Dyslipidaemia and global cardiovascular risk: clinical issues
Institute of Arteriosclerosis Research, University of Münster, Domagkstrasse 3, 48149 Münster, Germany
Corresponding author. Tel: +49 251 83 47 222; fax: +49 251 83 47 225. E-mail address: assmann{at}uni-muenster.de
Improvements in cardiovascular outcomes have occurred in recent decades, but a serious burden of cardiovascular morbidity and mortality remains. Data from large, prospective observational studies, such as the PROspective CArdiovascular Münster (PROCAM) Study, have facilitated the design of simple risk factor scoring systems suitable for the estimation of global cardiovascular risk in routine clinical practice. These systems show that dyslipidaemia remains an important contributor to global cardiovascular risk, despite the increased success in controlling LDL cholesterol in recent years. Data from PROCAM have shown that low HDL cholesterol is prognostically important, especially in patients at high global risk due to the presence of concomitant risk factors and in patients with concomitant low HDL cholesterol and hypertriglyceridaemia. Newer techniques, including neural network analysis, myocardial imaging, and genotyping, are likely to add to the precision with which patients requiring cardiovascular intervention are identified in the future. The management of global cardiovascular risk is based on addressing individual cardiovascular risk factors, including hypercholesterolaemia, low HDL cholesterol, and hypertension. In particular, consideration should be given to correcting low HDL cholesterol by the addition of nicotinic acid or a fibrate to the therapeutic regimen in addition to treatments to control LDL cholesterol.
Key Words: Cardiovascular risk • Coronary heart disease • Cardiovascular risk engines • Dyslipidaemia