Hormonal
In patients at high cardiovascular risk who have achieved LDL-C goals, elevated triglycerides (≥1.7 mmol/L) and/or low HDL-C (<1.0 mmol/L) remain independent predictors of cardiovascular events, and therapeutic targeting of these markers provides incremental risk reduction.
If you are at high risk for heart disease and your LDL cholesterol is already at the target level, do not stop monitoring your lipids. Check your triglycerides and HDL levels. If triglycerides are high (≥150 mg/dL) or HDL is low (<40 mg/dL), discuss with your doctor. The first step is lifestyle changes (diet, exercise), but if these don't correct the levels, adding medications like niacin or fibrates, or intensifying your current therapy, may be necessary to further reduce your risk.
Current evidence supports a causal association between elevated TRL and their remnants, low HDL-C, and cardiovascular risk... The Panel believes that therapeutic targeting of elevated triglycerides (≥1.7 mmol/L or 150 mg/dL), a marker of TRL and their remnants, and/or low HDL-C (<1.0 mmol/L or 40 mg/dL) may provide further benefit.
Why this rating
Based on a consensus of large epidemiological studies (ERFC), genetic data, and clinical trial post-hoc analyses, though genetic evidence for HDL-C is noted as 'unclear'.
Source
Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management
M. John Chapman et al. · European Heart Journal · 2011
DOI 10.1093/eurheartj/ehr112
More from this paper
- Elevated triglycerides serve as a marker for increased numbers of triglyceride-rich lipoprotein (TRL) remnants, which are directly atherogenic by penetrating the arterial wall, accumulating in plaques, and promoting inflammation and thrombosis.Good
- Low HDL-C is associated with increased cardiovascular risk independent of LDL-C levels, and therapeutic strategies to raise HDL-C (e.g., niacin, fibrates) may provide benefit, although genetic evidence for HDL-C as a causal factor is less clear than for TRL remnants.Moderate
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