Press release || New European Atherosclerosis Society Statement on Triglyceride-Rich Lipoproteins
New European Atherosclerosis Society Statement on Triglyceride-Rich Lipoproteins and their Remnants
September 02, 2021: Gothenburg.
Triglycerides, a marker for triglyceride-rich lipoproteins and their remnants, are the focus of this latest Statement from the European Atherosclerosis Society (EAS) Consensus Panel. This ‘State-of-the Art’ review, published in The European Heart Journal, teases out what is known about these lipoproteins, and is a unique resource for all clinicians and scientists working with lipid disorders.
Co-lead author Professor Chris Packard of the University of Glasgow added: ‘A primary objective of the Consensus Panel was to provide a conceptual framework for current understanding of the structure and metabolism of triglyceride-rich lipoproteins, and in particular how ‘remnant’ particles are generated. This Statement will hopefully serve as a reference point for understanding the mechanism of action of novel lipid-lowering agents, and for the interpretation of future clinical trials.’
Consensus Panel Co‑chair Professor Henry N. Ginsberg of Columbia University, New York, USA said: ‘This work is the culmination of an 18-month effort by an international group of experts in the field of lipids and cardiovascular disease. Our goal was to offer clinicians and scientists a wide-ranging review of the very complex relations between elevated triglyceride levels and cardiovascular disease. While we did not answer all the questions, we believe this Consensus Panel Statement provides a path to improved treatment of individuals with hypertriglyceridaemia.’
Cardiovascular disease, which includes heart attacks and strokes, accounts for nearly half of all deaths and is a major cause of disability in Europe and beyond.1 Low-density lipoprotein cholesterol (LDL-C) is without doubt causal for cardiovascular disease, as discussed by past EAS Consensus Panel statements and the 2019 European Society of Cardiology/EAS dyslipidaemia guidelines.2,4 Yet even when LDL-C levels are below guideline-recommended goals, some patients continue to experience cardiovascular events. Triglycerides have long been thought to contribute to this residual cardiovascular risk, supported by population and genetic studies, as well as insights from clinical trials.
This new Statement provides essential background to the structure, metabolism, and atherogenicity of triglycerides, triglyceride-rich lipoproteins, and remnants, as well as appraisal of the latest evidence from clinical trials. Different strategies for lowering these lipoproteins are also considered. The Consensus Panel focuses on key questions about triglyceride-rich lipoproteins and their remnants, including:
- When do elevated triglyceride levels become clinically relevant?
- What are remnants: how do we define and measure these lipoproteins?
- How are remnant lipoproteins proatherogenic – and how are these properties assessed?
- How does the atherogenicity of triglyceride-rich lipoproteins and remnants compare with that of LDL?
At this time, the Consensus Panel recommends that clinicians should use triglycerides as a surrogate measure of triglyceride-rich lipoproteins and remnants. The Panel proposes working criteria for hypertriglyceridaemia, with a value >1.7 mmol/L or >150 mg/dL considered clinically relevant for risk for cardiovascular disease. Very much higher levels, (>10 mmol/L or 880 mg/dL), confer a high risk of pancreatitis.
The Panel highlights the need to develop a validated routine assay to measure remnants, as well as therapeutic options to lower circulating levels of these lipoproteins to reduce residual cardiovascular risk. This statement is especially timely as several novel approaches to managing elevated triglycerides are in late clinical trials. The Consensus Panel does, however, stress that LDL-C should remain the priority lipid target in the clinic.
Ginsberg HN, Packard CJ, Chapman MJ, Borén J, Aguilar-Salinas CA, Averna M, Ference BA, Gaudet D, Hegele RA, Kersten S, Lewis GF, Lichtenstein AH, Moulin P, Nordestgaard BG, Remaley AT, Staels B, Stroes ESG, Taskinen M-R, Tokgözoğlu LS, Tybjaerg-Hansen A, Stock JK, Catapano AL. Triglyceride-rich lipoproteins and their remnants: metabolic insights, role in atherosclerotic cardiovascular disease, and emerging therapeutic strategies—a consensus statement from the European Atherosclerosis Society. Eur Heart J 2021; doi:10.1093/eurheartj/ehab551
- Wilkins E, Wilson L, Wickramasinghe K, et al. European Cardiovascular Disease Statistics 2017. European Heart Network, Brussels. Available at www.ehnheart.org/cvd-statistics/cvd-statistics-2017.html
- Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017;38:2459-72.
- Borén J, Chapman MJ, Krauss RM, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease; pathophysiological, genetic and therapeutic insights. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2020;41:2313-30.
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-88.
EAS Administration Executive, Dr Carmel Hayes
Tel: +46 768 61 00 51
About the European Atherosclerosis Society
The EAS was founded in 1964 with the mission to “advance and exchange knowledge concerning the causes, natural history, treatment and prevention of atherosclerotic disease”. With atherosclerosis becoming an increasingly important concern as European populations grow older, the work of the Society is today more relevant than ever. The European Atherosclerosis Society represents nearly 1,000 basic scientists and clinicians.
For further information https://eas-society.org/
About the EAS Consensus Panel
This latest Consensus Panel Statement is the final in a series co-chaired by Professor John Chapman (France), Professor Henry N. Ginsberg (USA), and Professor Alberico L. Catapano (Italy). For further information: https://eas-society.org/publications-2/consensus/-2/consensus/