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Zheng S, Du Y, Peng Q, Fan X, Li J, Chen M. Trimetazidine Protects Against Atherosclerosis by Changing Energy Charge and Oxidative Stress. Med Sci Monit 2018; 24:8459-8468. [PMID: 30468686 PMCID: PMC6266541 DOI: 10.12659/msm.911317] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/24/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study investigated the effect and the possible mechanism of trimetazidine in atherosclerosis. MATERIAL AND METHODS We established an atherosclerotic rat model by high-fat diet and vitamin D injection. Rats were separated into 3 different groups: control, atherosclerosis, and trimetazidine (n=10). The aortic artery was isolated and its morphological features were examined by hematoxylin and eosin (HE) staining. Serum low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), and triglycerides (TG) were analyzed using an automatic biochemical analyzer. Human aortic smooth muscle cells (HASMCs) were cultured and divided into 5 groups: no treatment, H₂O₂ treatment only, trimetazidine preincubation before H₂O₂ treatment, oxidized low-density lipoprotein (oxLDL) treatment only, and trimetazidine preincubation before oxLDL treatment. HASMCs proliferation was tested using the Cell Counting Kit-8. Reactive oxygen species (ROS) and malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity of the aortic artery, and HASMCs were measured using commercially available kits. RESULTS HE staining assay showed that trimetazidine suppressed the progression of atherosclerosis and reduced foam cell formation in the aortic artery without affecting serum lipid levels. HASMCs proliferation assay revealed that trimetazidine alleviated the inhibitory effect of H₂O₂ on HASMCs proliferation and inhibited oxLDL-induced proliferation of HASMCs. Moreover, trimetazidine ameliorated ROS up-regulation elicited by H₂O₂ or oxLDL in HASMCs. Additionally, trimetazidine restored SOD activity and reduced MDA content of HASMCs. CONCLUSIONS Trimetazidine suppressed the progression of atherosclerosis by enhancing energy value, decreasing ROS level of aortic artery, modulating HASMCs proliferation, and reducing oxidative stress in HASMCs.
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Affiliation(s)
- Shuzhan Zheng
- West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
- The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Yanfei Du
- The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Qiqi Peng
- Nanxin Community Health Center, Gaoxin District, Chengdu, Sichuan, P.R. China
| | - Xinrong Fan
- The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Jiafu Li
- The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, P.R. China
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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Okopień B, Bułdak Ł, Bołdys A. Benefits and risks of the treatment with fibrates––a comprehensive summary. Expert Rev Clin Pharmacol 2018; 11:1099-1112. [DOI: 10.1080/17512433.2018.1537780] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Bogusław Okopień
- Department of Internal Medicine and Clinical Pharmacology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Łukasz Bułdak
- Department of Internal Medicine and Clinical Pharmacology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Bołdys
- Department of Internal Medicine and Clinical Pharmacology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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53
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New joint consensus initiative on quantifying atherogenic lipoproteins. Atherosclerosis 2018; 279:97-99. [PMID: 30318139 DOI: 10.1016/j.atherosclerosis.2018.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/29/2018] [Indexed: 11/23/2022]
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Hernández-Mijares A, Ascaso JF, Blasco M, Brea Á, Díaz Á, Mantilla T, Pedro-Botet J, Pintó X, Millán J. Residual cardiovascular risk of lipid origin. Components and pathophysiological aspects. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2018; 31:75-88. [PMID: 30262442 DOI: 10.1016/j.arteri.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/10/2018] [Accepted: 06/19/2018] [Indexed: 11/24/2022]
Abstract
There is no doubt about the relationship between LDL-c and cardiovascular risk, as well as about the benefits of statin treatment. Once the objective of LDL-c has been achieved, the evidences that demonstrate the persistence of a high cardiovascular risk, a concept called residual risk, are notable. The residual risk of lipid origin is based on atherogenic dyslipidemia, characterized by an increase in triglycerides and triglyceride-rich lipoproteins, a decrease in HDL-c and qualitative alterations in LDL particles. The most commonly used measures to identify this dyslipidemia are based on the determination of total cholesterol, triglycerides, HDL, non-HDL cholesterol and remaining cholesterol, as well as apolipoprotein B100 and lipoprotein (a) in certain cases. The treatment of atherogenic dyslipidemia is based on weight loss and physical exercise. Regarding pharmacological treatment, we have no evidence of cardiovascular benefit with drugs aimed at lowering triglycerides and HDL-c, fenofibrate seems to be effective in situations of atherogenic dyslipidemia.
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Affiliation(s)
- Antonio Hernández-Mijares
- Fundación para la Investigación Sanitaria y Biomédica de la Comunidad Valenciana FISABIO, Servicio de Endocrinología y Nutrición, Hospital Universitario Dr. Peset Valencia; Departamento de Medicina, Universitat de València, Valencia, España.
| | - Juan F Ascaso
- Servicio de Endocrinología, Hospital Clínico Universitario; Departamento de Medicina, Universitat de València, Valencia, España
| | - Mariano Blasco
- Área Sanitaria de Delicias, Atención Primaria, Zaragoza, España
| | - Ángel Brea
- Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | - Ángel Díaz
- Centro de Salud de Bembibre, Bembibre (León), España
| | - Teresa Mantilla
- Centro de Salud de Prosperidad, Atención Primaria, Madrid, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, Universitat de Barcelona, CIBERobn-ISCIII, Barcelona, España
| | - Jesús Millán
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España.
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55
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Haas MJ, Jurado-Flores M, Hammoud R, Plazarte G, Onstead-Haas L, Wong NC, Mooradian AD. Regulation of apolipoprotein A-I gene expression by the histamine H1 receptor: Requirement for NF-κB. Life Sci 2018; 208:102-110. [DOI: 10.1016/j.lfs.2018.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/27/2018] [Accepted: 07/12/2018] [Indexed: 01/22/2023]
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56
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Langlois MR, Nordestgaard BG. Which Lipids Should Be Analyzed for Diagnostic Workup and Follow-up of Patients with Hyperlipidemias? Curr Cardiol Rep 2018; 20:88. [PMID: 30120626 DOI: 10.1007/s11886-018-1036-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW To summarize and discuss the clinical use of lipid and apolipoprotein tests in the settings of diagnosis and therapeutic follow-up of hyperlipidemia. RECENT FINDINGS The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently produced recommendations on the measurement of atherogenic lipoproteins, taking into account the strengths and weaknesses of analytical and clinical performances of the tests. Total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and calculated non-HDL cholesterol (= LDL + remnant cholesterol) constitute the primary lipid panel for hyperlipidemia diagnosis and cardiovascular risk estimation. LDL cholesterol is the primary target of lipid-lowering therapies. Non-HDL cholesterol or apolipoprotein B should be used as secondary therapeutic target in patients with mild-to-moderate hypertriglyceridemia, 2-10 mmol/l (175-880 mg/dl). Lipoprotein (a) is included in LDL cholesterol and should be measured at least once in all patients at cardiovascular risk, including to explain poor response to statin treatment.
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Affiliation(s)
- Michel R Langlois
- AZ St.-Jan Hospital, Department of Laboratory Medicine, Ruddershove 10, 8000, Brugge, Belgium. .,University of Ghent, Ghent, Belgium.
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
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57
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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: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [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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Increased activin A levels in prediabetes and association with carotid intima-media thickness: a cross-sectional analysis from I-Lan Longitudinal Aging Study. Sci Rep 2018; 8:9957. [PMID: 29967428 PMCID: PMC6028626 DOI: 10.1038/s41598-018-27795-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/04/2018] [Indexed: 12/14/2022] Open
Abstract
Activin A and its binding protein follistatin may be crucial in glucose homeostasis, as multifunctional proteins mediating inflammatory and anti-inflammatory effects. However, clinical data on the activin A level in prediabetes, and the association between the circulating activin A level and carotid intima-media thickness (cIMT), are lacking. We aimed to investigate activin A and follistatin levels and their associations with cIMT. In total, 470 inhabitants of I-Lan county (235 men; mean age 69 ± 9 years) with measurements of serum activin A and follistatin levels were included. Patients with prediabetes and diabetes had significantly increased activin A concentrations compared with those in the normal glycemic group (both p < 0.001). A multivariable logistic regression model demonstrated that the circulating activin A level was associated with prediabetes and diabetes independently of other risk factors. Moreover, the circulating activin A levels were associated positively with cIMT in prediabetes (rs = 0.264, p = 0.001). In conclusion, activin A level, but not follistatin, was elevated independent of demographic variables with borderline significance and was correlated positively with cIMT in prediabetes. Activin A and follistatin levels were elevated in diabetes. In addition, elevated activin A was an independent risk factor for prediabetes and diabetes.
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59
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Yvan-Charvet L, Cariou B. Poststatin era in atherosclerosis management: lessons from epidemiologic and genetic studies. Curr Opin Lipidol 2018; 29:246-258. [PMID: 29553996 DOI: 10.1097/mol.0000000000000505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular diseases (CVD) are the leading cause of death worldwide with over 17 million deaths every year and represent a major public health challenge. The last decade has seen the emergence of novel antiatherogenic therapies. RECENT FINDINGS Despite intensive lipid and blood pressure interventions, the burden of CVD is expected to markedly progress because of the global aging of the population and increasing exposure to detrimental lifestyle-related risk. Epidemiologic and genetic studies helped to better apprehend the biology of atherosclerosis and allowed pharmaceutical innovation and recent translational successes. This includes the development of novel lipid and glucose-lowering therapies and the leverage of anti-inflammatory therapies. SUMMARY Here, we discuss promises and expectations of emerging scientific and pharmaceutical innovations and translational successes to meet the global therapeutic demand.
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Affiliation(s)
- Laurent Yvan-Charvet
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1065, Université Côte d'Azur, Centre Méditerranéen de Médecine Moléculaire (C3M), Atip-Avenir, Fédération Hospitalo-Universitaire (FHU) Oncoage, Nice
| | - Bertrand Cariou
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
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60
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Koopal C, Visseren FLJ, Westerink J, van der Graaf Y, Ginsberg HN, Keech AC. Predicting the Effect of Fenofibrate on Cardiovascular Risk for Individual Patients With Type 2 Diabetes. Diabetes Care 2018; 41:1244-1250. [PMID: 29472432 DOI: 10.2337/dc17-0968] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 01/26/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In clinical trials, treatment with fenofibrate did not reduce the incidence of major cardiovascular events (MCVE) in patients with type 2 diabetes mellitus (T2DM). However, treatment effects reported by trials comprise patients who respond poorly and patients who respond well to fenofibrate. Our aim was to use statistical modeling to estimate the expected treatment effect of fenofibrate for individual patients with T2DM. RESEARCH DESIGN AND METHODS To estimate individual risk, the FIELD risk model, with 5-year MCVE as primary outcome, was externally validated in T2DM patients from ACCORD and the SMART observational cohort. Fenofibrate treatment effect was estimated in 17,142 T2DM patients from FIELD, ACCORD, and SMART. Individual treatment effect, expressed as absolute risk reduction (ARR), is the difference between treated and untreated MCVE risk. Results were stratified for patients with and without dyslipidemia (i.e., high triglycerides and low LDL cholesterol). RESULTS External validation of the FIELD risk model showed good calibration and moderate discrimination in ACCORD (C-statistic 0.67 [95% CI 0.65-0.69]) and SMART (C-statistic 0.66 [95% CI 0.63-0.69]). Median 5-year MCVE risk in all three studies combined was 6.7% (interquartile range [IQR] 4.0-11.7) in patients without (N = 13,224) and 9.4% (IQR 5.4-16.1%) in patients with (N = 3,918) dyslipidemia. The median ARR was 2.15% (IQR 1.23-3.68) in patients with dyslipidemia, corresponding with a number needed to treat (NNT) of 47, and 0.22% (IQR 0.13-0.38) in patients without dyslipidemia (NNT 455). CONCLUSIONS In individual patients with T2DM, there is a wide range of absolute treatment effect of fenofibrate, and overall the fenofibrate treatment effect was larger in patients with dyslipidemia. The method of individualized treatment effect prediction of fenofibrate on MCVE risk reduction in T2DM can be used to guide clinical decision making.
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Affiliation(s)
- Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henry N Ginsberg
- Irving Institute for Clinical and Translational Research, Columbia College of Physicians and Surgeons, New York, NY
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, Sydney Medical School, University of Sydney, Sydney, Australia
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61
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Tachibana K, Yuzuriha T, Tabata R, Fukuda S, Maegawa T, Takahashi R, Tanimoto K, Tsujino H, Nunomura K, Lin B, Matsuura Y, Tanaka T, Hamakubo T, Sakai J, Kodama T, Kobayashi T, Ishimoto K, Miyachi H, Doi T. Discovery of peroxisome proliferator-activated receptor α (PPARα) activators with a ligand-screening system using a human PPARα-expressing cell line. J Biol Chem 2018; 293:10333-10343. [PMID: 29764933 DOI: 10.1074/jbc.ra118.002077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/04/2018] [Indexed: 11/06/2022] Open
Abstract
Peroxisome proliferator-activated receptor α (PPARα) is a ligand-activated transcription factor that belongs to the superfamily of nuclear hormone receptors. PPARα is mainly expressed in the liver, where it activates fatty acid oxidation and lipoprotein metabolism and improves plasma lipid profiles. Therefore, PPARα activators are often used to treat patients with dyslipidemia. To discover additional PPARα activators as potential compounds for use in hypolipidemic drugs, here we established human hepatoblastoma cell lines with luciferase reporter expression from the promoters containing peroxisome proliferator-responsive elements (PPREs) and tetracycline-regulated expression of full-length human PPARα to quantify the effects of chemical ligands on PPARα activity. Using the established cell-based PPARα-activator screening system to screen a library of >12,000 chemical compounds, we identified several hit compounds with basic chemical skeletons different from those of known PPARα agonists. One of the hit compounds, a 1H-pyrazolo[3,4-b]pyridine-4-carboxylic acid derivative we termed compound 3, selectively up-regulated PPARα transcriptional activity, leading to PPARα target gene expression both in vitro and in vivo Of note, the half-maximal effective concentrations of the hit compounds were lower than that of the known PPARα ligand fenofibrate. Finally, fenofibrate or compound 3 treatment of high fructose-fed rats having elevated plasma triglyceride levels for 14 days indicated that compound 3 reduces plasma triglyceride levels with similar efficiency as fenofibrate. These observations raise the possibility that 1H-pyrazolo[3,4-b]pyridine-4-carboxylic acid derivatives might be effective drug candidates for selective targeting of PPARα to manage dyslipidemia.
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Affiliation(s)
- Keisuke Tachibana
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871,
| | - Tomohiro Yuzuriha
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871.,the Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101
| | - Ryotaro Tabata
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Syohei Fukuda
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Takashi Maegawa
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Rika Takahashi
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Keiichi Tanimoto
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Hirofumi Tsujino
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Kazuto Nunomura
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Bangzhong Lin
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Yoshiharu Matsuura
- the Department of Molecular Virology, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871
| | | | - Takao Hamakubo
- the Department of Quantitative Biology and Medicine, and
| | - Juro Sakai
- the Division of Metabolic Medicine, Research Center for Advanced Science and Technology, Research Center for Advanced Science and Technology, University of Tokyo, 4-6-1 Komaba, Meguro, Tokyo 153-8904, and
| | | | - Tadayuki Kobayashi
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Kenji Ishimoto
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871
| | - Hiroyuki Miyachi
- the Lead Exploration Unit, Drug Discovery Initiative, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - Takefumi Doi
- From the Graduate School of Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka 565-0871,
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62
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Langlois MR, Chapman MJ, Cobbaert C, Mora S, Remaley AT, Ros E, Watts GF, Borén J, Baum H, Bruckert E, Catapano A, Descamps OS, von Eckardstein A, Kamstrup PR, Kolovou G, Kronenberg F, Langsted A, Pulkki K, Rifai N, Sypniewska G, Wiklund O, Nordestgaard BG. Quantifying Atherogenic Lipoproteins: Current and Future Challenges in the Era of Personalized Medicine and Very Low Concentrations of LDL Cholesterol. A Consensus Statement from EAS and EFLM. Clin Chem 2018; 64:1006-1033. [PMID: 29760220 DOI: 10.1373/clinchem.2018.287037] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/09/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The European Atherosclerosis Society-European Federation of Clinical Chemistry and Laboratory Medicine Consensus Panel aims to provide recommendations to optimize atherogenic lipoprotein quantification for cardiovascular risk management. CONTENT We critically examined LDL cholesterol, non-HDL cholesterol, apolipoprotein B (apoB), and LDL particle number assays based on key criteria for medical application of biomarkers. (a) Analytical performance: Discordant LDL cholesterol quantification occurs when LDL cholesterol is measured or calculated with different assays, especially in patients with hypertriglyceridemia >175 mg/dL (2 mmol/L) and low LDL cholesterol concentrations <70 mg/dL (1.8 mmol/L). Increased lipoprotein(a) should be excluded in patients not achieving LDL cholesterol goals with treatment. Non-HDL cholesterol includes the atherogenic risk component of remnant cholesterol and can be calculated in a standard nonfasting lipid panel without additional expense. ApoB more accurately reflects LDL particle number. (b) Clinical performance: LDL cholesterol, non-HDL cholesterol, and apoB are comparable predictors of cardiovascular events in prospective population studies and clinical trials; however, discordance analysis of the markers improves risk prediction by adding remnant cholesterol (included in non-HDL cholesterol) and LDL particle number (with apoB) risk components to LDL cholesterol testing. (c) Clinical and cost-effectiveness: There is no consistent evidence yet that non-HDL cholesterol-, apoB-, or LDL particle-targeted treatment reduces the number of cardiovascular events and healthcare-related costs than treatment targeted to LDL cholesterol. SUMMARY Follow-up of pre- and on-treatment (measured or calculated) LDL cholesterol concentration in a patient should ideally be performed with the same documented test method. Non-HDL cholesterol (or apoB) should be the secondary treatment target in patients with mild to moderate hypertriglyceridemia, in whom LDL cholesterol measurement or calculation is less accurate and often less predictive of cardiovascular risk. Laboratories should report non-HDL cholesterol in all standard lipid panels.
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Affiliation(s)
- Michel R Langlois
- Department of Laboratory Medicine, AZ St-Jan, Brugge, and University of Ghent, Belgium;
| | - M John Chapman
- National Institute for Health and Medical Research (INSERM), and Endocrinology-Metabolism Service, Pitié-Salpetriere University Hospital, Paris, France
| | - Christa Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Samia Mora
- Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Emilio Ros
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain
| | - Gerald F Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Jan Borén
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hannsjörg Baum
- Institute for Laboratory Medicine, Blutdepot und Krankenhaushygiene, Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany
| | - Eric Bruckert
- Pitié-Salpetriere University Hospital, Paris, France
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Italy
| | | | | | - Pia R Kamstrup
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Genovefa Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Florian Kronenberg
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Langsted
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Turku and Turku University Hospital, Turku, Finland
| | - Nader Rifai
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Grazyna Sypniewska
- Department of Laboratory Medicine, Collegium Medicum, NC University, Bydgoszcz, Poland
| | - Olov Wiklund
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Børge G Nordestgaard
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
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Hermans MP, Valensi P. Elevated triglycerides and low high-density lipoprotein cholesterol level as marker of very high risk in type 2 diabetes. Curr Opin Endocrinol Diabetes Obes 2018; 25:118-129. [PMID: 29493554 DOI: 10.1097/med.0000000000000398] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to describe in diabetic patients the determinants underlying atherogenic dyslipidemia, a complex dyslipidemia defined as the coexistence of fasting hypertriglyceridemia and low high-density lipoprotein cholesterol level. Atherogenic dyslipidemia is often comorbid with hyperglycemia in patients with the common form of type 2 diabetes mellitus (T2DM), namely that associated with obesity, insulin resistance, hyperinsulinemia and the metabolic syndrome phenotype. RECENT FINDINGS The role of triglyceride-rich lipoproteins, both fasting and nonfasting, is increasingly considered as a direct driver of atherosclerosis in diabetic patients, even in those receiving best standards of care, including low-density lipoprotein cholesterol level adequately controlled by statins and/or ezetimibe. The residual cardiovascular risk related to atherogenic dyslipidemia in T2DM patients can be inferred from subgroup analysis of diabetic patients within landmark lipid-lowering trials, or from T2DM-only trials, such as Fenofibrate Intervention and Event Lowering in Diabetes study or Action to Control Cardiovascular Risk in Diabetes-Lipid trial. SUMMARY The presence of atherogenic dyslipidemia markedly increases cardiovascular risk, and there is evidence that part of the residual cardiovascular risk in T2DM can be safely and effectively reduced by fibrates. Ongoing trials will determine whether new classes of drugs or dietary intervention targeting hypertriglyceridemia (such as n-3 fatty acids or SPPARMα) will reduce macro and microvascular residual risk in T2DM patients with atherogenic dyslipidemia at inclusion.
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Affiliation(s)
- 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
| | - Paul Valensi
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Paris 13 University, Bondy, France
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Casteleijn MG, Parkkila P, Viitala T, Koivuniemi A. Interaction of lecithin:cholesterol acyltransferase with lipid surfaces and apolipoprotein A-I-derived peptides. J Lipid Res 2018; 59:670-683. [PMID: 29438987 PMCID: PMC5880497 DOI: 10.1194/jlr.m082685] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/22/2018] [Indexed: 12/12/2022] Open
Abstract
LCAT is an enzyme responsible for the formation of cholesteryl esters from unesterified cholesterol (UC) and phospholipid (PL) molecules in HDL particles. However, it is poorly understood how LCAT interacts with lipoproteins and how apoA-I activates it. Here we have studied the interactions between LCAT and lipids through molecular simulations. In addition, we studied the binding of LCAT to apoA-I-derived peptides, and their effect on LCAT lipid association-utilizing experiments. Results show that LCAT anchors itself to lipoprotein surfaces by utilizing nonpolar amino acids located in the membrane-binding domain and the active site tunnel opening. Meanwhile, the membrane-anchoring hydrophobic amino acids attract cholesterol molecules next to them. The results also highlight the role of the lid-loop in the lipid binding and conformation of LCAT with respect to the lipid surface. The apoA-I-derived peptides from the LCAT-activating region bind to LCAT and promote its lipid surface interactions, although some of these peptides do not bind lipids individually. The transfer free-energy of PL from the lipid bilayer into the active site is consistent with the activation energy of LCAT. Furthermore, the entry of UC molecules into the active site becomes highly favorable by the acylation of SER181.
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Affiliation(s)
- Marco G Casteleijn
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Petteri Parkkila
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Tapani Viitala
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Artturi Koivuniemi
- Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
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Budoff M, Brent Muhlestein J, Le VT, May HT, Roy S, Nelson JR. Effect of Vascepa (icosapent ethyl) on progression of coronary atherosclerosis in patients with elevated triglycerides (200-499 mg/dL) on statin therapy: Rationale and design of the EVAPORATE study. Clin Cardiol 2018; 41:13-19. [PMID: 29365351 PMCID: PMC5838559 DOI: 10.1002/clc.22856] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Despite reducing progression and promoting regression of coronary atherosclerosis, statin therapy does not fully address residual cardiovascular (CV) risk. High‐purity eicosapentaenoic acid (EPA) added to a statin has been shown to reduce CV events and induce regression of coronary atherosclerosis in imaging studies; however, data are from Japanese populations without high triglyceride (TG) levels and baseline EPA serum levels greater than those in North American populations. Icosapent ethyl is a high‐purity prescription EPA ethyl ester approved at 4 g/d as an adjunct to diet to reduce TG levels in adults with TG levels >499 mg/dL. The objective of the randomized, double‐blind, placebo‐controlled EVAPORATE study is to evaluate the effects of icosapent ethyl 4 g/d on atherosclerotic plaque in a North American population of statin‐treated patients with coronary atherosclerosis, TG levels of 200 to 499 mg/dL, and low‐density lipoprotein cholesterol levels of 40 to 115 mg/dL. The primary endpoint is change in low‐attenuation plaque volume measured by multidetector computed tomography angiography. Secondary endpoints include incident plaque rates; quantitative changes in different plaque types and morphology; changes in markers of inflammation, lipids, and lipoproteins; and the relationship between these changes and plaque burden and/or plaque vulnerability. Approximately 80 patients will be followed for 9 to 18 months. The clinical implications of icosapent ethyl 4 g/d treatment added to statin therapy on CV endpoints are being evaluated in the large CV outcomes study REDUCE‐IT. EVAPORATE will provide important imaging‐derived data that may add relevance to the clinically derived outcomes from REDUCE‐IT.
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Affiliation(s)
- Matthew Budoff
- Department of Internal Medicine, Los Angeles Biomedical Research Institute, Torrance, California
| | - J Brent Muhlestein
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City
| | - Viet T Le
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Heidi T May
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Sion Roy
- Department of Internal Medicine, Los Angeles Biomedical Research Institute, Torrance, California
| | - John R Nelson
- Department of Cardiology, California Cardiovascular Institute, Fresno, California
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Radler BT, Rigotti A, Ryff CD. Persistently high psychological well-being predicts better HDL cholesterol and triglyceride levels: findings from the midlife in the U.S. (MIDUS) longitudinal study. Lipids Health Dis 2018; 17:1. [PMID: 29298716 PMCID: PMC5751819 DOI: 10.1186/s12944-017-0646-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/17/2017] [Indexed: 11/23/2022] Open
Abstract
Background Psychological correlates of blood lipid levels have been previously evaluated mostly in cross sectional studies. However, prospectively measured psychological factors might also predict favorable blood lipid profiles, thereby indicating a healthy mind/body interplay that is associated with less disease, better health and longer lives. Methods This paper examined whether longitudinal profiles of psychological well-being over 9–10 years are predictors of blood lipid profiles. Using the MIDUS (Midlife in the U.S.) biological subsample (n = 1054, aged 34 to 84, 55% female), cross-time trajectories of well-being were linked with three lipid outcomes (i.e., HDL cholesterol, triglycerides, and LDL cholesterol), measured for the first time at the 2nd wave of the study. Results Most adults showed largely stable profiles of well-being, albeit at different levels. Some showed persistently high well-being over time, while others revealed persistently low or moderate well-being. After adjusting for the effect of demographics, health behaviors, medications, and insulin resistance, adults with persistently high levels of environmental mastery and self-acceptance—two components of psychological well-being—had significantly higher levels of HDL as well as significantly lower levels of triglycerides compared to adults with persistently low levels of well-being. Converging with prior findings, no association was found between well-being and LDL cholesterol. Conclusions Over 9–10 years, persistently high levels of psychological well-being measures predicted high HDL cholesterol and low triglycerides. These findings add longitudinal evidence to the growing body of research showing that positive psychological factors are linked with better lipoprotein profiles. A better blood lipid profile, particularly higher HDL-C, may be key in mediating how psychological well-being positively impacts health and length of life. Additional research is required to further validate this hypothesis as well as to establish potential underlying mechanisms.
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Affiliation(s)
- Barry T Radler
- University of Wisconsin-Madison Institute on Aging, 2245 Medical Science Center, Madison, WI, 53703, USA.
| | - Attilio Rigotti
- Departamento de Gastroenterología, Pontificia Universidad Católica, Marcoleta #367, interior, Santiago, Chile
| | - Carol D Ryff
- University of Wisconsin-Madison Institute on Aging, 2245 Medical Science Center, Madison, WI, 53703, USA
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Duntas LH, Brenta G. A Renewed Focus on the Association Between Thyroid Hormones and Lipid Metabolism. Front Endocrinol (Lausanne) 2018; 9:511. [PMID: 30233497 PMCID: PMC6129606 DOI: 10.3389/fendo.2018.00511] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/15/2018] [Indexed: 12/19/2022] Open
Abstract
Thyroid dysfunction, manifesting as either overt or subclinical hypothyroidism, negatively affects lipid metabolism: this leads to hypercholesterolemia which progressively increases the risk for cardiovascular disease and, potentially, mortality. Hypercholesterolemia in hypothyroidism is mainly due to a reduction in low-density lipoprotein (LDL) receptor activity, this accompanied by concomitant diminishing control by triiodothyronine (T3) of sterol regulatory element-binding protein 2 (SREBP-2), which modulates cholesterol biosynthesis by regulating rate-limit degrading enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA) activity. Recently, 3,5-diiodothyronine (T2), a natural thyroid hormone derivative, was found to repress the transcription factor carbohydrate-response element-binding protein (ChREBP) and also to be involved in lipid catabolism and lipogenesis, though via a different pathway than that of T3. While thyroid hormone could therapeutically reverse the dyslipidemic profile commonly occurring in hypothyroidism, it should be borne in mind that the potency of the effects may be age-and sex-dependent. Thyroid hormone administration possibly also sustains and enhances the efficacy of hypolipidemic drugs, such as statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9), in patients with dyslipidemia and hypothyroidism.
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Affiliation(s)
- Leonidas H. Duntas
- Unit of Endocrinology Diabetes and Metabolism, Thyroid Section, Evgenideion Hospital, University of Athens, Athens, Greece
- *Correspondence: Leonidas H. Duntas
| | - Gabriela Brenta
- Unit of Endocrinology and Metabolism, Thyroid Section, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
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Copple T, Ciffone NA. Managing hypertriglyceridemia: What can we learn from cardiovascular outcomes trials? Nurse Pract 2017; 42 Suppl 12:3-9. [PMID: 29176336 DOI: 10.1097/01.npr.0000526627.04268.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiovascular (CV) risk remains in some patients who are treated with statins. Evidence supports a role for triglycerides (TGs) in CV disease. TG-lowering agent outcomes studies have been inconsistent, but eicosapentaenoic acid significantly reduced coronary events in hypercholesterolemic patients who were treated with statins. Ongoing outcomes studies will clarify the role of TG-lowering treatments in CV risk reduction.
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Affiliation(s)
- Tina Copple
- Tina Copple is a Senior Nurse Practitioner at the Diabetes & Glandular Disease Clinic, San Antonio, Tex. Nicole A. Ciffone is an Adult Nurse Practitioner, Clinical Lipid Specialist, and Founder of the Arizona Center for Advanced Lipidology, Tucson, Ariz
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69
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Peng J, Luo F, Ruan G, Peng R, Li X. Hypertriglyceridemia and atherosclerosis. Lipids Health Dis 2017; 16:233. [PMID: 29212549 PMCID: PMC5719571 DOI: 10.1186/s12944-017-0625-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/27/2017] [Indexed: 11/12/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and it has been confirmed that increased low density lipoprotein cholesterol (LDL-C) is an independent risk factor for atherosclerosis. Recently, the increasing evidence has showed that hypertriglyceridemia is associated with incremental ASCVD risk. But the proatherogenic mechanism of triglyceride (TG) remains unclear. Therefore, this article focuses on the clinical studies and proatherogenic mechanism related to hypertriglyceridemia, in order to provide reference for the prevention and treatment of ASCVD.
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Affiliation(s)
- Jia Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China
| | - Fei Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China
| | - Guiyun Ruan
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China
| | - Ran Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China
| | - Xiangping Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, China.
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Abstract
PURPOSE OF REVIEW Dyslipidaemias are a major risk factor for cardiovascular disease (CVD); in particular, high levels of low-density lipoprotein cholesterol (LDL-C) have been associated to a higher cardiovascular risk. Reducing LDL-C levels decreases the risk of coronary heart disease (CHD), and the greater the LDL-C reduction, the greater the decrease in cardiovascular risk. Although statins represent the first line lipid-lowering therapy, many patients do not reach the recommended goals or exhibit adverse side effects leading to therapy discontinuation; in addition, a significant percentage of statin-treated patients continue to experience cardiovascular events even in the presence of well controlled LDL-C levels, because of alterations in other lipid/lipoprotein classes, including triglycerides and high-density lipoprotein cholesterol. RECENT FINDINGS These conditions require further therapeutic interventions to achieve the recommended lipid goals. Several drugs have been developed to address these needs. Recent studies have shown that the association of ezetimibe with rosuvastatin or atorvastatin results in a better hypolipidaemic effect; in addition to this, PCSK9 inhibitors significantly reduce LDL-C levels and cardiovascular events. SUMMARY For patients who are intolerant to statins or not able to reach the recommended LDL-C levels, despite maximal tolerated dose of statin, or exhibiting additional lipid alterations, several drugs are available that can be used either in monotherapy or on top of the maximally tolerated dose of statins.
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Affiliation(s)
- Angela Pirillo
- aCenter for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo bIRCCS Multimedica Hospital, Sesto San Giovanni cDepartment of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy dSchool of Biomedical Sciences, Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia
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71
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Nelson JR, True WS, Le V, Mason RP. Can pleiotropic effects of eicosapentaenoic acid (EPA) impact residual cardiovascular risk? Postgrad Med 2017; 129:822-827. [DOI: 10.1080/00325481.2017.1385365] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Viet Le
- Intermountain Medical Center, Murray, UT, USA
| | - R. Preston Mason
- Department of Medicine, Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Elucida Research, Beverly, MA, USA
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72
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Fruchart JC. Pemafibrate (K-877), a novel selective peroxisome proliferator-activated receptor alpha modulator for management of atherogenic dyslipidaemia. Cardiovasc Diabetol 2017; 16:124. [PMID: 28978316 PMCID: PMC5628452 DOI: 10.1186/s12933-017-0602-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023] Open
Abstract
Despite best evidence-based treatment including statins, residual cardiovascular risk poses a major challenge for clinicians in the twenty first century. Atherogenic dyslipidaemia, in particular elevated triglycerides, a marker for increased triglyceride-rich lipoproteins and their remnants, is an important contributor to lipid-related residual risk, especially in insulin resistant conditions such as type 2 diabetes mellitus. Current therapeutic options include peroxisome proliferator-activated receptor alpha (PPARα) agonists, (fibrates), but these have low potency and limited selectivity for PPARα. Modulating the unique receptor-cofactor binding profile to identify the most potent molecules that induce PPARα-mediated beneficial effects, while at the same time avoiding unwanted side effects, offers a new therapeutic approach and provides the rationale for development of pemafibrate (K-877, Parmodia™), a novel selective PPARα modulator (SPPARMα). In clinical trials, pemafibrate either as monotherapy or as add-on to statin therapy was effective in managing atherogenic dyslipidaemia, with marked reduction of triglycerides, remnant cholesterol and apolipoprotein CIII. Pemafibrate also increased serum fibroblast growth factor 21, implicated in metabolic homeostasis. There were no clinically meaningful adverse effects on hepatic or renal function, including no relevant serum creatinine elevation. A major outcomes study, PROMINENT, will provide definitive evaluation of the role of pemafibrate for management of residual cardiovascular risk in type 2 diabetes patients with atherogenic dyslipidaemia despite statin therapy.
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Wong ND. Residual Risk After Treatment of Patients With Atherosclerotic Cardiovascular Disease With Proprotein Convertase Subtilisin-Kexin Type 9 Monoclonal Antibody Therapy (from the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk Trial). Am J Cardiol 2017; 120:1220-1222. [PMID: 28802511 DOI: 10.1016/j.amjcard.2017.06.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine,Irvine, California.
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74
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Won KB, Hur SH, Nam CW, Ann SH, Park GM, Lee SG, Kim HE, Cho YK, Yoon HJ, Park HS, Kim H, Han S, Jeong MH, Ahn YK, Rha SW, Kim CJ, Cho MC, Kim HS, Chae SC, Kim KS, Kim YJ, Kim KB, Barter P. Evaluation of the impact of statin therapy on the obesity paradox in patients with acute myocardial infarction: A propensity score matching analysis from the Korea Acute Myocardial Infarction Registry. Medicine (Baltimore) 2017; 96:e7180. [PMID: 28858077 PMCID: PMC5585471 DOI: 10.1097/md.0000000000007180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The phenomenon of obesity paradox after acute myocardial infarction (AMI) has been reported under strong recommendation of statin therapy. However, the impact of statin therapy on this paradox has not been investigated. This study investigated the impact of statin therapy on 1-year mortality according to obesity after AMI. A total of 2745 AMI patients were included from the Korea Acute Myocardial Infarction Registry after 1:4 propensity score matching analysis (n = 549 for nonstatin group and n = 2196 for statin group). Primary and secondary outcomes were all-cause and cardiac death, respectively. During 1-year follow-up, the incidence of all-cause (8.4% vs 3.7%) and cardiac (6.2% vs 2.3%) death was higher in nonstatin group than in statin (P < .001, respectively). In nonstatin group, the incidence of all-cause (7.2% vs 9.0%) and cardiac (5.5% vs 6.5%) death did not differ significantly between obese and nonobese patients. However, in statin group, obese patients had lower 1-year rate of all-cause (1.7% vs 4.8%) and cardiac (1.2% vs 2.9%) death (P < .05, respectively), and lower cumulative rates by Kaplan-Meier analysis of all-cause and cardiac death compared with nonobese patients (log-rank P < .05, respectively). The overall risk of all-cause death was significantly lower in obese than in nonobese patients only in statin group (hazard ratio: 0.35; P = .001). After adjusting for confounding factors, obesity was independently associated with decreased risk of all-cause death in statin group. In conclusion, the greater benefit of statin therapy for survival in obese patients is further confirmation of the obesity paradox after AMI.
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Affiliation(s)
- Ki-Bum Won
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Soe Hee Ann
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Gyung-Min Park
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Sang-Gon Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
| | - Hyo-Eun Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Yun-Kyeong Cho
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Hyuck-Jun Yoon
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Hyoung-Seob Park
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Hyungseop Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Seongwook Han
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Myung-Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju
| | - Young-Keun Ahn
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju
| | - Seung-Woon Rha
- Department of Internal Medicine, Korea University Guro Hospital, Seoul
| | - Chong-Jin Kim
- Department of Internal Medicine, Kyunghee University Hospital, Seoul
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju
| | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul
| | - Shung-Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu
| | - Kee-Sik Kim
- Department of Internal Medicine, Daegu Catholic University Hospital, Daegu
| | - Young-Jo Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Kwon-Bae Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu
| | - Philip Barter
- Department of Internal Medicine, University of New South Wales, Sydney, Australia
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von Eckardstein A. [Not Available]. PRAXIS 2017; 106:941-948. [PMID: 28830319 DOI: 10.1024/1661-8157/a002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Mit steigenden Plasma-Konzentrationen der Triglyzeride nehmen die Risiken für atherosklerotische Herz-Kreislauf-Erkrankungen (ASKVK) und akute Pankreatitis zu. Ein niedriger HDL-Cholesterin-Spiegel erhöht das ASKVK-Risiko. Bei hohen Konzentrationen von HDL-Cholesterin ist das Risiko für ASKVK nicht vermindert, aber das für Mortalität erhöht. Hypertriglyzeridämie und niedriges HDL-Cholesterin treten häufig gemeinsam und zusammen mit anderen Risikofaktoren auf. Genetische Studien und gescheiterte Interventionsstudien machen eine kausale Beziehung zwischen HDL-Cholesterin und ASKVK unwahrscheinlich, sodass die Erhöhung des HDL-Cholesterin-Spiegels kein Behandlungsziel ist. Genetische Analysen sprechen zwar für eine kausale Beziehung der triglyzeridreichen Lipoproteine zum kardiovaskulären Risiko, aber es gibt keine Erfolgsnachweise aus Interventionsstudien. Deswegen ist die Senkung der Triglyzeride nur bei Chylomikronämie primäres Behandlungsziel. Bei moderater Hypertriglyzeridämie (<10 mmol/l) und niedrigem HDL-Cholesterin ist die Kontrolle anderer ASKVK-Risikofaktoren, insbesondere die Erreichung des LDL-Cholesterin-Zielwertes, primäres Behandlungsziel. Hohe Triglyzerid-Konzentrationen lassen sich besonders gut durch Lebensstil (körperliche Aktivität), Ernährungsweise (Vermeidung von Alkohol, gesättigten Fettsäuren und leicht resorbierbaren Kohlenhydraten) und Behandlung der Grundkrankheit (vor allem Diabetes) senken. Fibrate und Omega-3-Fettsäuren kommen in Betracht, wenn diese Massnahmen versagen.
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Corral P, Ruiz AJ. [PCSK-9 inhibitors, effects on LDL-C and future implications: What you should know]. HIPERTENSION Y RIESGO VASCULAR 2017; 34:176-183. [PMID: 28709786 DOI: 10.1016/j.hipert.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Abstract
The discovery of proprotein convertase subtilisin/kexin type 9 (PCSK9) in 2003 in families with familial hypercholesterolemia (HF) later generated the development of pharmacological strategies in order to inhibit this protein. Twelve years after this discovery, the first two biological compounds (monoclonal antibodies) were approved, which have been shown to substantially decrease LDL-C and other lipid subfractions. The objective of the present article is to review the history of the discovery of PCSK9, its physiology and pathophysiology and subsequent pharmacological development. The objectives and goals reached to date and the pending questions regarding the efficacy and safety of its clinical use are presented.
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Affiliation(s)
- P Corral
- Especialista en Medicina Interna, lipidólogo clínico, Facultad Medicina, Universidad FASTA, Departamento Farmacología, Mar del Plata, Buenos Aires, Argentina.
| | - A J Ruiz
- Departamento de Medicina Interna, Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
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Wong ND, Zhao Y, Quek RGW, Blumenthal RS, Budoff MJ, Cushman M, Garg P, Sandfort V, Tsai M, Lopez JAG. Residual atherosclerotic cardiovascular disease risk in statin-treated adults: The Multi-Ethnic Study of Atherosclerosis. J Clin Lipidol 2017; 11:1223-1233. [PMID: 28754224 DOI: 10.1016/j.jacl.2017.06.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/17/2017] [Accepted: 06/14/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Residual atherosclerotic cardiovascular disease (ASCVD) risk in statin-treated US adults without known ASCVD is not well described. OBJECTIVE To quantitate residual ASCVD risk and its predictors in statin-treated adults. METHODS We studied 1014 statin-treated adults (53.3% female, mean 66.0 years) free of clinical ASCVD in the Multi-Ethnic Study of Atherosclerosis. We examined ASCVD event rates by National Lipid Association risk groups over 11-year follow-up and the relation of standard risk factors, biomarkers, and subclinical atherosclerosis measures with residual ASCVD event risk. RESULTS Overall, 5.3% of participants were at low, 12.2% at moderate, 60.3% at high, and 22.2% at very high baseline risk. Despite statin therapy, age- and race-standardized ASCVD rates per 1000 person-years for men and women were both 4.9 for low/moderate risk, 19.1 and 14.2 for high risk, and 35.6 and 26.7 for very high risk, respectively. Specific independent predictors of residual risk included current smoking, family history, diabetes, high-sensitivity C-reactive protein, low-density lipoprotein particle number, carotid intimal medial thickness, and especially coronary artery calcium score. Those on moderate- or high-intensity statins at baseline (compared with low intensity) had 39% lower risks and those who increased statin intensity 62% lower ASCVD event risks (P < .01). CONCLUSION Residual risk of ASCVD remains high despite statin treatment and is predicted by specific risk factors and subclinical atherosclerosis. These findings may be helpful for identifying those at highest risk needing more aggressive treatment.
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Affiliation(s)
- Nathan D Wong
- Division of Cardiology, Department of Medicine, University of California at Irvine, Heart Disease Prevention Program, Irvine, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA.
| | - Yanglu Zhao
- Division of Cardiology, Department of Medicine, University of California at Irvine, Heart Disease Prevention Program, Irvine, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ruben G W Quek
- Global Health Economics and United States Medical Organization, Amgen, Inc, Thousand Oaks, CA, USA
| | - Roger S Blumenthal
- Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Mary Cushman
- Department of Pathology, University of Vermont, Burlington, VT, USA
| | - Parveen Garg
- Division of Cardiology, Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Veit Sandfort
- Department of Cardiovascular Imaging, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Michael Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - J Antonio G Lopez
- Global Health Economics and United States Medical Organization, Amgen, Inc, Thousand Oaks, CA, USA
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The application of atherogenic dyslipidaemia consensus recommendations in the primary care setting. DAT-AP study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017. [PMID: 28648670 DOI: 10.1016/j.arteri.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS The "DAT-AP" (from the Spanish, "Dislipemia ATerogénica en Atención Primaria", for Atherogenic Dyslipidaemia in Primary Care) study objective is to determine to what extent published consensus guidelines for the diagnostic and therapeutic management of AD are used in the primary care setting, and to evaluate the approach of the participating physicians towards the detection, diagnosis, and treatment of AD. METHODS This is descriptive, cross-sectional, multicentre study performed between January and May 2015 in primary care centres throughout Spain. Study data were collected in 2 independent blocks, the first addressing theoretical aspects of AD and the second, practical aspects (clinical cases) RESULTS: The theoretical part is in the process of publication. This manuscript depicts the clinical cases block. Although study participants showed good knowledge of the subject, the high prevalence of this disease requires an additional effort to optimise detection and treatment, with the implementation of appropriate lifestyle interventions and the prescription of the best treatment.
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Practical recommendations for the management of cardiovascular risk associated with atherogenic dyslipidemia, with special attention to residual risk. Spanish adaptation of a European Consensus of Experts. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:168-177. [PMID: 28433209 DOI: 10.1016/j.arteri.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/03/2016] [Indexed: 11/26/2022]
Abstract
This document has discussed clinical approaches to managing cardiovascular risk in clinical practice, with special focus on residual cardiovascular risk associated with lipid abnormalities, especially atherogenic dyslipidaemia (AD). A simplified definition of AD was proposed to enhance understanding of this condition, its prevalence and its impact on cardiovascular risk. AD can be defined by high fasting triglyceride levels (≥2.3mmol/L / ≥200mg/dL) and low high-density lipoprotein cholesterol (HDL-c) levels (≤1,0 / 40 and ≤1,3mmol/L / 50mg/dL in men and women, respectively) in statin-treated patients at high cardiovascular risk. The use of a single marker for the diagnosis and treatment of AD, such as non-HDL-c, was advocated. Interventions including lifestyle optimization and low density lipoprotein (LDL) lowering therapy with statins (±ezetimibe) are recommended by experts. Treatment of residual AD can be performed with the addition of fenofibrate, since it can improve the complete lipoprotein profile and reduce the risk of cardiovascular events in patients with AD. Others clinical condictions in which fenofibrate may be prescribed include patients with very high TGs (≥5.6mmol/L / 500mg/dL), patients who are intolerant or resistant to statins, and patients with AD and at high cardiovascular risk. The fenofibrate-statin combination was considered by the experts to benefit from a favorable benefit-risk profile. In conclusion, cardiovascular experts adopt a multifaceted approach to the prevention of atherosclerotic cardiovascular disease, with lifestyle optimization, LDL-lowering therapy and treatment of AD with fenofibrate routinely used to help reduce a patient's overall cardiovascular risk.
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Nelson J, Wani O, May H, Budoff M. Potential benefits of eicosapentaenoic acid on atherosclerotic plaques. Vascul Pharmacol 2017; 91:1-9. [DOI: 10.1016/j.vph.2017.02.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 12/31/2022]
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81
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Udata C, Garzone PD, Gumbiner B, Joh T, Liang H, Liao KH, Williams JH, Meng X. A Mechanism-Based Pharmacokinetic/Pharmacodynamic Model for Bococizumab, a Humanized Monoclonal Antibody Against Proprotein Convertase Subtilisin/Kexin Type 9, and Its Application in Early Clinical Development. J Clin Pharmacol 2017; 57:855-864. [DOI: 10.1002/jcph.867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/05/2016] [Indexed: 12/15/2022]
Affiliation(s)
| | - Pamela D. Garzone
- World Wide Research and Development; Pfizer Inc; San Diego California
| | - Barry Gumbiner
- World Wide Research and Development; Pfizer Inc; San Diego California
| | - Tenshang Joh
- World Wide Research and Development; Pfizer Inc; San Diego California
| | - Hong Liang
- World Wide Research and Development; Pfizer Inc; San Diego California
| | - Kai-Hsin Liao
- World Wide Research and Development; Pfizer Inc; San Diego California
| | - Jason H. Williams
- World Wide Research and Development; Pfizer Inc; San Diego California
| | - Xu Meng
- World Wide Research and Development; Pfizer Inc; San Diego California
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Banach M, Jankowski P, Jóźwiak J, Cybulska B, Windak A, Guzik T, Mamcarz A, Broncel M, Tomasik T, Rysz J, Jankowska-Zduńczyk A, Hoffman P, Mastalerz-Migas A. PoLA/CFPiP/PCS Guidelines for the Management of Dyslipidaemias for Family Physicians 2016. Arch Med Sci 2017; 13:1-45. [PMID: 28144253 PMCID: PMC5206369 DOI: 10.5114/aoms.2017.64712] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Piotr Jankowski
- 1 Department of Cardiology, Interventional Electrocardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Jóźwiak
- Institute of Health and Nutrition Sciences, Czestochowa University of Technology, Czestochowa, Poland
| | | | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Guzik
- Department of Internal Diseases and Rural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Mamcarz
- 3 Department of Internal Diseases and Cardiology, 2 Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marlena Broncel
- Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Lodz, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | | | - Piotr Hoffman
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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Eicosapentaenoic acid reduces membrane fluidity, inhibits cholesterol domain formation, and normalizes bilayer width in atherosclerotic-like model membranes. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2016; 1858:3131-3140. [DOI: 10.1016/j.bbamem.2016.10.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/01/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022]
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Handelsman Y, Shapiro MD. TRIGLYCERIDES, ATHEROSCLEROSIS, AND CARDIOVASCULAR OUTCOME STUDIES: FOCUS ON OMEGA-3 FATTY ACIDS. Endocr Pract 2016; 23:100-112. [PMID: 27819772 DOI: 10.4158/ep161445.ra] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To provide an overview of the roles of triglycerides and triglyceride-lowering agents in atherosclerosis in the context of cardiovascular outcomes studies. METHODS We reviewed the published literature as well as ClinicalTrials.gov entries for ongoing studies. RESULTS Despite improved atherosclerotic cardiovascular disease (ASCVD) outcomes with statin therapy, residual risk remains. Epidemiologic data and recent genetic insights provide compelling evidence that triglycerides are in the causal pathway for the development of atherosclerosis, thereby renewing interest in targeting triglycerides to improve ASCVD outcomes. Fibrates, niacin, and omega-3 fatty acids (OM3FAs) are three classes of triglyceride-lowering drugs. Outcome studies with triglyceride-lowering agents have been inconsistent. With regard to OM3FAs, the JELIS study showed that eicosapentaenoic acid (EPA) significantly reduced major coronary events in statin-treated hypercholesterolemic patients. Regarding other agents, extended-release niacin and fenofibrate are no longer recommended as statin add-on therapy (by some guidelines, though not all) because of the lack of convincing evidence from outcome studies. Notably, subgroup analyses from the outcome studies have generated the hypothesis that triglyceride lowering may provide benefit in statin-treated patients with persistent hypertriglyceridemia. Two ongoing OM3FA outcome studies (REDUCE-IT and STRENGTH) are testing this hypothesis in high-risk, statin-treated patients with triglyceride levels of 200 to 500 mg/dL. CONCLUSION There is consistent evidence that triglycerides are in the causal pathway of atherosclerosis but inconsistent evidence from cardiovascular outcomes studies as to whether triglyceride-lowering agents reduce cardiovascular risk. Ongoing outcomes studies will determine the role of triglyceride lowering in statin-treated patients with high-dose prescription OM3FAs in terms of improved ASCVD outcomes. ABBREVIATIONS AACE = American Association of Clinical Endocrinologists ACCORD = Action to Control Cardiovascular Risk in Diabetes AIM-HIGH = Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes apo = apolipoprotein ASCEND = A Study of Cardiovascular Events in Diabetes ASCVD = atherosclerotic cardiovascular disease BIP = Bezafibrate Infarction Prevention CHD = coronary heart disease CI = confidence interval CV = cardiovascular CVD = cardiovascular disease DHA = docosahexaenoic acid DO-IT = Diet and Omega-3 Intervention Trial EPA = eicosapentaenoic acid FIELD = Fenofibrate Intervention and Event Lowering in Diabetes GISSI-HF = GISSI-Heart Failure HDL-C = high-density-lipoprotein cholesterol HPS2-THRIVE = Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events HR = hazard ratio JELIS = Japan Eicosapentaenoic Acid Lipid Intervention Study LDL = low-density lipoprotein LDL-C = low-density-lipoprotein cholesterol MI = myocardial infarction OM3FAs = omega-3 fatty acids VITAL = Vitamin D and Omega-3 Trial.
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Foucher C, Aubonnet P, Reichert P, Berli M, Schaeffer A, Calvo Vargas CG, Lochocka A, Belenky D, Koch HF. New Fixed-Dose Combinations of Fenofibrate/Simvastatin Therapy Significantly Improve the Lipid Profile of High-Risk Patients with Mixed Dyslipidemia Versus Monotherapies. Cardiovasc Ther 2016; 33:329-37. [PMID: 26227087 DOI: 10.1111/1755-5922.12148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS Guidelines propose additional therapy to statin to treat elevated triglycerides (TG) and low high-density lipoprotein cholesterol (HDLC) in dyslipidemic patients. We evaluated the effects of new fixed-dose combinations (FDC) of fenofibrate/simvastatin on plasma lipids versus simvastatin or fenofibrate monotherapies. METHODS Subjects with mixed dyslipidemia at high or very high cardiovascular risk on stable statin therapy for at least 3 months were included in a randomized, double-blind, active-control, parallel-group study. Patients were treated with FDC fenofibrate/simvastatin 145/20 mg or 145/40 mg, simvastatin 20 mg or 40 mg, or fenofibrate 145 mg for 12 weeks. Plasma lipids, C-reactive protein, and cystatin C were measured before and after treatments. Differences in % changes were compared between FDC fenofibrate/simvastatin and monotherapies. RESULTS Significant differences between FDC fenofibrate/simvastatin and simvastatin monotherapies were observed for the % change of TG (LS mean difference [two-sided 95% CI]: -32.2% [-38.6%, -25.8%], P < 0.001) and HDL-C (7.5% [4.7%, 10.2%], P < 0.001). A significant difference between the FDC fenofibrate/simvastatin and fenofibrate was observed for LDLC % changes (-34.7% [-40.8%, -28.5%], P < 0.001). Significant differences between FDC fenofibrate/simvastatin and their respective monotherapies were also observed for Apo B and non-HDLC % changes. The FDC were well tolerated with a similar safety profile compared with monotherapies. CONCLUSIONS FDC fenofibrate/simvastatin are effective and well-tolerated therapies to improve the TG and HDLC profile in high-risk patients with mixed dyslipidemia.
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Affiliation(s)
| | | | - Petr Reichert
- Samostatna ordinace lekare specialisty - internisty, Teplice, Czech Republic
| | - Mario Berli
- Centro de Diagnóstico y Rehabilitación - CEDIR, Santa Fe, Argentina
| | | | | | - Anna Lochocka
- Niepubliczny Zakład Opieki Zdrowotnej Centrum Medyczne "OMEGA" Sp. z o.o.ul., Płock, Poland
| | - Dmitry Belenky
- Clinical Emergency Hospital, Novosibirsk, Russian Federation
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Millán J, Hernández-Mijares A, Ascaso JF, Blasco M, Brea A, Díaz Á, González-Santos P, Mantilla T, Pedro-Botet J, Pintó X. La auténtica dimensión del colesterol-no-HDL: colesterol aterogénico. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2016; 28:265-270. [DOI: 10.1016/j.arteri.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
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Puri R, Nissen SE, Shao M, Elshazly MB, Kataoka Y, Kapadia SR, Tuzcu EM, Nicholls SJ. Non-HDL Cholesterol and Triglycerides. Arterioscler Thromb Vasc Biol 2016; 36:2220-2228. [DOI: 10.1161/atvbaha.116.307601] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/01/2016] [Indexed: 01/21/2023]
Abstract
Objectives—
Non–high-density lipoprotein cholesterol (non-HDLC) levels reflect the full burden of cholesterol transported in atherogenic lipoproteins. Genetic studies suggest a causal association between elevated triglycerides (TGs)-rich lipoproteins and atherosclerosis. We evaluated associations between achieved non-HDLC and TG levels on changes in coronary atheroma volume.
Approach and Results—
Data were analyzed from 9 clinical trials involving 4957 patients with coronary disease undergoing serial intravascular ultrasonography to assess changes in percent atheroma volume (ΔPAV) and were evaluated against on-treatment non-HDLC and TG levels. The effects of lower (<100 mg/dL) versus higher (≥100 mg/dL) achieved non-HDLC levels and lower (<200 mg/dL) versus higher (≥200 mg/dL) achieved TG levels were evaluated in populations with variable on-treatment low-density lipoprotein cholesterol (LDLC) </≥70 mg/dL and C-reactive protein </≥2 mg/L and in patients with or without diabetes mellitus. On-treatment non-HDLC levels linearly associated with ΔPAV. Overt PAV progression (ΔPAV>0) was associated with achieved TG levels >200 mg/dL, respectively. Lower on-treatment non-HDLC and TG levels associated with significant PAV regression compared with higher non-HDLC and TG levels across all levels of LDLC and C-reactive protein and irrespective of diabetic status (
P
<0.001 across all comparisons). ΔPAV were more strongly influenced by changes in non-HDLC (β=0.62;
P
<0.001) compared with changes in LDLC (β=0.51;
P
<0.001). Kaplan–Meier sensitivity analyses demonstrated significantly greater major adverse cardiovascular event rates in those with higher versus lower non-HDLC and TG levels, with an earlier separation of the non-HDLC compared with the LDLC curve.
Conclusions—
Achieved non-HDLC levels seem more closely associated with coronary atheroma progression than LDLC. Plaque progression associates with achieved TGs, but only above levels of 200 mg/dL. These observations support a more prominent role for non-HDLC (and possibly TG) lowering in combating residual cardiovascular risk.
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Affiliation(s)
- Rishi Puri
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
| | - Steven E. Nissen
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
| | - Mingyuan Shao
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
| | - Mohamed B. Elshazly
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
| | - Yu Kataoka
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
| | - Samir R. Kapadia
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
| | - E. Murat Tuzcu
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
| | - Stephen J. Nicholls
- From the Cleveland Clinic Coordinating Center for Clinical Research (C5R) (R.P., S.E.N., M.S.), and Department of Cardiovascular Medicine (R.P., S.E.N., M.B.E., S.R.K., E.M.T.), Cleveland Clinic, OH; Department of Medicine, University of Adelaide, Australia (R.P., S.J.N.); and South Australian Health and Medical Research Institute, Adelaide, Australia (Y.K., S.J.N.)
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Crandell JR, Tartaglia C, Tartaglia J. Lipid effects of switching from prescription EPA+DHA (omega-3-acid ethyl esters) to prescription EPA only (icosapent ethyl) in dyslipidemic patients. Postgrad Med 2016; 128:859-864. [PMID: 27684412 DOI: 10.1080/00325481.2016.1241129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Residual cardiovascular risk and persistently elevated triglycerides (TGs) may remain despite statin therapy in patients with dyslipidemia. Prescription omega-3 fatty acid formulations containing docosahexaenoic acid (DHA) and/or eicosapentaenoic acid (EPA) have been shown to reduce TGs and may potentially lower residual cardiovascular risk. However, DHA may raise low-density lipoprotein cholesterol (LDL-C) and compromise treatment goals. Icosapent ethyl (Vascepa®), a high-purity prescription EPA formulation, has been shown to lower TGs and other lipid parameters without raising LDL-C. There are no prospective, randomized, controlled trials of the effects of switching patients from omega-3-acid ethyl esters (Lovaza®), a prescription formulation containing EPA+DHA, to icosapent ethyl. METHODS This retrospective chart review included records of high-risk patients aged ≥18 years receiving stable statin therapy for dyslipidemia who had been switched from prescription omega-3-acid ethyl esters 4 g/day to prescription icosapent ethyl 4 g/day and had available laboratory lipid profiles after receiving each for ≥2 months. Lipid assessments were conducted by local laboratories. Patient records were excluded if there were changes in medication or health condition that could affect lipid parameters. RESULTS The records of 8 patients (6 women and 2 men; 54-83 years) met eligibility criteria. Following the switch to icosapent ethyl, LDL-C changes ranged from +3.2% to -69.1% (reduced in 7 patients), total cholesterol was reduced in all patients (-3.5% to -44.3%), and TG changes ranged from +32.4% to -59.0% (reduced in 6 patients). Decreases or no changes in non-high-density lipoprotein cholesterol were observed; changes in high-density lipoprotein cholesterol varied. No adverse events related to either product were reported. CONCLUSION In this real-world retrospective analysis, switching high-risk statin-treated patients from omega-3-acid ethyl esters to icosapent ethyl resulted in favorable lipid changes. The analysis was limited by the small patient numbers, but lipid results were consistent with randomized controlled trials and previous case series.
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Philip S, Chowdhury S, Nelson JR, Benjamin Everett P, Hulme-Lowe CK, Schmier JK. A novel cost-effectiveness model of prescription eicosapentaenoic acid extrapolated to secondary prevention of cardiovascular diseases in the United States. J Med Econ 2016; 19:1003-10. [PMID: 27352086 DOI: 10.1080/13696998.2016.1207652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Given the substantial economic and health burden of cardiovascular disease and the residual cardiovascular risk that remains despite statin therapy, adjunctive therapies are needed. The purpose of this model was to estimate the cost-effectiveness of high-purity prescription eicosapentaenoic acid (EPA) omega-3 fatty acid intervention in secondary prevention of cardiovascular diseases in statin-treated patient populations extrapolated to the US. METHODS The deterministic model utilized inputs for cardiovascular events, costs, and utilities from published sources. Expert opinion was used when assumptions were required. The model takes the perspective of a US commercial, third-party payer with costs presented in 2014 US dollars. The model extends to 5 years and applies a 3% discount rate to costs and benefits. Sensitivity analyses were conducted to explore the influence of various input parameters on costs and outcomes. RESULTS Using base case parameters, EPA-plus-statin therapy compared with statin monotherapy resulted in cost savings (total 5-year costs $29,393 vs $30,587 per person, respectively) and improved utilities (average 3.627 vs 3.575, respectively). The results were not sensitive to multiple variations in model inputs and consistently identified EPA-plus-statin therapy to be the economically dominant strategy, with both lower costs and better patient utilities over the modeled 5-year period. LIMITATIONS The model is only an approximation of reality and does not capture all complexities of a real-world scenario without further inputs from ongoing trials. The model may under-estimate the cost-effectiveness of EPA-plus-statin therapy because it allows only a single event per patient. CONCLUSION This novel model suggests that combining EPA with statin therapy for secondary prevention of cardiovascular disease in the US may be a cost-saving and more compelling intervention than statin monotherapy.
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Affiliation(s)
| | | | - John R Nelson
- c California Cardiovascular Institute , Fresno , CA , USA
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Sawada T, Tsubata H, Hashimoto N, Takabe M, Miyata T, Aoki K, Yamashita S, Oishi S, Osue T, Yokoi K, Tsukishiro Y, Onishi T, Shimane A, Taniguchi Y, Yasaka Y, Ohara T, Kawai H, Yokoyama M. Effects of 6-month eicosapentaenoic acid treatment on postprandial hyperglycemia, hyperlipidemia, insulin secretion ability, and concomitant endothelial dysfunction among newly-diagnosed impaired glucose metabolism patients with coronary artery disease. An open label, single blinded, prospective randomized controlled trial. Cardiovasc Diabetol 2016; 15:121. [PMID: 27565734 PMCID: PMC5002116 DOI: 10.1186/s12933-016-0437-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/12/2016] [Indexed: 01/18/2023] Open
Abstract
Background Recent experimental studies have revealed that n-3 fatty acids, such as eicosapentaenoic acid (EPA) regulate postprandial insulin secretion, and correct postprandial glucose and lipid abnormalities. However, the effects of 6-month EPA treatment on postprandial hyperglycemia and hyperlipidemia, insulin secretion, and concomitant endothelial dysfunction remain unknown in patients with impaired glucose metabolism (IGM) and coronary artery disease (CAD). Methods and results We randomized 107 newly diagnosed IGM patients with CAD to receive either 1800 mg/day of EPA (EPA group, n = 53) or no EPA (n = 54). Cookie meal testing (carbohydrates: 75 g, fat: 28.5 g) and endothelial function testing using fasting-state flow-mediated dilatation (FMD) were performed before and after 6 months of treatment. The primary outcome of this study was changes in postprandial glycemic and triglyceridemic control and secondary outcomes were improvement of insulin secretion and endothelial dysfunction. After 6 months, the EPA group exhibited significant improvements in EPA/arachidonic acid, fasting triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C). The EPA group also exhibited significant decreases in the incremental TG peak, area under the curve (AUC) for postprandial TG, incremental glucose peak, AUC for postprandial glucose, and improvements in glycometabolism categorization. No significant changes were observed for hemoglobin A1c and fasting plasma glucose levels. The EPA group exhibited a significant increase in AUC-immune reactive insulin/AUC-plasma glucose ratio (which indicates postprandial insulin secretory ability) and significant improvements in FMD. Multiple regression analysis revealed that decreases in the TG/HDL-C ratio and incremental TG peak were independent predictors of FMD improvement in the EPA group. Conclusions EPA corrected postprandial hypertriglyceridemia, hyperglycemia and insulin secretion ability. This amelioration of several metabolic abnormalities was accompanied by recovery of concomitant endothelial dysfunction in newly diagnosed IGM patients with CAD. Clinical Trial Registration UMIN Registry number: UMIN000011265 (https://www.upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000013200&language=E) Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0437-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takahiro Sawada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan.
| | - Hideo Tsubata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Naoko Hashimoto
- Division of Diabetes and Endocrinology, Hyogo Prefectural Himeji Cardiovascular Center, 520, Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Michinori Takabe
- Division of Diabetes and Endocrinology, Hyogo Prefectural Himeji Cardiovascular Center, 520, Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Taishi Miyata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Kosuke Aoki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Soichiro Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Shogo Oishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Tsuyoshi Osue
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Kiminobu Yokoi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Yasue Tsukishiro
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Tetsuari Onishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Akira Shimane
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Yasuyo Taniguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Yoshinori Yasaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Takeshi Ohara
- Division of Diabetes and Endocrinology, Hyogo Prefectural Himeji Cardiovascular Center, 520, Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Hiroya Kawai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
| | - Mitsuhiro Yokoyama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Hyogo Prefectural Himeji Cardiovascular Center, 520 Saisho-Kou, Himeji, Hyogo, 670-0981, Japan
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Girona J, Ibarretxe D, Plana N, Guaita-Esteruelas S, Amigo N, Heras M, Masana L. Circulating PCSK9 levels and CETP plasma activity are independently associated in patients with metabolic diseases. Cardiovasc Diabetol 2016; 15:107. [PMID: 27488210 PMCID: PMC4973048 DOI: 10.1186/s12933-016-0428-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/22/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND PCSK9 inhibition is a new powerful cholesterol-lowering strategy. Recently, it was reported that CETP inhibitors influence PCSK9 levels as an off-target effect. We explored the relationship between circulating PCSK9 levels and CETP activity in patients with metabolic disease who were not on lipid-lowering therapy. METHODS Plasma CETP activity and PCSK9 levels were measured in 450 participants (median age, 58 years; 49 % women) who attended the metabolism unit because of metabolic syndrome (MetS) (78 %), atherogenic dyslipidemia (32 %), obesity (50 %), type 2 diabetes mellitus (72 %), and other risk factors (13 %). A 6 week lipid-lowering drug wash-out period was established in treated patients. RESULTS Both PCSK9 levels and CETP activity were higher in patients with an increasing number of MetS components. PCSK9 levels were positively correlated with CETP activity in the entire cohort (r = 0.256, P < 0.0001) independent of age, gender, body mass index (BMI), systolic blood pressure (SBP), LDL cholesterol (LDL-C), triglycerides and glucose. Individuals with the loss-of-function PCSK9 genetic variant rs11591147 (R46L) had lower levels of PCSK9 (36.5 %, P < 0.0001) and LDL-C (17.8 %, P = 0.010) as well as lower CETP activity (10.31 %, P = 0.009). This association remained significant in the multiple regression analysis even after adjusting for gender, age, BMI, LDL-C, triglycerides, glucose, lecithin-cholesterol acyltransferase, SBP and MetS (P = 0.003). CONCLUSIONS Our data suggest a metabolic association between PCSK9 and CETP independent of lipid-lowering treatment. The clinical implications of this metabolic relationship could be relevant for explaining the effect of PCSK9 and CETP inhibition on overall lipid profiles.
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Affiliation(s)
- Josefa Girona
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, C Sant Llorenç, 21, 43201, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and AssociatedMetabolic Disorders (CIBERDEM), Madrid, Spain
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, C Sant Llorenç, 21, 43201, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and AssociatedMetabolic Disorders (CIBERDEM), Madrid, Spain
| | - Nuria Plana
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, C Sant Llorenç, 21, 43201, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and AssociatedMetabolic Disorders (CIBERDEM), Madrid, Spain
| | - Sandra Guaita-Esteruelas
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, C Sant Llorenç, 21, 43201, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and AssociatedMetabolic Disorders (CIBERDEM), Madrid, Spain
| | - Nuria Amigo
- Biosfer Teslab, Reus and Department of Electronic Engineering, Universitat Rovira i Virgili, IISPV, Tarragona, Spain.,Spanish Biomedical Research Centre in Diabetes and AssociatedMetabolic Disorders (CIBERDEM), Madrid, Spain
| | - Mercedes Heras
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, C Sant Llorenç, 21, 43201, Reus, Spain.,Spanish Biomedical Research Centre in Diabetes and AssociatedMetabolic Disorders (CIBERDEM), Madrid, Spain
| | - Luis Masana
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV, C Sant Llorenç, 21, 43201, Reus, Spain. .,Spanish Biomedical Research Centre in Diabetes and AssociatedMetabolic Disorders (CIBERDEM), Madrid, Spain.
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92
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Wilke T, Mueller S, Groth A, Berg B, Hammar N, Tsai K, Fuchs A, Stephens S, Maywald U. Effectiveness of sulphonylureas in the therapy of diabetes mellitus type 2 patients: an observational cohort study. J Diabetes Metab Disord 2016; 15:28. [PMID: 27486568 PMCID: PMC4969981 DOI: 10.1186/s40200-016-0251-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/27/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND We compared all-cause mortality, major macrovascular events (MACE) and diabetes-related hospitalizations in T2DM-incident patients newly treated with metformin (MET) versus sulphonylureas (SU) monotherapy and in T2DM-prevalent patients newly treated with MET+SU versus MET+DPP4-inhibitor combination therapy. METHODS We analysed anonymized data obtained from a German health fund. Patients were included when they had started MET versus SU therapy or MET+SU versus MET+DPP4 therapy between 01/07/2010 and 31/12/2011. Observation started with the first MET/SU prescription or the first prescription of the second agent of a MET+SU/MET+DPP4 combination therapy. Follow-up time lasted until the end of data availability (a minimum of 12 months), death or therapy discontinuation. RESULTS In total, 434,291 T2DM-prevalent and 35,661 T2DM-incident patients were identified. Of the identified T2DM-incident patients, 904/7,874 started SU/MET monotherapy, respectively, with a mean age of 70.1/61.4 years (54.6/50.3 % female; Charlson Comorbidity Index (CCI) 1.4/2.2; 933/7,350 observed SU/MET patient years). 4,157/1,793 SU+MET/DPP4+MET therapy starters had a mean age of 68.1/62.2 years (53.4/50.8 % female; CCI 2.8/2.6; 4,556/1,752 observed SU+MET/ DPP4+MET patient years). In a propensity score matched (PSM) comparison, the HRs (95 % CIs) associated with SU monotherapy compared to MET monotherapy exposure were 1.4 (0.9-2.3) for mortality, 1.4 (0.9-2.2) for MACE, 4.1 (1.5-10.9) for T2DM hospitalizations and 1.6 (1.2-2.3) for composite event risk. In a multivariable Cox regression model, SU monotherapy was associated with higher mortality (aHR 2.0; 1.5-2.6), higher MACE (aHR 1.3; 1.0-1.7) and higher T2DM hospitalizations (aHR 2.8; 1.8-4.4), which corresponded with a higher composite event risk (aHR 1.8; 1.5-2.1). No significant differences in event rates were observed in the PSM comparison between DPP4+MET/SU+MET combination therapy starters and in the multivariable Cox regression analysis. CONCLUSIONS Our results show that SU monotherapy may be associated with increased mortality, MACE and T2DM hospitalizations, compared to MET monotherapy. When considering SU therapy, the associated cardiovascular risk should also be taken into account.
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Affiliation(s)
- Thomas Wilke
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Sabrina Mueller
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Antje Groth
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Bjoern Berg
- IPAM, University of Wismar, Alter Holzhafen 19, 23966 Wismar, Germany
| | - Niklas Hammar
- AstraZeneca R&D Mölndal, Pepparedsleden 1, Mölndal, 431 83 Sweden
| | - Katherine Tsai
- AstraZeneca R&D, 101 Orchard Ridge Drive, 2207K, Gaithersburg, MD 20878 USA
| | | | | | - Ulf Maywald
- AOK PLUS, Sternplatz 7, 01067 Dresden, Germany
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93
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Fialkow J. Omega-3 Fatty Acid Formulations in Cardiovascular Disease: Dietary Supplements are Not Substitutes for Prescription Products. Am J Cardiovasc Drugs 2016; 16:229-239. [PMID: 27138439 PMCID: PMC4947114 DOI: 10.1007/s40256-016-0170-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Omega-3 fatty acid products are available as prescription formulations (icosapent ethyl, omega-3-acid ethyl esters, omega-3-acid ethyl esters A, omega-3-carboxylic acids) and dietary supplements (predominantly fish oils). Most dietary supplements and all but one prescription formulation contain mixtures of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Products containing both EPA and DHA may raise low-density lipoprotein cholesterol (LDL-C). In clinical trials, the EPA-only prescription product, icosapent ethyl, did not raise LDL-C compared with placebo. To correct a common misconception, it is important to note that omega-3 fatty acid dietary supplements are not US FDA-approved over-the-counter drugs and are not required to demonstrate safety and efficacy prior to marketing. Conversely, prescription products are supported by extensive clinical safety and efficacy investigations required for FDA approval and have active and ongoing safety monitoring programs. While omega-3 fatty acid dietary supplements may have a place in the supplementation of diet, they generally contain lower levels of EPA and DHA than prescription products and are not approved or intended to treat disease. Perhaps due to the lack of regulation of dietary supplements, EPA and DHA levels may vary widely within and between brands, and products may also contain unwanted cholesterol or fats or potentially harmful components, including toxins and oxidized fatty acids. Accordingly, omega-3 fatty acid dietary supplements should not be substituted for prescription products. Similarly, prescription products containing DHA and EPA should not be substituted for the EPA-only prescription product, as DHA may raise LDL-C and thereby complicate the management of patients with dyslipidemia.
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Affiliation(s)
- Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, 8900 N. Kendall Drive, Miami, FL, 33176, USA.
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94
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Valensi P, Avignon A, Sultan A, Chanu B, Nguyen MT, Cosson E. Atherogenic dyslipidemia and risk of silent coronary artery disease in asymptomatic patients with type 2 diabetes: a cross-sectional study. Cardiovasc Diabetol 2016; 15:104. [PMID: 27450534 PMCID: PMC4957891 DOI: 10.1186/s12933-016-0415-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/30/2016] [Indexed: 01/02/2023] Open
Abstract
Background To investigate whether atherogenic dyslipidemia, a dyslipidemic profile combining elevated triglycerides and low high-density lipoprotein (HDL) cholesterol, is predictive of risk of silent myocardial ischemia (SMI) or angiographic coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes. Methods Cohort study in 1080 asymptomatic patients with type 2 diabetes with a normal resting electrocardiogram, at least one additional cardiovascular risk factor and low density lipoprotein (LDL) cholesterol <3.35 mmol/L. Patients initially underwent screening for SMI by stress myocardial scintigraphy. Patients with SMI underwent coronary angiography. Results Overall, 60 (5.5 %) patients had atherogenic dyslipidemia (triglycerides ≥2.26 mmol/L and HDL cholesterol ≤0.88 mmol/L). In multivariate analyses taking into account the parameters associated in univariate analyses with SMI and then CAD, atherogenic dyslipidemia was associated with SMI (odds ratio 1.8[1.0–3.3]), as were male gender (OR 2.1[1.5–2.9]), BMI (OR 0.97[0.94–0.997]), retinopathy (OR 1.4[1.1–1.9]), peripheral occlusive arterial disease (POAD: OR 2.5[1.6–3.8]) and mean blood pressure (OR 1.01[1.00–1.03]); atherogenic dyslipidemia was associated with CAD (OR 4.0[1.7–9.2]), as were male gender (OR 3.0[1.6–5.6]), BMI (OR 0.94[0.90–0.995]), retinopathy (OR 1.7[1.0–2.9], POAD (OR 4.0[2.1–7.4]) and mean blood pressure (OR 1.03[1.01–1.05]). In the subgroup of 584 patients with LDL cholesterol <2.6 mmol/L, atherogenic dyslipidemia was also associated with CAD (OR 3.6[1.5–9.0]). Conclusions Atherogenic dyslipidemia was associated with an increased risk of SMI and silent CAD in patients with type 2 diabetes and LDL cholesterol levels <3.35 mmol/L. Specific management of atherogenic dyslipidemia might help reducing the high residual burden of cardiovascular disease.
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Affiliation(s)
- Paul Valensi
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France.
| | - Antoine Avignon
- Department of Endocrinology-Diabetology-Nutrition, CHRU Montpellier, 34295, Montpellier Cedex 5, France.,PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295, Montpellier Cedex 5, France
| | - Ariane Sultan
- Department of Endocrinology-Diabetology-Nutrition, CHRU Montpellier, 34295, Montpellier Cedex 5, France.,PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295, Montpellier Cedex 5, France
| | - Bernard Chanu
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France
| | - Minh Tuan Nguyen
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France
| | - Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Jean Verdier Hospital, Université Paris 13, Sorbonne Paris Cité, Avenue du 14 Juillet, 93143, Bondy Cedex, France.,Unité de Recherche Epidémiologique Nutritionnelle, UMR U1153 INSERM/U11125 INRA/CNAM/Université Paris 13, 93000, Bobigny, France
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95
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Crandell JR. Switching from EPA + DHA (Omega-3-acid Ethyl Esters) to High-Purity EPA (Icosapent Ethyl) in a Statin-Treated Patient with Persistent Dyslipidemia and High Cardiovascular Risk: A Case Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:123-8. [PMID: 27478390 PMCID: PMC4957603 DOI: 10.4137/cmc.s38123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 11/08/2022]
Abstract
Cardiovascular (CV) risk may remain despite statin treatment, and there is a need to address this risk with add-on therapy. The lipid effects of two different prescription omega-3 fatty acid therapies are described in a 55-year-old statin- and niacin-treated female with severe dyslipidemia and high CV risk. The patient was initially treated with omega-3-acid ethyl esters (eicosapentaenoic acid [EPA] and docosahexaenoic acid) 4 g/day. Due to persistently elevated low-density lipoprotein cholesterol (LDL-C), she was switched to icosapent ethyl (high-purity EPA ethyl ester) 4 g/day. Approximately 28 months after switching to icosapent ethyl, her LDL-C decreased by 69% to 52 mg/dL, triglycerides decreased by 35% to 119 mg/dL, non-high-density lipoprotein cholesterol (non-HDL-C) decreased by 63% to 76 mg/dL, total cholesterol decreased by 44% to 137 mg/dL, and HDL-C increased by 45% to 61 mg/dL. Total and small dense LDL particle concentrations decreased by 60 and 59%, respectively. Treatment was well tolerated, with improvements maintained over two years.
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96
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Rosenblit PD. Common medications used by patients with type 2 diabetes mellitus: what are their effects on the lipid profile? Cardiovasc Diabetol 2016; 15:95. [PMID: 27417914 PMCID: PMC4946113 DOI: 10.1186/s12933-016-0412-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022] Open
Abstract
Dyslipidemia is the most fundamental risk factor for atherosclerotic cardiovascular disease (ASCVD). In clinical practice, many commonly prescribed medications can alter the patient's lipid profile and, potentially, the risk for ASCVD-either favorably or unfavorably. The dyslipidemia observed in type 2 diabetes mellitus (T2DM) can be characterized as both ominous and cryptic, in terms of unrecognized, disproportionately elevated atherogenic cholesterol particle concentrations, in spite of deceptively and relatively lower levels of low-density lipoprotein cholesterol (LDL-C). Several factors, most notably insulin resistance, associated with the unfavorable discordance of elevated triglyceride (TG) levels and low levels of high-density lipoprotein cholesterol (HDL-C), have been shown to correlate with an increased risk/number of ASCVD events in patients with T2DM. This review focuses on known changes in the routine lipid profile (LDL-C, TGs, and HDL-C) observed with commonly prescribed medications for patients with T2DM, including antihyperglycemic agents, antihypertensive agents, weight loss medications, antibiotics, analgesics, oral contraceptives, and hormone replacement therapies. Given that the risk of ASCVD is already elevated for patients with T2DM, the use of polypharmacy may warrant close observation of overall alterations through ongoing lipid-panel monitoring. Ultimately, the goal is to reduce levels of atherogenic cholesterol particles and thus the patient's absolute risk.
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Affiliation(s)
- Paul D Rosenblit
- Diabetes/Lipid Management & Research Center, 18821 Delaware St, Suite 202, Huntington Beach, CA, 92648, USA.
- Division of Endocrinology, Diabetes, Metabolism, Department of Medicine, University of California, Irvine (UCI) School of Medicine, Irvine, CA, USA.
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97
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Thompson JA, D'Angelo G, Mintz JD, Fulton DJ, Stepp DW. Pressor recovery after acute stress is impaired in high fructose-fed Lean Zucker rats. Physiol Rep 2016; 4:4/12/e12758. [PMID: 27335430 PMCID: PMC4923227 DOI: 10.14814/phy2.12758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/16/2016] [Indexed: 11/24/2022] Open
Abstract
Insulin resistance is a powerful predictor of cardiovascular disease; however, the mechanistic link remains unclear. This study aims to determine if early cardiovascular changes associated with short‐term fructose feeding in the absence of obesity manifest as abnormal blood pressure control. Metabolic dysfunction was induced in Lean Zucker rats by short‐term high‐fructose feeding. Rats were implanted with telemetry devices for the measurement of mean arterial blood pressure (MAP) and subjected to air jet stress at 5 and 8 weeks after feeding. Additional animals were catheterized under anesthesia for the determination of MAP and blood flow responses in the hind limb and mesenteric vascular beds to intravenous injection of isoproterenol (0.001–0.5 μm), a β‐adrenergic agonist. Metabolic dysfunction in high‐fructose rats was not accompanied by changes in 24‐h MAP. Yet, animals fed a high‐fructose diet for 8 weeks exhibited a marked impairment in blood pressure recovery after air‐jet stress. Dose‐dependent decreases in MAP and peripheral blood flow in response to isoproterenol treatment were significantly attenuated in high‐fructose rats. These data suggest that impaired blood pressure recovery to acute mental stress precedes the onset of hypertension in the early stages of insulin resistance. Further, blunted responses to isoproterenol implicate β2‐adrenergic sensitivity as a possible mechanism responsible for altered blood pressure control after short‐term high‐fructose feeding.
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Affiliation(s)
| | - Gerard D'Angelo
- Vascular Biology Center, Georgia Regents University, Augusta, Georgia
| | - James D Mintz
- Vascular Biology Center, Georgia Regents University, Augusta, Georgia
| | - David J Fulton
- Vascular Biology Center, Georgia Regents University, Augusta, Georgia
| | - David W Stepp
- Vascular Biology Center, Georgia Regents University, Augusta, Georgia
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98
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Jiang B, Li B, Wang Y, Han B, Wang N, Li Q, Yang W, Huang G, Wang J, Chen Y, Chen Y, Zhu C, Lin D, Lu Y. The nine-year changes of the incidence and characteristics of metabolic syndrome in China: longitudinal comparisons of the two cross-sectional surveys in a newly formed urban community. Cardiovasc Diabetol 2016; 15:84. [PMID: 27255215 PMCID: PMC4891912 DOI: 10.1186/s12933-016-0402-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/24/2016] [Indexed: 01/07/2023] Open
Abstract
Background To assess the 9-year changes of the incidence and characteristics of metabolic syndrome (MetS) in Chinese community under the background of dramatically changed environment. Methods Two cross-sectional surveys of the general population were carried out in 2005 and 2014 in Dengmin and Hongnan villages of Fengcheng community, a newly formed urban community from rural area 10 years ago. All permanent adult residents aged 18–80 without active malignant tumors and pregnancy were invited to attend the study. They participated in clinical examinations for anthropometric and blood pressure measurements. Fasting blood samples were drawn for analysis of lipids and glucose. Presence of MetS was defined based on the IDF/AHA harmonized criteria. MetS z-score was calculated to evaluate the degree of total metabolic disorder. Results A total of 1042 subjects in 2005 and 1053 subjects in 2014 were included in the final analysis. The participants were stratified by gender. The incidence of MetS was higher in 2014 than 2005 in both genders (female, 48.28 vs 31.61 %; male, 41.12 vs 26.30 %; p value, both <0.001). Of the five MetS components, the FBG and TG levels were higher in 2014 than 2005 in both gender, however, the SBP and DBP values were even lower in 2014 than 2005. The differences of FBG, blood pressure and lipid levels between 2005 and 2014 still exist after ruling out recognized diabetic, hypertensive and dyslipidemic subjects, individually. In MetS subjects, MetS z-score showed the whole metabolic profile get worse in 2014 than 2005 in both sex (female, 1.97 ± 2.53 vs 1.74 ± 2.29; male, 2.51 ± 2.79 vs 1.01 ± 2.38. both P < 0.001). Using 3 abnormal components as a combination, we found the frequency of different kinds of combination also changed in MetS subjects. In female, the combination of WC + BP + HDL disorder decreased from 29.7 % (2005) to 11.0 % (2014) and WC + FBG + BP disorder became the most popular phenotype (18.8 %) in 2014. Conclusions The dramatically changed environments have extensive influence on metabolic parameters of local residents. More targeted measures need to be taken to meet the serious challenges of metabolic diseases. Trial registration ChiCTR-ECS-14005052, http://www.chictr.org, Survey on Prevalence in East China for Metabolic Diseases and Risk Factors (SPECT-China) Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0402-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Boren Jiang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Bin Li
- Fengcheng Hospital, Fengxian District, Shanghai, China
| | - Yongbin Wang
- Fengcheng Hospital, Fengxian District, Shanghai, China
| | - Bing Han
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Ningjian Wang
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Qin Li
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Weihong Yang
- Fengcheng Hospital, Fengxian District, Shanghai, China
| | - Guolan Huang
- Fengcheng Hospital, Fengxian District, Shanghai, China
| | - Jinhua Wang
- Fengcheng Hospital, Fengxian District, Shanghai, China
| | - Yi Chen
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Yingchao Chen
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Chunfang Zhu
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Dongping Lin
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Yingli Lu
- Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China.
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Affiliation(s)
- Ajay Chaudhuri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY
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Reuven Y, Dreiher J, Shvartzman P. The prevalence of diabetes, hypertension and obesity among immigrants from East Africa and the former Soviet Union: a retrospective comparative 30-year cohort study. Cardiovasc Diabetol 2016; 15:74. [PMID: 27151384 PMCID: PMC4858852 DOI: 10.1186/s12933-016-0392-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/27/2016] [Indexed: 01/21/2023] Open
Abstract
Background Previous studies have reported an increasing prevalence of metabolic abnormalities in immigrants who moved from low-cardiovascular-risk regions to Western countries, but little is known about time trends following immigration. Methods A retrospective cohort study of immigrants from Ethiopia in east Africa (EAI), the former Soviet Union (FSUI) and native-born Israelis (NBI) over a 35-year period. EAI were divided into three groups by date of immigration. Associations between ethnicity, age, sex and metabolic risk factors were assessed using logistic regression models. Results The study included 58,901 individuals (20,768 EAI, 20,507 FSUI, and 17,626 NBI). The multivariate odds ratios (OR) for diabetes were 2.4 (95 % CI 2.1–2.6), 2.1 (95 % CI 1.9–2.2) and 1.5 (95 % CI 1.3–1.7), respectively, for the three waves of EAI immigrations (P < 0.001 for trend) and 1.1 (95 % CI 0.9–1.2) for FSUI. For hypertension, the corresponding ORs were 1.8 (95 % CI 1.6–1.9), 1.4 (95 % CI 1.3–1.5), and 1.1 (95 % CI 0.9–1.2), respectively (P < 0.001) for EAI, and 2.1 (95 % CI 1.9–2.2) for FSUI. For obesity the ORs were −0.5 (95 % CI 0.4–0.6), 0.5 (95 % CI 0.4–0.6), and 0.3 (95 % CI 0.2–0.3), respectively (P < 0.001) for EAI, and 1.2 (95 % CI 1.1–1.3) for FSUI. The prevalence of diabetes in NBI with a BMI of 30 was identical to a BMI of 23.4 for EAI and 28.9 for FSUI. Conclusions The prevalence of diabetes and hypertension was higher in EAI and increased over the years, despite a lower prevalence of obesity. It exceeded the prevalence rates in NBI.
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Affiliation(s)
- Yonatan Reuven
- Division of Community Health, Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University of the Negev, PO Box 653, 84150, Beer-sheva, Israel.
| | - Jacob Dreiher
- Division of Community Health, Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University of the Negev, PO Box 653, 84150, Beer-sheva, Israel.,Hospital Division, Clalit Health Services, Tel Aviv, Israel
| | - Pesach Shvartzman
- Division of Community Health, Department of Family Medicine and Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University of the Negev, PO Box 653, 84150, Beer-sheva, Israel.,Southern District, Clalit Health Services, Beer-sheva, Israel
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