Common pathways of hypercholesterolemia and hypertension leading to atherothrombosis: the need for a global approach in the management of cardiovascular risk factors

José Tuñón¹, José Luis Martín-Ventura¹, Luis Miguel Blanco-Colio¹, Nieves Tarín², Jesús Egido¹

¹Cardiology and Vascular Research Departments, Fundación Jiménez Díaz, Autónoma University, Madrid, Spain; ²Department of Cardiology, Hospital de Móstoles, Madrid, Spain

Abstract: In the last years there has been increasing evidence suggesting that the treatment of cardiovascular risk factors must be done on a global rather than on a separate approach, because they have additive effects and share common pathways leading to atherothrombosis. Of special interest is the relationship between hypertension and dyslipidemia. An excessive activity of the renin-angiotensin system (RAS), that plays an important role in hypertension, contributes to endothelial dysfunction, vascular inflammation and thrombosis. Dyslipidemia induces the same effects through similar mechanisms. In fact, combined therapy with statins and RAS modulators shows synergic beneficial effects in the treatment of atherosclerosis. Then, in the future, the traditional hypertension and dyslipidemia units should probably evolve into global cardiovascular risk management Units. Also, polypills combining antihypertensive and lipid-lowering drugs will make easier the treatment of these conditions. These changes would provide us the necessary tools to treat our patients in accordance with the current strategies of cardiovascular therapy and prevention.

Keywords: Angiotensin, atherosclerosis, endothelium, hypercholesterolemia, hypertension, inflammation