The Forgotten Majority
Open accessAbstract
Despite meaningful progress in the identification of risk factors and the development of highly effective clinical tools, deaths from cardiovascular disease continue to increase worldwide. Sparked by an obesity epidemic, the metabolic syndrome and the rising incidence of type 2 diabetes have led to an upsurge of cardiovascular risk. Although pharmacologic treatments with the statin class of drugs have reduced cholesterol levels and lowered mortality rates, several large controlled clinical trials, including the Scandinavian Simvastatin Survival Study, the Cholesterol and Recurrent Events trial, the Air Force/Texas Coronary Atherosclerosis Prevention studies, and Long-term Intervention with Pravastatin in Ischemic Disease study, have indicated that cardiovascular events continue to occur in two thirds of all patients. Follow-up studies, such as the Heart Protection Study and the Pravastatin or Atorvastatin Evaluation and Infection Therapy/Thrombolysis In Myocardial Infarction-22 trials, reinforced these earlier results. Although therapy with gemfibrozil, a fibric acid derivative, showed reduced occurrence of cardiovascular events in the Helsinki Heart Study and the Veterans Affairs HDL Intervention Trial, results of other studies, e.g., the Bezafibrate Intervention Program and the Diabetes Atherosclerosis Intervention study, showed less encouraging results. Although lifestyle modifications, such as improved diet and increased exercise levels, benefit general health and the metabolic syndrome and insulin resistance in particular, most people continue to resist changes in their daily routines. Thus, physicians must continue to educate their patients regarding an optimal balance of drug therapy and personal behavior.
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The substantial residual risk of atherothrombotic events that remains after current optimum medical therapy has led to the pursuit of novel therapeutic strategies or adjunct therapies.
“The substantial residual risk of atherothrombotic events that remains after current optimum medical therapy has led to the pursuit of novel therapeutic strategies or adjunct therapies48, some of which are discussed below.”
From Perspectives and opportunities for nanomedicine in the management of atherosclerosis (2011) · cites this paper as [48]
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- Authors
- Libby, P.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Libby, Peter
- ORCID
- Libby, Peter
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-10
- Volume
- 46
- Issue
- 7
- Pages
- 1225-1228
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1609483177
- Cited by
- 388
- References
- 25
- Citations by year
- 2026: 14 · 2025: 15 · 2024: 15 · 2023: 16 · 2022: 15 · 2021: 10 · 2020: 15 · 2019: 22 · 2018: 22 · 2017: 26 · 2016: 24 · 2015: 24 · 2014: 24 · 2013: 16 · 2012: 23
- FWCI
- 13.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (P50HL056985, HL56985)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- cardiovascular disease, statins, statin therapy, cardiovascular risk, metabolic syndrome, type 2 diabetes, obesity, gemfibrozil, fibrates, lifestyle modification, patient education, cardiovascular mortality
- MeSH terms
- Cardiovascular Diseases, Humans, Risk Factors, Time Factors
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