Residual macrovascular risk in 2013: what have we learned?
Residual macrovascular risk in 2013: what have we learned?
复制标题
DOI：
10.1186/1475-2840-13-26
复制
发表时间：
2014-01-24
影响因子：
9.3
通讯作者：
Residual Risk Reduction Initiative (R3i)
中科院分区：
文献类型：
--
作者：
Fruchart JC;Davignon J;Hermans MP;Al-Rubeaan K;Amarenco P;Assmann G;Barter P;Betteridge J;Bruckert E;Cuevas A;Farnier M;Ferrannini E;Fioretto P;Genest J;Ginsberg HN;Gotto AM Jr;Hu D;Kadowaki T;Kodama T;Krempf M;Matsuzawa Y;Núñez-Cortés JM;Monfil CC;Ogawa H;Plutzky J;Rader DJ;Sadikot S;Santos RD;Shlyakhto E;Sritara P;Sy R;Tall A;Tan CE;Tokgözoğlu L;Toth PP;Valensi P;Wanner C;Zambon A;Zhu J;Zimmet P;Residual Risk Reduction Initiative (R3i)
心血管疾病是 21 世纪的一项重大挑战，肥胖、代谢综合征和 2 型糖尿病的流行加剧了这一挑战。虽然包括高剂量他汀类药物在内的最佳护理标准可以降低血管并发症的风险，但患者仍然面临心血管事件的高风险。残余风险降低计划 (R3i) 此前曾强调致动脉粥样硬化血脂异常，定义为富含促动脉粥样硬化甘油三酯的载脂蛋白 B 脂蛋白与抗动脉粥样硬化载脂蛋白 A-I 脂蛋白（如高密度脂蛋白，HDL）之间的不平衡，是导致脂质相关残余心血管风险的重要可改变因素，尤其是在胰岛素抵抗的情况下。作为提高对致动脉粥样化血脂异常的认识和临床管理的使命的一部分，R3i 确定了三个关键优先行动事项： i) 提高对患有或不患有糖尿病的心脏代谢高风险患者的动脉粥样化血脂异常的认识； ii) 改善基于指南的治疗的实施和遵守； iii) 改善治疗致动脉粥样硬化血脂异常的策略。 R3i 认为，监测非 HDL 胆固醇为管理脂质相关残余心血管风险的治疗决策提供了一种简单实用的工具。添加贝特类、烟酸（北美和南美）、omega-3 脂肪酸或依折麦布都是与他汀类药物联合使用以进一步降低非 HDL 胆固醇的选择，尽管缺乏心血管结局益处的确凿证据。几种新兴的治疗方法可能会带来希望。其中包括下一代过氧化物酶体增殖物激活受体α激动剂、胆固醇酯转移蛋白抑制剂和针对前蛋白转化酶枯草杆菌蛋白酶/kexin 9型的单克隆抗体疗法。然而，显然需要长期结果和安全性数据。总之，R3i 认为，正在进行的这些新疗法的试验可能有助于确定致动脉粥样硬化血脂异常的最佳治疗方法，以减少残余心血管风险的临床和社会经济负担。
Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.
登录
查看更多内容
影响因子：
16.2
作者：
Cariou B;Hanf R;Lambert-Porcheron S;Zaïr Y;Sauvinet V;Noël B;Flet L;Vidal H;Staels B;Laville M
通讯作者：
Laville M
DOI：
10.1056/nejmoa1001288
发表时间：
2010-07-15
期刊：
The New England journal of medicine
影响因子：
--
作者：
ACCORD Study Group;ACCORD Eye Study Group;Chew EY;Ambrosius WT;Davis MD;Danis RP;Gangaputra S;Greven CM;Hubbard L;Esser BA;Lovato JF;Perdue LH;Goff DC Jr;Cushman WC;Ginsberg HN;Elam MB;Genuth S;Gerstein HC;Schubart U;Fine LJ
通讯作者：
Fine LJ
影响因子：
39.3
作者：
Chapman MJ;Ginsberg HN;Amarenco P;Andreotti F;Borén J;Catapano AL;Descamps OS;Fisher E;Kovanen PT;Kuivenhoven JA;Lesnik P;Masana L;Nordestgaard BG;Ray KK;Reiner Z;Taskinen MR;Tokgözoglu L;Tybjærg-Hansen A;Watts GF;European Atherosclerosis Society Consensus Panel
通讯作者：
European Atherosclerosis Society Consensus Panel
影响因子：
9.8
作者：
Asztalos, Bela F.;Collins, Dorothea;Schaefer, Ernst J.
通讯作者：
Schaefer, Ernst J.
影响因子：
39.3
作者：
Angeloni, Emiliano;Paneni, Francesco;Cosentino, Francesco
通讯作者：
Cosentino, Francesco