Background: Atherosclerotic Cardiovascular Disease (ASCVD) is the first cause
of death in Western Countries. Several risk factors contribute to generate atherosclerosis and
the preventive therapeutic approaches, in particular statin therapy, reduce the mortality.
However, the residual risk in statin treated patients remains significant, despite reaching the
low density lipoproteins cholesterol (LDL-C) goals.
Methods: we reviewed the literature published in PUB-MED to discuss the role of residual
dyslipidemia in particular high density lipoprotein cholesterol (HDL-C), triglycerides (TGs)
and lipoprotein(a) [Lp(a)], genetic factors, suboptimal implementation of lifestyle therapy,
mood disorders associated to low compliance to application of evidence-based therapies or
related to ASCVD.
Results: we summarized the current knowledge on the topic, evidencing its contradictory
Conclusion: HDL-C is an important biomarker for predicting cardiovascular risk, but the classical HDL hypothesis
is no longer correct and it is now being replaced by the HDL function hypothesis, thought more studies are
needed to validate it. The connection between cardiovascular risk and levels of TGs is not so definite. APOE
genotype and Lp(a) levels are two genetics factors associated to CV risk. Healthy lifestyle with particular dietetic
factors, connected to psychological aspects, are very important for the optimal control of the global risk.