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Remnant Lipo Proteins –Residual Vascular Risk 237

• Remnant lipoproteins levels correlated well with (ANGPTL3 ANGPTL4) and IHD.
CV risk also
• Pivotal role of Peroxisome –Proliferator Activated
• in Japanese patients with established CAD Receptor PPAR is controlling key areas lipid me-
tabolism leading to the drug Pemafibrate which is
• In patients with Fredrickson type III dysbetalipo- now being evaluated in PROMINENT CARDIOVAS-
protienemia (Familiar type due to defective apo E) CULAR outcomes study.
serum remnants are increased leading to develop-
ment of xanthomas and risks for cv events . • CANTOS ( Canakinumab-Antiinflammatory Throm-
bosis outcomes study).
• Recently , levels of RLPs defined as (sum of VLD3
+ IDL) are highly associated with risk for CV events • -Atherosclerosis multidimensional event.
in Framingham heart study and Jackson heart • Canakinumab is a monoclonal antibody selectively
study and meta analysis performed in both co- neutralited IL-1. which plays multiple roles in athero
horts.
thrombolic process.
• Thus, RLPs similarly correlated with CV events in
both Caucasians and African Americans. CONCLUSION:

• The Residual Risk reduction initiative has highlight- Perhaps, therefore we need to revise how we man-
ed the importance of this RLPs related dyslipid- age residual vascular risk since Atherosclerosis is
emia as a major risk factor especially in patients multifactorail.not only we need to consider cholester-
with Diabetes Melitus Obesity. ol related residual risk typified by high LDL-C levels
but also by high levels of triglyceride rich RLP s or
Therapeutic Perspectives:4 increased inflammation.
• Therapeutic targeting of Triglyceride levels below Given the escalating burden of cardiomatabolic dis-
150 mg is recommended in patients at high risk eases globally, this would make sense clinically and
of Vascular Diseases after LDL lowering. fiscaly.

Life Style Pharmocological REFERENCES:
1. Weight reduction 1. Statins 1. Pharmacology &Therapeutics. 141.2014.358-367. AneHe varbo.marianne
2. Regular Physical 2. Niacin Benn, BorgeG, Nordestgaard., Associate Editor : M.J.Chapman.
activity 2. Remnant Lipoprotiens and Atherosclerotic disease Feb10.2014., Peter.p.
Toth.M.D.Ph.D.FACC American college of Cardiology.
3. Smoking cessation 3. Fibrates
3. Current opinion in Lipidology Remnant Lipoproteins. Vaebo, AneHe,Nord-
4. Reduced alcohol 4. Considering data from estgaard,BorgeG, August.2017-volume 28-Issue 4-P300-307.
↓ largely completed and
Act decreasing Hepatic ongoing trials. 4. R31 Editorial .28 July.2017. Targeting residual Cardiovascular risk: Lipids
and beyond. Prof .Jean Charles Fvuchart. Prof. Michael Hermans. Prof.
Secretion and Pierre Amarenco.
↑ Hepatic Clarence of Final word is not said
VLDL for the effective of
these drugs in lowering
Residual risk.
• Omega -3 Fatty acids- Fish oils here conflicting
results.
• Drugs targeting apo B –mipomersen MTP inhibi-
tor-Lomitapide.
• Antibodies against Plasma Proprotein Convertase
Subtilisiol Kexin type a (PCSKQ).
• Promotes update of LDL and increases desvada-
tion of LDL.
• Genetherapy for LDL deficiency.
• Genetic studies showing evidence of associa-
tion between apo c III|Angiopoietinslike 3 and 4

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