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The increase in total cholesterol, c-LDL, low levels of HDL-c are considered major cardiovascular risk factors and hypertriglyceridemia is considered as an additional cardiovascular risk factor in the most recent management guidelines, such as the American Association of Clinical Endocrinologists enacted in 2017 (1). The CARMELA study, conducted in 7 Latin American cities, showed a high prevalence of dyslipidemia in the region, from 37.8% in Buenos Aires to Barquisimeto (Venezuela), to 68.1% in Lima (Peru) (2) . The reduction of LDL-C with statins is one of the key pharmacological strategies to reduce atherogenic cardiovascular risk: a reduction of 39 mg / dL in LDL-C levels reduces the risk of major cardiovascular events by 21% (3) . The residual cardiovascular risk persists despite optimal treatment with statins, and is partly explained by the persistence of other risk factors such as hypertriglyceridemia and low levels of HDL-C, which together with high concentrations of dense LDL and small, constitute the atherogenic triad (4). The addition of other therapies to statin therapy, such as fibrates to reduce triglycerides and increase c-HDL and the addition of ezetimibe to achieve LDL targets in patients who do not achieve them with monotherapy, are recommended in current management guidelines of dyslipidemias (1).


  1. Jellinger PS,et al. American Association Of Clinical Endocrinologists And American College Of Endocrinology Guidelines For Management Of Dyslipidemia And Prevention Of Cardiovascular Disease. Endocr Pract. 2017 Apr;23(Suppl 2):1-87.
  2. Vinueza R, et al; CARMELA Study Investigators. Dyslipidemia in seven Latin American cities: CARMELA study. Prev Med. 2010 Mar;50(3):106-11.
  3. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2889‑934.
  4. Fruchart JC, et al; Residual Risk Reduction Initiative (R3i). Residual macrovascular risk in 2013: what have we learned? Cardiovasc Diabetol. 2014 Jan 24;13:26.

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