Treating lipids in cardiovascular disease: new directions
Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
* Correspondence: Professor Olov Wiklund, Department of Cardiology, Sahlgrenska University Hospital, Sahlgrenska, SE-413 45 Göteborg, Sweden
Abstract
Aims To review the importance of lipid parameters beside low-density lipoprotein (LDL) levels as risk factors for cardiovascular disease, and their potential as therapeutic targets for lipid-lowering agents.
Methods and Results Large numbers of studies have shown that, as well as high low-density lipoprotein (LDL) levels, low high-density lipoprotein (HDL) levels and a high LDL/HDL ratio are important cardiovascular disease risk factors. The new generation of statins, such as cerivastatin, demonstrates greater potency in getting more patients to their LDL-C targets, as recommended by the U.S. NCEP guidelines. Statins and also fibrates can increase HDL levels. In the VA-HIT study, for example, a 6% increase in HDL level using gemfibrozil was associated with a 22% reduction in the relative risk of coronary events compared with placebo. Statin treatment, by decreasing LDL and increasing HDL levels, produces strong reductions in the LDL/HDL ratio. In a cerivastatin study, the percentage of patients with LDL/HDL ratio <3 (low risk of coronary heart disease) increased from 32% (baseline) to 90% after 8 weeks of therapy. The density of LDL particles also affects cardiovascular disease risk. Studies have shown that small dense LDL particles have atherogenic properties, and that lipid-lowering therapy can alter the LDL density profile. The TRIGMA trial is investigating the effect of cerivastatin on LDL particle size and triglyceride levels in patients with type 2 diabetes.
Conclusions Other lipid parameters, besides LDL levels, can provide new targets for lipid intervention therapy.
Key Words: Cardiovascular disease • low-density lipoprotein • high-density lipoprotein • statins • cerivastatin