk even in individuals with LDL-C < 70 mg/dL. Although statins do not generally lower lipoprotein(a), proprotein convertase subtilisin/kexin type 9 inhibitors reduce lipoprotein(a) and cardiovascular outcomes, and newer approaches are in development. Persistent increases in C-reactive protein after intensive lipid therapy have been consistently associated with increased risk for ASCVD events.
Summary
We review the evidence that biochemical assays to measure TGRLs, lipoprotein(a), and C-reactive protein are associated with residual risk in patients treated to low concentrations of LDL-C. Growing evidence supports a causal role for TGRLs, lipoprotein(a), and inflammation in ASCVD; novel therapies that target TGRLs, lipoprotein(a), and inflammation are in development to reduce residual ASCVD risk.
Publisher
Oxford University Press,American Association for Clinical Chemistry, Inc
Subject
/ Atherosclerosis - epidemiology
/ Atherosclerosis - prevention & control
/ C-Reactive Protein - analysis
/ C-Reactive Protein - metabolism
/ Cholesterol, LDL - metabolism
/ Humans
/ Hypolipidemic Agents - therapeutic use
/ Inflammation - prevention & control
/ Kexin
/ Lipids
/ Patients
/ Proteins
/ Reviews
/ Risk
/ Statins
