Management of atherogenic dyslipidemia of the metabolic syndrome: Evolving rationale for combined drug therapy

Atherogenic dyslipidemia is common in a variety of conditions associated with central obesity, hypertension, hyperurecemia, and impaired pancreatic β cell function, (ie, the metabolic syndrome). Most high-risk patients who have atherogenic dyslipidemia will require statin therapy; such therapy is encouraged on the basis of clinical trial evidence. Coadministration of drugs targeted for the reduction of LDL precursors (VLDL and IDL) are likely to improve the profile of atherogenic lipoproteins. In addition, coadministration will produce a significant rise in HDL cholesterol. Large clinical trials that show CHD risk reduction or improvement in CHD are needed with combined drug therapy. New drugs undoubtedly are needed to target fatty acid metabolism and inflammation. As we progress in the understanding of the metabolic origins of atherogenic dyslipidemia, new targets of therapy likely will be identified and new drug combinations will prove to be even more efficacious than those currently available for treatment of atherogenic dyslipidemia.