New European Atherosclerosis Society’s guidance highlights need to target triglycerides and high-density lipoproteins to reduce cardiovascular disease risk
New European Atherosclerosis Society’s guidance highlights need to target triglycerides
Wokingham, England, 27 June 2011:Kowa Pharmaceutical Europe welcomes new guidance from the European Atherosclerosis Society (EAS) that focuses on the importance of tackling elevated triglycerides (TGs) and increasing low levels of high-density lipoprotein cholesterol (HDL-C).[i]
"There is a real need for change in the way clinicians treat patients and the strategies recommended by the EAS should be applied in daily practice as soon as possible," said Drummond Paris, President of Kowa Research Europe and Kowa Pharmaceuticals Europe. "The EAS guidance and its focus on targeting HDL-C and TGs, as well as LDL-C, is an important step towards better management of patients at risk of cardiovascular disease."
Currently, lifestyle modifications form the basis of all lipid and cholesterol management, but poor adherence often results in the need for pharmacological intervention.1 In these cases, statins remain first-line treatment for patients at risk of cardiovascular disease (CVD), as they typically decrease low-density lipoprotein cholesterol (LDL-C),[ii] which is associated with an increased risk of heart attack and stroke.[iii]
However, the EAS guidance, published in the European Heart Journal, recommends targeting HDL-C,1 which is suggested to be the second most important coronary risk factor, after LDL-C, in type 2 diabetes patients.[iv] Evidence suggests that patients with cardiometabolic abnormalities who achieve reduced levels of LDL-C remain at high risk of cardiovascular events. In fact, 50% of all high risk patients being treated with a statin may require treatment optimisation to help elevate HDL-C. A further 10-15% may need additional treatment to target high TGs and low levels of HDL-C.1
Consistent with the European Society of Cardiology (ESC) guidelines on CVD prevention in clinical practice,2 the EAS recommends HDL-C should be less than 1.0 mmol/L (40 mg/dL) in men and women. TGs should also be more than or equal to 1.7mmol/L (150 mg/dL). 1
To date, physicians have relied on combination therapy to increase HDL-C. However, recent trials have failed to demonstrate the benefit of combination therapy.[v],[vi],[vii] The AIM-HIGH trial, designed to demonstrate whether extended-release niacin could decrease the risk of heart disease in patients when given in combination with simvastatin, was halted in May 2011. This was due to lack of efficacy.5
Recently published data from Japan suggests that differences between statins regarding their effects on HDL-C may lead to differences in cardiovascular outcomes.[viii] Patients are already benefitting from newer statins that have been shown to effectively manage additional lipid fractions, targeting not only LDL-C, but also HDL-C and TGs.[ix],[x],[xi],[xii],[xiii]
[i] Chapman MJ, Ginsberg HN, Amarenco P et al. European Atherosclerosis Society Consensus. European Heart Journal. Available: http://eurheartj.oxfordjournals.org/content/early/2011/04/29/eurheartj.ehr112.full.pdf+html . Accessed May 2011.
[ii] Graham I, Atar D, Borch-Johnsenet al. European guidelines on cardiovascular disease prevention in clinical practice: executive
summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts).Eur Heart J2007;28:2375-2414.
[iii] Mackay J, Mensah G.Atlas of Heart Disease and Stroke.2004 World Health Organization. Geneva
[iv] Turner R, Millns H, Neil HA, et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23).BMJ1998;316:823-828
[v] National Institute of Health. NIH stops clinical trial on combination cholesterol treatment. Available http://www.nih.gov/news/health/may2011/nhlbi-26.htm. Accessed June 2011
[vi] Tonkin AM, Chen L. Effects of combination lipid therapy in the management of patients with type 2 diabetes mellitus in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.Circulation. 2010;122(8):850-2
[vii] Barter P. Lessons learned from the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) trial.Am J Cardiol. 2009;104(10 Suppl):10E-5E.
[viii] Maruyama T, Takada M, Nishibori Yet al.Comparison of Preventive Effect on Cardiovascular Events With Different Statins. The CIRCLE Study.Circulation Journal in press 2011
[ix] Budinski D, Arneson V, Hounslow N,et al. Pitavastatin compared with atorvastatin in primary hypercholesterolemia or combined dyslipidemia.Clin Lipidol 2009;4(3):291-302
[x] Stender S, Hounslow N. Robust efficacy of pitavastatin and comparable safety to pravastatin.Atherosclerosis Suppl. 2009; 10(2):e945
[xi] Ose L, Budinski D, Hounslow Net al. Long-term treatment with pitavastatin is effective and well tolerated by patients with primary hypercholesterolemia or combined dyslipidemia.Atherosclerosis2010;210(1):202-208
[xii] Ose L, Budinski D, Hounslow Net al. Comparison of pitavastatin with simvastatin in primary hypercholesterolaemia or combined dyslipidaemia.Current Medical Research and Opinion 2009;25(11):2755-2764
[xiii] Ose L. Pitavastatin: finding its place in therapy.Ther Adv Chronic Dis. 2011. Published online before print. January 26, 2011, doi: 10.1177/2040622310389227