Addressing residual risk beyond statin therapy: New targets in the management of dyslipidaemias–A report from the European Society of Cardiology Cardiovascular Round Table
Open accessAbstract
Cardiovascular (CV) disease is the most common cause of death in Europe. Despite proven benefits, use of lipid-lowering therapy remains suboptimal. Treatment goals are often not achieved, even in patients at high risk with atherosclerotic CV disease (ASCVD). The occurrence of CV events in patients on lipid-lowering drugs is defined as "residual risk", and can result from inadequate control of plasma lipids or blood pressure, inflammation, diabetes, and environmental hazards. Assessment of CV risk factors and vascular imaging can aid in the evaluation and management decisions for individual patients. Lifestyle measures remain the primary intervention for lowering CV risk. Where drug therapies are required to reach lipid treatment targets, their effectiveness increases when they are combined with lifestyle measures delivered through formal programs. However, lipid drug dosage and poor adherence to treatment remain major obstacles to event-free survival. This article discusses guideline-supported treatment algorithms beyond statin therapy that can help reduce residual risk in specific patient profiles while also likely resulting in substantial healthcare savings through better patient management and treatment adherence.
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Residual cardiovascular risk is multifactorial, involving elevated lipoprotein(a), chronic low-grade inflammation, and persistent elevations in triglyceride-rich lipoproteins.
“This risk is increasingly recognized as multifactorial, involving elements such as elevated lipoprotein(a), chronic low-grade inflammation (e.g., high-sensitivity C-reactive protein), and persistent elevations in triglyceride-rich lipoproteins (TRLs) [2].”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [2]
Residual cardiovascular risk persists in many patients despite optimal control of established factors such as LDL-C, blood pressure and glycaemia.
“However, despite intensive lipid-lowering therapy and achievement of guideline-recommended LDL-C targets, a substantial proportion of patients remain at high risk for cardiovascular events, a phenomenon known as residual cardiovascular risk [2].”
From Targeting triglycerides for cardiovascular risk reduction (2026) · cites this paper as [2]
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- Authors
- Mach, F., Visseren, F. L. J., Cater, N. B., Salhi, N., Soronen, J., Ray, K. K., Delgado, V., Jukema, J. W., Laufs, U., Zamorano, J.-L., Ros, E., Plat, J., Gesztes, A. G., Tokgozoglu, L., Packard, C., & Libby, P.
- Affiliations
- University Hospital of Geneva (CH)
- University Medical Center Utrecht (NL)
- Pfizer (United States) (US)
- Daiichi Sankyo (Germany) (DE)
- Imperial College London (GB)
- Hospital Universitari Germans Trias i Pujol (ES)
- Leiden University Medical Center (NL)
- University Hospital Leipzig (DE)
- Hospital Universitario Ramón y Cajal (ES)
- Hospital Clínic de Barcelona (ES)
- Maastricht University (NL)
- University of Glasgow (GB)
- Brigham and Women's Hospital (US)
- Corresponding author
- Mach, François
- ORCID
- Venue
- Journal of Clinical Lipidology
- Publisher
- Elsevier BV
- Published
- 2024-09
- Volume
- 18
- Issue
- 5
- Pages
- e685-e700
- ISSN
- 1876-4789 (ISSN-L)
- 1933-2874
- OpenAlex
- W4400390730
- Cited by
- 57
- References
- 133
- Citations by year
- 2026: 30 · 2025: 24 · 2024: 3
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- green
- dspace.library.uu.nl
- Licence
- Locations
- Journal of clinical lipidology (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Funders
- European Society of Cardiology
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- residual cardiovascular risk, dyslipidemia, lipid-lowering therapy, statin therapy, atherosclerotic cardiovascular disease, treatment goals, medication adherence, lifestyle intervention, cardiovascular risk assessment, vascular imaging, treatment algorithm, healthcare savings
- MeSH terms
- Cardiovascular Diseases, Europe, Humans, Risk Factors, Societies, Medical, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Dyslipidemias
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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