NENEWLY ASSESSED TRIGLYCERIDE LEVELS AND RESIDUAL RISK OF ATHEROSCLEROSIS

Morbidity and mortality caused by atherosclerotic cardiovascular disease (CVD) remain a major challenge in modern medicine. Extensive prospective studies of epidemiologic, genetic, and clinical data clearly demonstrate that LDL-cholesterol is a major risk factor for atherosclerosis and cardiovascular disease risk. In recent years, LDL-C levels have decreased with active intervention. Nevertheless, the so-called development of atherosclerosis and cardiovascular diseases (CVD) remained in a certain part of patients as known as Residual risk. One of the risk factors for this is an increase level of triglycerides (HTG) and lipoproteins containing triglycerides (Lp-TG) in the blood serum. Aim of the study: The aim of this review article is to show that, despite the widely studied and generally recognized pharmacological means of reducing the level of triglycerides and triglyceride-containing lipoproteins (Lp-TG) in the treatment of dyslipidemia, due to the global nature of the problem, the questions need to be answered. It is necessary to obtain information and consider new perspectives. The article discusses the relationship between elevated triglyceride (TG) and triglyceride-replacing lipoprotein (Lp-TG) levels and residual risk of atherosclerosis. Materials and Methods: Morbidity and mortality caused by atherosclerotic diseases are still the main challenge of modern medicine. Cardiovascular diseases (CVD) do not lose their relevance. This is indicated by the 2021 guideline for the reduction of cardiovascular disease of the European Society of Cardiology. There is found and indicated reductions based on which it was determined that even when the target level of LDL-C is reached, there is still a residual risk of developing CVD. The article discusses the studies based on the relationship between the increase in the level of triglycerides (TG) and triglyceride-replacing lipoproteins (Lp-TG) and the risk of developing atherosclerosis. Although the reduction of LDL-C level is the main fact of pharmacotherapy of dyslipidemia, the article deals with the current results of TG-lowering agents and the role of fibrates in this therapy, which are recognized by modern guidelines as the most effective class of TG-lowering agents. Conclusion: Cardiovascular diseases do not lose their relevance. This is indicated by the 2021 guideline for the reduction of cardiovascular disease of the European Society of Cardiology. Replacement of the SKORE table for the fatal risk of cardiovascular disease, which was widely implemented until now, with the SKORE -2 and SKORE OP (OLD PERSON) tables, where total cholesterol was replaced by non-DHL as one of the important predictors of the residual risk of atherosclerosis. The question that the therapy of dyslipidemia was subject to revision was raised, the picture was exacerbated in recent years by the increase in patients diagnosed with metabolic syndrome, obesity, diabetes mellitus type-2, whose blood (TG) and LDL-C levels were quite high. While hypolipidemic (high-intensity statins, ezetimibe, monoclonal antibodies) significantly decreases (up to the norm and below) the level of LDL.