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Tzanaki I, Agouridis AP, Kostapanos MS. Is there a role of lipid-lowering therapies in the management of fatty liver disease? World J Hepatol 2022; 14:119-139. [PMID: 35126843 PMCID: PMC8790403 DOI: 10.4254/wjh.v14.i1.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/30/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
Atherogenic dyslipidemia is characterized by increased triglyceride-rich lipoproteins and low high-density lipoprotein cholesterol concentrations. It is highly prevalent in non-alcoholic fatty liver disease (NAFLD) and contributes to the increased cardiovascular risk associated with this condition. Alongside insulin resistance it plays an important pathogenetic role in NAFLD/non-alcoholic steatohepatitis (NASH) development and progression. It has been shown that cholesterol-lowering reduces cardiovascular risk more in NAFLD vs non-NAFLD high-risk individuals. This evidence highlights the importance of effective lipid modulation in NAFLD. In this narrative review the effects of the most commonly used lipid-lowering therapies on liver outcomes alongside their therapeutic implications in NAFLD/NASH are critically discussed. Preclinical and clinical evidence suggests that statins reduce hepatic steatosis, inflammation and fibrosis in patients with NAFLD/NASH. Most data are derived from observational and small prospective clinical studies using changes in liver enzyme activities, steatosis/fibrosis scores, and imaging evidence of steatosis as surrogates. Also, relevant histologic benefits were noted in small biopsy studies. Atorvastatin and rosuvastatin showed greater benefits, whereas data for other statins are scarce and sometimes conflicting. Similar studies to those of statins showed efficacy of ezetimibe against hepatic steatosis. However, no significant anti-inflammatory and anti-fibrotic actions of ezetimibe have been shown. Preclinical studies showed that fibrates through peroxisome proliferator-activated receptor (PPAR)α activation may have a role in NAFLD prevention and management. Nevertheless, no relevant benefits have been noted in human studies. Species-related differences in PPARα expression and its activation responsiveness may help explain this discrepancy. Omega-3 fatty acids reduced hepatic steatosis in numerous heterogeneous studies, but their benefits on hepatic inflammation and fibrosis have not been established. Promising preliminary data for the highly purified eicosapentaenoic acid require further confirmation. Observational studies suggest that proprotein convertase subtilisin/kexin9 inhibitors may also have a role in the management of NAFLD, though this needs to be established by future prospective studies.
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Affiliation(s)
- Ismini Tzanaki
- School of Medicine, European University Cyprus, Nicosia, Cyprus, Nicosia 2404, Cyprus
| | - Aris P Agouridis
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
| | - Michael S Kostapanos
- General Medicine, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB20QQ, United Kingdom
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2
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Parthymos I, Kostapanos MS, Liamis G, Florentin M. Early Investigational and Experimental Therapeutics for the Treatment of Hypertriglyceridemia. J Cardiovasc Dev Dis 2022; 9:jcdd9020042. [PMID: 35200696 PMCID: PMC8874974 DOI: 10.3390/jcdd9020042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/01/2022] [Accepted: 01/20/2022] [Indexed: 02/04/2023] Open
Abstract
Hypertriglyceridemia has been identified as a risk factor for cardiovascular disease and acute pancreatitis. To date, there are only few drug classes targeting triglyceride levels such as fibrates and ω-3 fatty acids. These agents are at times insufficient to address very high triglycerides and the residual cardiovascular risk in patients with mixed dyslipidemia. To address this unmet clinical need, novel triglyceride-lowering agents have been in different phases of early clinical development. In this review, the latest and experimental therapies for the management of hypertriglyceridemia are presented. Specifically, ongoing trials evaluating novel apolipoprotein C-III inhibitors, ω-3 fatty acids, as well as fibroblast growth 21 analogues are discussed.
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Affiliation(s)
- Ioannis Parthymos
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (I.P.); (G.L.)
| | - Michael S. Kostapanos
- Lipid Clinic, Department of General Medicine, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - George Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (I.P.); (G.L.)
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45110 Ioannina, Greece; (I.P.); (G.L.)
- Correspondence: ; Tel.: +30-6944662406; Fax: +30-26510-07016
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Parthymos I, Kostapanos MS, Mikhailidis DP, Florentin M. Lipoprotein (a) as a treatment target for cardiovascular disease prevention and related therapeutic strategies: a critical overview. Eur J Prev Cardiol 2021; 29:739-755. [PMID: 34389859 DOI: 10.1093/eurjpc/zwab052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/30/2020] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
Advances in several fields of cardiovascular (CV) medicine have produced new treatments (e.g. to treat dyslipidaemia) that have proven efficacy in terms of reducing deaths and providing a better quality of life. However, the burden of CV disease (CVD) remains high. Thus, there is a need to search for new treatment targets. Lipoprotein (a) [Lp(a)] has emerged as a potential novel target since there is evidence that it contributes to CVD events. In this narrative review, we present the current evidence of the potential causal relationship between Lp(a) and CVD and discuss the likely magnitude of Lp(a) lowering required to produce a clinical benefit. We also consider current and investigational treatments targeting Lp(a), along with the potential cost of these interventions.
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Affiliation(s)
- Ioannis Parthymos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina 45110, Greece
| | - Michael S Kostapanos
- Department of General Medicine, Lipid Clinic, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London NW3 2QG, UK
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina 45110, Greece
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4
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Jimenez-Royo P, Bombardieri M, Ciurtin C, Kostapanos M, Tappuni AR, Jordan N, Saleem A, Fuller T, Port K, Pontarini E, Lucchesi D, Janiczek R, Galette P, Searle G, Patel N, Kershaw L, Gray C, Ratia N, van Maurik A, de Groot M, Wisniacki N, Bergstrom M, Tarzi R. Advanced imaging for quantification of abnormalities in the salivary glands of patients with primary Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:2396-2408. [PMID: 33221921 PMCID: PMC8121449 DOI: 10.1093/rheumatology/keaa624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/21/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives To assess non-invasive imaging for detection and quantification of gland structure, inflammation and function in patients with primary Sjogren's syndrome (pSS) using PET-CT with 11C-Methionine (11C-MET; radiolabelled amino acid), and 18F-fluorodeoxyglucose (18F-FDG; glucose uptake marker), to assess protein synthesis and inflammation, respectively; multiparametric MRI evaluated salivary gland structural and physiological changes. Methods In this imaging/clinical/histology comparative study (GSK study 203818; NCT02899377) patients with pSS and age- and sex-matched healthy volunteers underwent MRI of the salivary glands and 11C-MET PET-CT. Patients also underwent 18F-FDG PET-CT and labial salivary gland biopsies. Clinical and biomarker assessments were performed. Primary endpoints were semi-quantitative parameters of 11C-MET and 18F-FDG uptake in submandibular and parotid salivary glands and quantitative MRI measures of structure and inflammation. Clinical and minor salivary gland histological parameter correlations were explored. Results Twelve patients with pSS and 13 healthy volunteers were included. Lower 11C-MET uptake in parotid, submandibular and lacrimal glands, lower submandibular gland volume, higher MRI fat fraction, and lower pure diffusion in parotid and submandibular glands were observed in patients vs healthy volunteer, consistent with reduced synthetic function. Disease duration correlated positively with fat fraction and negatively with 11C-MET and 18F-FDG uptake, consistent with impaired function, inflammation and fatty replacement over time. Lacrimal gland 11C-MET uptake positively correlated with tear flow in patients, and parotid gland 18F-FDG uptake positively correlated with salivary gland CD20+ B-cell infiltration. Conclusion Molecular imaging and MRI may be useful tools to non-invasively assess loss of glandular function, increased glandular inflammation and fat accumulation in pSS.
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Affiliation(s)
| | - Michele Bombardieri
- Experimental Medicine and Rheumatology, Queen Mary University of London, London
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London
| | - Michalis Kostapanos
- GlaxoSmithKline Clinical Unit Cambridge, Cambridge.,Department of Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Anwar R Tappuni
- Institute of Dentistry, Queen Mary University of London, London
| | - Natasha Jordan
- Rheumatology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Azeem Saleem
- Invicro, Centre for Imaging Sciences, A Konica Minolta Company, London.,Faculty of Health Sciences, University of Hull, Hull
| | - Teresa Fuller
- Research and Development, GlaxoSmithKline, Stevenage
| | - Kathleen Port
- Research and Development, GlaxoSmithKline, Stevenage
| | - Elena Pontarini
- Experimental Medicine and Rheumatology, Queen Mary University of London, London
| | - Davide Lucchesi
- Experimental Medicine and Rheumatology, Queen Mary University of London, London
| | | | - Paul Galette
- Research and Development, GlaxoSmithKline, Stevenage
| | - Graham Searle
- Invicro, Centre for Imaging Sciences, A Konica Minolta Company, London
| | - Neel Patel
- Research and Development, GlaxoSmithKline, Stevenage
| | - Lucy Kershaw
- Centre for Inflammation Research, University of Edinburgh.,Edinburgh Imaging, University of Edinburgh, Edinburgh
| | - Calum Gray
- Edinburgh Imaging, University of Edinburgh, Edinburgh
| | - Nirav Ratia
- Research and Development, GlaxoSmithKline, Stevenage
| | | | - Marius de Groot
- Research and Development, GlaxoSmithKline, Stevenage.,GlaxoSmithKline Clinical Unit Cambridge, Cambridge
| | | | | | - Ruth Tarzi
- Research and Development, GlaxoSmithKline, Stevenage
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Cacciottolo PJ, Kostapanos MS, Hernan Sancho E, Pavey H, Kaloyirou F, Vamvaka E, Helmy J, Hubsch A, McEniery CM, Wilkinson IB, Cheriyan J. Investigating the Lowest Threshold of Vascular Benefits from LDL Cholesterol Lowering with a PCSK9 mAb Inhibitor (Alirocumab) in Patients with Stable Cardiovascular Disease (INTENSITY-HIGH): protocol and study rationale for a randomised, open label, parallel group, mechanistic study. BMJ Open 2021; 11:e037457. [PMID: 33849844 PMCID: PMC8051397 DOI: 10.1136/bmjopen-2020-037457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 01/04/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Elevated low-density lipoprotein cholesterol (LDL-C) is a strong independent risk predictor of cardiovascular (CV) events, while interventions to reduce it remain the only evidence-based approach to reduce CV morbidity and mortality. Secondary prevention statin trials in combination with ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors showed that there is no 'J shaped curve' in LDL-C levels with regard to CV outcomes. The lowest threshold beyond which reduction of LDL-C confers no further CV benefits has not been identified.The INTENSITY-HIGH study seeks to explore physiological mechanisms mediating CV benefits of LDL-C lowering by PCSK9 inhibition in patients with established cardiovascular disease (CVD). The study examines the changes in measures of endothelial function and vascular inflammation imaging following intervention with PCSK9 and against standard of care. METHODS AND ANALYSIS This is a single-centre, randomised, open label, parallel group, mechanistic physiological study. It will include approximately 60 subjects with established CVD, with LDL-C of <4.1 mmol/L on high-intensity statins. All eligible participants will undergo 18-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) scanning of the aorta and carotid arteries, as well as baseline endothelial function assessment. Subsequently, they will be randomised on a 1:1 basis to either alirocumab 150 mg or ezetimibe 10 mg/day. Repeat FDG-PET/CT scan and vascular assessments will be undertaken after 8 weeks of treatment. Any changes in these parameters will be correlated with changes in lipid levels and systemic inflammation biomarkers. ETHICS AND DISSEMINATION The study received a favourable opinion from the Wales Research Ethics Committee 4, was registered on clinicaltrials.gov and conformed to International Conference for Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use Good Clinical Practice. The results of this study will be reported through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT03355027.
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Affiliation(s)
- Paul J Cacciottolo
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | | | - Elena Hernan Sancho
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Holly Pavey
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fotini Kaloyirou
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Evangelia Vamvaka
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Joanna Helmy
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Annette Hubsch
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Carmel M McEniery
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
| | - Ian B Wilkinson
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics (EMIT), University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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6
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Gudu T, Stober C, Cope AP, Cheriyan J, Galloway J, Wilkinson IB, Kostapanos M, Jayne D, Hall F. Baricitinib set to join the Covid-19 therapeutic arsenal? Rheumatology (Oxford) 2021; 60:1585-1587. [PMID: 33502499 PMCID: PMC7928625 DOI: 10.1093/rheumatology/keab061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tania Gudu
- Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Carmel Stober
- Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Andrew P Cope
- Centre for Rheumatic Disease, King’s College London, London
| | - Joseph Cheriyan
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust
- Division of Experimental Medicine & Immunotherapeutics, School of Clinical Medicine, University of Cambridge
| | - James Galloway
- Centre for Rheumatic Disease, King’s College London, London
| | - Ian B Wilkinson
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust
- Division of Experimental Medicine & Immunotherapeutics, School of Clinical Medicine, University of Cambridge
| | - Michalis Kostapanos
- Division of Experimental Medicine & Immunotherapeutics, School of Clinical Medicine, University of Cambridge
- Cambridge University Hospitals NHS Foundation Trust
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Frances Hall
- Rheumatology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge
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7
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Tompson DJ, Davies C, Scott NE, Cannons EP, Kostapanos M, Gross AS, Powell M, Ino H, Shimamura R, Ogura H, Nagakubo T, Igarashi H, Nakano A. Comparison of the Pharmacokinetics of RIPK1 Inhibitor GSK2982772 in Healthy Western and Japanese Subjects. Eur J Drug Metab Pharmacokinet 2020; 46:71-83. [PMID: 33165774 PMCID: PMC7811991 DOI: 10.1007/s13318-020-00652-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background and Objectives GSK2982772 is an oral small-molecule RIPK1 inhibitor with potential therapeutic efficacy in immune-mediated inflammatory diseases (IMIDs). An inter-ethnic comparison of GSK2982772 pharmacokinetics was conducted based on data from Western (Study 1) and Japanese subjects (Study 2). Methods Both studies were single-centre, randomised, double-blind, placebo-controlled studies with objectives to assess the safety and characterise the pharmacokinetics of GSK2982772. Western subjects in Study 1 (NCT03305419), Part A (N = 15), were randomly assigned to receive 120 mg three times daily (TID), 240 mg TID, or 360 mg twice daily (BID) doses of GSK2982772, or placebo (TID or BID) for 1 day. Part B subjects (N = 47) received GSK2982772 120 mg TID, 240 mg TID, or placebo TID for 14 days. Japanese subjects in Study 2 (N = 13) (NCT03590613) were randomly assigned to receive TID doses of GSK2982772 60, 120, 240 mg TID or placebo TID for 1 day. Results GSK2982772 was well tolerated and adverse events were generally mild. Maximum observed plasma drug concentration (Cmax), time to reach Cmax (Tmax), area under the plasma drug concentration versus time curve after the first GSK2982772 dose (AUC(0–7)) of 120 and 240 mg, and (AUC(0–24)) values for the 120 and 240 mg TID doses over a single day were similar in Japanese and Western subjects. Conclusions The pharmacokinetics and tolerability of GSK2982772 were similar between Western and Japanese subjects, justifying inclusion of Japanese subjects in future global clinical studies to assess the therapeutic potential of RIPK1 inhibition for the treatment of IMIDs. Clinical Trials: NCT03305419 and NCT03590613 available from http://www.clinicaltrials.gov. Electronic supplementary material The online version of this article (10.1007/s13318-020-00652-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Debra J Tompson
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, UK.
| | - Carwyn Davies
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Sydney, NSW, Australia
| | - Nicola E Scott
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire, UK
| | - Edward P Cannons
- Global Clinical Sciences and Delivery, GlaxoSmithKline, Medicines Research Centre, Stevenage, Hertfordshire, UK
| | - Michalis Kostapanos
- Clinical Care Unit Cambridge, GlaxoSmithKline, and Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Annette S Gross
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Sydney, NSW, Australia
| | - Marcy Powell
- Safety and Medical Governance, GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Hiroko Ino
- Clinical Pharmacology, Medicines Development, GlaxoSmithKline, Tokyo, Japan
| | - Ryutaro Shimamura
- Clinical Pharmacology, Medicines Development, GlaxoSmithKline, Tokyo, Japan
| | - Hirofumi Ogura
- Clinical Pharmacology, Medicines Development, GlaxoSmithKline, Tokyo, Japan
| | - Takashi Nagakubo
- Biomedical Data Sciences Department, GlaxoSmithKline, Tokyo, Japan
| | - Harue Igarashi
- Pre-Clinical Development Department, GlaxoSmithKline, Tokyo, Japan
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Lu IN, Kulkarni S, Fisk M, Kostapanos M, Banham-Hall E, Kadyan S, Bond S, Norton S, Cope A, Galloway J, Hall F, Jayne D, Wilkinson IB, Cheriyan J. muLTi-Arm Therapeutic study in pre-ICu patients admitted with Covid-19-Experimental drugs and mechanisms (TACTIC-E): A structured summary of a study protocol for a randomized controlled trial. Trials 2020; 21:690. [PMID: 32736592 PMCID: PMC7393245 DOI: 10.1186/s13063-020-04618-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives To determine if a specific intervention reduces the composite of progression of patients with COVID-19-related disease to organ failure or death as measured by time to incidence of any one of the following: death, invasive mechanical ventilation, ECMO, cardiovascular organ support (inotropes or balloon pump), or renal failure (estimated Cockcroft Gault creatinine clearance <15ml/min). Trial design Randomised, parallel arm, open-label, adaptive platform Phase 2/3 trial of potential disease modifying therapies in patients with late stage 1/stage 2 COVID-19-related disease, with a diagnosis based either on a positive assay or high suspicion of COVID-19 infection by clinical, laboratory and radiological assessment. Participants Patients aged 18 and over, with a clinical picture strongly suggestive of COVID-19-related disease (with/without a positive COVID-19 test) AND a risk count (as defined below) >3 OR ≥3 if risk count includes “Radiographic severity score >3”. A risk count is calculated by the following features on admission (1 point for each): radiographic severity score >3, male gender, non-white ethnicity, diabetes, hypertension, neutrophils >8.0 x109/L, age >40 years and CRP >40 mg/L. Patients should be considered an appropriate subject for intervention with immunomodulatory or other disease modifying agents in the opinion of the investigator and are able to swallow capsules or tablets. The complete inclusion and exclusion criteria as detailed in the Additional file 1 should be fulfilled. Drug specific inclusion and exclusion criteria will also be applied to the active arms. Patients will be enrolled prior to the need for invasive mechanical ventilation, cardiac or renal support. Participants will be recruited across multiple centres in the UK including initially at Cambridge University Hospitals NHS Foundation Trust and St George’s University NHS Foundation Trust. Other centres will be approached internationally in view of the evolving pandemic. Intervention and comparator There is increasing evidence of the role of immunomodulation in altering the course of COVID-19. Additionally, various groups have demonstrated the presence of pulmonary shunting in patients with COVID-19 as well as other cardiovascular complications. TACTIC-E will assess the efficacy of the novel immunomodulatory agent EDP1815 versus the approved cardio-pulmonary drugs, Dapagliflozin in combination with Ambrisentan versus the prevailing standard of care. EDP1815 will be given as 2 capsules twice daily (1.6 x 1011 cells) for up to 7 days with the option to extend up to 14 days at the discretion of the principal investigator or their delegate, if the patient is felt to be clinically responding to treatment, is tolerating treatment, and is judged to be likely to benefit from a longer treatment course. Ambrisentan 5mg and Dapagliflozin 10mg will be given in combination once daily orally for up to maximum of 14 days. Patients will be randomised in a 1:1:1 ratio across treatments. Each active arm will be compared with standard of care alone. Additional arms may be added as the trial progresses. No comparisons will be made between active arms in this platform trial. Main outcomes The primary outcome is the incidence (from baseline up to Day 14) to the occurrence of the any one of the following events: death, invasive mechanical ventilation, extra corporeal membrane oxygenation, cardiovascular organ support (inotropes or balloon pump), or renal failure (estimated Cockcroft Gault creatinine clearance <15ml/min). Randomisation Eligible patients will be randomised using a central web-based randomisation service (Sealed Envelope) in a 1:1:1 ratio, stratified by site to one of the treatment arms or standard of care. Blinding (masking) This is an open-label trial. Data analysis will not be blinded. Numbers to be randomised (sample size) There is no fixed sample size for this study. There will be an early biomarker-based futility analysis performed at a point during the study. If this biomarker futility analysis is not conclusive, then a second futility analysis based on clinical endpoints will be performed after approximately 125 patients have been recruited per arm. Provisionally, further analyses of clinical endpoints will be performed after 229 patients per active arm and later 469 patients per arm have been recruited. Further additional analyses may be triggered by the independent data monitoring committee. Trial Status TACTIC-E Protocol version number 1.0 date May 27th, 2020. Recruitment starts on the 3rd of July 2020. The end trial date will be 18 months after the last patient’s last visit and cannot be accurately predicted at this time. Trial registration Registered on EU Clinical Trials Register EudraCT Number: 2020-002229-27 registered: 9 June 2020. The trial was also registered on ClinicalTrials.gov (NCT04393246) on 19 May 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Ing Ni Lu
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - Spoorthy Kulkarni
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Marie Fisk
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michalis Kostapanos
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Edward Banham-Hall
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sonakshi Kadyan
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Simon Bond
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sam Norton
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrew Cope
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Galloway
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Frances Hall
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David Jayne
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian B Wilkinson
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Cheriyan
- Clinical Pharmacology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Kulkarni S, Fisk M, Kostapanos M, Banham-Hall E, Bond S, Hernan-Sancho E, Norton S, Cheriyan J, Cope A, Galloway J, Hall F, Jayne D, Wilkinson IB. Repurposed immunomodulatory drugs for Covid-19 in pre-ICu patients - mulTi-Arm Therapeutic study in pre-ICu patients admitted with Covid-19 - Repurposed Drugs (TACTIC-R): A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:626. [PMID: 32641154 PMCID: PMC7341462 DOI: 10.1186/s13063-020-04535-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To determine if a specific immunomodulatory intervention reduces progression of COVID-19-related disease to organ failure or death, compared to standard of care (SoC). TRIAL DESIGN Randomised, parallel 3-arm (1:1:1 ratio), open-label, Phase IV platform trial of immunomodulatory therapies in patients with late stage 1 or stage 2 COVID-19-related disease, with a diagnosis based either on a positive assay or high suspicion of COVID-19 infection by clinical and/or radiological assessment. PARTICIPANTS Patients aged 18 and over, with a clinical picture strongly suggestive of COVID-19-related disease (with/without a positive COVID-19 test) AND a Risk count (as defined below) >3 OR ≥3 if risk count includes "Radiographic severity score >3". A risk count is calculated by the following features on admission (1 point for each): radiographic severity score >3, male gender, non-white ethnicity, diabetes, hypertension, neutrophils >8.0 x109/L, age >40 years and CRP >40 mg/L. Patients should be considered an appropriate subject for intervention with immunomodulatory therapies in the opinion of the investigator and be able to be maintained on venous thromboembolism prophylaxis during the inpatient dosing period, according to local guidelines. The complete inclusion and exclusion criteria as detailed in the additional file 1 should be fulfilled. Patients will be enrolled prior to the need for invasive mechanical ventilation, cardiac or renal support. Participants will be recruited across multiple centres including initially at Cambridge University Hospitals NHS Foundation Trust, King's College Hospital NHS Foundation Trust, Guy's and St Thomas' NHS Foundation Trust, University Hospital of Wales, Gloucestershire Royal Hospitals NHS Foundation Trust and The Royal Wolverhampton NHS Trust. INTERVENTION AND COMPARATOR Each active comparator arm will be compared against standard of care (SoC). The immunomodulatory drugs were selected from a panel of licenced candidates by a drug evaluation committee, which considered potential efficacy, potential toxicity, scalability and novelty of each strategy. The initial active arms comprise baricitinib and ravulizumab. Baricitinib will be given 4 mg orally (once daily (OD)) on days 1-14 or until day of discharge. The dose will be reduced to 2 mg OD for patients aged > 75 years and those with an estimated Cockcroft Gault creatinine clearance of 30-60 ml/min. Ravulizumab will be administered intravenously once according to the licensed weight-based dosing regimen (see Additional file 1). Each active arm will be compared with standard of care alone. No comparisons will be made between active arms in this platform trial. MAIN OUTCOMES The primary outcome is the incidence (from baseline up to Day 14) of any one of the events (whichever comes first): death, invasive mechanical ventilation, extra corporeal membrane oxygenation, cardiovascular organ support (inotropes or balloon pump), or renal failure (estimated Cockcroft Gault creatinine clearance <15ml/min). RANDOMISATION Eligible patients will be randomised using a central web-based randomisation service (Sealed Envelope) in a 1:1:1 ratio, stratified by site to one of the treatment arms or SoC. BLINDING (MASKING) This is an open-label trial. Data analysis will not be blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) There is no fixed sample size for this study. Serial interim analyses will be triggered by an Independent Data Monitoring Committee (IDMC), including analysis after 125 patients are recruited to each arm, 375 in total assuming 3 arms. Additional interim analyses are projected after 229 patients per arm, and potentially then after 469 per arm, but additional analyses may be triggered by the IDMC. TRIAL STATUS TACTIC-R Protocol version number 2.0 date May 20, 2020, recruitment began May 7, 2020 and the end trial will be the date 18 months after the last patient's last visit. The recruitment end date cannot yet be accurately predicted. TRIAL REGISTRATION Registered on EU Clinical Trials Register EudraCT Number: 2020-001354-22 Registered: 6 May 2020 It was registered on ClinicalTrials.gov ( NCT04390464 ) and on ISRCTN (ISRCTN11188345) FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Spoorthy Kulkarni
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Marie Fisk
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Michalis Kostapanos
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Edward Banham-Hall
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Simon Bond
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Elena Hernan-Sancho
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Sam Norton
- King’s College London, Strand, London, WC2R 2LS UK
| | - Joseph Cheriyan
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Andrew Cope
- King’s College London, Strand, London, WC2R 2LS UK
| | | | - Frances Hall
- Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - David Jayne
- University of Cambridge, The Old Schools, Trinity Lane, Cambridge, CB2 1TN UK
| | - Ian B. Wilkinson
- University of Cambridge, The Old Schools, Trinity Lane, Cambridge, CB2 1TN UK
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10
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Ford SL, Lou Y, Lewis N, Kostapanos M, D'Amico R, Spreen W, Patel P. Effect of rifabutin on the pharmacokinetics of oral cabotegravir in healthy subjects. Antivir Ther 2020; 24:301-308. [PMID: 30896438 DOI: 10.3851/imp3306] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cabotegravir (CAB) is an integrase strand transfer inhibitor in development as a long-acting injectable formulation, with an oral formulation used during a safety lead-in period. Tuberculosis (TB)-HIV coinfection is common, often requiring simultaneous treatment. Rifabutin (RBT) is an alternative antimycobacterial agent for TB and a moderate inducer of cytochrome P450 and UDP-glucuronosyltransferase isoenzymes. This study evaluated the impact of RBT on the pharmacokinetics (PK) of oral CAB. METHODS In this Phase I, single-centre, open-label, two-period, fixed-sequence, drug interaction study, subjects received oral CAB 30 mg once daily for 14 days in period 1, and oral CAB plus RBT 300 mg once daily for 14 days in period 2. Serial PK sampling was performed on days 14 and 28. Geometric least squares (GLS) mean ratios with associated 90% CIs were calculated to compare CAB noncompartmental PK parameters following CAB+RBT versus CAB alone. Safety was also assessed. RESULTS A total of 15 male subjects were enrolled and 12 completed all treatments. Comparing CAB+RBT with CAB alone, the GLS mean ratios (90% CIs) for CAB area under the concentration-time curve from time zero to the end of the dosing interval (AUC0-τ), maximum observed plasma concentration (Cmax) and concentration at the end of the dosing interval (Cτ) were 0.79 (0.74, 0.83), 0.83 (0.76, 0.90) and 0.74 (0.70, 0.78), respectively. 11 subjects reported 24 adverse events (AEs); 22 were reported with CAB+RBT (3 drug-related) and 2 with CAB alone (not drug-related). All AEs resolved by study end. CONCLUSIONS RBT had a modest impact on plasma CAB exposure following oral coadministration, resulting in overall plasma CAB trough exposures above the 10 mg oral dose shown to maintain viral suppression in HIV-1-infected subjects. Oral CAB can be coadministered with RBT without dosage adjustment.
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Affiliation(s)
- Susan L Ford
- GlaxoSmithKline, Research Triangle Park, NC, USA
| | - Yu Lou
- Parexel International, Research Triangle Park, NC, USA
| | | | - Michalis Kostapanos
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,GSK Clinical Unit Cambridge, Cambridge, UK
| | | | | | - Parul Patel
- ViiV Healthcare, Research Triangle Park, NC, USA
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11
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Florentin M, Kostapanos MS, Anagnostis P, Liamis G. Recent developments in pharmacotherapy for hypertriglyceridemia: what’s the current state of the art? Expert Opin Pharmacother 2019; 21:107-120. [PMID: 31738617 DOI: 10.1080/14656566.2019.1691523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Michael S Kostapanos
- Lipid clinic, Department of General Medicine, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Panagiotis Anagnostis
- Unit of reproductive endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Florentin M, Kostapanos MS, Elisaf MS, Liberopoulos EN. Prevalence, Identification, and Scouting for Familial Hypercholesterolaemia Including Registries. Curr Pharm Des 2019; 24:3605-3615. [PMID: 30306861 DOI: 10.2174/1381612824666181009103440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/22/2022]
Abstract
Background:
Familial Hypercholesterolaemia (FH) is the most common metabolic genetic disorder,
with around 13 million people worldwide having the disease. However, FH is globally underdiagnosed and undertreated,
while the vast majority of those treated do not achieve treatment goals.
Objective:
This review aims to clarify how to identify patients with FH.
Methods:
We performed a comprehensive search of the literature to identify available data.
Results:
Patients with FH are at high risk for cardiovascular events and death at an early age. Therefore, prompt
detection of individuals with FH is of pivotal importance in order to implement appropriate preventive measures
at a young age. Patient registries are a powerful tool for recording and monitoring a disease and encouraging
clinical practices, subsequently improving outcomes and reducing healthcare costs. National FH registries are
successfully applied in several countries (e.g. Spain, Denmark, UK, USA and the Netherlands). Importantly, in
the last few years, the European Atherosclerosis Society (EAS) launched a global FH network aiming to collect
data from specialized FH centres from different countries and establish a worldwide, standardised registry of
patients with FH.
Conclusion:
It appears that the establishment and proper function of such registries will improve FH diagnosis,
as well as preventive measures and management of FH patients.
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Affiliation(s)
- Matilda Florentin
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Michael S. Kostapanos
- Lipid Clinic, Department of General Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Moses S. Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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13
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Zhao TX, Kostapanos M, Griffiths C, Arbon EL, Hubsch A, Kaloyirou F, Helmy J, Hoole SP, Rudd JHF, Wood G, Burling K, Bond S, Cheriyan J, Mallat Z. Low-dose interleukin-2 in patients with stable ischaemic heart disease and acute coronary syndromes (LILACS): protocol and study rationale for a randomised, double-blind, placebo-controlled, phase I/II clinical trial. BMJ Open 2018; 8:e022452. [PMID: 30224390 PMCID: PMC6144322 DOI: 10.1136/bmjopen-2018-022452] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Inflammation and dysregulated immune responses play a crucial role in atherosclerosis, underlying ischaemic heart disease (IHD) and acute coronary syndromes (ACSs). Immune responses are also major determinants of the postischaemic injury in myocardial infarction. Regulatory T cells (CD4+CD25+FOXP3+; Treg) induce immune tolerance and preserve immune homeostasis. Recent in vivo studies suggested that low-dose interleukin-2 (IL-2) can increase Treg cell numbers. Aldesleukin is a human recombinant form of IL-2 that has been used therapeutically in several autoimmune diseases. However, its safety and efficacy is unknown in the setting of coronary artery disease. METHOD AND ANALYSIS Low-dose interleukin-2 in patients with stable ischaemic heart disease and acute coronary syndromes is a single-centre, first-in-class, dose-escalation, two-part clinical trial. Patients with stable IHD (part A) and ACS (part B) will be randomised to receive either IL-2 (aldesleukin; dose range 0.3-3×106 IU) or placebo once daily, given subcutaneously, for five consecutive days. Part A will have five dose levels with five patients in each group. Group 1 will receive a dose of 0.3×106 IU, while the dose for the remaining four groups will be determined on completion of the preceding group. Part B will have four dose levels with eight patients in each group. The dose of the first group will be based on part A. Doses for each of the subsequent three groups will similarly be determined after completion of the previous group. The primary endpoint is safety and tolerability of aldesleukin and to determine the dose that increases mean circulating Treg levels by at least 75%. ETHICS AND DISSEMINATION The study received a favourable opinion by the Greater Manchester Central Research Ethics Committee, UK (17/NW/0012). The results of this study will be reported through peer-reviewed journals, conference presentations and an internal organisational report. TRIAL REGISTRATION NUMBER NCT03113773; Pre-results.
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Affiliation(s)
- Tian Xiao Zhao
- Department of Medicine, Division of Cardiovascular Medicine, University of Cambridge Medicine, Cambridge, UK
- Division of Experimental Medicine and Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge Medicine, Cambridge, Cambridgeshire, UK
| | - Michalis Kostapanos
- Division of Experimental Medicine and Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge Medicine, Cambridge, Cambridgeshire, UK
| | - Charmaine Griffiths
- Cambridge Clinical Trials Unit, Cambridge University Hospitals, Cambridge, Cambridgeshire, UK
| | - Emma L Arbon
- Cambridge Clinical Trials Unit, Cambridge University Hospitals, Cambridge, Cambridgeshire, UK
| | - Annette Hubsch
- Division of Experimental Medicine and Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge Medicine, Cambridge, Cambridgeshire, UK
| | - Fotini Kaloyirou
- Division of Experimental Medicine and Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge Medicine, Cambridge, Cambridgeshire, UK
| | - Joanna Helmy
- Division of Experimental Medicine and Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge Medicine, Cambridge, Cambridgeshire, UK
| | - Stephen P Hoole
- Department of Interventional Cardiology, Royal Papworth Hospital NHS Trust, Cambridge, UK
| | - James H F Rudd
- Department of Medicine, Division of Cardiovascular Medicine, University of Cambridge Medicine, Cambridge, UK
| | - Graham Wood
- Department of Immunology, Cambridge University Hospitals, Cambridge, UK
| | - Keith Burling
- Clinical Biochemistry, Cambridge University Hospitals, Cambridge, UK
| | - Simon Bond
- Cambridge Clinical Trials Unit, Cambridge University Hospitals, Cambridge, Cambridgeshire, UK
| | - Joseph Cheriyan
- Division of Experimental Medicine and Immunotherapeutics (EMIT), Department of Medicine, University of Cambridge Medicine, Cambridge, Cambridgeshire, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals, Cambridge, Cambridgeshire, UK
| | - Ziad Mallat
- Department of Medicine, Division of Cardiovascular Medicine, University of Cambridge Medicine, Cambridge, UK
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Kostapanos MS, Elisaf MS. Statins and mortality: the untold story. Br J Clin Pharmacol 2017; 83:938-941. [PMID: 27921324 DOI: 10.1111/bcp.13202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 10/21/2016] [Accepted: 11/16/2016] [Indexed: 12/12/2022] Open
Abstract
Statins are first-line evidence-based drugs for the management of dyslipidaemias and to reduce the risk of cardiovascular events. However, statin clinical trials have shown marginally significant benefits on mortality, especially in the primary prevention setting. A major limitation of those trials is their relatively short follow-up. A reduced number of fatal events within a 5-year follow-up make mortality benefits unlikely to arise. This is particularly relevant for the primary prevention trials, where the risk of cardiovascular death is low. The short follow-up is a limitation for safety assessments too. However, extended major statin trials failed to detect any major safety concerns. Safety and efficacy assessments are even more complicated considering the differences of cardiovascular risk status in primary prevention individuals, and also given some potential ethnic and inter-individual genetic variations in response to statin treatment. Considerable evidence suggests a favourable risk-benefit balance for statin treatment. It can be assumed that statins reduce mortality in the long term by preventing cardiovascular events with complications that reduce lifespan. Unfortunately, this hypothesis cannot be proven as there is no current ethical basis on designing long-term placebo-controlled statin trials. Nevertheless, by effectively reducing disabilities related to cardiovascular events, statins have major benefits for public health. Therefore, clinicians should not withhold statin treatment awaiting proof of mortality benefits, as this may remain an 'untold story'.
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Affiliation(s)
- Michael S Kostapanos
- Clinical Pharmacology Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Moses S Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Abstract
Vital organs are exposed to the central rather than the brachial blood pressure. To date, central blood pressure can be assessed noninvasively through the use of several devices. In this review, we critically discuss the clinical relevance of central blood pressure assessment. Considerable evidence suggests that central blood pressure is a better predictor of end-organ damage than brachial blood pressure. However, there is still uncertainty concerning the value of central pressure for predicting cardiovascular outcomes, as the existing studies are underpowered to address this issue. A full synthesis of the available data is needed in this regard. Among the different antihypertensive drug classes, beta-blockers appear to lower central blood pressure less than brachial blood pressure. This difference may, at least in part, explain the reduced efficacy of beta-blockers in the prevention of cardiovascular outcomes compared with the other antihypertensive drug classes, which may lower central and brachial blood pressure to a similar extent. Nevertheless, this differential effect might not be relevant to the newer beta-blockers with vasodilating properties, including nebivolol, celliprolol and carvedilol. However, whether a preferential reduction of central blood pressure results in better outcomes should be further assessed by appropriately powered clinical trials. Other emerging challenges include the assessment of the potential predictive value of central blood pressure variability and the development of new antihypertensive medications based on central blood pressure rather than brachial blood pressure.
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Affiliation(s)
- Michael Kostapanos
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Carmel M McEniery
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Ian B Wilkinson
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
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Milionis HJ, Kostapanos MS, Vakalis K, Theodorou I, Bouba I, Kalaitzidis R, Georgiou I, Elisaf MS, Siamopoulos KC. Impact of renin-angiotensin-aldosterone system genes on the treatment response of patients with hypertension and metabolic syndrome. J Renin Angiotensin Aldosterone Syst 2016; 8:181-9. [PMID: 18205097 DOI: 10.3317/jraas.2007.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective. To evaluate the influence of clinical, biochemical and genetic markers on the response to antihypertensive treatment in patients with essential hypertension and the metabolic syndrome (MetS). Methods. Measurements of anthropometric indices, blood pressure (BP), and metabolic parameters were obtained from the medical records of 132 (77 women) newly diagnosed, untreated hypertensive patients. Renin-angiotensin-aldosterone system (RAAS) genes polymorphisms (including ACE I/D, angiotensinogen M235T, angiotensin II type 1 receptor [AT1-receptor] A1166C) were determined. Response to treatment was defined as BP less than 140/90 mmHg. Results. Patients with MetS (n=60) had higher systolic BP and pulse pressure and a more atherogenic lipid profile than patients without MetS.The frequencies of the ACE and the AT1-receptor gene polymorphisms were similar between patients with and without MetS. Response to treatment was positively associated with pulse pressure, and the presence of the C allele as well as the AC genotype of the AT1-receptor gene and inversely with age after adjustment for confounding factors. Conclusions. RAAS genes distribution does not differ between hypertensive patients with and without the MetS. Higher baseline pulse pressure levels, the presence of the C allele and/or the AC genotype may be in favour of a better response to structured antihypertensive treatment in patients with MetS. However, these findings need to be evaluated in future studies.
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Affiliation(s)
- Haralampos J Milionis
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Michael S Kostapanos
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos Vakalis
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioanna Theodorou
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioanna Bouba
- Laboratory of Human Reproductive Genetics, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Rigas Kalaitzidis
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioannis Georgiou
- Laboratory of Human Reproductive Genetics, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Moses S Elisaf
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Kostas C Siamopoulos
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
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Kostapanos MS, Milionis HJ, Saougos VG, Lagos KG, Kostara C, Bairaktari ET, Elisaf MS. Dose-Dependent Effect of Rosuvastatin Treatment on Urinary Protein Excretion. J Cardiovasc Pharmacol Ther 2016; 12:292-7. [PMID: 18172223 DOI: 10.1177/1074248407306676] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Concerns have been raised because of observations of proteinuria associated with rosuvastatin treatment. In this open-label study, a potential dose-dependent effect was investigated of rosuvastatin on urinary protein excretion and renal function parameters in 90 hyperlipidemic patients randomly assigned to rosuvastatin 10 mg/day (n = 45) or 20 mg/day (n = 45). Urinary samples were collected from patients and 40 age- and gender-matched controls to determine electrolyte, uric acid, creatinine, and protein (total, albumin, IgG, and α1-microglobulin) levels at baseline and after 12 weeks. A dose-dependent increase in the excretion of α1-microglobulin (17.6% in rosuvastatin 10 vs 34.9% in rosuvastatin, 20 mg/day; P = .03 for the comparison between groups) was observed. A trend toward an increase in the estimated glomerular filtration rate was noted in only patients receiving 20 mg/day of rosuvastatin. These findings indicate that rosuvastatin treatment increases the urinary excretion of α1-microglobulin urinary excretion in a dose-dependent manner without adversely affecting renal function.
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Affiliation(s)
| | | | - Vasilios G. Saougos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
| | | | - Christine Kostara
- Laboratory of Clinical Chemistry, School of Medicine, University of Ioannina, Greece
| | - Eleni T. Bairaktari
- Laboratory of Clinical Chemistry, School of Medicine, University of Ioannina, Greece
| | - Moses S. Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
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Tsimihodimos V, Kostapanos MS, Moulis A, Nikas N, Elisaf MS. Effects of benchmarking on the quality of type 2 diabetes care: results of the OPTIMISE (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment) study in Greece. Ther Adv Endocrinol Metab 2015; 6:199-209. [PMID: 26445642 PMCID: PMC4579413 DOI: 10.1177/2042018815592803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To investigate the effect of benchmarking on the quality of type 2 diabetes (T2DM) care in Greece. METHODS The OPTIMISE (Optimal Type 2 Diabetes Management Including Benchmarking and Standard Treatment) study [ClinicalTrials.gov identifier: NCT00681850] was an international multicenter, prospective cohort study. It included physicians randomized 3:1 to either receive benchmarking for glycated hemoglobin (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) treatment targets (benchmarking group) or not (control group). The proportions of patients achieving the targets of the above-mentioned parameters were compared between groups after 12 months of treatment. Also, the proportions of patients achieving those targets at 12 months were compared with baseline in the benchmarking group. RESULTS In the Greek region, the OPTIMISE study included 797 adults with T2DM (570 in the benchmarking group). At month 12 the proportion of patients within the predefined targets for SBP and LDL-C was greater in the benchmarking compared with the control group (50.6 versus 35.8%, and 45.3 versus 36.1%, respectively). However, these differences were not statistically significant. No difference between groups was noted in the percentage of patients achieving the predefined target for HbA1c. At month 12 the increase in the percentage of patients achieving all three targets was greater in the benchmarking (5.9-15.0%) than in the control group (2.7-8.1%). In the benchmarking group more patients were on target regarding SBP (50.6% versus 29.8%), LDL-C (45.3% versus 31.3%) and HbA1c (63.8% versus 51.2%) at 12 months compared with baseline (p < 0.001 for all comparisons). CONCLUSION Benchmarking may comprise a promising tool for improving the quality of T2DM care. Nevertheless, target achievement rates of each, and of all three, quality indicators were suboptimal, indicating there are still unmet needs in the management of T2DM.
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Affiliation(s)
- Vasilis Tsimihodimos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Michael S. Kostapanos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Nikos Nikas
- Medical Department, AstraZeneca SA, Athens, Greece
| | - Moses S. Elisaf
- Professor of Medicine, Department of Internal Medicine, Medical School, University of Ioannina, 451 10 Ioannina, Greece
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Kostapanos MS, Agouridis AP, Elisaf MS. Variable effects of statins on glucose homeostasis parameters and their diabetogenic role. Diabetologia 2015; 58:1960-1. [PMID: 26026652 DOI: 10.1007/s00125-015-3633-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/06/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Michael S Kostapanos
- Clinical Pharmacology Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Level 3 ACCI Building, Hill's Road, Cambridge, CB2 0QQ, UK,
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Barkas F, Milionis H, Kostapanos MS, Mikhailidis DP, Elisaf M, Liberopoulos E. How effective are the ESC/EAS and 2013 ACC/AHA guidelines in treating dyslipidemia? Lessons from a lipid clinic. Curr Med Res Opin 2015; 31:221-8. [PMID: 25418708 DOI: 10.1185/03007995.2014.982751] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE There is a paucity of data regarding the attainment of lipid-lowering treatment goals according to the recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The aim of the present study was to assess how applicable these 2013 recommendations are in the setting of an Outpatient University Hospital Lipid Clinic. METHODS This was a retrospective (from 1999 to 2013) observational study including 1000 consecutive adults treated for hyperlipidemia and followed up for ≥3 years. Comparisons for the applicability of current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and recent ACC/AHA guidelines were performed. RESULTS Achievement rates of low density lipoprotein cholesterol (LDL-C) targets set by ESC/EAS were 21%, 44% and 62% among patients at very high, high and moderate cardiovascular risk, respectively, receiving statin monotherapy. Among individuals on high-intensity statins only 47% achieved the anticipated ≥50% LDL-C reduction, i.e. the ACC/AHA target. The corresponding rate was significantly greater among those on statin + ezetimibe (76%, p < 0.05). Likewise, higher rates of LDL-C target attainment according to ESC/EAS guidelines were observed in patients on statin + ezetimibe compared with statin monotherapy (37, 50 and 71% for the three risk groups, p < 0.05 for the very high risk group). CONCLUSION The application of the ACC/AHA guidelines may be associated with undertreatment of high risk patients due to suboptimal LDL-C response to high-intensity statins in clinical practice. Adding ezetimibe substantially increases the rate of the ESC/EAS LDL-C target achievement together with the rate of LDL-C lowering response suggested by the ACC/AHA.
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Affiliation(s)
- Fotios Barkas
- Department of Internal Medicine, School of Medicine, University of Ioannina , Ioannina , Greece
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Rizos CV, Kostapanos MS, Rizos EC, Tselepis AD, Elisaf MS. The Effect of Rosuvastatin on Low-Density Lipoprotein Subfractions in Patients With Impaired Fasting Glucose. J Cardiovasc Pharmacol Ther 2014; 20:276-83. [PMID: 25237153 DOI: 10.1177/1074248414549419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 08/01/2014] [Indexed: 11/15/2022]
Abstract
Background: Prediabetes substantially increases cardiovascular risk. We examined the effect of rosuvastatin on the quantity and quality of low-density lipoprotein cholesterol (LDL-C) in patients with dyslipidemia having impaired fasting glucose (IFG) compared to normoglycemic patients with dyslipidemia. Methods: This was a prospective observational study including patients with dyslipidemia and IFG (IFG group, n = 49) matched with normoglycemic patients with dyslipidemia (control group, n = 64). Study participants, following dietary intervention, were prescribed rosuvastatin 10 or 20 mg/d to achieve LDL-C goals. Baseline as well as 24 weeks posttreatment changes in the serum lipid profile were evaluated. Moreover, analysis of the LDL subfraction profile was conducted using a polyacrylamide tube gel electrophoresis method. Results: Similar effects were observed in lipid profile in both treatment groups. Patients with IFG experienced a greater decrease in the cholesterol concentration of small dense LDL particles (−65.7%, P < .001 vs baseline) compared to controls (−38.5%, P < .001 vs baseline; P = .018 vs patients with IFG). There was no significant difference in the changes of cholesterol concentration of large and buoyant LDL particles in the IFG group when compared to the control group. A greater increase in the mean LDL particle size (+1.5%, P < .001 vs baseline) was noted in the IFG group compared to the control group at 24 weeks (+0.4%, P = .028 vs baseline; P = .008 vs IFG group). Conclusion: Targeting dyslipidemia with rosuvastatin was associated with more favorable changes in the LDL subfraction profile in patients with IFG compared to normoglycemic ones.
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Affiliation(s)
- Christos V. Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Michael S. Kostapanos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Evangelos C. Rizos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros D. Tselepis
- Laboratory of Biochemistry, School of Chemistry, University of Ioannina, Ioannina, Greece
| | - Moses S. Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Barkas F, Liberopoulos EN, Kostapanos MS, Liamis G, Tziallas D, Elisaf M. Lipid target achievement among patients with very high and high cardiovascular risk in a lipid clinic. Angiology 2014; 66:346-53. [PMID: 24830420 DOI: 10.1177/0003319714535073] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This was a retrospective study that assessed achievement of lipid-lowering treatment targets in the setting of a University Hospital Lipid Clinic. Low-density lipoprotein cholesterol (LDL-C) goal attainment according to National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines was recorded in 1000 consecutive adult patients followed for ≥3 years (mean 8 years). The LDL-C targets according to the NCEP ATP III were attained by 66% and 86% of patients with "very high" (n = 477) and "high" (n = 408) cardiovascular risk, respectively. Fewer patients were within LDL-C goals according to the ESC/EAS guidelines: 25% and 42%. Overall, 92% of the patients were on statins: 67% were on statin monotherapy, while 33% were on combinations with ezetimibe (25%), ω-3 fatty acids (5%), fibrates (4%), or colesevelam (2%). Even in a specialist lipid clinic, a large proportion of patients are not at goal according to the recent ESC/EAS guidelines.
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Affiliation(s)
- Fotios Barkas
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | | | - Michael S Kostapanos
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - George Liamis
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Dimitrios Tziallas
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Moses Elisaf
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
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Affiliation(s)
- Michael S Kostapanos
- Department of Internal Medicine, Medical School, University of Ioannina, St. Niarchou Avenue, 45110, Ioannina, Greece
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Abstract
After the withdrawal of troglitazone and rosiglitazone, pioglitazone remains the sole thiazolidinedione (TZD) still available. Pioglitazone is efficacious in improving glycemic control and reduce the risk of cardiovascular events. Although generally well-tolerated, pioglitazone was withdrawn by some national medicines agencies (e.g. in France and Germany) due to reports of increased incidence of bladder cancer. In this article, we review the literature on the association between pioglitazone and cancer in several sites, including the bladder. Pioglitazone, like other TZDs, increased differentiation, inhibited growth and proliferation, while provoked apoptosis in various cancer cells, including bladder cancer, in vitro and in vivo. However, a rat-specific carcinogenic effect of pioglitazone on the bladder was noted in vivo. Clinical data for the risk of various cancer sites mostly come from observational studies and are subject to bias. An increased risk for bladder cancer by pioglitazone was suggested by retrospective analyses. This risk was associated with the time of exposure and the age, by identifying 24 months and 65 years, respectively, as time 'thresholds' above which this risk becomes relevant. In contrast, no increased risk for bladder cancer was associated with pioglitazone in randomized clinical trials. Pioglitazone was associated with increased incidence of melanoma and non-Hodgkin lymphoma and decreased risk of renal cancer in one cohort study. These findings need to be re-evaluated on a prospective basis. There is no convincing evidence that pioglitazone increases or decreases the risk of cancer in other sites. In contrast, it was suggested that this drug may be useful either in the treatment of cancer complications or as an adjunct to chemotherapeutic agents. Considering the clinical benefit from the use of pioglitazone it is reasonable to wait until data from ongoing clinical trials are available before reaching definitive conclusions. Nevertheless, the potential for increased risk of bladder cancer should be taken into consideration, especially in the presence of other risk factors for bladder carcinogenesis (e.g. smoking).
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Affiliation(s)
- Michael S Kostapanos
- Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), Pond Street, London NW3 2QG, London, UK
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Kostapanos M, Florentin M, Elisaf M, Mikhailidis D. Hemostatic Factors and the Metabolic Syndrome. Curr Vasc Pharmacol 2014; 11:880-905. [PMID: 24168445 DOI: 10.2174/15701611113116660171] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/28/2012] [Accepted: 07/12/2012] [Indexed: 11/22/2022]
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Georgousopoulou EN, Kastorini CM, Milionis HJ, Ntziou E, Kostapanos MS, Nikolaou V, Vemmos KN, Goudevenos JA, Panagiotakos DB. Association between mediterranean diet and non-fatal cardiovascular events, in the context of anxiety and depression disorders: a case/case-control study. Hellenic J Cardiol 2014; 55:24-31. [PMID: 24491932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the effect of the Mediterranean diet on the likelihood of having a non-fatal cardiovascular outcome, taking into account anxiety and depression status. METHODS This was a case-control study with individual matching by age and sex. During 2009-2010, 1000 participants were enrolled; 250 were consecutive patients with a first acute coronary syndrome (ACS), 250 were consecutive patients with a first ischemic stroke, and 500 were population-based control subjects, one-for-one matched to the patients by age and sex. Among other characteristics, adherence to the Mediterranean diet was assessed by the MedDietScore, anxiety was assessed with the Spielberger State-Trait Anxiety Inventory form Y-2, while depressive symptomatology was evaluated by the Zung Depression Rating Scale. RESULTS Higher adherence to the Mediterranean diet was associated with a lower likelihood of ACS and ischemic stroke, even after adjusting for anxiety or depression (ACS: OR=0.92, 95%CI 0.87-0.98 and 0.93, 0.88-0.98, respectively; ischemic stroke: 0.91, 0.84-0.98 and 0.90, 0.83-0.97, respectively). For both ACS and stroke patients, anxiety and depression were associated with a higher likelihood of ACS and stroke. When stratifying for depression or anxiety status, the Mediterranean diet remained a significantly protective factor only for people with low levels of depression and anxiety for ACS, and only for people with low levels of anxiety, as far as stroke was concerned. CONCLUSION Anxiety and depression seem to play a mediating role in the protective relationship between adherence to the Mediterranean diet and the likelihood of developing cardiovascular events.
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Catapano AL, Elisaf MS, Florentin M, Mikhailidis DP, Kostapanos MS. Achieving current goals in prevention and treatment of vascular disease: an update. Curr Pharm Des 2013; 19:3749-52. [PMID: 23286439 DOI: 10.2174/1381612811319210001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kostapanos MS, Kei A, Elisaf MS. Current role of fenofibrate in the prevention and management of non-alcoholic fatty liver disease. World J Hepatol 2013; 5:470-478. [PMID: 24073298 PMCID: PMC3782684 DOI: 10.4254/wjh.v5.i9.470] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 07/24/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a common health problem with a high mortality burden due to its liver- and vascular-specific complications. It is associated with obesity, high-fat diet as well as with type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). Impaired hepatic fatty acid (FA) turnover together with insulin resistance are key players in NAFLD pathogenesis. Peroxisome proliferator-activated receptors (PPARs) are involved in lipid and glucose metabolic pathways. The novel concept is that the activation of the PPARα subunit may protect from liver steatosis. Fenofibrate, by activating PPARα, effectively improves the atherogenic lipid profile associated with T2DM and MetS. Experimental evidence suggested various protective effects of the drug against liver steatosis. Namely, fenofibrate-related PPARα activation may enhance the expression of genes promoting hepatic FA β-oxidation. Furthermore, fenofibrate reduces hepatic insulin resistance. It also inhibits the expression of inflammatory mediators involved in non-alcoholic steatohepatitis pathogenesis. These include tumor necrosis factor-α, intercellular cell adhesion molecule-1, vascular cell adhesion molecule-1 and monocyte chemoattractant protein-1. Consequently, fenofibrate can limit hepatic macrophage infiltration. Other liver-protective effects include decreased oxidative stress and improved liver microvasculature function. Experimental studies showed that fenofibrate can limit liver steatosis associated with high-fat diet, T2DM and obesity-related insulin resistance. Few studies showed that these benefits are also relevant even in the clinical setting. However, these have certain limitations. Namely, these were uncontrolled, their sample size was small, fenofibrate was used as a part of multifactorial approach, while histological data were absent. In this context, there is a need for large prospective studies, including proper control groups and full assessment of liver histology.
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Florentin M, Liberopoulos EN, Rizos CV, Kei AA, Liamis G, Kostapanos MS, Elisaf MS. Colesevelam Plus Rosuvastatin 5 mg/Day Versus Rosuvastatin 10 mg/Day Alone on Markers of Insulin Resistance in Patients with Hypercholesterolemia and Impaired Fasting Glucose. Metab Syndr Relat Disord 2013; 11:152-6. [PMID: 23170931 DOI: 10.1089/met.2012.0103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Matilda Florentin
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | | | - Christos V. Rizos
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Anastazia A. Kei
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - George Liamis
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Michael S. Kostapanos
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Moses S. Elisaf
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
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Affiliation(s)
- Michael S Kostapanos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
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Abstract
BACKGROUND Fenofibrate has been used for the management of atherogenic dyslipidaemia for many years. Reports of fenofibrate-associated increases in serum creatinine (SCr) levels raised concerns regarding deleterious effects on renal function. DESIGN In this narrative review, we discuss available literature on the effect of fenofibrate on the kidney. RESULTS Most clinical studies showed a rapid (within weeks) raising effect of fenofibrate on SCr levels. This was often accompanied by declined estimated glomerular filtration rate. Risk predictors of this adverse effect might include increased age, impaired renal function and high-dose treatment. Also, the concomitant use of medications affecting renal hemodynamics (e.g. angiotensin-converting enzyme-inhibitors (ACEi) and angiotensin receptor blockers) may predispose to fenofibrate-associated increased SCr levels. Interestingly, SCr increases by fenofibrate were transient and reversible even without treatment discontinuation. Furthermore, fenofibrate was associated with a slower progression of renal function impairment and albuminuria in a long-term basis. Also, fenofibrate might be protective against pathological changes in diabetic nephropathy and hypertensive glomerulosclerosis. In this context, it is uncertain whether fenofibrate-associated increase in SCr levels mirrors true renal function deterioration. Several theories have been expressed. The most dominant one involved the inhibition of renal vasodilatory prostaglandins reducing renal plasma flow and glomerular pressure. Increased creatinine secretion or reduced creatinine clearance by fenofibrate was also suggested. These hypotheses should be settled by further studies. CONCLUSIONS Fenofibrate may not be a nephrotoxic drug. However, a close monitoring of SCr levels is relevant especially in high-risk patients. Increases in SCr levels ≥30% can impose treatment discontinuation.
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Affiliation(s)
- Michael S Kostapanos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Kostapanos MS, Rizos EC, Papanas N, Maltezos E, Elisaf MS. Mitochondrial Triglyceride Transfer Protein Inhibition: New Achievements in the Treatment of Dyslipidemias. Curr Pharm Des 2013; 19:3150-60. [PMID: 23317403 DOI: 10.2174/1381612811319170023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/18/2013] [Indexed: 11/22/2022]
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Kostapanos MS, Milionis HJ, Gazi I, Kostara C, Bairaktari ET, Elisaf M. Rosuvastatin Increases α-1 Microglobulin Urinary Excretion in Patients With Primary Dyslipidemia. J Clin Pharmacol 2013; 46:1337-43. [PMID: 17050799 DOI: 10.1177/0091270006292629] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The renoprotective effect of statins has been recently disputed because of observations of proteinuria associated with rosuvastatin treatment, the newest drug of the class. Statin-induced proteinuria findings were mainly based on crudely quantitative dipstick assays. The authors quantitatively evaluated the effect of rosuvastatin at the recommended starting dose of 10 mg/d, on urine protein excretion in patients with primary dyslipidemia. Serum lipid and nonlipid parameters as well as urinary electrolyte, creatinine, and protein (total, albumin, immunoglobulin G, and alpha-1 microglobulin) levels were measured in 40 patients treated with rosuvastatin and 30 controls at baseline and after 12 weeks. The protein-to-creatinine ratios were used to assess urinary protein excretion. Rosuvastatin improved the lipid profile, produced no deterioration of kidney function, but induced a small but significant increase in the excretion of alpha-1 microglobulin (by 16%, P < .05) indicating that statin-related proteinuria involves low-molecular-weight proteins and is of proximal tubular origin.
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Affiliation(s)
- Michael S Kostapanos
- Department of Internal Medicine, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
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Kastorini CM, Milionis HJ, Georgousopoulou E, Kostapanos MS, Yannakoulia M, Nikolaou V, Vemmos KN, Goudevenos JA, Panagiotakos DB. Modelling eating practices in non-fatal acute coronary syndrome or stroke development: a case/case-control study. Nutr Metab Cardiovasc Dis 2013; 23:242-249. [PMID: 22459077 DOI: 10.1016/j.numecd.2011.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 12/23/2011] [Accepted: 12/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Although significant evidence exists regarding the role of specific foods and dietary patterns on the development of cardiovascular disease, the influence of eating practices has not been thoroughly examined and understood. The aim of the present work was to evaluate the independent role of eating practices on the likelihood of developing an acute coronary syndrome (ACS) or ischemic stroke. METHODS AND RESULTS During 2009-2010, 1000 participants were enrolled; 250 were consecutive patients with a first ACS, 250 were consecutive patients with a first ischemic stroke and 500 were population-based control subjects (250 age-sex matched one-for-one with ACS patients, and 250 age-sex matched one-for-one with stroke patients). Eating practices were evaluated using a special questionnaire. Socio-demographic, clinical, psychological, dietary and other lifestyle characteristics were also measured. After controlling for potential confounding factors, each 20 min prolongation of dinner-to-sleep time was associated with 10% lower likelihood of ischemic stroke (95%CI: 0.83-0.98). Furthermore, eating practices related to stress (i.e., eating while being stressed, eating while working at the same time, skipping a meal due to work obligations) were associated with higher likelihood of having an ACS. Finally, eating while watching television was associated with lower likelihood of having an ACS (OR: 0.46, 95%CI: 0.27-0.78) or stroke event (OR: 0.42, 95%CI: 0.23-0.77). CONCLUSION Results of this work, present novel information, indicating the significance of eating practices, in addition to dietary patterns, regarding the development of coronary heart disease and stroke, and could be used in the primary prevention of CVD.
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Affiliation(s)
- C M Kastorini
- School of Medicine, University of Ioannina, Ioannina, Greece
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Liberopoulos EN, Makariou SE, Moutzouri E, Kostapanos MS, Challa A, Elisaf M. Effect of simvastatin/ezetimibe 10/10 mg versus simvastatin 40 mg on serum vitamin D levels. J Cardiovasc Pharmacol Ther 2013; 18:229-33. [PMID: 23288870 DOI: 10.1177/1074248412470513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low levels of 25-hydroxyvitamin D (25(OH)VitD) have been recognized as an emerging cardiovascular disease (CVD) risk factor. Statins are reported to increase 25(OH)VitD concentration. Animal studies suggest that ezetimibe is a moderate inhibitor of intestinal 25(OH)VitD absorption, but its effect in humans is unknown. AIM To investigate whether combined treatment with simvastatin/ezetimibe 10/10 mg would increase 25(OH)VitD levels compared to simvastatin 40 mg monotherapy in patients with primary hypercholesterolemia. METHODS In a Prospective Randomized Open-label Blinded End point study, 50 patients with primary hypercholesterolemia received either simvastatin/ezetimibe 10/10 mg (n = 25) or simvastatin 40 mg (n = 25) daily for 3 months. The primary end point was between-group difference in the change of serum 25(OH)VitD levels. RESULTS Simvastatin/ezetimibe 10/10 mg was associated with a 36.7% increase in 25(OH)VitD serum levels (from 6.8 to 9.3 ng/mL, P = .000), while simvastatin 40 mg was associated with a 79.1% increase (from 6.7 to 12.0 ng/mL, P = .008). The increase in 25(OH)VitD levels in the simvastatin 40 mg group was significantly greater compared to that in the simvastatin/ezetimibe 10/10 mg group (P = .04). Both groups exhibited similar reductions in low-density lipoprotein cholesterol (LDL-C) levels. CONCLUSION For similar LDL-C lowering simvastatin 40 mg is associated with greater increase in 25(OH)VitD compared to simvastatin/ezetimibe 10/10 mg. Whether this difference is relevant in terms of CVD risk reduction is unknown.
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Kostapanos MS, Athyros VG, Mikhailidis DP, Elisaf MS. Evaluation of the incidence and risk factors for development of fenofibrate-associated nephrotoxicity. J Clin Lipidol 2013; 7:88. [PMID: 23351588 DOI: 10.1016/j.jacl.2012.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 02/13/2012] [Indexed: 11/30/2022]
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Kostapanos MS, Mikhailidis DP, Elisaf MS, Steiropoulos P, Papanas N. Obstructive sleep apnoea syndrome and cardiovascular risk. Arch Med Sci 2012; 8:1115-6. [PMID: 23319990 PMCID: PMC3542504 DOI: 10.5114/aoms.2012.32425] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 02/05/2012] [Accepted: 02/08/2012] [Indexed: 12/21/2022] Open
Affiliation(s)
- Michael S. Kostapanos
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London NW3 2QG, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London NW3 2QG, UK
| | - Moses S. Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Greece
| | | | - Nikolaos Papanas
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Greece
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Kostapanos MS, Florentin M, Elisaf MS. Gender Differences in the Epidemiology, Clinical Presentation, Prevention, and Prognosis of Acute Coronary Syndromes. Angiology 2012; 64:5-8. [PMID: 23221620 DOI: 10.1177/0003319712446188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Michael S. Kostapanos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Moses S. Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA 2012; 308:1024-33. [PMID: 22968891 DOI: 10.1001/2012.jama.11374] [Citation(s) in RCA: 687] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Considerable controversy exists regarding the association of omega-3 polyunsaturated fatty acids (PUFAs) and major cardiovascular end points. OBJECTIVE To assess the role of omega-3 supplementation on major cardiovascular outcomes. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through August 2012. STUDY SELECTION Randomized clinical trials evaluating the effect of omega-3 on all-cause mortality, cardiac death, sudden death, myocardial infarction, and stroke. DATA EXTRACTION Descriptive and quantitative information was extracted; absolute and relative risk (RR) estimates were synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Subgroup analyses were performed for the presence of blinding, the prevention settings, and patients with implantable cardioverter-defibrillators, and meta-regression analyses were performed for the omega-3 dose. A statistical significance threshold of .0063 was assumed after adjustment for multiple comparisons. DATA SYNTHESIS Of the 3635 citations retrieved, 20 studies of 68,680 patients were included, reporting 7044 deaths, 3993 cardiac deaths, 1150 sudden deaths, 1837 myocardial infarctions, and 1490 strokes. No statistically significant association was observed with all-cause mortality (RR, 0.96; 95% CI, 0.91 to 1.02; risk reduction [RD] -0.004, 95% CI, -0.01 to 0.02), cardiac death (RR, 0.91; 95% CI, 0.85 to 0.98; RD, -0.01; 95% CI, -0.02 to 0.00), sudden death (RR, 0.87; 95% CI, 0.75 to 1.01; RD, -0.003; 95% CI, -0.012 to 0.006), myocardial infarction (RR, 0.89; 95% CI, 0.76 to 1.04; RD, -0.002; 95% CI, -0.007 to 0.002), and stroke (RR, 1.05; 95% CI, 0.93 to 1.18; RD, 0.001; 95% CI, -0.002 to 0.004) when all supplement studies were considered. CONCLUSION Overall, omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke based on relative and absolute measures of association.
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Affiliation(s)
- Evangelos C Rizos
- Lipid Disorders Clinic, Department of Internal Medicine, University Hospital of Ioannina, Ioannina, Greece
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Agouridis AP, Kostapanos MS, Tsimihodimos V, Kostara C, Mikhailidis DP, Bairaktari ET, Tselepis AD, Elisaf MS. Effect of rosuvastatin monotherapy or in combination with fenofibrate or ω-3 fatty acids on lipoprotein subfraction profile in patients with mixed dyslipidaemia and metabolic syndrome. Int J Clin Pract 2012; 66:843-53. [PMID: 22897461 DOI: 10.1111/j.1742-1241.2012.02972.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Raised triglycerides (TG), decreased high-density lipoprotein cholesterol (HDL-C) levels and a predominance of small dense low density lipoproteins (sdLDL) are characteristics of the metabolic syndrome (MetS). OBJECTIVE To compare the effect of high-dose rosuvastatin monotherapy with moderate dosing combined with fenofibrate or ω-3 fatty acids on the lipoprotein subfraction profile in patients with mixed dyslipidaemia and MetS. METHODS We previously randomised patients with low-density lipoprotein cholesterol (LDL-C) > 160 and TG > 200 mg/dl to rosuvastatin monotherapy 40 mg/day (R group, n = 30) or rosuvastatin 10 mg/day combined with fenofibrate 200 mg/day (RF group, n = 30) or ω-3 fatty acids 2 g/day (Rω group, n = 30). In the present study, only patients with MetS were included (24, 23 and 24 in the R, RF and Rω groups respectively). At baseline and after 12 weeks of treatment, the lipoprotein subfraction profile was determined by polyacrylamide 3% gel electrophoresis. RESULTS The mean LDL size was significantly increased in all groups. This change was more prominent with RF than with other treatments in parallel with its greater hypotriglyceridemic capacity (p < 0.05 compared with R and Rω). A decrease in insulin resistance by RF was also noted. Only RF significantly raised HDL-C levels (by 7.7%, p < 0.05) by increasing the cholesterol of small HDL particles. The cholesterol of larger HDL subclasses was significantly increased by R and Rω. CONCLUSIONS All regimens increased mean LDL size; RF was the most effective. A differential effect of treatments was noted on the HDL subfraction profile.
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Affiliation(s)
- A P Agouridis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Agouridis AP, Liberopoulos EN, Kostapanos MS, Elisaf MS. New-onset extremely low levels of high-density lipoprotein cholesterol. J Clin Lipidol 2012; 6:593-5. [PMID: 23312055 DOI: 10.1016/j.jacl.2012.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 11/19/2022]
Abstract
We report the case of a 55-year-old man who presented to the outpatient lipid clinic for his scheduled follow-up with severely low high-density lipoprotein cholesterol levels of new onset. Diagnostic workup showed that he was infected by visceral leishmaniasis. He was treated with liposomal amphotericin B and serum lipid levels returned to usual values.
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Affiliation(s)
- Aris P Agouridis
- Department of Internal Medicine, Medical School, University of Ioannina, 45 110 Ioannina, Greece
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Kostapanos MS, Elisaf MS, Mikhailidis DP. Hypertriglyceridemia-induced acute pancreatitis: clinical considerations. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/clp.12.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Kostapanos MS, Elisaf MS, Mikhailidis DP. Effect of Atorvastatin Monotherapy and Low-Dose Atorvastatin/Ezetimibe Combination on Fasting and Postprandial Triglycerides in Combined Hyperlipidemia. J Cardiovasc Pharmacol Ther 2012; 17:427; author reply 428. [PMID: 22529215 DOI: 10.1177/1074248412443424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael S. Kostapanos
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
- Department of Internal Medicine, Medical School, University of Ioannina, Greece
| | - Moses S. Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Tziallas D, Kastanioti C, Kostapanos MS, Skapinakis P, Elisaf MS, Mavreas V. The impact of the metabolic syndrome on health-related quality of life: a cross-sectional study in Greece. Eur J Cardiovasc Nurs 2012; 11:297-303. [PMID: 21398183 DOI: 10.1016/j.ejcnurse.2011.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Metabolic syndrome [MetS] is a chronic, progressive and multi-complex health problem that can trigger physical, emotional and psychosocial problems. The aim of this study is to investigate the association between MetS and health-related quality of life (HRQoL) as well as depressive and anxiety disorders. METHODS New consecutive patients who attended an outpatient lipid clinic for evaluation for MetS were eligible for inclusion in the study. The MetS was defined according to the new definition of International Diabetes Federation (IDF). The medical outcomes study, short form-36 (SF-36) was used to assess HRQoL. Anxiety and depressive symptoms were assessed by a validated Greek version of the hospital anxiety and depression scale (HADS). RESULTS Three hundred and fifty-nine subjects were involved of whom 206 [57.4%] met the diagnostic criteria for the MetS (cases) and 153 [42.6%] were free of MetS criteria (comparator group). MetS was associated with lower scores of all subscales of the SF-36 except of bodily pain. The physical component summary score of SF-36 was independently associated with gender (β = 2.41, P = .01), married or living together (β = 5.18, P = .001) and satisfactory household income (β = 5.77, P < .0001). The mental component summary score of SF-36 was independently associated with gender (β = 3.20, P = .003) and satisfactory household income (β = 3.94, P = .02). A predominance of anxiety and depressive symptoms was observed among subjects with MetS. CONCLUSIONS Our study demonstrated that subjects with MetS have significantly more impaired HRQoL than those without MetS. These findings suggest that HRQoL should be considered in the management of subjects with MetS.
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Affiliation(s)
- Dimitrios Tziallas
- Department of Internal Medicine, University of Ioannina, Ioannina, Greece.
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Kostapanos MS, Athyros VG, Karagiannis A, Mikhailidis DP. Mechanisms linking nonalcoholic fatty liver disease with coronary artery disease. Dig Dis Sci 2012; 57:1109. [PMID: 22311368 DOI: 10.1007/s10620-012-2066-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 01/16/2012] [Indexed: 01/06/2023]
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