The National
Cholesterol Education Program Adult Treatment Panel guidelines have established
low-density lipoprotein cholesterol (
LDL-C) treatment goals, and secondary non-
high-density lipoprotein (HDL)-C treatment goals for persons with
hypertriglyceridemia. The use of
lipid-lowering
therapies, particularly
statins, to achieve these goals has reduced
cardiovascular disease (CVD) morbidity and mortality; however, significant residual risk for events remains. This, combined with the rising prevalence of
obesity, which has shifted the risk profile of the population toward patients in whom
LDL-C is less predictive of CVD events (
metabolic syndrome, low HDL-C, elevated
triglycerides), has increased interest in the clinical use of inflammatory and
lipid biomarker assessments. Furthermore, the cost effectiveness of pharmacological intervention for both the initiation of
therapy and the intensification of
therapy has been enhanced by the availability of a variety of generic
statins. This report describes the consensus view of an expert panel convened by the National
Lipid Association to evaluate the use of selected
biomarkers [
C-reactive protein,
lipoprotein-associated phospholipase A(2),
apolipoprotein B,
LDL particle concentration,
lipoprotein(a), and
LDL and HDL subfractions] to improve risk assessment, or to adjust
therapy. These panel recommendations are intended to provide practical advice to clinicians who wrestle with the challenges of identifying the patients who are most likely to benefit from
therapy, or intensification of
therapy, to provide the optimum protection from CV risk.