"The R3i has a huge task ahead to get people recognizing the threat of residual vascular risk and acting to better manage it," said Professor Jean-Charles Fruchart of the University of Lille, France and President of the R3i. "We have to look beyond using statins as a silver bullet to reduce LDL-cholesterol. The mindset that reducing one component to prevent heart disease is wrong and needs to change."

Epidemiological study methods

The PROCAM analysis used a case-control approach in which 823 men who had survived a MI were matched with an equal number of controls. Patients, who were matched for age, smoking status, type 2 diabetes status, blood pressure and LDL-C to an equal number of MI-free controls from the PROCAM cohort of 50,000 participants, a unique prospective investigation of coronary artery disease (CAD) and stroke risk factors in Germany.

The macrovascular REALIST survey was designed to determine, in patients at goal for LDL-C (less than or equal to 130 mg/dL whether treated or untreated for elevated LDL-C) with a first or subsequent coronary event, whether low HDL-C and/or elevated TG levels are associated with a significant risk of coronary event after adjustment for other risk factors. Adult male or female patients admitted to coronary care units (CCUs) or explored in cardiac catheter laboratories were matched with controls hospitalized for other reasons.

The microvascular REALIST survey was designed to determine whether low HDL-C and/or elevated TG levels are associated with a significant residual risk of microvascular complications. Data will be adjusted for other risk factors such as age, gender, diabetes duration, HbA1C, LDL-C levels, blood pressure, BMI and smoking status in patients with type 2 diabetes nearly at goal for LDL-C and presenting with incident microvascular complication (retinopathy, maculopathy or nephropathy). Diabetic neuropathy is an exploratory disease due to difficulties in establishing it with certainty in retrospective analysis. The REALIST surveys are currently being conducted in Belgium, Croatia, France, Italy, Japan, Philippines, Poland, Saudi Arabia, Spain, Thailand, Turkey and the U.S.

In the past three decades in the U.S., while the prevalence of abnormal levels of LDL-C has decreased, the prevalence of combined abnormal TG (greater than or equal to 150 mg/dL) and HDL-C ((less than)40 mg/dL) has doubled and the prevalence of elevated TG (greater than or equal to 150 mg/dL) has increased five-fold.(5) Elevated TG ((greater than)150 mg/dL) is also common, affecting about 50 percent of adults with prior CVD.(6)

Atherogenic dyslipidemia contributes to the increased risk of macrovascular events such as myocardial infarction and stroke, and may be implicated in microvascular complications such as diabetic eye, kidney and lower limb disease.(7)

- Among patients achieving LDL-C (less than)70 mg/dL with a statin, CVD risk is almost 60 percent greater for patients with TG (greater than) 200 mg/dL(8)

- In patients achieving LDL-C (less than)70 mg/dL with a statin, CV risk was higher in patients with a low HDL-C (HDL-C (less than)37 mg/dL vs. those with a HDL-C (greater than)55 mg/dL)(9)

Source: RESIDUAL RISK REDUCTION INITIATIVE FOUNDATION