Press release
European Atherosclerosis Society Consensus Panel provides new guidance for managing elevated triglycerides/low high-density lipoprotein (HDL) cholesterol in patients at high risk of cardiovascular disease.
29 April 2011 - World-wide, clinicians are facing an explosion of cardiometabolic disease with major implications for healthcare systems. In developing guidance for the management of lipid abnormalities typical of cardiometabolic disease, the European Atherosclerosis Society Consensus Panel critically reviewed available evidence from epidemiological, genetic, mechanistic and clinical intervention studies. This appraisal supported a causal association of elevated triglyceride-rich lipoproteins and their remnants, for which triglycerides are a marker, together with low HDL cholesterol with elevated cardiovascular risk. The guidance was published today in the European Heart Journal.
1
Elevated triglycerides with or without low HDL cholesterol – often referred to as atherogenic dyslipidemia – is prevalent in individuals at high risk of cardiovascular disease.
2,3 This lipid phenotype clusters with other cardiometabolic abnormalities, including central obesity, insulin resistance, dyslipidemia and hypertension. Recent data from the Framingham Heart Study show that coronary risk associated with elevated triglycerides and low HDL cholesterol is substantially increased in the presence of insulin resistance.
4 While lowering low-density lipoprotein (LDL) cholesterol is the primary priority in these high-risk patients, it does not sufficiently address cardiovascular risk that persists due to high triglyceride/low HDL cholesterol dyslipidemia.
In the new guidance, the European Atherosclerosis Society Consensus Panel recommends that elevated triglycerides (≥1.7 mmol/L or 150 mg/dL) and/or a low HDL cholesterol concentration (<1.0 mmol/L or 40 mg/dL) should be targeted in high-risk patients at LDL cholesterol goal. The Panel stresses that lifestyle intervention should be the first step in clinical management, together with consideration of compliance with existing therapy and secondary causes of dyslipidemia (e.g. poor glycaemic control, obesity, and lifestyle factors).
If these measures are insufficient, then addition of niacin or a fibrate, or intensification of LDL cholesterol lowering should be considered. Clinicians should take into account relevant safety issues when deciding which option to add to statin therapy. Based on the current level of evidence, fenofibrate might be preferred as the fibrate for combination with a statin.
In patients with very high triglycerides (>5.5 mmol/L or 490 mg/dL), fenofibrate, niacin or high-dose omega-3 fatty acids (3-4 g/day), together with a very low fat diet and reduced alcohol consumption are recommended to prevent pancreatitis, in line with current guidelines.
According to the Co-Chairs of this Consensus Panel, Professor M. John Chapman, President of the European Atherosclerosis Society, Pitié-Salpétrière University Hospital, INSERM UMR-S939, Paris, France and Professor Henry N. Ginsberg, Irving Institute for Clinical and Translational Research, Columbia University, New York, USA: ‘
The European Atherosclerosis Society Consensus Panel believes that these evidence-based recommendations will be especially relevant for the many clinicians practising in this expanding therapeutic area. Together with the members of the Consensus Panel we believe that this guidance will help to reduce the persistent high cardiovascular risk in patients with cardiometabolic abnormalities at LDL cholesterol goal.’
Notes to Editors
For information about the EAS Consensus Panel, Click
HERE
References
1. Chapman MJ, Ginsberg HN, Amarenco P, Andreotti F, Boren J, Catapano AL, Descamps OL, Fisher E, Kovanen PT, Kuivenhoven JA, Lesnik P, Masana L, Nordestgaard BG, Ray KK, Reiner Z, Taskinen M-R, Tokgozoglu L, Tybjærg-Hansen A, Watts GF for the European Atherosclerosis Society Consensus Panel. Published on-line European Heart Journal April 29, 2011. doi: 10.1093/eurheartj/ehr112.
http://eurheartj.oxfordjournals.org/content/early/2011/04/29/eurheartj.ehr112.full?sid=98eafb9e-9c26-4050-8cc5-03dd647886c0
2. Eriksson M, Zethelius B, Eeg-Olofsson K, Nilsson PM, Gudbjörnsdottir S, Cederholm J, Eliasson B. Blood lipids in 75 048 type 2 diabetic patients: a population-based survey from the Swedish National diabetes register. Eur J Cardiovasc Prev Rehab 2011;18:97-105.
3. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U; EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009;16:121-37.
4. Robins SJ, Lyass A, Zachariah JP, Massaro JM, Vasan RS. Insulin resistance and the relationship of a dyslipidemia to coronary heart disease. The Framingham Heart Study. Arterioscler Thromb Vasc Biol 2011;31:doi:10.1161/atvbaha.110.219055.