Cardiovascular risk and lipid management beyond statin therapy: the potential role of omega–3 polyunsaturated fatty acid ethyl esters

Abstract

Although statins are widely effective at reducing LDL cholesterol (LDL–C) and clinical cardiovascular events, the risk of cardiovascular disease remains high in certain patient subgroups, despite effective LDL–C reduction. This is typically the case in those with Type 2 diabetes. This ‘residual risk’ is partly attributable to lipid abnormalities distinct from LDL–C, such as elevated triglyceride (TG)–rich lipoproteins and low levels of HDL cholesterol (HDL–C). Clinical trials demonstrate that use of other lipid–modifying therapies in combination with statins can further improvelipidprofiles:inhibitorsofcholesterolandbileaciduptakemainlyaffectLDL-C,whileniacin,fibratesand ω–3 polyunsaturated fatty acid ethyl esters target other plasma lipids, particularly TG and HDL–C. In current practice,patientswithhigherTGsandlowerHDL-Cappeartohavethegreatestpotentialtobenefitfromuseof additional medications on the background of statin therapy.

Key Words:

• cardiovascular disease
• cholesterol
• dyslipidemia
• ezetimibe
• fibrate
• nicotinic acid
• ω–3 PUFA ethyl ester
• statin
• triglyceride