Aliza Hussain1, Christie M Ballantyne1,2, Anum Saeed3, Salim S Virani4,5,6,7. 1. Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA. 2. Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. 3. University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 5. Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 6. Section of Cardiology, Michael E. DeBakey Veterans Affairs Hospital, Houston, TX, USA. virani@bcm.edu. 7. Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA. virani@bcm.edu.
Abstract
PURPOSE OF REVIEW: This review focuses on recent evidence examining the role triglycerides (TG) and triglyceride-enriched lipoproteins (TGRL) play in atherosclerotic cardiovascular disease (ASCVD). It also provides a succinct overview of current and future TG-lowering therapies for ASCVD risk reduction. RECENT FINDINGS: Epidemiological and Mendelian randomization studies have consistently shown that TGRL are strongly associated with ASCVD. REDUCE-IT demonstrated cardiovascular benefit with icosapent ethyl in high-risk patients with hypertriglyceridemia on statin therapy. Polymorphisms in APOC3 and ANGPTL3 are associated with ASCVD and use of RNA-interfering therapies to target these proteins has shown TG lowering in early phase trials. TG and TGRL are causally associated with ASCVD. Lifestyle modifications and statin therapy can lower TG/TGRL and are considered first-line treatment for hypertriglyceridemia. Icosapent ethyl has been shown to reduce residual ASCVD risk in high-risk patients on maximally tolerated statins. Ongoing clinical trials will better define optimal therapy for patients on statins with residual hypertriglyceridemia.
PURPOSE OF REVIEW: This review focuses on recent evidence examining the role triglycerides (TG) and triglyceride-enriched lipoproteins (TGRL) play in atherosclerotic cardiovascular disease (ASCVD). It also provides a succinct overview of current and future TG-lowering therapies for ASCVD risk reduction. RECENT FINDINGS: Epidemiological and Mendelian randomization studies have consistently shown that TGRL are strongly associated with ASCVD. REDUCE-IT demonstrated cardiovascular benefit with icosapent ethyl in high-risk patients with hypertriglyceridemia on statin therapy. Polymorphisms in APOC3 and ANGPTL3 are associated with ASCVD and use of RNA-interfering therapies to target these proteins has shown TG lowering in early phase trials. TG and TGRL are causally associated with ASCVD. Lifestyle modifications and statin therapy can lower TG/TGRL and are considered first-line treatment for hypertriglyceridemia. Icosapent ethyl has been shown to reduce residual ASCVD risk in high-risk patients on maximally tolerated statins. Ongoing clinical trials will better define optimal therapy for patients on statins with residual hypertriglyceridemia.
Authors: Alejandro Hernández-Camba; Marta Carrillo-Palau; Laura Ramos; Laura de Armas-Rillo; Milagros Vela; Laura Arranz; Miguel Á González-Gay; Iván Ferraz-Amaro Journal: Clin Transl Gastroenterol Date: 2022-06-01 Impact factor: 4.396