Q: My doctor has me on Lipitor and is happy with my LDL, but he is now bothered by something he calls “residual risk.” I don’t understand this concept and was hoping you might explain it.
A: Residual risk is the term commonly used to refer to the remaining risk of a heart attack or stroke that remains after a patient’s LDL is brought under control with therapy. Things that contribute to this are high triglyceride levels (which have been shown to cause hardening of the arteries by themselves) and low HDL levels, which have also been shown to confer a risk of atherosclerosis. Data shows that if you just lower the LDL to goal, you may still have 65-75 percent of the original risk of a cardiac event remaining (hence the term “residual” risk). Most physicians use statins to control LDL. To reduce residual risk, non-statin drugs are used in combination with statins. The right combination is dictated by the patient’s unique lipid issues. Just as combination therapy is used in the treatment of high blood pressure and diabetes, it is often used in the optimal management of lipid disorders, with the most complex patients requiring up to six different drugs to get, and keep, them under control.
— Dr. John Wood, Beacon Associates in Internal Medicine, Chattanooga-Hamilton County Medical Society
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