ABSTRACT

In the “lipid world,” the reduction of plasma cholesterol (particularly LDL-cholesterol) concentrations is widely and appropriately emphasized in the management of the patient at high risk of coronary heart disease (CHD). However, patients and physicians also need to be aware that abdominal obesity, especially when accompanied by markers of metabolic abnormalities such as elevated triglyceride concentrations or other features of the metabolic syndrome, is characterized by an atherogenic dyslipidemia which CHD risk is not often captured by LDLcholesterol levels (1,2). For instance, the typical high triglyceride-low HDL-cholesterol, small dense LDL dyslipidemia, which is trequently found in patients with abdominal obesity, further increases the risk of CHD assumed from the presence of classical risk factors including a given LDL-cholesterol level (3-6). Thus, even optimal management of traditional risk factors is unlikely to normalize the level of CHD risk found in patients who have the additional athero-thrombotic-inflammatory abnormalities of abdominal obesity.