Editorial [Hot Topic: Cardiovascular Disease: Focus on Dyslipidemia (Executive Guest Editor: I. Gouni-Berthold)]

Atherosclerotic vascular disease is the most prevalent medical condition in Western societies and is associated with significant morbidity and mortality. One of the most important factors for atherogenesis is the low-density lipoprotein (LDL)-cholesterol. The review articles included in this issue, authored by international experts in the field, are aiming to summarize in a multidisciplinary manner the current knowledge on the subject of dyslipidemia and cardiovascular disease and to discuss future and alternative therapeutic options for the management of dyslipidemia. In the first article [1], the author offers a review of the existing evidence on lipid-lowering therapy with statins in primary and secondary prevention of cardiovascular disease. Poss et al. [2] discuss the other key lipoprotein in cardiovascular disease pathophysiology, namely high density lipoprotein (HDL)-cholesterol. The authors discuss the epidemiological evidence supporting the role of low HDL-cholesterol as a cardiovascular risk factor, offer pathophysiological mechanisms through which HDL may exert its anti-atherosclerotic effects and review currently available strategies as well as therapeutic options under development for increasing HDL-cholesterol concentrations. They furthermore discuss the role that triglycerides may play in the pathogenesis of atherosclerosis reviewing the epidemiological evidence supporting such an association, and the therapeutic modalities available for the treatment of hypertriglyceridemia. The review by Parhofer [3] addresses the treatment options available for decreasing the blood concentrations of another pro-atherogenic lipoprotein, namely lipoprotein (a). The effects of currently available therapeutic options (albeit of limited potency) such as aspirin, thyroid and sex hormones, L-carnitine, statins and niacin are being evaluated and emerging therapeutic options such as CETP-inhibitors are being reviewed. The role of lipoprotein (a) apheresis is critically discussed. Berthold [4] tackles the complex problem of lipid-lowering drug therapy in a rapidly rising part of the population, namely the elderly. In a comprehensive review he addresses questions such as for which of the lipid-lowering drugs there is evidence of benefit for the elderly, how should the risk assessment be performed in this population, what do the American and European guidelines recommend, what is the evidence for primary and for secondary cardiovascular disease prevention, what do meta-analytic evaluations show, what evidence is there for statin use and cerebrovascular endpoints and the role (if any) of other (non-statin) lipid-lowering drugs. Furthermore, the author discusses the very relevant issue of safety of lipid-lowering therapy in the elderly, as well as the question whether statins may affect cognitive function and their role (if any) in preventing and/or treating dementia. Burst [5] reviews the subject of dyslipidemia and cardiovascular disease in the patient with chronic kidney disease (CKD). Issues discussed are the epidemiology of cardiovascular disease in the patient with CKD, the lipid disorders associated with renal disease and the available evidence regarding the use of lipid-lowering treatment in this population. Moreover, the dyslipidemia of the nephrotic syndrome and the dyslipidemia that develops after liver transplantation are addressed as well as the respective guidelines. Economou et al. [6] discuss the dyslipidemia observed in women with the polycystic ovary syndrome (PCOS). In specific, the authors address the pathophysiologic mechanisms of dyslipidemia in PCOS, the pattern of dyslipidemia, the issue of the potentially increased risk of cardiovascular disease in this population and the pluripotential effects of lipid-lowering treatment. Moreover, they address the effects of the various drugs used in women with PCOS, such as metformin, thiazolidinediones and antiandrogens, on the lipid profile. The review of Baumgartner et al. [7] examines the role of plant sterols and stanols in the treatment of dyslipidemia as well as their effects beyond LDL-cholesterol lowering such as effects on triacylglycerol concentrations and endothelial function. The controversial issue of the potential atherogenicity of plant sterols is comprehensively discussed. A known authority in the area of vitamin D research Armin Zittermann [8] reviews the role of vitamin D in dyslipidemia and cardiovascular disease. Experimental studies on the role of vitamin D and atherosclerosis as well as epidemiological studies on the association between vitamin D and blood lipids, the role of vitamin D supplementation on blood lipids, and the effects of statins on vitamin D metabolite concentrations are addressed. Moreover, the trials examining the association between vitamin D, vascular calcification and cardiovascular disease are critically discussed. Rizzo [9] reviews the role of a new class of lipid-modulating drugs, namely the microsomal transport protein inhibitors. Pre-clinical and clinical data available on these agents are being presented and their adverse events addressed. Subject of the last review [10] of this issue is the potential role of antisense oligonucleotides (ASO) in the treatment of dyslipidemia. The development of ASO is being discussed, from first to third generation, with emphasis put on the efficacy and safety data of the first ASO to soon become commercially available, namely mipomersen, an ASO against apolipoprotein B-100. The role of proprotein convertase subtilisin-like/kexin type 9 (PCSK9), diacylglycerol acyltransferase (DGAT), the peroxisome proliferator-activated receptor γ coactivator-1 (PGC-1), the adipose differentiation-related protein (ADRP) and the steatoryl-CoA desaturase 1 (SCD1) as potential targets of antisense technology for the treatment of dyslipidemia is also discussed. I would like to thank the contributors to this special issue for their participation and hope that this issue will provide some insights for all scientists working on the challenging field of cardiovascular disease....