Current trends in solving the problem of residual cardiovascular risk

Abstract

Cardiovascular mortality is an urgent health problem not only in the Russian Federation, but also throughout the world. Patients of high cardiovascular risk, which suffering from ischemic heart disease and attending dyslipidemia, remain with high residual risk of cardiovascular complications such as unstable angina, myocardial infarction, stroke even in the case of achieved target level of atherogenic lipoproteins, no matter effective multicomponent hypolipidemic therapy. This article reviews the relevant scientific literature, meta-analyses of studies, randomized clinical trials of lipid-lowering drugs, examines the main reasons for the persistence of residual cardiovascular risk, evaluates the role of each clinical diagnostic marker in its progression, among which are the level of lipoprotein (a), triglycerides and other atherogenic lipoproteins, persistent aseptic inflammation of the vascular wall, the markers of which are highly sensitive C-reactive protein, interleukin-6, interleukin-1β. Possible therapeutic strategies for reducing residual risk depending on the etiological factor are discussed including the effectiveness in reducing residual cardiovascular risk with omega-3 polyunsaturated fatty acids, fibrates, options for RNA interference with small interfering RNA and antisense oligonucleotides usage, lipoprotein apheresis, as well as anti-inflammatory therapy using colchicine, low doses of methotrexate and monoclonal antibodies that inhibit the production of proinflammatory interleukins. Assessing a patient’s residual risk in clinical practice allows us to determine the insufficiency or ineffectiveness of secondary prevention measures and choose a different, more modern or comprehensive tactic for cardiovascular risk reducing.