| 'Trig-onometry': non-high-density lipoprotein cholesterol as a therapeutic target in dyslipidaemia. | |
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MedLine Citation:
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PMID: 21105969 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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Targeting elevations in low-density lipoprotein cholesterol (LDL-C) remains the cornerstone of cardiovascular prevention. However, this fraction does not adequately capture elevated triglyceride-rich lipoproteins (TRLs; e.g. intermediate-density lipoprotein, very low density lipoprotein) in certain patients with metabolic syndrome or diabetic dyslipidaemia. Many such individuals have residual cardiovascular risk that might be lipid/lipoprotein related despite therapy with first-line agents (statins). Epidemiological evidence encompassing > 100,000 persons supports the contention that non-high-density lipoprotein cholesterol (non-HDL-C) is a superior risk factor vs. LDL-C for incident coronary heart disease (CHD) in certain patient populations. In studies with clinical end-points evaluated in the current article, a 1:1 to 1:3 relationship was observed between reductions in non-HDL-C and in the relative risk of CHD after long-term treatment with statins, niacin (nicotinic acid) and fibric-acid derivatives (fibrates); this relationship increased to 1:5 to 1:10 in smaller subgroups of patients with elevated triglycerides and low HDL-C levels. Treatment with statin-, niacin-, fibrate-, ezetimibe-, and omega 3 fatty acid-containing regimens reduced non-HDL-C by approximately 9-65%. In a range of clinical trials, long-term treatment with these agents also significantly decreased the incidence of clinical/angiographic/imaging efficacy outcome variables. For patients with dyslipidaemia, consensus guidelines have established non-HDL-C treatment targets 30 mg/dl higher than LDL-C goals. Ongoing prospective randomised controlled trials should help to resolve controversies concerning (i) the clinical utility of targeting non-HDL-C in patients with dyslipidaemia; (ii) the most efficacious and well-tolerated therapies to reduce non-HDL-C (e.g. combination regimens); and (iii) associations between such reductions and clinical, angiographic, and/or imaging end-points. |
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Authors:
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T A Jacobson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-11-24 |
Journal Detail:
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Title: International journal of clinical practice Volume: 65 ISSN: 1742-1241 ISO Abbreviation: Int. J. Clin. Pract. Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9712381 Medline TA: Int J Clin Pract Country: England |
Other Details:
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Languages: eng Pagination: 82-101 Citation Subset: IM |
Copyright Information:
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© 2010 Blackwell Publishing Ltd. |
Affiliation:
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Office of Health Promotion and Disease Prevention, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. tjaco02@emory.edu |
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Descriptor/Qualifier:
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| Comments/Corrections | |
Comment In:
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Int J Clin Pract. 2011 Jan;65(1):3-5
[PMID:
21155938
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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