Management of Dyslipidemia

Abstract

In the United States, 790,000 people sustain a myocardial infarction annually or one every 40 s (Mozaffarian et al. Circulation 131:e29–322, 2015). Of these, 114,000 will be fatal. Atherosclerosis is a complex, multifactorial disease. Over the course of the past five decades, numerous prospective observational cohort studies have established beyond any doubt that risk for atherosclerotic disease is driven by a number of risk factors, which include dyslipidemia, hypertension, insulin resistance and diabetes mellitus, obesity, cigarette smoking, and age (Stamler et al. JAMA 256:2823–2828, 1986; Castelli Can J Cardiol 4:5A–10A, 1988; Assmann et al. Eur Heart J 19:A2–11, 1998; Goldbourt et al. Br Med J Clin Res Ed 290:1239–1243, 1985; Verschuren et al. JAMA 274:131–136, 1995). The greater the burden of risk factors, the higher the likelihood for developing such manifestations of atherosclerosis as coronary artery disease (CAD), carotid artery disease, and peripheral arterial disease. Atherosclerotic disease is unequivocally associated with increased risk for myocardial infarction, stroke, renal artery disease and renal insufficiency, claudication and lower extremity amputation, and death. Progressive accumulation of lipid in arterial walls resulting in luminal obstruction is a cardinal structural manifestation of atherosclerotic disease. Arresting this process of lipid infiltration and retention is an important goal in modern cardiovascular medicine. Dyslipidemia is highly prevalent in the United States (Toth et al. J Clin Lipidol 6:325–330, 2012). Even when patients are treated, they tend to be undertreated leaving them with significant residual risk for developing atherosclerotic disease and sustaining both primary and secondary acute cardiovascular events (Toth Resid Staff Physician 53:s1–s7, 2007; Punekar et al. Clin Cardiol 38: 483–491, 2015; Punekar et al. Curr Med Res Opin 33:869–876, 2017).