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Generoso G, Bensenor IM, Santos IS, Santos RD, Goulart AC, Jones SR, Kulkarni KR, Blaha MJ, Toth PP, Lotufo PA, Bittencourt MS. Diabetes alters the association between high-density lipoprotein subfractions and carotid intima-media thickness: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Diab Vasc Dis Res 2018; 15:541-547. [PMID: 30024274 DOI: 10.1177/1479164118788080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/17/2022] Open
Abstract
INTRODUCTION High-density lipoprotein cholesterol comprises a group of heterogeneous subfractions that might have differential effects on atherosclerosis. Moreover, prior investigations suggest that the presence of diabetes (T2D) modifies the impact of some subfractions on atherosclerosis. In this study, we aimed to evaluate the association between high-density lipoprotein cholesterol subfractions and carotid intima-media thickness in the baseline assessment of the Brazilian Longitudinal Study of Adult Health participants from the São Paulo investigation centre. METHODS We evaluated 3930 individuals between 35 and 74 years without previous cardiovascular disease not using lipid-lowering drugs. High-density lipoprotein cholesterol subfractions (HDL2-C and HDL3-C) were measured by vertical ultracentrifugation (vertical auto profile). The relationship between each high-density lipoprotein cholesterol subfraction and carotid intima-media thickness was analysed by multiple linear regression models. RESULTS Total high-density lipoprotein cholesterol, as well as HDL2-C and HDL3-C, was negatively associated with carotid intima-media thickness after adjustment for demographic data (all p < 0.001) and traditional risk factors (all p < 0.05). When stratified by T2D status, the HDL2-C/HDL3-C ratio showed a negative association with carotid intima-media thickness in participants with T2D ( p = 0.032), even after fully controlling for confounding variables, including total high-density lipoprotein cholesterol. CONCLUSION HDL2-C, HDL3-C and HDL2/HDL3-C ratio are inversely associated with carotid intima-media thickness after adjustment for traditional risk factors. Association of the HDL2-C/HDL3-C ratio is modified by the presence of diabetes, being more pronounced in diabetic individuals.
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Affiliation(s)
- Giuliano Generoso
- 1 Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabela M Bensenor
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Departamento de Clinica Medica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Itamar S Santos
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Departamento de Clinica Medica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Raul D Santos
- 1 Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alessandra C Goulart
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven R Jones
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | | | - Michael J Blaha
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Peter P Toth
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
- 6 Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Paulo A Lotufo
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Departamento de Clinica Medica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcio Sommer Bittencourt
- 1 Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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152
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Ferrières J, Lautsch D, Gitt AK, De Ferrari G, Toplak H, Elisaf M, Drexel H, Horack M, Baxter C, Ambegaonkar B, Brudi P, Toth PP. Body mass index impacts the choice of lipid-lowering treatment with no correlation to blood cholesterol - Findings from 52 916 patients in the Dyslipidemia International Study (DYSIS). Diabetes Obes Metab 2018; 20:2670-2674. [PMID: 29888459 PMCID: PMC6220851 DOI: 10.1111/dom.13415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 11/28/2022]
Abstract
A high body mass index (BMI) is associated with increased cardiovascular risk. We sought to identify whether BMI influences the choice of lipid-lowering treatment in a large, real-world cohort of 52 916 patients treated with statins. The Dyslipidemia International Study (DYSIS) is a cross-sectional, observational, multicentre study in statin-treated patients ≥45 years of age from 30 countries; 1.1% were underweight (BMI < 18.5 kg/m2 ), 33.1% had normal weight (BMI 18.5-24.9 kg/m2 ), 41.5% were overweight (BMI 25-29.9 kg/m2 ), 17.1% had class I obesity (BMI 30.0-34.9 kg/m2 ), 5.0% had class II obesity (BMI 35-39.9 kg/m2 ), and 2.1% had class III obesity (≥40 kg/m2 ). BMI correlated with high-density lipoprotein cholesterol (HDL-C) and triglycerides (Spearman's ρ: -0.147 and 0.170, respectively; P < 0.0001 for both); however, there was no correlation with low-density lipoprotein cholesterol (LDL-C; ρ: 0.003; P = 0.51). Statin intensity increased with increasing BMI (ρ: 0.13; P < 0.001), an association that held after adjustment for comorbidities (OR: 2.4; 95% CI: 2.0-3.0) on BMI ≥ 30 kg/m2 for atorvastatin equivalent ≥40 mg/d.
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Affiliation(s)
- Jean Ferrières
- Department of CardiologyToulouse Rangueil University HospitalToulouseFrance
- Department of Epidemiology and Public HealthUMR INSERM 1027, Toulouse University School of MedicineToulouseFrance
| | | | - Anselm K. Gitt
- Herzzentrum LudwigshafenLudwigshafenGermany
- Stiftung Institut für HerzinfarktforschungLudwigshafenGermany
| | - Gaetano De Ferrari
- Department of CardiologyIRCCS Fondazione Policlinico San Matteo, and University of PaviaPaviaItaly
| | - Hermann Toplak
- Lipid Clinic, Department of MedicineMedical University of GrazGrazAustria
| | - Moses Elisaf
- School of MedicineUniversity of IoanninaIoanninaGreece
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT)FeldkirchAustria
- Department of Medicine and CardiologyPrivate University of the Principality of LiechtensteinTriesenLiechtenstein
- Department of Medicine Division of CardiologyDrexel University College of MedicinePhiladelphiaPennsylvania
| | - Martin Horack
- Stiftung Institut für HerzinfarktforschungLudwigshafenGermany
| | | | | | | | - Peter P. Toth
- CGH Medical CenterSterlingIllinois
- Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins University School of MedicineBaltimoreMaryland
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153
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Banach M, Mazidi M, Mikhailidis DP, Toth PP, Jozwiak J, Rysz J, Watts GF. Association between phenotypic familial hypercholesterolaemia and telomere length in US adults: results from a multi-ethnic survey. Eur Heart J 2018; 39:3635-3640. [PMID: 30165413 DOI: 10.1093/eurheartj/ehy527] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 06/24/2018] [Accepted: 08/09/2018] [Indexed: 12/24/2022] Open
Abstract
Aims Familial hypercholesterolaemia (FH) accelerates atherosclerotic cardiovascular disease (ASCVD) and accordingly is the most potent hereditary cause of premature coronary heart disease. The association between telomere length (TL), a biological index of ageing, and FH has not been hitherto investigated. We addressed this question using data from the US National Health and Education National Surveys (NHANES, 1999-2002). Methods and results We included individuals, who had TL measurements (with quantitative polymerase chain reaction method) and a phenotypic diagnosis of FH based on the Dutch Lipid Clinic Network (DLCN) criteria. Sample weights were applied for unequal probabilities of selection, non-response bias, and oversampling by complex sample analysis. The adult prevalence of FH in NHANES was 0.43% [95% confidence interval (95% CI) 0.33-0.57]. The frequencies of probable FH (mean DLCN score: 6.2) and definite FH (mean DLCN score: 8.9) were 0.42% (95% CI 0.32-0.48) and 0.03% (95% CI 0.02-0.06), respectively. Subjects with FH had a higher prevalence of non-communicable diseases (hypertension, diabetes 2 type, and obesity) and early atherosclerosis (2.9% in overall population vs. 42.2% in FH). Overall, the mean TL in the non-FH population was 1.09 (95% CI 1.06-1.12) (T/S ratio) and 1.09 (95% CI 1.03-1.12) [(T/S ratio) for total FH]. Telomere length adjusted for age, sex, race, and body mass index was shorter in FH compared with healthy subjects (FH 0.89, 95% CI 0.84-0.93 vs. healthy: 1.05, 95% CI 0.97-1.11 T/S ratio; P < 0.001). Subjects with longer TL (highest quartile) had 12% less chance of having FH compared with those with TL in the lowest quartile (Q1, 95% CI 0.78-0.93). Conclusions These preliminary data suggest an association between TL, an index of biological age, and the presence of FH, the most common inherited cause of premature ASCVD. Given our relatively low sample size, the findings need confirmation in larger studies.
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Affiliation(s)
- Maciej Banach
- Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, Lodz, Poland
- Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zyty 28, Zielona Gora, Poland
| | - Mohsen Mazidi
- Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Kemigarden 4, Gothenburg, Sweden
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), Pond Street, London, UK
| | - Peter P Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, 600 N. Wolfe St, Carnegie 565-G, Baltimore, MD, USA
- Preventive Cardiology, CGH Medical Center, 01 East Miller Road, Sterling, IL, USA
| | - Jacek Jozwiak
- Department of Medicine and Public Health, University of Opole, Kopernika 11A, Opole, Poland
| | - Jacek Rysz
- Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, Lodz, Poland
| | - Gerald F Watts
- Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley, WA, Australia
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154
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Ferrieres J, De Ferrari GM, Hermans MP, Elisaf M, Toth PP, Horack M, Brudi P, Lautsch D, Bash LD, Baxter CA, Ashton V, Ambegaonkar B, Gitt AK. Predictors of LDL-cholesterol target value attainment differ in acute and chronic coronary heart disease patients: Results from DYSIS II Europe. Eur J Prev Cardiol 2018; 25:1966-1976. [DOI: 10.1177/2047487318806359] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 01/09/2023]
Abstract
Background Patients with coronary heart disease (CHD) and survivors of acute coronary syndrome (ACS) are at very high risk for adverse cardiovascular events. Lowering low-density lipoprotein cholesterol (LDL-C) can reduce the risk, with effective lipid-lowering therapy (LLT) readily available; however, dyslipidemia remains prevalent throughout Europe. Design The observational Dyslipidemia International Study II (DYSIS II) aimed to identify unmet treatment needs in adult ACS and CHD patients. Data for the seven participating European countries are presented herein. Methods The study was carried out from December 2012 to November 2014. Use of LLT and attainment of European-guideline-recommended LDL-C targets were assessed. For ACS patients, changes in lipid levels and LLT were evaluated 4 months post-hospitalization. Results Of the 4344 patients enrolled, 2946 were attending a physician visit for the assessment of stable CHD, while 1398 had been hospitalized for an ACS event. In both patient sets, mean LDL-C levels were high (89.5 and 112.5 mg/dl, respectively) and <70 mg/dl target attainment extremely poor. The mean daily statin dosage (normalized to atorvastatin potency) was 27 ± 20 mg for CHD and 22 ± 17 mg for ACS patients. Treatment was intensified slightly for ACS subjects after hospitalization, with the dosage reaching 35 ± 24 mg/day. LDL-C target attainment was higher by the end of the 4-month follow up (30.9% and 41.5% for patients on LLT and without LLT at baseline, respectively; p < 0.05). Conclusion Elevated blood cholesterol levels are highly prevalent across Europe, with low numbers of coronary patients reaching their recommended LDL-C target. While use of LLT is widespread, there is significant scope for intensifying treatment.
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Affiliation(s)
- Jean Ferrieres
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France; Department of Epidemiology and INSERM UMR 1027, Toulouse University School of Medicine, Toulouse, France
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Michel P. Hermans
- Division of Endocrinology & Nutrition, Cliniques Universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Moses Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Peter P. Toth
- CGH Medical Center, Sterling, Illinois, and Ciccarone Center for the Prevention of heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | | | | | | | | | - Anselm K. Gitt
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
- Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
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155
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Laufs U, Dent R, Kostenuik PJ, Toth PP, Catapano AL, Chapman MJ. Why is hypercholesterolaemia so prevalent? A view from evolutionary medicine. Eur Heart J 2018; 40:2825-2830. [DOI: 10.1093/eurheartj/ehy479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/07/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Ulrich Laufs
- Klinik und Poliklinik für Kardiologie; Universitätsklinikum Leipzig, Liebigstr. 20, Leipzig, Germany
| | | | - Paul J Kostenuik
- University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Phylon Pharma Services, Newbury Park, CA, USA
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA
- Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Alberico Luigi Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milano, Via Balzaretti 9, Milan, Italy
- Multimedica IRCCS Via Milanese, 300, Sesto San Giovanni, Milano, Italy
| | - M John Chapman
- National Institute for Health and Medical Research (INSERM), University of Pierre and Marie Curie, Pitié-Salpêtrière University Hospital, Paris, France
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156
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Penson P, Long LD, Howard G, Toth PP, Muntner P, Howard VJ, Safford MM, Jones SR, Catapano AL, Banach M. P5086Associations between very low concentrations of LDL-Cholesterol, hsCRP and health outcomes in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/14/2022] Open
Affiliation(s)
- P Penson
- Liverpool John Moores University, School of Pharmacy & Biomolecular Sciences, Liverpool, United Kingdom
| | - L D Long
- University of Alabama Birmingham, Department of Biostatistics, Birmingham, United States of America
| | - G Howard
- University of Alabama Birmingham, Department of Biostatistics, Birmingham, United States of America
| | - P P Toth
- Johns Hopkins University of Baltimore, Division of Cardiology, Department of Medicine, Baltimore, United States of America
| | - P Muntner
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - V J Howard
- University of Alabama Birmingham, Department of Epidemiology, Birmingham, United States of America
| | - M M Safford
- Weill Cornell Medical College, Department of Medicine, New York, United States of America
| | - S R Jones
- Johns Hopkins University of Baltimore, Division of Cardiology, Department of Medicine, Baltimore, United States of America
| | - A L Catapano
- San Raffaele Hospital of Milan (IRCCS), Department of Pharmacological and Biomolecular Sciences, Milan, Italy
| | - M Banach
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
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157
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Toth PP, Granowitz C, Hull M, Liassou D, Anderson A, Philip S. High Triglycerides Are Associated With Increased Cardiovascular Events, Medical Costs, and Resource Use: A Real-World Administrative Claims Analysis of Statin-Treated Patients With High Residual Cardiovascular Risk. J Am Heart Assoc 2018; 7:e008740. [PMID: 30371242 PMCID: PMC6201477 DOI: 10.1161/jaha.118.008740] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/06/2018] [Indexed: 12/25/2022]
Abstract
Background The American Heart Association recognizes high triglycerides as a cardiovascular risk factor. Methods and Results This retrospective observational administrative claims analysis (Optum Research Database) included statin-treated patients ≥45 years old with diabetes mellitus and/or atherosclerotic cardiovascular disease, triglycerides 2.26 to 5.64 mmol/L, and a propensity-matched comparator cohort with triglycerides <1.69 mmol/L and high-density lipoprotein cholesterol >1.04 mmol/L. In the high-triglycerides cohort versus comparators (both n=10 990, 49% women), mean age was 61.7 versus 62.2 years and follow-up was 41.3 versus 42.1 months, respectively. Multivariate analysis of composite major cardiovascular events demonstrated significantly increased risk in the high-triglycerides (n=13 411 patients) versus comparator (n=32 506 patients) cohorts (hazard ratio [ HR ], 1.35; 95% confidence interval [ CI ], 1.225-1.485; P<0.001), with significantly higher risk for nonfatal myocardial infarction ( HR , 1.35; 95% CI , 1.19-1.52; P<0.001), nonfatal stroke ( HR , 1.27; 95% CI , 1.14-1.42; P<0.001), and need for coronary revascularization ( HR , 1.51; 95% CI , 1.34-1.69; P<0.001), but not unstable angina or cardiovascular death. Increased cardiovascular risk in the high-triglycerides versus comparator cohort was maintained, even with addition of non-high-density lipoprotein cholesterol to the multivariate model and when analyzing high and low high-density lipoprotein cholesterol subgroups. Average total healthcare cost per patient per month (cost ratio, 1.15; 95% CI , 1.084-1.210; P<0.001) and rate of occurrence of inpatient hospital stay ( HR , 1.17; 95% CI , 1.113-1.223; P<0.001) were also significantly greater in the high-triglycerides cohort. Conclusions In this real-world analysis, patients with high cardiovascular risk and high triglycerides had worse composite cardiovascular and health economic outcomes than patients with well-managed triglycerides and high-density lipoprotein cholesterol >1.04 mmol/L.
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Affiliation(s)
- Peter P. Toth
- CGH Medical CenterSterlingIL
- Johns Hopkins University School of MedicineBaltimoreMD
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158
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Toth PP, Philip S, Hull M, Liassou D, Anderson A, Granowitz C. P739Triglycerides 150 mg/dL and above are associated with an increased risk of peripheral arterial revascularization in high-risk statin-treated patients: A real-world analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Affiliation(s)
- P P Toth
- CGH Medical Center, Sterling, United States of America
| | - S Philip
- Amarin Pharma Inc., Bedminster, United States of America
| | - M Hull
- Optum, Eden Prairie, United States of America
| | - D Liassou
- Optum, Eden Prairie, United States of America
| | - A Anderson
- Optum, Eden Prairie, United States of America
| | - C Granowitz
- Amarin Pharma Inc., Bedminster, United States of America
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159
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Toth PP, Philip S, Hull M, Liassou D, Granowitz C. Elevated Triglycerides (≥150 mg/dL) and High Triglycerides (200-499 mg/dL) are Significant Predictors of New Heart Failure Diagnosis: A Real-World Analysis of High-Risk Statin-Treated Patients. J Card Fail 2018. [DOI: 10.1016/j.cardfail.2018.07.094] [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: 10/28/2022]
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160
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Mazidi M, Toth PP, Rysz J, Jozwiak J, Banach M. P6268Association between familial hypercholesterolemia and telomere length in US adults. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- M Mazidi
- Chalmers University of Technology, Department of Biology and Biological Engineering, Food and Nutrition Science, Gothenburg, Sweden
| | - P P Toth
- University of Illinois at Chicago, Chicago, United States of America
| | - J Rysz
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
| | - J Jozwiak
- Czestochowa University of Technology, Czestochowa, Poland
| | - M Banach
- Medical University of Lodz, Department of Hypertension, Lodz, Poland
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161
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Sathiyakumar V, Kapoor K, Jones SR, Banach M, Martin SS, Toth PP. Novel Therapeutic Targets for Managing Dyslipidemia. Trends Pharmacol Sci 2018; 39:733-747. [PMID: 29970260 DOI: 10.1016/j.tips.2018.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/16/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in developed nations. Therapeutic modulation of dyslipidemia by inhibiting 3'-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase is standard practice throughout the world. However, based on findings from Mendelian studies and genetic sequencing in prospective longitudinal cohorts from around the world, novel therapeutic targets regulating lipid and lipoprotein metabolism, such as apoprotein C3, angiopoietin-like proteins 3 and 4, and lipoprotein(a), have been identified. These targets may provide additional avenues to prevent and treat atherosclerotic disease. We therefore review these novel molecular targets by addressing available Mendelian and observational data, therapeutic agents in development, and early outcomes results.
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Affiliation(s)
- Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karan Kapoor
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, CGH Medical Center, Sterling, IL, USA.
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162
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Nikolic D, Castellino G, Banach M, Toth PP, Ivanova E, Orekhov AN, Montalto G, Rizzo M. PPAR Agonists, Atherogenic Dyslipidemia and Cardiovascular Risk. Curr Pharm Des 2018; 23:894-902. [PMID: 27719644 DOI: 10.2174/1381612822666161006151134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/30/2016] [Indexed: 11/22/2022]
Abstract
Peroxisome proliferator-activated receptors (PPAR) are implicated in the pathology of several metabolic diseases including obesity, diabetes, and atherosclerosis. PPAR agonists exert multiple lipid modifying actions which are beneficial to the prevention of atherosclerosis. Such benefits in lipid lowering actions include improvements in atherogenic dyslipidemia that seems to be particularly expressed in individuals at higher cardiovascular (CV) risk. In addition, the favorable effects of PPAR agonists on different cardio-metabolic parameters are established in several metabolic conditions, such as diabetes mellitus, insulin resistance, and heightened systemic inflammation. The goal of this review is to summarize the current evidence on PPAR agonists and their effects on atherogenic dyslipidemia and CV risk. The main findings indicate that PPAR agonists improve not only the lipid profile, but also lipoprotein subfractions associated with atherogenic dyslipidemia and other CV markers. However, future prospective studies are required to establish the long-term effects of such therapies on atherogenic lipoproteins and their benefit on CV outcomes.
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Affiliation(s)
- Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Peter P Toth
- CGH Medical Center, Sterling, Illinois, USA; University of Illinois, School of Medicine, Peoria, Illinois; Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Ekaterina Ivanova
- Department of Development and Regeneration, Group of Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Alexander N Orekhov
- Laboratory of Angiopathology, Institute for Atherosclerosis Research (Skolkovo), Moscow, Russian Federation
| | - Giuseppe Montalto
- Consiglio Nazionale delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
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Abstract
Statin therapy is generally well tolerated and very effective in the prevention and treatment of cardiovascular disease, regardless of cholesterol levels; however, it can be associated with various adverse events (myalgia, myopathy, rhabdomyolysis, and diabetes mellitus, among others). Patients frequently discontinue statin therapy without medical advice because of perceived side effects and consequently increase their risk for cardiovascular events. In patients with statin intolerance, it may be advisable to change the dose, switch to a different statin, or try an alternate-day regimen. If intolerance is associated with all statins-even at the lowest dose-non-statin drugs and certain nutraceuticals can be considered. This review focuses on the definition of statin intolerance and on the development of clinical and therapeutic strategies for its management, including emerging alternative therapies.
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Affiliation(s)
- Peter P Toth
- CGH Medical Center, Sterling, IL, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angelo Maria Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Rosaria Vincenza Giglio
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Giuseppa Castellino
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Maciej Banach
- Chair of Nephrology and Hypertension, Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
- Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
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164
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Toth PP, Dwyer JP, Cannon CP, Colhoun HM, Rader DJ, Upadhyay A, Louie MJ, Koren A, Letierce A, Mandel J, Banach M. Efficacy and safety of lipid lowering by alirocumab in chronic kidney disease. Kidney Int 2018. [DOI: 10.1016/j.kint.2017.12.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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165
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Generoso G, Bensenor IM, Santos RD, Santos IS, Goulart AC, Jones SR, Kulkarni KR, Blaha MJ, Toth PP, Lotufo PA, Bittencourt MS. Association between high-density lipoprotein subfractions and low-grade inflammation, insulin resistance, and metabolic syndrome components: The ELSA-Brasil study. J Clin Lipidol 2018; 12:1290-1297.e1. [PMID: 29941395 DOI: 10.1016/j.jacl.2018.05.003] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND High-density lipoprotein cholesterol (HDL-C) can be divided into subfractions, which may have variable effects in atherogenesis. The results about the association between HDL-C subfractions and risk factors for cardiovascular disease are mixed. OBJECTIVE The objective of this study was to analyze the association between HDL-C subfractions and each metabolic syndrome component, homeostasis model assessment-estimated insulin resistance (HOMA-IR) and C-reactive protein (CRP). METHODS Four thousand five hundred thirty-two individuals between 35 and 74 years old without previous manifest cardiovascular disease not using fibrates were enrolled. HDL-C subfractions were separated by vertical ultracentrifugation (vertical auto profile-in mg/dL) into HDL2-C and HDL3-C. HDL2-C/HDL3-C ratio, HOMA-IR, and high-sensitivity CRP were also included in the analysis. RESULTS Mean age of participants was 51 ± 9 years, and 54.8% were women. In univariate analysis, HDL-C, HDL2-C, and HDL3-C were all inversely associated with each of the metabolic syndrome defining factors, HOMA-IR values, and serum CRP. We also observed a negative association between HDL2-C/HDL3-C ratio with the variables aforementioned even after adjusting for smoking, alcohol use, physical activity, and HDL-C levels (P < .01). CONCLUSION HDL-C and its subfractions (HDL2-C and HDL3-C) are inversely associated with the defining features of metabolic syndrome, insulin resistance, and systemic inflammation. In addition, the HDL2-C/HDL3-C ratio measured by vertical auto profile is significantly associated with the former factors even after comprehensive adjustment for HDL-C and other confounding variables.
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Affiliation(s)
- Giuliano Generoso
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil; Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Raul D Santos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil; Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Steven R Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | | | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Peter P Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.
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166
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Patti AM, Toth PP, Giglio RV, Banach M, Noto M, Nikolic D, Montalto G, Rizzo M. Nutraceuticals as an Important Part of Combination Therapy in Dyslipidaemia. Curr Pharm Des 2018; 23:2496-2503. [PMID: 28317482 DOI: 10.2174/1381612823666170317145851] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/13/2017] [Indexed: 11/22/2022]
Abstract
Several risk factors such as abnormality of lipid metabolism (e.g. high levels of low-density lipoprotein cholesterol (LDL-C), elevated triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C)) play a central role in the aetiology of cardiovascular disease (CVD). Nutraceutical combination together with a cholesterol- lowering action, when associated with suitable lifestyle, should furnish an alternative to pharmacotherapy in patients reporting statin-intolerance and in subjects at low cardiovascular risk. The present review is focused on nutraceuticals and their synergetic combinations demonstrating a beneficial effect in the management of dyslipidaemia. Several nutraceuticals have been shown to positively modulate lipid metabolism having different functions. Plant sterols and soluble fibres can, for example, decrease the intestinal assimilation of lipids and increase their elimination. Furthermore, berberine and soybean proteins improve the cholesterol uptake in the liver. Policosanols, monacolins and bergamot inhibit hydroxy-methyl-glutaryl coenzyme A reductase (HMGCoA reductase) enzyme action determining the cholesterol hepatic synthesis. Moreover, pomegranate can decrease LDL oxidation and positively affect subclinical atherosclerosis; red yeast rice and berberine play, instead, an important role on endothelial dysfunction and psyllium, plant sterols and bergamot have positive effects on LDL subclasses. To the best of our knowledge, there are no long-term large-scale studies on the anti-atherogenic effect of the nutraceuticals that are available on the market. Thus, further clinical studies should investigate in order to achieve long term tolerability and safety and to provide a better nutraceutical combination tailored to the patient needs.
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Affiliation(s)
- Angelo M Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA; School of Medicine, University of Illinois, Peoria, IL, USA; Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rosaria V Giglio
- Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Marcello Noto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Dragana Nikolic
- Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy
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167
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Abstract
PURPOSE OF REVIEW Recent studies and dyslipidemia treatment guidelines indicate that combination lipid-lowering therapy is frequently needed and its use has increased in recent years. Ezetimibe and simvastatin as a fixed dose is an efficacious treatment choice based on positive results of the recent IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT). In this review, we discuss recent controversies surrounding ezetimibe and provide clinical perspective on the results of the IMPROVE-IT study. RECENT FINDINGS IMPROVE-IT is the first trial that demonstrates a significant clinical benefit of a nonstatin hypolipidemic agent (ezetimibe) used in combination with statin (simvastatin) therapy in patients who have experienced an acute coronary syndrome. For almost a decade, the use of ezetimibe was limited by a relative lack of definitive evidence. However, the most recent Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound study showed greater coronary plaque regression by statin/ezetimibe combination compared with statin monotherapy. The results of the IMPROVE-IT trial are fostering new debate about the value of adjunctive low-density lipoprotein cholesterol lowering over and above a statin. SUMMARY Ezetimibe/simvastatin combination, either as a single pill or as the combined use of the individual compounds, represents a well-tolerated and efficacious choice for dyslipidemia treatment in high-risk subjects, including patients with diabetes. Limited additional risk for adverse events compared with simvastatin monotherapy is observed, and an individualized, patient-centered approach to therapy is recommended.
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Affiliation(s)
- Maciej Banach
- aDepartment of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland bBiomedical Department of Internal Medicine and Medical Specialties, University of Palermo cEuro-Mediterranean Institute of Science and Technology, Palermo, Italy dCGH Medical Centre, Sterling, Illinois; University of Illinois, School of Medicine, Peoria, Illinois eJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
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168
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Quispe R, Baradaran Noveiry B, Faridi KF, Martin SS, Toth PP, Jones SR. Abstract 422: Association of Remnant Lipoprotein Cholesterol and Levels of Glucose and Insulin: the Very Large Database of Lipids. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
A defining feature of diabetic dyslipidemia is elevation of triglyceride-rich lipoproteins, particularly remnant lipoprotein cholesterol (RLP-C). Lowering these lipoproteins may reduce risk of atherosclerotic cardiovascular disease in diabetic patients, though the relationship between RLP-C and hyperglycemia as well as hyperinsulinemia remains inadequately characterized. The purpose of this study was to determine the association of RLP-C with serum glucose and insulin across a broad range of insulin resistance.
Methods:
We used a sample of individuals from the Very Large Database of Lipids with measured fasting serum glucose and insulin levels, as well as lipoprotein cholesterol levels measured by the Vertical Auto Profile test (Atherotech, Birmingham, AL). RLP-C was defined as the sum of VLDL
3
-C + IDL-C. The study population was divided into deciles of HOMA-IR, calculated as [Insulin х Glucose/405]. We performed multivariable linear regression models to determine associations of RLP-C with insulin and glucose after adjusting for age, sex, real LDL-C, triglycerides, AST, BUN and creatinine. Covariates not normally distributed were log-transformed. Analysis was performed in overall population and across HOMA-IR deciles.
Results:
We included a total of 146,826 individuals (43.6% male, mean age 54.9 ± 15.9 years). Median values were: insulin, 9 uU/mL; glucose, 95 mg/dL; RLP-C, 26 mg/dL. The models in our Table explained 60% of variance in RLP-C. Overall, insulin (β=-1.85, p<0.001) and glucose (β=-0.84, p<0.001) had significant negative associations with RLP-C. However, levels of RLP-C were significantly associated with insulin but not glucose across most HOMA-IR deciles (Table).
Conclusion:
RLP-C is significantly associated with levels of serum insulin but not with glucose across a spectrum of insulin resistance. Further characterization of the relationship between RLP-C and serum insulin is needed to help guide future therapies for patients with diabetes.
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Affiliation(s)
- Renato Quispe
- Johns Hopkins Univ, Jacobi Med Cntr/Albert Einstein College of Medicine, New York, NY
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169
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Huang C, Miles J, Tavori H, Toth PP, Toth PP, Fazio S. Abstract 033: Differential Effects of Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Production and Function on Microsomal Triglyceride Transfer Protein. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a circulating protein that plays a key role in the regulation of plasma low-density lipoprotein (LDL) cholesterol levels. PCSK9 binding to the LDL receptor (LDLR) leads to receptor-mediated endocytosis and lysosomal degradation of LDLR. Prior studies have shown that PCSK9 increases production of triglyceride-rich apoB-lipoproteins via up-regulation of lipogenic genes, and that PCSK9 inhibition reduces plasma triglyceride levels. However, the effect of PCSK9 inhibition on hepatic lipogenic genes expression remain unclear.
Using a human hepatocellular carcinoma cell line (HepG2) we show that overexpression of PCSK9 upregulated the expression of several lipogenic genes, including a 1.5-fold increase in ATP citrate lyase (ACLY), a 1.2-fold increase in Fatty Acid Synthase (FAS), a 1.2-fold increase in HMG-CoA-reductase, and a 1.8-fold increase in microsomal triglyceride transfer protein (MTTP), when compared with untransfected HepG2 cells. Overexpression of a gain-of-function mutant of PCSK9 (PCSK9-D374Y) had stronger effects in the same direction: a 2.3-fold increase in ACLY, a 1.8-fold increase in FAS, a 1.6-fold increase in HMG-CoA-reductase, and a 2.1-fold increase in MTTP. In HepG2 cells overexpressing either normal PCSK9 or PCSK9-D374Y, inhibition of PCSK9 function using a monoclonal antibody blocked PCSK9-mediated degradation of LDLR, and reduced expression of SREBP-dependent genes (ACLY, FAS and HMG-CoA-reductase) to levels of untransfected HepG2 cells. Interestingly, while inhibition of PCSK9 function via monoclonal antibody did not affect MTTP gene expression in these cells, inhibition of PCSK9 production via RNA interference reduced MTTP gene expression by 66%.
We conclude that inhibition of PCSK9 production decreases MTTP gene expression, whereas blockade of PCSK9 function (and cellular re-entry) only decreases SREBP-dependent genes expression, but does not affect MTTP gene expression. This study shows that while PCSK9 exerts an influence on genes related to both lipogenesis and lipoprotein assembly, any inhibition of PCSK9 controls SREPB-dependent genes but only inhibiting PCSK9 production controls MTTP gene expression.
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170
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Maierean SM, Mikhailidis DP, Toth PP, Grzesiak M, Mazidi M, Maciejewski M, Banach M. The potential role of statins in preeclampsia and dyslipidemia during gestation: a narrative review. Expert Opin Investig Drugs 2018; 27:427-435. [DOI: 10.1080/13543784.2018.1465927] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School, University College London (UCL), London, UK
| | - Peter P. Toth
- Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariusz Grzesiak
- Department of Gynecology and Obstetrics, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Moshen Mazidi
- Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden
| | - Marek Maciejewski
- Department of Cardiology, Chair of Cardiology and Cardiac Surgery Medical University of Lodz, Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
- Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Cardiovascular Research Centre, University of Zielona-Gora, Zielona-Gora, Poland
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171
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Giglio RV, Patti AM, Cicero AF, Lippi G, Rizzo M, Toth PP, Banach M. Polyphenols: Potential Use in the Prevention and Treatment of Cardiovascular Diseases. Curr Pharm Des 2018; 24:239-258. [DOI: 10.2174/1381612824666180130112652] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/26/2017] [Accepted: 01/26/2018] [Indexed: 11/22/2022]
Abstract
Background:
Polyphenols are bioactive compounds that can be found mostly in foods like fruits, cereals,
vegetables, dry legumes, chocolate and beverages such as coffee, tea and wine. They are extensively used in
the prevention and treatment of cardiovascular disease (CVD) providing protection against many chronic illnesses.
Their effects on human health depend on the amount consumed and on their bioavailability. Many studies
have demonstrated that polyphenols have also good effects on the vascular system by lowering blood pressure,
improving endothelial function, increasing antioxidant defences, inhibiting platelet aggregation and low-density
lipoprotein oxidation, and reducing inflammatory responses.
Methods:
This review is focused on some groups of polyphenols and their effects on several cardiovascular risk
factors such as hypertension, oxidative stress, atherogenesis, endothelial dysfunction, carotid artery intima-media
thickness, diabetes and lipid disorders.
Results:
It is proved that these compounds have many cardio protective functions: they alter hepatic cholesterol
absorption, triglyceride biosynthesis and lipoprotein secretion, the processing of lipoproteins in plasma, and inflammation.
In some cases, human long-term studies did not show conclusive results because they lacked in appropriate
controls and in an undefined polyphenol dosing regimen.
Conclusion:
Rigorous evidence is necessary to demonstrate whether or not polyphenols beneficially impact CVD
prevention and treatment.
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Affiliation(s)
- Rosaria Vincenza Giglio
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Angelo Maria Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Peter P. Toth
- CGH Medical Center, Sterling, Illinois; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
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172
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Karagiannis AD, Liu M, Toth PP, Zhao S, Agrawal DK, Libby P, Chatzizisis YS. Pleiotropic Anti-atherosclerotic Effects of PCSK9 Inhibitors From Molecular Biology to Clinical Translation. Curr Atheroscler Rep 2018. [DOI: 10.1007/s11883-018-0718-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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173
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Sathiyakumar V, Park J, Quispe R, Elshazly MB, Michos ED, Banach M, Toth PP, Whelton SP, Blumenthal RS, Jones SR, Martin SS. Impact of Novel Low-Density Lipoprotein-Cholesterol Assessment on the Utility of Secondary Non-High-Density Lipoprotein-C and Apolipoprotein B Targets in Selected Worldwide Dyslipidemia Guidelines. Circulation 2018; 138:244-254. [PMID: 29506984 DOI: 10.1161/circulationaha.117.032463] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/19/2022]
Abstract
BACKGROUND Selected dyslipidemia guidelines recommend non-high-density lipoprotein-cholesterol (non-HDL-C) and apolipoprotein B (apoB) as secondary targets to the primary target of low-density lipoprotein-cholesterol (LDL-C). After considering 2 LDL-C estimates that differ in accuracy, we examined: (1) how frequently non-HDL-C guideline targets could change management; and (2) the utility of apoB targets after meeting LDL-C and non-HDL-C targets. METHODS We analyzed 2518 adults representative of the US population from the 2011 to 2012 National Health and Nutrition Examination Survey and 126 092 patients from the Very Large Database of Lipids study with apoB. We identified all individuals as well as those with high-risk clinical features, including coronary artery disease, diabetes mellitus, and metabolic syndrome who met very high- and high-risk guideline targets of LDL-C <70 and <100 mg/dL using Friedewald estimation (LDL-CF) and a novel, more accurate method (LDL-CN). Next, we examined those not meeting non-HDL-C (<100, <130 mg/dL) and apoB (<80, <100 mg/dL) guideline targets. In those meeting dual LDL-C and non-HDL-C targets (<70 and <100 mg/dL, respectively, or <100 and <130 mg/dL, respectively), we determined the proportion of individuals who did not meet guideline apoB targets (<80 or <100 mg/dL). RESULTS A total of 7% to 9% and 31% to 36% of individuals had LDL-C <70 and <100 mg/dL, respectively. Among those with LDL-CF<70 mg/dL, 14% to 15% had non-HDL-C ≥100 mg/dL, and 7% to 8% had apoB ≥80 mg/dL. Among those with LDL-CF<100 mg/dL, 8% to 10% had non-HDL-C ≥130 mg/dL and 2% to 3% had apoB ≥100 mg/dL. In comparison, among those with LDL-CN<70 or 100 mg/dL, only ≈2% and ≈1% of individuals, respectively, had non-HDL-C and apoB values above guideline targets. Similar trends were upheld among those with high-risk clinical features: ≈0% to 3% of individuals with LDL-CN<70 mg/dL had non-HDL-C ≥100 mg/dL or apoB ≥80 mg/dL compared with 13% to 38% and 9% to 25%, respectively, in those with LDL-CF<70 mg/dL. With LDL-CF or LDL-CN<70 mg/dL and non-HDL-C <100 mg/dL, 0% to 1% had apoB ≥80 mg/dL. Among all dual LDL-CF or LDL-CN<100 mg/dL and non-HDL-C <130 mg/dL individuals, 0% to 0.4% had apoB ≥100 mg/dL. These findings were robust to sex, fasting status, and lipid-lowering therapy status. CONCLUSIONS After more accurately estimating LDL-C, guideline-suggested non-HDL-C targets could alter management in only a small fraction of individuals, including those with coronary artery disease and other high-risk clinical features. Furthermore, current guideline-suggested apoB targets provide modest utility after meeting cholesterol targets. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01698489.
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Affiliation(s)
- Vasanth Sathiyakumar
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Jihwan Park
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.P.)
| | - Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Mohamed B Elshazly
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College-Qatar, Education City, Doha, Qatar (M.B.E.)
| | - Erin D Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Maciej Banach
- Department of Hypertension, Division of Nephrology and Hypertension, Medical University of Lodz, Poland (M.B.)
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.).,Department of Preventive Cardiology, CGH Medical Center, Sterling, IL (P.P.T.).,College of Medicine, University of Illinois, Peoria, IL (P.P.T.)
| | - Seamus P Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.)
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (V.S., R.Q., E.D.M., P.P.T., S.P.W., R.S.B., S.R.J., S.S.M.). .,Welch Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M.)
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174
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Bittencourt M, Generoso G, Bensenor I, Santos IS, Santos RD, Goulart AC, Staniak HL, Sharovsky R, Jones S, Kulkarni KR, Blaha MJ, Toth PP, Lotufo PA. HIGH-DENSITY LIPOPROTEIN SUBFRACTIONS ARE NOT INDEPENDENTLY ASSOCIATED WITH CORONARY ARTERY CALCIUM: A CROSS-SECTION ANALYSIS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32224-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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175
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Patti AM, Al-Rasadi K, Giglio RV, Nikolic D, Mannina C, Castellino G, Chianetta R, Banach M, Cicero AF, Lippi G, Montalto G, Rizzo M, Toth PP. Natural approaches in metabolic syndrome management. Arch Med Sci 2018; 14:422-441. [PMID: 29593818 PMCID: PMC5868676 DOI: 10.5114/aoms.2017.68717] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [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: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 12/25/2022] Open
Abstract
Metabolic syndrome (MetS) is characterized as a group of cardiometabolic risk factors that raise the risk for heart disease and other health problems, such as diabetes mellitus and stroke. Treatment strategies include pharmacologic interventions and supplementary (or "alternative") treatments. Nutraceuticals are derived from food sources (isolated nutrients, dietary supplements and herbal products) that are purported to provide health benefits, in addition to providing basic nutritional value. Nutraceuticals are claimed to prevent chronic diseases, improve health, delay the aging process, increase life expectancy, and support the structure and function of the body. The study of the beneficial effects of nutraceuticals in patients with MetS, including product standardization, duration of supplementation and definition of optimal dosing, could help better define appropriate treatment. This review focuses on widely marketed nutraceuticals (namely polyphenols, omega-3 fatty acids, macroelements and vitamins) with clinically demonstrated effects on more than one component of MetS.
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Affiliation(s)
- Angelo Maria Patti
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Khalid Al-Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University, Muscat, Oman
| | - Rosaria Vincenza Giglio
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Carlo Mannina
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Giuseppa Castellino
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Roberta Chianetta
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Arrigo F.G. Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
- EuroMediterranean Institute of Science and Technology, Italy
| | - Peter P. Toth
- CGH Medical Center, Sterling, Illinois; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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176
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Power TP, Ke X, Zhao Z, Bonine NG, Cziraky MJ, Grabner M, Barron JJ, Quimbo R, Vangerow B, Toth PP. Clinical characteristics, patterns of lipid-lowering medication use, and health care resource utilization and costs among patients with atherosclerotic cardiovascular disease. Vasc Health Risk Manag 2018; 14:23-36. [PMID: 29440909 PMCID: PMC5804267 DOI: 10.2147/vhrm.s146266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Indexed: 01/14/2023] Open
Abstract
Purpose The aim of this study was to investigate real-world patient characteristics, medication use, and health care resource utilization (HCRU) and costs among patients with clinical atherosclerotic cardiovascular disease (ASCVD) as defined by 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, to examine burden of disease and unmet needs, such as potential undertreatment. Patients and methods This retrospective cohort study utilized a nationally representative managed care database to identify newly diagnosed ASCVD patients between January 1, 2007, and November 30, 2012 (index = first ASCVD diagnosis date) in the USA. Patients had ≥12-month pre-index (baseline) and ≥12-month post-index (follow-up) health plan enrollment and no baseline lipid-lowering medication (LLM). Patient characteristics, LLM utilization patterns, HCRU, and costs were examined for all patients and by subgroups based on LLM use pattern and/or follow-up low-density lipoprotein cholesterol (LDL-C) levels. Results A total of 128,017 ASCVD patients were identified with a mean (SD) age of 59 (13) years, 43.1% female, and 48.8% with ≥36-month follow-up. Within 12-month follow-up, 10.6% had high-intensity statins and 56.9% had no LLM fills. Baseline mean (SD) all-cause costs were $8,852 ($25,608). At 12-month follow-up, mean (SD) all-cause and ASCVD-related costs were $31,443 ($54,040) and $20,289 ($45,159), respectively. The 36-month analyses showed similar distributions. Multivariable analyses showed that age, gender, region, health insurance type, baseline comorbidities, baseline use of specific medications, baseline lipid profiles, and index ASCVD type were significantly associated with all-cause and ASCVD-related health care costs. Conclusion Patients have nonoptimal treatment for ASCVD and substantial HCRU and costs associated with residual risk. Unmet needs and cost burdens of ASCVD patients merit additional investigation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Peter P Toth
- CGH Medical Center, Sterling, IL.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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177
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Abstract
AIMS Utility values inform estimates of the cost-effectiveness of treatment for cardiovascular disease (CVD), but values can vary depending on the method used. The aim of this systematic literature review (SLR) was to explore how methods of elicitation impact utility values for CVD. MATERIALS AND METHODS This review identified English-language articles in Embase, MEDLINE, and the gray literature published between September 1992 and August 2015 using keywords for "utilities" and "stroke", "heart failure", "myocardial infarction", or "angina". Variability in utility values based on the method of elicitation, tariff, or type of respondent was then reported. RESULTS This review screened 4,341 citations; 290 of these articles qualified for inclusion in the SLR because they reported utility values for one or more of the cardiovascular conditions of interest listed above. Of these 290, the 41 articles that provided head-to-head comparisons of utility methods for CVD were reviewed. In this sub-set, it was found that methodological differences contributed to variation in utility values. Direct methods often yielded higher scores than did indirect methods. Within direct methods, there were no clear trends in head-to-head studies (standard gamble [SG] vs time trade-off); but general population respondents often provided lower scores than did patients with the disease when evaluating the same health states with SG methods. When comparing indirect methods, the EQ-5D typically yielded higher values than the SF-6D, but also showed more sensitivity to differences in health states. CONCLUSIONS When selecting CVD utility values for an economic model, consideration of the utility elicitation method is important, as this review demonstrates that methodology of choice impacts utility values in CVD.
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Affiliation(s)
| | | | - Lung-I Cheng
- c Takeda Oncology , Cambridge , MA , USA (current)
| | | | - Peter P Toth
- d CGH Medical Center , Sterling , IL , USA
- e Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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178
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Bliden KP, Singla A, Gesheff MG, Toth PP, Tabrizchi A, Ens G, Guyer K, Singh M, Franzese CJ, Stapleton DD, Tantry US, Gurbel PA. Statin therapy and thromboxane generation in patients with coronary artery disease treated with high-dose aspirin. Thromb Haemost 2017; 112:323-31. [DOI: 10.1160/th14-01-0094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/03/2014] [Indexed: 11/05/2022]
Abstract
SummaryAspirin and statin therapy are mainstay treatments in patients with coronary artery disease (CAD). The relation between statin therapy, in vivo thromboxane (Tx) generation; a marker of inflammation, and blood thrombogenicity has never been explored. Urinary 11-dehydro (dh) TxB2 was determined in patients with suspected CAD on 325 mg daily aspirin therapy prior to undergoing cardiac catheterisation (n=281). Thrombogenicity was estimated by thrombelastographic measurement of thrombin-induced platelet-fibrin clot strength (TIP-FCS) and lipids/lipoproteins were determined by vertical density gradient ultracentrifugation/ELISA. The influence of statin therapy and dose was analysed by the atorvastatin equivalent dose (5–10 mg, 20–40 mg, or 80 mg daily). Statin therapy (n=186) was associated with a dose-dependent reduction in urinary 11-dh TxB2 (p=0.046) that was independent of LDL and apo B100 levels but was strongly related to TIP-FCS (p=0.006). By multivariate analysis, no statin therapy (n=95) and female gender were independently associated with high urinary 11-dh TxB2 [OR=2.95 (0.1.57–5.50, p=0.0007); OR=2.25 (1.24–4.05, p=0.007)], respectively. In aspirin-treated patients, statin therapy was independently and inversely associated with inflammation in a dose-dependent manner. Elevated 11-dh TxB2 was associated with a prothrombotic state indicated by high TIP-FCS. Our data suggest that measurement of urinary 11-dTxB2 may be a useful method to optimise statin dosing in order to reduce thrombotic risk.
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179
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Toth PP. Management of Acute Coronary Syndromes in Patients with Diabetes. J Fam Pract 2017; 66:jfp_6612n. [PMID: 29300792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Given the heightened risk for adverse cardiovascular outcomes in patients with diabetes mellitus, it is important that primary care clinicians be comfortable with the routine management of acute coronary syndromes (ACS) in this patient population. Notably, patients with diabetes are more likely to present atypically during an ACS. To improve health outcomes, patients with a history of diabetes and ACS should be evaluated for peripheral arterial disease and encouraged to pursue cardiac rehabilitation. Clinicians should also be cognizant of the high rate of polypharmacy in patients with diabetes and the potential glycemic and cardioprotective impact of medications they prescribe for these patients. For patients with diabetes presenting with an acute ACS, guidelines recommend an early invasive strategy as opposed to an initial conservative approach. Apart from ensuring effective glycemic control, guidelines largely recommend that patients with and without diabetes be treated similarly. Accordingly, dual antiplatelet therapy is the standard of care for ACS patients, irrespective of diabetes status. Although clopidogrel may be the most widely used of the P2Y12 inhibitors recommended for dual antiplatelet therapy, there is evidence of an impaired response in patients with diabetes. Newer oral P2Y12 inhibitors such as ticagrelor and prasugrel have demonstrated greater efficacy than clopidogrel in improving the cardiovascular outcomes of patients with ACS and diabetes.
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Affiliation(s)
- Peter P Toth
- Director of Preventative Cardiology, CGH Medical Center, Sterling, IL, USA
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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180
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Brown WV, Brown AS, Toth PP, Underberg J. What is sufficient drug therapy for lipoprotein elevations? J Clin Lipidol 2017; 11:1300-1308. [PMID: 29102497 DOI: 10.1016/j.jacl.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Alan S Brown
- Advocate Health System, Loyola Stritch School of Medicine, Chicago, IL, USA
| | - Peter P Toth
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Underberg
- New York University Langone Medical School, New York, NY, USA
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181
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Sattar N, Toth PP, Blom DJ, Koren MJ, Soran H, Uhart M, Elliott M, Cyrille M, Somaratne R, Preiss D. Effect of the Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Evolocumab on Glycemia, Body Weight, and New-Onset Diabetes Mellitus. Am J Cardiol 2017; 120:1521-1527. [PMID: 28844508 DOI: 10.1016/j.amjcard.2017.07.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
Statin therapy modestly increases new-onset diabetes risk. The effect of proprotein convertase subtilisin/kexin type 9 inhibition on new-onset diabetes, glycemia, and weight remains unclear. We studied the effects of the proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab on fasting plasma glucose, glycated hemoglobin, weight, and new-onset diabetes mellitus. We pooled 1-year (48-week) data for participants who had completed an evolocumab parent study before entering an open-label extension (OLE) trial. Data were available for 4,802 participants (1,602 on standard of care [SOC]; 3,200 on evolocumab plus SOC) in 2 OLE trials. Evolocumab lowered low-density lipoprotein cholesterol by approximately 60% compared with SOC alone. Over the first year of the OLE trials, there was no difference in median (Q1, Q3) change in glycated hemoglobin (0.1% [-0.1, 0.2] for both SOC and evolocumab plus SOC) and fasting plasma glucose (0.06 mmol/L [-0.28, 0.38 mmol/L] for SOC and 0.06 mmol/L [-0.28, 0.44 mmol/L] for evolocumab plus SOC). Mean weight change (standard error) at 1 year was -0.1 kg (0.2) on SOC compared with 0.3 kg (0.1) on evolocumab plus SOC. The exposure-adjusted incidence rate (95% confidence intervals) for new-onset diabetes per 100 patient years was 3.7 (2.9 to 4.7) on control/SOC alone and 3.9 (3.2 to 4.6) on evolocumab/evolocumab plus SOC treatment. Glycemic changes observed in 6,430 participants at week 12 in the parent studies were comparable with OLE trial findings. In conclusion, evolocumab therapy has no effect on glucose homeostasis over 1 year of open-label treatment.
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182
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Chaudhary R, Mathew D, Bliden K, Tantry US, Sharma T, Gesheff MG, Franzese CJ, Pandya S, Toth PP, Gurbel PA. Low-density lipoprotein 4: a novel predictor of coronary artery disease severity. Curr Med Res Opin 2017; 33:1979-1984. [PMID: 28787217 DOI: 10.1080/03007995.2017.1365052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 01/06/2023]
Abstract
BACKGROUND Hyperlipidemia is a well established risk factor for coronary artery disease (CAD). Severe CAD has been observed in patients with normal levels of total and low-density lipoprotein (LDL) cholesterol. Small dense LDL particle subtypes (LDL3 and LDL4) have been observed to be more oxidizable and atherogenic. We aimed to identify the role of cholesterol particle subtypes in predicting CAD severity. METHODS Blood samples were obtained immediately before cardiac catheterization in 179 consecutive patients with suspected CAD. Detailed lipid profiling was performed using a VAP cholesterol test. CAD severity was categorized angiographically as no/minor CAD (<20% luminal diameter stenosis [LDS]), moderate CAD (20% to 74% LDS) and severe CAD (>75% LDS of any major coronary vessel). RESULTS Patients with severe CAD had significantly higher LDL4 and triglycerides, and lower total HDL, HDL2, HDL3, LDL2 and LDL3 compared to patients with no/minor CAD (p < .05 for all). Multivariate analysis showed high LDL4 as an independent predictive of severe CAD. ROC analysis showed an area under the curve of 0.62 (p < .0001) with a cut-point of >16.9 mg/dL to predict severe CAD with a sensitivity of 53% and specificity of 79%. CONCLUSION Elevated LDL4 levels are associated with severe CAD. Further large-scale investigations are required to evaluate the utility of LDL4 in predicting CAD severity.
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Affiliation(s)
| | - Denny Mathew
- a Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Kevin Bliden
- b Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute , Fairfax , VA , USA
| | - Udaya S Tantry
- b Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute , Fairfax , VA , USA
| | - Tushar Sharma
- a Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Martin G Gesheff
- b Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute , Fairfax , VA , USA
| | - Christopher J Franzese
- b Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute , Fairfax , VA , USA
| | - Shachi Pandya
- a Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Peter P Toth
- c CGH Medical Center, Sterling Illinois, and University of Illinois College of Medicine , Peoria , IL , USA
| | - Paul A Gurbel
- b Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute , Fairfax , VA , USA
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183
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Mazidi M, Kengne AP, Mikhailidis DP, Toth PP, Ray KK, Banach M. Dietary food patterns and glucose/insulin homeostasis: a cross-sectional study involving 24,182 adult Americans. Lipids Health Dis 2017; 16:192. [PMID: 28978343 PMCID: PMC5628497 DOI: 10.1186/s12944-017-0571-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 06/27/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022] Open
Abstract
Aim To investigate the association of major dietary patterns with glucose and insulin homeostasis parameters in a large American sample. The association between dietary patterns (DP) derived via principal components analysis (PCA), with glucose/insulin homeostasis parameters was assessed. The likelihood of insulin resistance (IR) across the DPs quarters was also explored. Method The United States National Health and Nutrition Examination Survey (NHANES) participants during 2005–2012 were included if they underwent measurement of dietary intake as well as glucose and insulin homeostasis parameters. Analysis of covariance (ANCOVA) and adjusted logistic and linear regression models were employed to account for the complex survey design and sample weights. Results A total of 24,182 participants were included; 48.9% (n = 11,815) were men. Applying PCA revealed three DP (56.8% of variance): the first was comprised mainly of saturated fat (SFA), total fat, mono-unsaturated fatty acids (MUFA) and carbohydrate (CHO); the second is highly enriched with vitamins, trace elements and dietary fiber; and the third was composed of polyunsaturated fatty acids (PUFA), cholesterol and protein. Among the total population, after adjustment for age, sex, race, C-reactive protein, smoking, and physical activity, glucose homeostasis factors, visceral adiposity index and lipid accumulation product improved across the quarters of the first and third DP; and a reverse pattern with the second DP. The same trend was observed for the non-diabetic subjects. Moreover, subjects with higher adherence to the first and third DP had higher likelihood for developing IR, whereas there was a lower likelihood for the second DP. Conclusion This study shows that the DP heavily loaded with CHO, SFA, PUFA, protein, total fat and MUFA as well as high-cholesterol-load foods is associated with impaired glucose tolerance; in contrast, the healthy pattern which is high in vitamins, minerals and fiber may have favourable effects on insulin sensitivity and glucose tolerance.
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Affiliation(s)
- Mohsen Mazidi
- Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, Beijing, China. .,Institute of Genetics and Developmental Biology, College, University of Chinese Academy of Science, Beijing, China.
| | - Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School, University College London (UCL), London, UK
| | - Peter P Toth
- Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kausik K Ray
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland.,Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona-Gora, Zielona-Gora, Poland
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184
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Toth PP, Worthy G, Gandra SR, Sattar N, Bray S, Cheng LI, Bridges I, Worth GM, Dent R, Forbes CA, Deshpande S, Ross J, Kleijnen J, Stroes ESG. Systematic Review and Network Meta-Analysis on the Efficacy of Evolocumab and Other Therapies for the Management of Lipid Levels in Hyperlipidemia. J Am Heart Assoc 2017; 6:JAHA.116.005367. [PMID: 28971955 PMCID: PMC5721820 DOI: 10.1161/jaha.116.005367] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors evolocumab and alirocumab substantially reduce low‐density lipoprotein cholesterol (LDL‐C) when added to statin therapy in patients who need additional LDL‐C reduction. Methods and Results We conducted a systematic review and network meta‐analysis of randomized trials of lipid‐lowering therapies from database inception through August 2016 (45 058 records retrieved). We found 69 trials of lipid‐lowering therapies that enrolled patients requiring further LDL‐C reduction while on maximally tolerated medium‐ or high‐intensity statin, of which 15 could be relevant for inclusion in LDL‐C reduction networks with evolocumab, alirocumab, ezetimibe, and placebo as treatment arms. PCSK9 inhibitors significantly reduced LDL‐C by 54% to 74% versus placebo and 26% to 46% versus ezetimibe. There were significant treatment differences for evolocumab 140 mg every 2 weeks at the mean of weeks 10 and 12 versus placebo (−74.1%; 95% credible interval −79.81% to −68.58%), alirocumab 75 mg (−20.03%; 95% credible interval −27.32% to −12.96%), and alirocumab 150 mg (−13.63%; 95% credible interval −22.43% to −5.33%) at ≥12 weeks. Treatment differences were similar in direction and magnitude for PCSK9 inhibitor monthly dosing. Adverse events were similar between PCSK9 inhibitors and control. Rates of adverse events were similar between PCSK9 inhibitors versus placebo or ezetimibe. Conclusions PCSK9 inhibitors added to medium‐ to high‐intensity statin therapy significantly reduce LDL‐C in patients requiring further LDL‐C reduction. The network meta‐analysis showed a significant treatment difference in LDL‐C reduction for evolocumab versus alirocumab.
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Affiliation(s)
- Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University and School of Medicine, Baltimore, MD .,CGH Medical Center, Sterling, IL
| | - Gillian Worthy
- Kleijnen Systematic Reviews Ltd, York, United Kingdom.,Amgen Inc, Thousand Oaks, CA
| | | | | | | | | | | | | | | | | | | | - Janine Ross
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom.,Department of Family Medicine, Maastricht University, Maastrict, The Netherlands
| | - Erik S G Stroes
- Faculty of Medicine, University of Amsterdam, The Netherlands
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185
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Mazidi M, Toth PP, Banach M. C-reactive Protein Is Associated With Prevalence of the Metabolic Syndrome, Hypertension, and Diabetes Mellitus in US Adults. Angiology 2017; 69:438-442. [PMID: 28914081 DOI: 10.1177/0003319717729288] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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
The prevalence of metabolic syndrome (MetS) has increased globally and is associated with an increased risk of cardiovascular diseases that may be related to its association with inflammation. We have assessed whether the prevalence of the MetS correlates with a serum high-sensitivity C-reactive protein (hsCRP) concentration in a population-based sample of US men and women. Participants were selected from the US National Health and Nutrition Examination Survey from 2005 to 2010. Of the 17 689 participants analyzed, 8607 (48.3%) were men. The mean age was 45.8 years in the overall sample (between men and women P = .047). The prevalence of MetS, diabetes mellitus, and hypertension increased across quartiles for hsCRP (all P < .001). Moreover, we found that for the age-, race-, sex-, and smoking-adjusted logistic regression, with increasing hsCRP, the risk of having MetS increased with an odds ratio of 5.20 (95% confidence interval, 4.54-5.93, P < .001) when comparing the highest quartile of serum hsCRP with the lowest. This study provides further evidence for an association between MetS and subclinical inflammation.
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Affiliation(s)
- Mohsen Mazidi
- 1 Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China.,2 Institute of Genetics and Developmental Biology, International College, University of Chinese Academy of Science, Beijing, China
| | - Peter P Toth
- 3 Department of Preventive Cardiology, CGH Medical Center, Sterling, IL, USA.,4 Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maciej Banach
- 5 Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland.,6 Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
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186
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Cicero AFG, Colletti A, Bajraktari G, Descamps O, Djuric DM, Ezhov M, Fras Z, Katsiki N, Langlois M, Latkovskis G, Panagiotakos DB, Paragh G, Mikhailidis DP, Mitchenko O, Paulweber B, Pella D, Pitsavos C, Reiner Ž, Ray KK, Rizzo M, Sahebkar A, Serban MC, Sperling LS, Toth PP, Vinereanu D, Vrablík M, Wong ND, Banach M. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nutr Rev 2017; 75:731-767. [PMID: 28938795 DOI: 10.1093/nutrit/nux047] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In recent years, there has been growing interest in the possible use of nutraceuticals to improve and optimize dyslipidemia control and therapy. Based on the data from available studies, nutraceuticals might help patients obtain theraputic lipid goals and reduce cardiovascular residual risk. Some nutraceuticals have essential lipid-lowering properties confirmed in studies; some might also have possible positive effects on nonlipid cardiovascular risk factors and have been shown to improve early markers of vascular health such as endothelial function and pulse wave velocity. However, the clinical evidence supporting the use of a single lipid-lowering nutraceutical or a combination of them is largely variable and, for many of the nutraceuticals, the evidence is very limited and, therefore, often debatable. The purpose of this position paper is to provide consensus-based recommendations for the optimal use of lipid-lowering nutraceuticals to manage dyslipidemia in patients who are still not on statin therapy, patients who are on statin or combination therapy but have not achieved lipid goals, and patients with statin intolerance. This statement is intended for physicians and other healthcare professionals engaged in the diagnosis and management of patients with lipid disorders, especially in the primary care setting.
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Affiliation(s)
- Arrigo F G Cicero
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; and Italian Society of Nutraceuticals
| | - Alessandro Colletti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; and Italian Society of Nutraceuticals
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo; and Kosovo Society of Cardiology
| | - Olivier Descamps
- Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine Saint-Paul, Belgium; and Belgian Atherosclerosis Society
| | - Dragan M Djuric
- Institute of Medical Physiology "Richard Burian," Faculty of Medicine, University of Belgrade, Belgrade, Serbia; and Serbian Association for Arteriosclerosis, Thrombosis and Vascular Biology Research
| | - Marat Ezhov
- Russian Cardiology Research and Production Centre, Moscow, Russia; and Russian National Atherosclerosis Society
| | - Zlatko Fras
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia; Chair for Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; and Slovenian Society of Cardiology
| | - Niki Katsiki
- Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Michel Langlois
- Department of Laboratory Medicine, AZ Sint-Jan Hospital, Bruges, Belgium; and Belgian Atherosclerosis Society
| | - Gustavs Latkovskis
- Faculty of Medicine and Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia; and Baltic Atherosclerosis Society
| | - Demosthenes B Panagiotakos
- School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Gyorgy Paragh
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; and Hungarian Atherosclerosis Society
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London, London, UK
| | - Olena Mitchenko
- Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Kiev, Ukraine; and Ukrainian Atherosclerosis Society
| | - Bernhard Paulweber
- 1st Department of Internal Medicine, Paracelsus Private Medical University, Salzburg, Austria; and Austrian Atherosclerosis Society
| | - Daniel Pella
- 1st Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia; and Slovak Association of Atherosclerosis
| | - Christos Pitsavos
- Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece; and Hellenic Atherosclerosis Society
| | - Željko Reiner
- University Hospital Centre Zagreb, School of Medicine University of Zagreb, Department of Internal Medicine, Zagreb, Croatia; and Croatian Atherosclerosis Society
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy; and Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maria-Corina Serban
- Center for Interdisciplinary Research, and Department of Functional Sciences, University of Medicine and Pharmacy "Victor Babes," Timisoara, Romania
| | - Laurence S Sperling
- Division of Cardiology, Emory University, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Peter P Toth
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA; and Preventive Cardiology, CGH Medical Center, Sterling, Illinois, USA
| | - Dragos Vinereanu
- University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania; Department of Cardiology, University and Emergency Hospital, Bucharest, Romania; and Romanian Society of Cardiology
| | - Michal Vrablík
- Third Department of Internal Medicine, First Medical Faculty, Charles University, Prague, Czech Republic; and Czech Atherosclerosis Society
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, California, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Polish Mother's Memorial Hospital Research Institute, Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland; Lipid and Blood Pressure Meta-Analysis Collaboration Group; and Polish Lipid Association
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187
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Affiliation(s)
- William Virgil Brown
- Charles Howard Candler Professor Emeritus, Emory University School of Medicine, Atlanta, GA, USA.
| | | | | | - Peter P Toth
- Cicaronne Center for the Prevention of Heart Disese, John Hopkins School of Medicine, Baltimore, MD
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188
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Kianoush S, Bittencourt MS, Lotufo PA, Bensenor IM, Jones SR, DeFilippis AP, Toth PP, Otvos JD, Tibuakuu M, Hall ME, Harada PHN, Blaha MJ. Association Between Smoking and Serum GlycA and High-Sensitivity C-Reactive Protein Levels: The Multi-Ethnic Study of Atherosclerosis (MESA) and Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Am Heart Assoc 2017; 6:JAHA.117.006545. [PMID: 28838917 PMCID: PMC5586473 DOI: 10.1161/jaha.117.006545] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Inflammation is suggested to be a central feature of atherosclerosis, particularly among smokers. We studied whether inflammatory biomarkers GlycA and high‐sensitivity C‐reactive protein are associated with cigarette smoking. Methods and Results A total of 11 509 participants, 6774 from the MESA (Multi‐Ethnic Study of Atherosclerosis) and 4735 from ELSA‐Brasil (The Brazilian Longitudinal Study of Adult Health) were included. We evaluated the cross‐sectional association between multiple measures of smoking behavior and the inflammatory biomarkers, GlycA and high‐sensitivity C‐reactive protein, using regression models adjusted for demographic, anthropometric, and clinical characteristics. Participants were 57.7±11.1 years old and 46.4% were men. Never, former, and current smokers comprised 51.7%, 34.0%, and 14.3% of the population, respectively. Multivariable‐adjusted mean absolute difference in GlycA levels (μmol/L) with 95% confidence interval (CI) were higher for former (4.1, 95% CI, 1.7–6.6 μmol/L) and current smokers (19.9, 95% CI, 16.6–23.2 μmol/L), compared with never smokers. Each 5‐unit increase in pack‐years of smoking was associated with higher GlycA levels among former (0.7, 95% CI, 0.3–1.1 μmol/L) and current smokers (1.6, 95% CI, 0.8–2.4 μmol/L). Among former smokers, each 5‐year increase in time since quitting smoking was associated with lower GlycA levels (−1.6, 95% CI, −2.4 to −0.8 μmol/L) and each 10‐unit increase in number of cigarettes/day was associated with higher GlycA among current smokers (2.8, 95% CI, 0.5–5.2 μmol/L). There were similar significant associations between all measures of smoking behavior, and both log‐transformed GlycA and high‐sensitivity C‐reactive protein. Conclusions Acute and chronic exposure to tobacco smoking is associated with inflammation, as quantified by both GlycA and high‐sensitivity C‐reactive protein. These biomarkers may have utility for the study and regulation of novel and traditional tobacco products.
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Affiliation(s)
- Sina Kianoush
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | | | - Paulo A Lotufo
- Center for Clinical and Epidemiologic Research, University of Sao Paulo, Brazil .,School of Medicine, University of Sao Paulo, Brazil
| | - Isabela M Bensenor
- Center for Clinical and Epidemiologic Research, University of Sao Paulo, Brazil.,School of Medicine, University of Sao Paulo, Brazil
| | - Steven R Jones
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD.,School of Medicine, University of Louisville, Louisville, KY
| | - Peter P Toth
- Sterling Rock Falls Clinic, Ltd., CGH Medical Center, University of Illinois School of Medicine, Sterling, IL
| | | | - Martin Tibuakuu
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
| | - Michael E Hall
- University of Mississippi Medical Center, Division of Cardiology, Jackson, MS
| | - Paulo H N Harada
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD
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189
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Bays HE, Leiter LA, Colhoun HM, Thompson D, Bessac L, Pordy R, Toth PP. Alirocumab Treatment and Achievement of Non-High-Density Lipoprotein Cholesterol and Apolipoprotein B Goals in Patients With Hypercholesterolemia: Pooled Results From 10 Phase 3 ODYSSEY Trials. J Am Heart Assoc 2017; 6:JAHA.117.005639. [PMID: 28862926 PMCID: PMC5586424 DOI: 10.1161/jaha.117.005639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Non‐high‐density lipoprotein cholesterol (non‐HDL‐C) and apolipoprotein (apo) B are better predictors of atherosclerotic cardiovascular disease risk than low‐density lipoprotein cholesterol alone. US and European lipid management guidelines support non‐HDL‐C and apoB as targets for lipid‐lowering therapy. Methods and Results This analysis evaluated the efficacy of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, on non‐HDL‐C and apoB. Data were derived from 4983 patients enrolled in 10 randomized, placebo‐ or ezetimibe‐controlled Phase 3 ODYSSEY trials. Primary end point for this pooled analysis was percent reduction in non‐HDL‐C and apoB at Week 24; secondary end points included the percentage of patients achieving guideline‐directed treatment goals (National Lipid Association guidelines: non‐HDL‐C <100 or <130 mg/dL for patients at very high and high cardiovascular risk, respectively; European Society of Cardiology/European Atherosclerosis Society guidelines: apoB <80 mg/dL for patients at very‐high cardiovascular risk). Data were grouped according to comparator, alirocumab starting dose, and concomitant statin use. Compared with controls, alirocumab produced significantly greater reductions in non‐HDL‐C and apoB at Week 24 (P<0.0001), an effect extending up to 78 weeks. More alirocumab‐treated patients achieved levels of non‐HDL‐C <100 mg/dL and apoB <80 mg/dL (P≤0.0001 versus control). By Week 24, >70% of alirocumab‐treated patients on background statin achieved non‐HDL‐C <100 or <130 mg/dL, and apoB <80 mg/dL. Safety was comparable across pooled groups and in line with previous reports. Conclusions Alirocumab produced significant, sustained reductions in non‐HDL‐C and apoB, allowing more patients to achieve lipid goals compared with placebo or ezetimibe and irrespective of maximally tolerated statin use.
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Affiliation(s)
- Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center (L-MARC), Louisville, KY
| | | | | | | | | | | | - Peter P Toth
- CGH Medical Center, Sterling, IL.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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190
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Maki KC, Palacios OM, Bell M, Toth PP. Use of supplemental long-chain omega-3 fatty acids and risk for cardiac death: An updated meta-analysis and review of research gaps. J Clin Lipidol 2017; 11:1152-1160.e2. [PMID: 28818347 DOI: 10.1016/j.jacl.2017.07.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/10/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) assessing use of long-chain omega-3 polyunsaturated fatty acids (LC-OM3), primarily eicosapentaenoic acid, and/or docosahexaenoic acid have shown mixed results. OBJECTIVE The objectives of the study were to update and further explore the available RCT data regarding LC-OM3 supplementation and risk for cardiac death and to propose testable hypotheses for the mixed results obtained in RCTs regarding supplemental LC-OM3 use and cardiac risk. METHODS A literature search was conducted using PubMed and Ovid/MEDLINE for RCTs assessing LC-OM3 supplements or pharmaceuticals with intervention periods of at least 6 months and reporting on the outcome of cardiac death. Meta-analysis was used to compare cumulative frequencies of cardiac death events between the LC-OM3 and control groups, including sensitivity and subset analyses. RESULTS Fourteen RCTs were identified for the primary analysis (71,899 subjects). In the LC-OM3 arms, 1613 cardiac deaths were recorded (4.48% of subjects), compared with 1746 cardiac deaths in the control groups (4.87% of subjects). The pooled relative risk estimate showed an 8.0% (95% confidence interval 1.6%, 13.9%, P = .015) lower risk in the LC-OM3 arms vs controls. Subset analyses showed numerically larger effects (12.9%-29.1% lower risks, all P < .05) in subsets of RCTs with eicosapentaenoic acid + docosahexaenoic acid dosages >1 g/d and higher risk samples (secondary prevention, baseline mean or median triglycerides ≥150 mg/dL, low-density lipoprotein cholesterol ≥130 mg/dL, statin use <40% of subjects). Heterogeneity was low (I2 ≤ 15.5%, P > .05) for the primary and subset analyses. CONCLUSION LC-OM3 supplementation is associated with a modest reduction in cardiac death.
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Affiliation(s)
- Kevin C Maki
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, IL, USA.
| | - Orsolya M Palacios
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, IL, USA
| | - Marjorie Bell
- Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Glen Ellyn, IL, USA
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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191
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Cicero AF, Colletti A, Bajraktari G, Descamps O, Djuric DM, Ezhov M, Fras Z, Katsiki N, Langlois M, Latkovskis G, Panagiotakos DB, Paragh G, Mikhailidis DP, Mitchenko O, Paulweber B, Pella D, Pitsavos C, Reiner Ž, Ray KK, Rizzo M, Sahebkar A, Serban MC, Sperling LS, Toth PP, Vinereanu D, Vrablík M, Wong ND, Banach M. Lipid lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Arch Med Sci 2017; 13:965-1005. [PMID: 28883839 PMCID: PMC5575230 DOI: 10.5114/aoms.2017.69326] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/28/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Arrigo F.G. Cicero
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Italian Society of Nutraceuticals (SINut)
| | - Alessandro Colletti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Italian Society of Nutraceuticals (SINut)
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo; Kosovo Society of Caridology
| | - Olivier Descamps
- Institute of Medical Physiology “Richard Burian“, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Serbian Association for Arteriosclerosis, Thrombosis and Vascular Biology Research
| | - Dragan M. Djuric
- Institute of Medical Physiology “Richard Burian“, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Serbian Association for Arteriosclerosis, Thrombosis and Vascular Biology Research
| | - Marat Ezhov
- Russian Cardiology Research and Production Centre, Moscow, Russia; Russian National Atherosclerosis Society
| | - Zlatko Fras
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Internal Medicine, University Medical Centre Ljubljana, Slovenia; Chair for Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia; Slovenian Society of Cardiology
| | - Niki Katsiki
- Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Michel Langlois
- Department of Laboratory Medicine, AZ Sint-Jan Hospital, Bruges, Belgium; Belgian Atheroclerosis Society
| | - Gustavs Latkovskis
- Faculty of Medicine and Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia; Baltic Atherosclerosis Society
| | - Demosthenes B. Panagiotakos
- School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Gyorgy Paragh
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Hungarian Atherosclerosis Society
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, Medical School, University College London (UCL), London, UK
| | - Olena Mitchenko
- 13Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Ukraine; Ukrainian Atherosclerosis Society
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Private Medical University, Salzburg, Austria; Austrian Atheroclerosis Society (AAS)
| | - Daniel Pella
- 1 Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia; Slovak Association of Atherosclerosis
| | - Christos Pitsavos
- Cardiology Clinic, School of Medicine, University of Athens, Greece; Hellenic Atherosclerosis Society
| | - Željko Reiner
- University Hospital Centre Zagreb, School of Medicine University of Zagreb, Department of Internal Medicine, Zagreb, Croatia; Croatian Atherosclerosis Society
| | - Kausik K. Ray
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy; Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maria-Corina Serban
- Center for Interdisciplinary Research, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; Department of Functional Sciences, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Laurence S. Sperling
- Division of Cardiology, Emory University, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Peter P. Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, Illinois, USA
| | - Dragos Vinereanu
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania; Department of Cardiology, University and Emergency Hospital, Bucharest, Romania; Romanian Society of Cardiology
| | - Michal Vrablík
- Third Department of Internal Medicine, First Medical Faculty, Charles University, Prague, Czech Republic; Czech Atherosclerosis Society
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland; Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group; Polish Lipid Association (PoLA)
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192
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Toth PP, Bays H, Farnier M, Jensen E, Tomassini JE, Polis A, Lin J, Bird S, Foody J, Tershakovec AM. A comparison of the attainment of guideline-recommended LDL-C lowering with statin and ezetimibe+statin therapies. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.781] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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193
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Awad K, Mikhailidis DP, Toth PP, Jones SR, Moriarty P, Lip GYH, Muntner P, Catapano AL, Pencina MJ, Rosenson RS, Rysz J, Banach M. Efficacy and Safety of Alternate-Day Versus Daily Dosing of Statins: a Systematic Review and Meta-Analysis. Cardiovasc Drugs Ther 2017; 31:419-431. [DOI: 10.1007/s10557-017-6743-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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194
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Awad K, Serban MC, Penson P, Mikhailidis DP, Toth PP, Jones SR, Rizzo M, Howard G, Lip GY, Banach M. Effects of morning vs evening statin administration on lipid profile: A systematic review and meta-analysis. J Clin Lipidol 2017; 11:972-985.e9. [DOI: 10.1016/j.jacl.2017.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/28/2017] [Accepted: 06/02/2017] [Indexed: 11/28/2022]
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Affiliation(s)
- Peter P Toth
- a CGH Medical Center , Sterling , IL , USA
- b Ciccarone Center for the Prevention of Heart Disease, John Hopkins University School of Medicine , Lutherville , MD , USA
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196
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Bromfield SG, Ngameni CA, Colantonio LD, Bowling CB, Shimbo D, Reynolds K, Safford MM, Banach M, Toth PP, Muntner P. Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension. Hypertension 2017; 70:259-266. [PMID: 28652459 DOI: 10.1161/hypertensionaha.116.09390] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/09/2017] [Accepted: 05/18/2017] [Indexed: 01/28/2023]
Abstract
Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. Systolic BP and diastolic BP were measured, and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility, and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries, or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2, or ≥3 indicators of frailty versus no frailty indicators was 1.18 (95% confidence interval, 0.99-1.40), 1.49 (95% confidence interval, 1.19-1.87), and 2.04 (95% confidence interval, 1.56-2.67), respectively. Systolic BP, diastolic BP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication.
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Affiliation(s)
- Samantha G Bromfield
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Cedric-Anthony Ngameni
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Lisandro D Colantonio
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - C Barrett Bowling
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Daichi Shimbo
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Kristi Reynolds
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Monika M Safford
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Maciej Banach
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Peter P Toth
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Paul Muntner
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.).
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197
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Ursoniu S, Mikhailidis DP, Serban MC, Penson P, Toth PP, Ridker PM, Ray KK, Kees Hovingh G, Kastelein JJ, Hernandez AV, Manson JE, Rysz J, Banach M. The effect of statins on cardiovascular outcomes by smoking status: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 2017; 122:105-117. [PMID: 28602797 DOI: 10.1016/j.phrs.2017.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 06/04/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 01/03/2023]
Abstract
Smoking is an important risk factor for cardiovascular disease (CVD) morbidity and mortality. The impact of statin therapy on CVD risk by smoking status has not been fully investigated. Therefore we assessed the impact of statin therapy on CVD outcomes by smoking status through a systematic review of the literature and meta-analysis of available randomized controlled trials (RCTs). The literature search included EMBASE, ProQuest, CINAHL and PUBMED databases to 30 January 2016 to identify RCTs that investigated the effect of statin therapy on cumulative incidence of major CVD endpoints (e.g. non-fatal myocardial infarction, revascularization, unstable angina, and stroke). Relative risks (RR) ratios were calculated from the number of events in different treatment groups for both smokers and non-smokers. Finally 11 trials with 89,604 individuals were included. The number of smokers and non-smokers in the statin groups of the analyzed studies was 8826 and 36,090, respectively. The RR for major CV events was 0.73 (95% confidence interval [CI]: 0.67-0.81; p<0.001) in nonsmokers and 0.72 (95%CI: 0.64-0.81; p<0.001) in smokers. Moderate to high heterogeneity was observed both in non-smokers (I2=77.1%, p<0.001) and in smokers (I2=51.6%, p=0.024) groups. Smokers seemed to benefit slightly more from statins than non-smokers according to the number needed to treat (NNT) analysis (23.5 vs 26.8) based on RRs applied to the control event rates. The number of avoided events per 1000 individuals was 42.5 (95%CI: 28.9-54.6) in smokers and 37.3 (95%CI: 27.2-46.4) in non-smokers. In conclusion, this meta-analysis suggests that the effect of statins on CVD is similar for smokers and non-smokers, but in terms of NNTs and number of avoided events, smokers seem to benefit more although non-significantly.
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Affiliation(s)
- Sorin Ursoniu
- Department of Functional Sciences, Discipline of Public Health, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
| | - Maria-Corina Serban
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Peter Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Peter P Toth
- Preventive Cardiology, CGH Medical Center, Sterling, Illinois, USA; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kausik K Ray
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - John J Kastelein
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Adrian V Hernandez
- Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jacek Rysz
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland; Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
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198
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Toth PP, Danese M, Villa G, Qian Y, Beaubrun A, Lira A, Jansen JP. Estimated burden of cardiovascular disease and value-based price range for evolocumab in a high-risk, secondary-prevention population in the US payer context. J Med Econ 2017; 20:555-564. [PMID: 28097904 DOI: 10.1080/13696998.2017.1284078] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 12/17/2022]
Abstract
AIM To estimate real-world cardiovascular disease (CVD) burden and value-based price range of evolocumab for a US-context, high-risk, secondary-prevention population. MATERIALS AND METHODS Burden of CVD was assessed using the UK-based Clinical Practice Research Datalink (CPRD) in order to capture complete CV burden including CV mortality. Patients on standard of care (SOC; high-intensity statins) in CPRD were selected based on eligibility criteria of FOURIER, a phase 3 CV outcomes trial of evolocumab, and categorized into four cohorts: high-risk prevalent atherosclerotic CVD (ASCVD) cohort (n = 1448), acute coronary syndrome (ACS) (n = 602), ischemic stroke (IS) (n = 151), and heart failure (HF) (n = 291) incident cohorts. The value-based price range for evolocumab was assessed using a previously published economic model. The model incorporated CPRD CV event rates and considered CV event reduction rate ratios per 1 mmol/L reduction in low-density lipoprotein-cholesterol (LDL-C) from a meta-analysis of statin trials by the Cholesterol Treatment Trialists Collaboration (CTTC), i.e. CTTC relationship. RESULTS Multiple-event rates of composite CV events (ACS, IS, or coronary revascularization) per 100 patient-years were 12.3 for the high-risk prevalent ASCVD cohort, and 25.7, 13.3, and 23.3, respectively, for incident ACS, IS, and HF cohorts. Approximately one-half (42%) of the high-risk ASCVD patients with a new CV event during follow-up had a subsequent CV event. Combining these real-world event rates and the CTTC relationship in the economic model, the value-based price range (credible interval) under a willingness-to-pay threshold of $150,000/quality-adjusted life-year gained for evolocumab was $11,990 ($9,341-$14,833) to $16,856 ($12,903-$20,678) in ASCVD patients with baseline LDL-C levels ≥70 mg/dL and ≥100 mg/dL, respectively. CONCLUSION Real-world CVD burden is substantial. Using the observed CVD burden in CPRD and the CTTC relationship, the cost-effectiveness analysis showed that, accounting for uncertainties, the expected value-based price for evolocumab is higher than its current annual cost, as long as the payer discount off list price is greater than 20%.
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Affiliation(s)
- Peter P Toth
- a CGH Medical Center , Sterling , IL , USA
- b Ciccarone Center for the Prevention of Heart Disease , Johns Hopkins University School of Medicine , Lutherville , MD , USA
| | - Mark Danese
- c Outcomes Insights, Inc , Westlake Village , CA , USA
| | | | - Yi Qian
- e Amgen Inc. , Thousand Oaks , CA , USA
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199
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Toth PP, Descamps O, Genest J, Sattar N, Preiss D, Dent R, Djedjos C, Wu Y, Geller M, Uhart M, Somaratne R, Wasserman SM. Pooled Safety Analysis of Evolocumab in Over 6000 Patients From Double-Blind and Open-Label Extension Studies. Circulation 2017; 135:1819-1831. [DOI: 10.1161/circulationaha.116.025233] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 08/29/2016] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
Background:
Evolocumab, a fully human monoclonal antibody to PCSK9 (proprotein convertase subtilisin/kexin type 9), markedly reduces low-density lipoprotein cholesterol across diverse patient populations. The objective of this study was to assess the safety and tolerability of evolocumab in a pooled safety analysis from phase 2 or 3 randomized and placebo or comparator-controlled trials (integrated parent trials) and the first year of open-label extension (OLE) trials that included a standard-of-care control group.
Methods:
This analysis included adverse event (AE) data from 6026 patients in 12 phase 2 and 3 parent trials, with a median exposure of 2.8 months, and, of those patients, from 4465 patients who continued with a median follow-up of 11.1 months in 2 OLE trials. AEs were analyzed separately for the parent and OLE trials. Overall AE rates, serious AEs, laboratory assessments, and AEs of interest were evaluated.
Results:
Overall AE rates were similar between evolocumab and control in the parent trials (51.1% versus 49.6%) and in year 1 of OLE trials (70.0% versus 66.0%), as were those for serious AEs. Elevations of serum transaminases, bilirubin, and creatine kinase were infrequent and similar between groups. Muscle-related AEs were similar between evolocumab and control. Neurocognitive AEs were infrequent and balanced during the double-blind parent studies (5 events [0.1%], evolocumab groups versus 6 events [0.3%], control groups). In the OLE trials, 27 patients (0.9%) in the evolocumab groups and 5 patients (0.3%) in the control groups reported neurocognitive AEs. No neutralizing antievolocumab antibodies were detected.
Conclusions:
Overall, this integrated safety analysis of 6026 patients pooled across phase 2/3 trials and 4465 patients who continued in OLE trials for 1 year supports a favorable benefit-risk profile for evolocumab.
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Affiliation(s)
- Peter P. Toth
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Olivier Descamps
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Jacques Genest
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Naveed Sattar
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - David Preiss
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Ricardo Dent
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Constantine Djedjos
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Yuna Wu
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Michelle Geller
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Magdalena Uhart
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Ransi Somaratne
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
| | - Scott M. Wasserman
- From CGH Medical Center, Sterling, IL, and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.); Lipid Clinic, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium (O.D.); The McGill University Health Centre, Montreal, Canada (J.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (N.S.); Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and
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Punekar RS, Fox KM, Paoli CJ, Richhariya A, Cziraky MJ, Gandra SR, Toth PP. Lipid-lowering treatment modifications among patients with hyperlipidemia and a prior cardiovascular event: a US retrospective cohort study. Curr Med Res Opin 2017; 33:869-876. [PMID: 28276256 DOI: 10.1080/03007995.2017.1292898] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Numerous studies demonstrate that, even with use of statins, many patients are unable to meet their LDL-C goals. This study examined modifications to statin and/or ezetimibe therapy among patients with hyperlipidemia and prior history of cardiovascular (CV) events in a US commercially insured population. METHODS Adults (age ≥18 years) initiating statins and/or ezetimibe between 1 January 2007 and 31 December 2008 were identified from HealthCore Integrated Research Database. The index date was the initiation date of statins and/or ezetimibe. All patients had ≥1 medical claims related to myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, coronary artery bypass graft, or percutaneous coronary intervention within 12 months prior to the index date. Treatment modifications to statins and/or ezetimibe initiated on the index date (index therapy) included permanent discontinuation of any lipid lowering therapy (LLT), rechallenge, switching, subtraction, augmentation, and dose changes. RESULTS Among 17,902 patients, around 90% initiated with statin monotherapy, followed by statin and ezetimibe combination (3.0%: 18-64 years; 3.8%: ≥65 years). Ten percent or less initiated on high intensity statins. Most common treatment modifications were rechallenging index therapy (25.2%: 18-64 years, 27.0%: ≥65 years), switching (27.5%: 18-64 years, 24.6%: ≥65 years), and permanent discontinuation of any LLT (18.6%: 18-64 years, 21.0%: ≥65 years). Only 10% of patients in both groups underwent dose escalation. CONCLUSIONS Real-world evidence indicates that few high-risk patients initiate therapy with high-intensity statins. More than 50% of patients underwent a rechallenge or switching. Despite high CVD risk profile, approximately 20% of patients permanently discontinued any LLT. Key limitations: Pharmacy claims do not provide information on whether patients who had a pharmacy fill actually took the medication as prescribed. It is unknown whether rechallenge was a simple delay in filling a prescription or an actual rechallenge of their index therapy. Reasons for treatment discontinuations or modifications were unavailable in claims data.
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Affiliation(s)
| | | | | | | | | | | | - Peter P Toth
- d CGH Medical Center , Sterling , IL , USA
- e Johns Hopkins University School of Medicine , Baltimore , MD , USA
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