Understanding and managing the atherogenic dyslipidemia: the new frontier for cardiovascular risk reduction

Over the few decades the global increase in obesity, -acquiring an almost epidemic nature-, has led to a change in the most common phenotype presentation of lipid abnormalities, being metabolic or atherogenic dyslipidemia, the most prevalent form, also strongly associated with an increased risk of cardiovascular disease. Despite the very good results achieved from statin management of LDL, there still remains a considerable residual risk, given the preponderance of clinical forms of non-LDL lipid abnormalities. These qualitative and quantitative lipid modifications are strongly associated with insulin resistance, obesity and type 2 diabetes. In this review, we analyze the pathophysiology of this type of dyslipidemia characterized by elevated triglycerides, low HDL-C, preponderance of small and dense LDL, accumulation of remnant lipoproteins and postprandial hyperlipidemia. We also discuss the relationship of atherogenic dyslipidemia with the development of atherosclerotic cardiovascular disease and we finally describe the therapeutic approaches that include changes in lifestyle as well as current pharmacological interventions to prevent cardiovascular events.