A review of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidaemia: A report from an expert consensus meeting on the role of fenofibrate-statin combination therapy.

Carlos Aguiar, Eduardo Alegria, Riccardo C Bonadonna, Alberico L Catapano, Francesco Cosentino, Moses Elisaf, Michel Farnier, Jean Ferrières, Pasquale Perrone Filardi, Nicolae Hancu, Meral Kayikcioglu, Alberto Mello E Silva, Jesus Millan, Željko Reiner, Lale Tokgozoglu, Paul Valensi, Margus Viigimaa, Michal Vrablik, Alberto Zambon, José Luis Zamorano, Roberto Ferrari

Journal: Atherosclerosis. Supplements 2016;19():1-12

PMID: 26315511

Full Text on Elsevier Science View on PubMed

Abstract

A meeting of European experts in cardiovascular (CV) disease and lipids was convened in Paris, France, on 10 November 2014 to discuss lipid profile, and in particular atherogenic dyslipidaemia (AD), and associated CV risk. Key points that were raised and discussed during the meeting are summarised in this paper, which also accounts for further discussion and agreement on these points by the group of experts. Elevated levels of low-density lipoprotein cholesterol (LDL-c) are commonly associated with a greater CV risk than low LDL-c levels, and are routinely managed with statins. However, even for patients controlled on statins and achieving low LDL-c levels, abnormal lipid profiles observed in some patients (i.e. elevated triglyceride levels, with/without low levels of high-density lipoprotein cholesterol [HDL-c]) have been linked to the presence of a residual CV risk. Therefore, it is recommended that both triglyceride and HDL-c levels be measured, to allow for the overall CV residual risk to be adequately managed. Favourable safety and clinical data support the combination of statins with other lipid-lowering agents, such as fenofibrate. Patients who have elevated triglyceride levels plus low levels of HDL-c are most likely to achieve clinical benefit from fenofibrate-statin combination therapy. In these patients with AD, achieving target non-HDL-c levels should be a key focus of CV risk management, and the use of non-HDL-c was advocated to provide a better measure of CV risk than LDL-c levels.

Address: Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Carnaxide, Portugal.; Cardiology Department, Policlínica Gipuzkoa, San Sebastián, Spain.; Division of Endocrinology, Department of Clinical and Experimental Medicine, University of Parma and Azienda Ospedaliera Universitaria of Parma, Italy.; Department of Pharmacological and Biomolecular Sciences, University of Milan, IRCCS Multimedica, Milan, Italy. Electronic address: [email protected].; Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.; Department of Internal Medicine, University of Ioannina Medical School, Greece.; Point Médical, Dijon, France.; Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France.; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.; Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.; Department of Cardiology, Ege University Medical School, İzmir, Turkey.; Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.; Hospital General Universitario Gregorio Marañón, Facultad de Medicina de la Universidad Complutense, Madrid, Spain.; University Hospital Center, School of Medicine, University of Zagreb, Croatia.; Hacettepe University, Ankara, Turkey.; Department of Endocrinology Diabetology Nutrition, Jean Verdier Hospital, APHP, Paris Nord University, CRNH-IdF, CINFO, Bondy, France.; North Estonia Medical Centre, Tallinn University of Technology, Estonia.; 3rd Department of Internal Medicine, 1st Medical Faculty, Charles University, Prague, Czech Republic.; Clinica Medica, Department of Medicine, University of Padova, Italy.; University Alcalá de Henares, Hospital Ramón y Cajal, Madrid, Spain.; Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, E.S: Health Science Foundation, Cotignola, Italy.

DOI: 10.1016/S1567-5688(15)30001-5

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MeSH Terms: Atherosclerosis, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Dyslipidemias, Europe, Fenofibrate, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypolipidemic Agents, Lipids, Paris