Atherogenic lipid triad: another type of dyslipidemia

Besides elevation of TC and LDL-cholesterol levels, several other types of dyslipidaemias appear to predispose to premature CVD6. A specific common pattern is termed the atherogenic lipid triad. It consists of the co-existence of three lipid abnormalities: mildly elevated plasma triglyceride (TG) levels (due to increased very low density lipoprotein remnant particles), low HDL-cholesterol concentrations and the presence of increased small,

dense LDL particles6. As there is limited evidence on the effectiveness and safety of intervening in this pattern to reduce CVD risk, this pattern or its components must be regarded as optional targets of CVD prevention6.

Therefore, lowering LDL-cholesterol remains the main target for reducing CVD risk.

Blood pressure: a second target for preventing CVD

Hypertension or elevated blood pressure (BP), namely Systolic BP ≥ 140 and/or Diastolic BP ≥ 90 mmHg has been identified as one of the major risk factors for CHD, stroke and heart failure10.

High sodium (salt) intake, low potassium intake, high alcohol consumption, smoking and physical inactivity, as well as body weight gain may increase BP in susceptible subjects11.

Targeted lifestyle modifications are the cornerstone for the prevention of hypertension. Healthy diet and lifestyle interventions are recommended in all patients with elevated or high-normal BP, namely pre-hypertension (Systolic BP 130-139 and/or Diastolic BP 85-89 mmHg), as well as to prevent elevated BP3.

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Dietary modifications should form the basis for CVD prevention

Other modifiable CVD risk factors: Obesity

Dyslipidemia, diabetes, and CVD, or any combination of these, are the most common metabolic complications of obesity. Risk of CHD, ischemic stroke and type 2 diabetes increases steadily with an increasing body mass index (BMI)12.

Weight reduction, as well as prevention of further body weight gain is indispensable to prevent or delay the major metabolic complications of obesity and to reduce CVD risk3.

Other modifiable CVD risk factors: Diabetes

CVD is the leading cause of morbidity and mortality in people with diabetes mellitus3. Patients with diabetes, especially type 2 diabetes, often have an unhealthy blood lipid profile, including high LDL-cholesterol, low HDL-cholesterol, and high TG. Together with hyperglycemia, dyslipidemia in diabetic patients may facilitate the development of CHD and other complications of atherosclerosis3.

Diet and lifestyle intervention remains a key component for CVD prevention also in patients with diabetes. Weight reduction in overweight or obese subjects, increasing physical activity and adopting a healthy, well-balanced diet are fundamental considerations to improve both glycemic control and the blood lipid profile, thus reducing CVD risk.