[Comment] Therapy for mixed dyslipidaemia through ANGPTL3 inhibition

In epidemiological, genetic, and intervention studies, mixed dyslipidaemia, characterised by elevated concentrations of total cholesterol and triglycerides due to the accumulation of LDL and VLDL particles in the blood, is associated with an increased risk of atherosclerotic cardiovascular disease.1–3 However, no conclusive evidence exists that lowering fasting triglycerides, which are surrogate for VLDL particles, effectively prevents atherosclerotic cardiovascular disease.3,4 One possible explanation for the disappointing results of well conducted trials involving triglyceride-lowering medications, such as PROMINENT with pemafibrate5 and STRENGTH with fish-oil combinations,4 is that these drugs might increase VLDL remodelling (ie, reduction in particle triglyceride and cholesterol content) but without promoting the removal of particle remnants, including LDL, from the blood.