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Zhang P, Su Q, Ye X, Guan P, Chen C, Hang Y, Dong J, Xu Z, Hu W. Trends in LDL-C and Non-HDL-C Levels with Age. Aging Dis 2020; 11:1046-1057. [PMID: 33014521 PMCID: PMC7505266 DOI: 10.14336/ad.2019.1025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022] Open
Abstract
Understanding how blood lipid levels change with age in the general population is a precondition to defining dyslipidemia. To explore age-related trends in LDL-C and non-HDL-C levels in the general population, a large-scale cross-sectional study with 49,201 males and 35,084 females was adopted. Trends of non-HDL-C and LDL-C levels were plotted against each age (18 to 85 years old, one-year increments); the trends, as well as the influence of confounding factors on the trends, were validated and adjusted by linear regression modeling. The trajectory of LDL-C and non-HDL-C levels by age displayed a nonlinear correlation trend. Further multivariate linear regression modeling that incorporated sex-specific age phases showed that age was positively associated with LDL-C and non-HDL-C levels, with coefficients of 0.018 and 0.031, respectively, in females aged ≥18 to ≤56 years and negatively associated with LDL-C and non-HDL-C levels, with coefficients of -0·013 and -0.015, respectively, in females aged ≥57 years. The LDL-C and non-HDL-C levels increased with age in males ≥18 to ≤33 years of age, with coefficients of 0.025 and 0.053, respectively; the lipid levels plateaued at ≥34 to ≤56 years of age and subsequently decreased in those ≥57 years of age, with coefficients of -0.008 and -0.018, respectively. In contrast, pooled analyses without age stratification concealed these details. In conclusion, fluctuating increasing and decreasing lipid levels occurred with phases of aging in both sexes. Well-grounded age stratification is necessary to improve lipid-related pathophysiological studies.
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Affiliation(s)
- Peng Zhang
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Qian Su
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaomiao Ye
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Ping Guan
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Chengjun Chen
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yanwen Hang
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Zhongjie Xu
- 2Shanghai Minhang District Medical Emergency Center, Shanghai, China
| | - Wei Hu
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
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202
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Banach M, Duell PB, Gotto AM, Laufs U, Leiter LA, Mancini GBJ, Ray KK, Flaim J, Ye Z, Catapano AL. Association of Bempedoic Acid Administration With Atherogenic Lipid Levels in Phase 3 Randomized Clinical Trials of Patients With Hypercholesterolemia. JAMA Cardiol 2020; 5:1124-1135. [PMID: 32609313 PMCID: PMC7330832 DOI: 10.1001/jamacardio.2020.2314] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Question Does an association exist between the administration of bempedoic acid and decreased levels of low-density lipoprotein cholesterol in patients with hypercholesterolemia? Findings In this pooled analysis of 3623 patients included in 4 pivotal randomized clinical trials, bempedoic acid administration was associated with decreased mean low-density lipoprotein cholesterol levels by 18% vs placebo when added to maximally tolerated statin therapy in patients with atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia or both and by 24% vs placebo in patients with a history of statin intolerance. Increased uric acid levels and gout occurred more frequently among patients treated with bempedoic acid than with placebo. Meaning Treatment with bempedoic acid was associated with decreased levels of low-density lipoprotein cholesterol in patients with hypercholesterolemia when added to background statin therapy and in patients with a history of statin intolerance. Importance Additional lipid-lowering therapy options are needed for patients who cannot achieve sufficient decreases in low-density lipoprotein cholesterol (LDL-C) levels using statins alone or for those who are statin intolerant. Objective To conduct a pooled analysis of phase 3 randomized clinical trials of bempedoic acid vs placebo. Design, Setting, and Participants This analysis pooled data from 4 double-blind, placebo-controlled randomized clinical trials conducted from 2016 to 2018. Patients were enrolled in North America and Europe. Eligibility criteria included hypercholesterolemia while receiving stable lipid-lowering therapy and high cardiovascular risk or hypercholesterolemia and statin intolerance. Interventions Patients were randomized 2:1 to bempedoic acid, 180 mg (n = 2425), or placebo (n = 1198) once daily for 12 to 52 weeks. Main Outcomes and Measures Primary efficacy end point was percentage change from baseline in LDL-C level at week 12 in the intention-to-treat population. Patients were parsed into 2 groups according to enrollment criteria: (1) patients with hypercholesterolemia and atherosclerotic cardiovascular disease (ASCVD) or with heterozygous familial hypercholesterolemia (HeFH) or with both and receiving statins and (2) patients with hypercholesterolemia who were statin intolerant receiving maximally tolerated statins. Results In this analysis of 3623 patients, the overall mean (SD) patient age was 65.5 (9.2) years (similar in both pools). Among patients with ASCVD or HeFH or both, the mean (SD) baseline LDL-C level was 107.6 (32.7) mg/dL. At week 12, the LDL-C level percentage change from baseline was −16.0% with bempedoic acid vs 1.8% with placebo (difference, −17.8%; 95% CI, −19.5% to −16.0%; P < .001). Patients with statin intolerance had a mean (SD) baseline LDL-C level of 144.4 (38.8) mg/dL. The percentage changes in LDL-C levels at week 12 were −23.0% in the bempedoic acid group and 1.5% in the placebo group (difference, −24.5%; 95% CI, −27.8% to −21.1%; P < .001). The decrease in LDL-C levels with bempedoic acid was sustained during long-term follow-up in both pools (patients with ASCVD or HeFH or both receiving a maximally tolerated statin, difference of −12.7% at week 52; patients with statin intolerance, difference of −22.2% at week 24). Decreases in non–high-density lipoprotein cholesterol, total cholesterol, apolipoprotein B, and high-sensitivity C-reactive protein levels were greater with bempedoic acid vs placebo. Treatment-emergent adverse events associated more frequently with bempedoic acid than with placebo included increased blood uric acid level (2.1% vs 0.5%), gout (1.4% vs 0.4%), decreased glomerular filtration rate (0.7% vs <0.1%), and increased levels of hepatic enzymes (2.8% vs 1.3%). Conclusions and Relevance Bempedoic acid added to maximally tolerated statins, including moderate- or high-intensity statins or no background statin, was associated with decreased LDL-C levels vs placebo in patients with hypercholesterolemia with an acceptable safety profile. As a nonstatin adjunct or statin alternative, bempedoic acid has potential for use in a broad spectrum of patients. Trial Registration ClinicalTrials.gov Identifiers: NCT02666664, NCT02991118, NCT03001076, and NCT02988115
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Medical University of Łódź, Łódź, Poland.,Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - P Barton Duell
- Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland
| | - Antonio M Gotto
- Cardiovascular Unit, Weill Cornell Medical College, New York, New York
| | - Ulrich Laufs
- Clinic and Polyclinic for Cardiology, Leipzig University, Leipzig, Germany
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - G B John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - JoAnn Flaim
- Esperion Therapeutics Inc, Ann Arbor, Michigan
| | - Zhan Ye
- Esperion Therapeutics Inc, Ann Arbor, Michigan
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and IRCCS Multimedica, Milan, Italy
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203
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Katoh S, Peltonen M, Zeniya M, Sakamoto Y, Utsunomiya K, Nishimura R, Tuomilehto J. Non-Alcoholic Fatty Liver Disease Markers Associated with Fasting Serum Insulin and Urinary Albumin Excretion Independent of Fasting Plasma Glucose. J Clin Med 2020; 9:jcm9103161. [PMID: 33003574 PMCID: PMC7650561 DOI: 10.3390/jcm9103161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022] Open
Abstract
Objective: We examined the association between non-alcoholic fatty liver disease (NAFLD) markers and fasting serum immunoreactive insulin (FIRI) and urinary albumin excretion (UAE). Subjects and methods: This study comprised Periods I and II from January 2007 to May 2009, and from June 2009 to December 2011, respectively. After excluding people with ethanol intake ≥210 g/week in men and ≥140 g/week in women, 961 people (613 men, 348 women; mean age: 44 years) were included. We evaluated the fatty liver using ultrasonography score (FLUS) and measured liver enzymes. Results: The mean observation period was 25 ± 9 months. We stratified people into two groups by fasting plasma glucose (FPG) in Period I. The cutoff point between the lower FPG and higher FPG was 100 mg/dL. In regression analysis, serum alanine aminotransferase (ALT) (p < 0.001), FLUS (p < 0.001) and γ-glutamyl transpeptidase (GGTP) (p = 0.022) in Period I were independently associated with FIRI in Period II, whereas in all participants FPG was not. ALT (p < 0.001) and GGTP (p = 0.001) were also independently associated with UAE in people with FPG < 100 mg/dL in Period II. Conclusions: Some NAFLD markers were associated with FIRI and UAE independently of fasting plasma glucose.
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Affiliation(s)
- Shuichi Katoh
- Division of Diabetes, Metabolism & Endocrinology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan;
- Correspondence: ; Tel.: +81-3-3433-1111; Fax: +81-3-3578-9753
| | - Markku Peltonen
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, FI-00271 Helsinki, Finland; (M.P.); (J.T.)
| | - Mikio Zeniya
- Gastroenterology, Akasaka Sanno Medical Center, 4-1-26W Akasaka, Minato-ku, Tokyo 107-8402, Japan;
| | - Yoichi Sakamoto
- The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan;
| | - Kazunori Utsunomiya
- Department of Health-Care Center, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan;
| | - Rimei Nishimura
- Division of Diabetes, Metabolism & Endocrinology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan;
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, FI-00271 Helsinki, Finland; (M.P.); (J.T.)
- Diabetes Research Group, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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204
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Goldberg AC, Dunbar RL, Hemphill L, Babirak SP, Wilson G, Wooten M, Iydroose M, Dacus K, Minchew H, Dutton JA, Moriarty PM. A retrospective analysis of clinical use of alirocumab in lipoprotein apheresis patients. J Clin Lipidol 2020; 14:818-824. [PMID: 32978095 DOI: 10.1016/j.jacl.2020.08.005] [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: 01/09/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The previously published ODYSSEY ESCAPE trial demonstrated a significant reduction in the use of lipoprotein apheresis for heterozygous familial hypercholesterolemia (HeFH) patients when placed on alirocumab 150 mg every 2 weeks. In patients with HeFH who have consistently elevated levels of low-density lipoprotein cholesterol (LDL-C) despite maximally tolerated statin therapy, current lipid guidelines recommend apheresis. Although apheresis reduces LDL-C levels by 50%-75%, it must be repeated, as frequently as every 1-2 weeks. OBJECTIVE To assess clinical experience with apheresis and alirocumab for patients in a real-world practice setting. METHODS This retrospective review included patients from 5 apheresis centers who were treated with apheresis and had started alirocumab therapy. In addition to LDL-C levels, total cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides, and particle numbers were evaluated if data were available. RESULTS Eleven of the 25 (44%) patients discontinued apheresis completely after initiation of alirocumab therapy, having achieved LDL-C <70 mg/dL or >50% reduction from baseline levels. Among the 14 patients who remained on apheresis, seven decreased the frequency of apheresis sessions. No significant safety problems were reported. CONCLUSION Alirocumab lowered LDL-C levels by an average of 55.5% in patients receiving apheresis for elevated LDL-C. Seventy-two percent of patients on alirocumab therapy discontinued or reduced the frequency of apheresis treatment. However, some patients continued to require apheresis due to elevated lipoprotein(a), extremely elevated LDL-C, or if alirocumab therapy was discontinued due to less than anticipated LDL-C reduction.
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Affiliation(s)
- Anne C Goldberg
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Richard L Dunbar
- Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda Hemphill
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Kelley Dacus
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Heather Minchew
- Department of Internal Medicine, Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julie-Ann Dutton
- Department of Internal Medicine, Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Patrick M Moriarty
- Department of Internal Medicine, Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
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205
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Implementation of Cholesterol-Lowering Therapy to Reduce Cardiovascular Risk in Persons Living with HIV. Cardiovasc Drugs Ther 2020; 36:173-186. [PMID: 32979175 DOI: 10.1007/s10557-020-07085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
The widespread availability of highly effective antiretroviral therapies has reduced mortality from opportunistic infections in persons living with HIV (PLHIV), resulting in an increase in atherosclerotic cardiovascular disease (ASCVD) and other chronic illnesses (Samji et al. 2013). Although there has been a decline in morbidity and mortality from ASCVD in the past several decades, contemporary studies continue to report higher rates of cardiovascular events (Rosenson et al. 2020). HIV has been identified as a risk enhancer for ASCVD by multiple professional guideline writing committees (Grundy Scott et al. 2019, Mach et al. 2020); however, the utilization of cholesterol-lowering therapies in PLHIV remains low (Rosenson et al. 2018). Moreover, the use of statin therapy in PLHIV is complicated by drug-drug interactions that may either elevate or lower the blood statin concentrations resulting in increased toxicity or reduced efficacy respectively. Other comorbidities commonly associated with HIV present other challenges for the use of cholesterol-lowering therapies. This review will summarize the data on lipoprotein-associated ASCVD risk in PLHIV and discuss the challenges with effective treatment. Finally, we present a clinical algorithm to optimize cardiovascular risk reduction in this high-risk population.
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206
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Panagiotopoulou O, Chiesa ST, Tousoulis D, Charakida M. Dyslipidaemias and Cardiovascular Disease: Focus on the Role of PCSK9 Inhibitors. Curr Med Chem 2020; 27:4494-4521. [PMID: 31453780 DOI: 10.2174/0929867326666190827151012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/23/2018] [Accepted: 01/15/2019] [Indexed: 12/19/2022]
Abstract
Genetic, experimental and clinical studies have consistently confirmed that inhibition of Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) can result in significant lowering of LDL-C and two fully human PCSK9 monoclonal antibodies have received regulatory approval for use in highrisk patients. Co-administration of PCSK9 with statins has resulted in extremely low LDL-C levels with excellent short-term safety profiles. While results from Phase III clinical trials provided significant evidence about the role of PCSK9 inhibitors in reducing cardiovascular event rates, their impact on mortality remains less clear. PCSK9 inhibitor therapy can be considered for high-risk patients who are likely to experience significant cardiovascular risk reduction.
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Affiliation(s)
- Olga Panagiotopoulou
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing St. Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Scott T Chiesa
- UCL Institute of Cardiovascular Sciences, London, United Kingdom
| | | | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, King's College London, 4th Floor, Lambeth Wing St. Thomas' Hospital, London SE1 7EH, United Kingdom
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207
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Relative effect of hypertriglyceridemia on non-HDLC and apolipoprotein B as cardiovascular disease risk markers. J Clin Lipidol 2020; 14:825-836. [PMID: 33032940 DOI: 10.1016/j.jacl.2020.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/30/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Non-high density lipoprotein cholesterol (non-HDLC) represents the cholesterol in triglyceride-rich lipoproteins (TRL) and low-density lipoproteins (LDL). Apolipoprotein B (apoB) reflects the number of TRL and LDL particles. In hypertriglyceridemia (HTG), there is triglyceride (TG) enrichment of TRLs, and also a substantial increase of cholesterol in larger TRLs that considerably augments the non-HDLC value. Therefore, in HTG, non-HDLC could increase disproportionately with respect to apoB. OBJECTIVE We aimed to compare the relative effect of the full range of mild, moderate, and severe HTG on the status of non-HDLC and apoB as cardiovascular disease (CVD) risk markers. METHODS Analysis of lipid profile data from 4347 patients in a Lipid Clinic cohort with baseline fasting lipid profiles documented prior to starting lipid-lowering medications. The correlation between non-HDLC and apoB was assessed in intervals of increasing TG. Non-HDLC and apoB were analyzed at each TG level using comparative CVD risk equivalent categories and assessed for divergence and discordance. RESULTS With increasing TG levels: (1) the correlation between non-HDLC and apoB diminished progressively, (2) non-HDLC levels increased continuously, whereas apoB levels plateaued after an initial increase up to TG of ~ 4.0-5.0 mmol/L (~354-443 mg/dL), (3) there was divergence in the stratification of non-HDLC and apoB into CVD risk equivalent categories. CONCLUSIONS Non-HDLC and apoB should not be viewed as interchangeable CVD risk markers in the presence of severe HTG. This has never been tested. With increasing HTG severity, discordance between non-HDLC and apoB can cause clinically important divergence in CVD risk categorization.
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208
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Pang J, Chan DC, Watts GF. The Knowns and Unknowns of Contemporary Statin Therapy for Familial Hypercholesterolemia. Curr Atheroscler Rep 2020; 22:64. [PMID: 32870376 PMCID: PMC7459268 DOI: 10.1007/s11883-020-00884-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Statins are first-line therapy for lowering low-density lipoprotein (LDL) cholesterol in familial hypercholesterolemia (FH), particularly in heterozygous patients. We review advances and new questions on the use of statins in FH. RECENT FINDINGS Cumulative evidence from registry data and sub-analyses of clinical trials mandates the value of statin therapy for prevention of atherosclerotic cardiovascular disease (ASCVD) in FH. Statins are safe in children and adolescents with FH, with longer term cardiovascular benefits. The potentially toxic effects of statins in pregnancy need to be considered, but no association has been reported in prospective cohort studies with birth defects. There is no rationale for discontinuation of statins in elderly FH unless indicated by adverse events. FH is undertreated, with > 80% of statin-treated FH patients failing to attain LDL cholesterol treatment targets. This may relate to adherence, tolerability, and genetic differences in statin responsiveness. Statin treatment from childhood may reduce the need for stringent cholesterol targets. Combination of statins with ezetimibe and PCSK9 inhibitors significantly improves the efficacy of treatment. Whether statin use could improve the clinical course of FH patients with COVID-19 and other respiratory infections remains an unsolved issue for future research. Statins are the mainstay for primary and secondary prevention of ASCVD in FH. Sustained long-term optimal statin treatment from an early age can effectively prevent ASCVD over decades of life. Despite their widespread use, statins merit further investigation in FH.
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Affiliation(s)
- Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Dick C Chan
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.
- Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, GPO Box X2213, Perth, WA, 6847, Australia.
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209
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Relationship between multiple healthy lifestyles and serum lipids among adults in rural China: A population-based cross-sectional study. Prev Med 2020; 138:106158. [PMID: 32473269 DOI: 10.1016/j.ypmed.2020.106158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/30/2020] [Accepted: 05/24/2020] [Indexed: 12/12/2022]
Abstract
Although several single lifestyles have been reported to meliorate serum lipid levels, there is little evidence of the relationship between multiple healthy lifestyles and lipid levels in Chinese adults. Cross-sectional data of 35,150 participants aged 18-79 years without dyslipidemia at baseline in the Henan Rural Cohort were collected from 2015 to 2017, to investigate the associations between individual and combinations of 6 healthy lifestyle factors and lipid levels. In multivariate linear regression analyses, non-current smoking, non-current alcohol consumption, regular physical exercise, healthy diet, lower body mass index, and lower waist-to-hip ratio were significantly associated with lower concentration of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) and higher concentrations of high-density lipoprotein cholesterol (HDL-C) (all P < .001). There were positive quantitative correlations between the number of healthy lifestyle factors and the low levels of lipids (all P for linear trend <0.001). People with 6 healthy lifestyle factors had 0.72-mmol/L (95% confidence interval [CI]: 0.64 to 0.81) lower TC, 1.02-mmol/L (95% CI: 0.93 to 1.11) lower TG, 0.54-mmol/L (95% CI: 0.47 to 0.61) lower LDL-C, and 0.32-mmol/L (95% CI: 0.29 to 0.34) higher HDL-C, than people who had 0-1 healthy lifestyle factors. In this study, we found an association between an increased number of healthy lifestyle factors and better serum lipid profiles. The causality and temporality between maintenance of a healthy lifestyle and optimal lipid levels merit further investigations.
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210
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Bhagavathula AS, Aldhaleei WA, Al Matrooshi NO, Rahmani J. Efficacy of Statin/Ezetimibe for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Asian Populations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Drug Investig 2020; 40:809-826. [PMID: 32671595 DOI: 10.1007/s40261-020-00951-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several clinical trials have investigated the effect of statin/ezetimibe combination therapy on secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the Asian population. OBJECTIVE This study aimed to summarize study results regarding the effect of statin/ezetimibe combination therapy on lipid parameters and highly sensitive C-reactive protein (HsCRP) biomarkers in ASCVD patients from Asian countries. METHODS We searched the PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar databases for relevant papers published from 2008 to June 2020. We included randomized controlled trials (RCTs) that (1) were conducted in ASCVD patients in Asian countries; (2) examined the effects of statin/ezetimibe combination therapies compared with a control group; and (3) reported sufficient data on lipid parameters and HsCRP biomarkers. The results were reported as weighted mean differences (WMDs) with 95% confidence intervals (CI) using random-effects models. Funnel plots and Egger's regression test were used to assess publication bias. RESULTS Twenty-four RCTs were reviewed and 20 were included in the meta-analysis. A total of 4344 participants were included (n = 2197 in the intervention group and n = 2147 in the control group), and the intervention durations ranged from 6 weeks to 3.6 years. Ezetimibe coadministered with statin therapy, compared with control treatment, significantly reduced low-density lipoprotein cholesterol (LDL-C; n = 20 studies) [WMD - 0.39 mmol/L, 95% CI - 0.73 to - 0.05; p < 0.001], triglycerides (TG; n = 18 studies) [WMD - 0.23 mmol/L, 95% CI - 0.33 to - 0.13; p < 0.001], and total cholesterol (TC; n = 17 studies) [WMD - 0.31 mmol/L, 95% CI - 0.45 to - 0.17; p < 0.001). Although the effect of statin/ezetimibe combinations on high-density lipoprotein cholesterol (HDL-C; n = 17 studies) [WMD 0.02 mmol/L, 95% CI - 0.05 to 0.09; p < 0.001) was very minimal and no effect was observed on HsCRP levels (n = 11 studies). CONCLUSIONS Our study found that statin/ezetimibe combinations reduced LDL-C, TC, and TG levels but had minimal effects on HDL-C and no effect HsCRP biomarkers in ASCVD patients. The statin/ezetimibe therapy enabled a more effective reduction in LDL-C levels; however, the duration of the treatment was suboptimal.
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Affiliation(s)
| | - Wafa Ali Aldhaleei
- Gastroenterology Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Jamal Rahmani
- Department of Community Nutrition, Student Research Committee, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pang J, Sullivan DR, Hare DL, Colquhoun DM, Bates TR, Ryan JDM, Bishop W, Burnett JR, Bell DA, Simons LA, Mirzaee S, Kostner KM, Nestel PJ, Wilson AM, O'Brien RC, Janus ED, Clifton PM, Ardill JJ, Chan DC, van Bockxmeer F, Watts GF. Gaps in the Care of Familial Hypercholesterolaemia in Australia: First Report From the National Registry. Heart Lung Circ 2020; 30:372-379. [PMID: 32873489 DOI: 10.1016/j.hlc.2020.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Familial hypercholesterolaemia (FH) is under-diagnosed and under-treated worldwide, including Australia. National registries play a key role in identifying patients with FH, understanding gaps in care and advancing the science of FH to improve care for these patients. METHODS The FH Australasia Network has established a national web-based registry to raise awareness of the condition, facilitate service planning and inform best practice and care services in Australia. We conducted a cross-sectional analysis of 1,528 FH adults enrolled in the registry from 28 lipid clinics. RESULTS The mean age at enrolment was 53.4±15.1 years, 50.5% were male and 54.3% had undergone FH genetic testing, of which 61.8% had a pathogenic FH-causing gene variant. Only 14.0% of the cohort were family members identified through cascade testing. Coronary artery disease (CAD) was reported in 28.0% of patients (age of onset 49.0±10.5 years) and 64.9% had at least one modifiable cardiovascular risk factor. The mean untreated LDL-cholesterol was 7.4±2.5 mmol/L. 80.8% of patients were on lipid-lowering therapy with a mean treated LDL-cholesterol of 3.3±1.7 mmol/L. Among patients receiving lipid-lowering therapies, 25.6% achieved an LDL-cholesterol target of <2.5 mmol/L without CAD or <1.8 mmol/L with CAD. CONCLUSION Patients in the national FH registry are detected later in life, have a high burden of CAD and risk factors, and do not achieve guideline-recommended LDL-cholesterol targets. Genetic and cascade testing are under-utilised. These deficiencies in care need to be addressed as a public health priority.
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Affiliation(s)
- Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - David R Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - David L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - David M Colquhoun
- School of Medicine, University of Queensland, Brisbane, Qld, Australia; Wesley Medical Centre, Wesley Hospital and Greenslopes Private Hospital, Brisbane, Qld, Australia
| | - Timothy R Bates
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Department of Medicine, St John of God Hospital Midland, Perth, WA, Australia; Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | | | - Warrick Bishop
- Department of Cardiology, Calvary Cardiac Centre, Calvary Health Care, Hobart, Tas, Australia
| | - John R Burnett
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, WA, Australia
| | - Damon A Bell
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, WA, Australia
| | - Leon A Simons
- University of New South Wales and St Vincent's Hospital, Sydney, NSW, Australia
| | - Sam Mirzaee
- Monash Cardiovascular Research Centre, MonashHeart, Melbourne, Vic, Australia
| | - Karam M Kostner
- Department of Cardiology, Mater Hospital, University of Queensland, Brisbane, Qld, Australia
| | - Paul J Nestel
- Baker Heart & Diabetes Institute, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Andrew M Wilson
- Department of Cardiology, St. Vincent's Hospital, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Richard C O'Brien
- Austin Clinical School, University of Melbourne, Melbourne, Vic, Australia; Department of Endocrinology, Austin Health, Melbourne, Vic, Australia
| | - Edward D Janus
- Western Health Chronic Disease Alliance, Western Health, Melbourne, Vic, Australia; Department of Medicine, Western Health Melbourne Medical School, University of Melbourne, Melbourne, Vic, Australia
| | - Peter M Clifton
- Department of Endocrinology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Dick C Chan
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Frank van Bockxmeer
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia; Department of Cardiology, Calvary Cardiac Centre, Calvary Health Care, Hobart, Tas, Australia.
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212
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Levintow SN, Reading SR, Saul BC, Yu Y, Reams D, McGrath LJ, Philip K, Dluzniewski PJ, Brookhart MA. Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines. Clin Epidemiol 2020; 12:835-845. [PMID: 32801921 PMCID: PMC7414934 DOI: 10.2147/clep.s259757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background The 2013 ACC/AHA cholesterol treatment guidelines removed the recommendation to treat adults at risk of cardiovascular disease to goal levels of low-density lipoprotein cholesterol (LDL-C). We anticipated that the frequency of LDL-C testing in clinical practice would decline as a result. To test this hypothesis, we evaluated the frequency of LDL-C testing before and after the guideline release. Methods We used the MarketScan® Commercial and Medicare Supplemental claims data (1/1/2007–12/31/2016) to identify four cohorts: 1) statin initiators (any intensity), 2) high-intensity statin initiators, 3) ezetimibe initiators, and 4) patients at very high cardiovascular risk (≥2 hospitalizations for myocardial infarction or ischemic stroke, with prevalent statin use). Rates of LDL-C testing by calendar year quarter were estimated for each cohort. To estimate rates in the absence of a guideline change, we fit a time-series model to the pre-guideline rates and extrapolated to the post-guideline period, adjusting for covariates, seasonality, and time trend. Results Pre- and post-guideline rates (LDL-C tests per 1,000 persons per quarter) were 248 and 235, respectively, for 3.9 million statin initiators; 263 and 246 for 1.3 million high-intensity statin initiators; 277 and 261 for 323,544 ezetimibe initiators; and 180 and 158 for 42,108 very high-risk patients. For all cohorts, observed post-guideline rates were similar to model-predicted rates. On average, the difference between observed and predicted rates was 8.5 for patients initiating any statin; 2.6 for patients initiating a high-intensity statin; 11.4 for patients initiating ezetimibe, and −0.5 for high-risk patients. Conclusion We observed no discernible impact of the release of the 2013 ACC/AHA guidelines on LDL-C testing rates. Rather, there was a gradual decline in testing rates starting prior to the guideline change and continuing throughout the study period. Our findings suggest that the guidelines had little to no impact on use of LDL-C testing.
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Affiliation(s)
- Sara N Levintow
- NoviSci, Inc, Durham, NC, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Ying Yu
- NoviSci, Inc, Durham, NC, USA
| | | | | | - Kiran Philip
- Center for Observational Research, Amgen, Thousand Oaks, CA, USA
| | | | - M Alan Brookhart
- NoviSci, Inc, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
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213
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Zhao Q, Zhang TY, Cheng YJ, Ma Y, Xu YK, Yang JQ, Zhou YJ. Prognostic impact of estimated remnant-like particle cholesterol in patients with differing glycometabolic status: an observational cohort study from China. Lipids Health Dis 2020; 19:179. [PMID: 32736631 PMCID: PMC7393817 DOI: 10.1186/s12944-020-01355-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/27/2020] [Indexed: 12/02/2022] Open
Abstract
Background It is uncertain whether estimated remnant-like particle cholesterol (RLP-C) could predict residual risk in patients with different glycometabolic status. This study aimed to evaluate the relationship between estimated RLP-C and adverse prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) treated with percutaneous coronary intervention (PCI) and to identify the potential impact of glycometabolism on the predictive value of estimated RLP-C. Methods The study assessed 2419 participants with NSTE-ACS undergoing PCI at Beijing Anzhen Hospital from January to December 2015. Estimated RLP-C was calculated as follows: total cholesterol (TC) minus low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The adverse events included all-cause death, non-fatal myocardial infarction (MI), and ischemia-driven revascularization. Results Estimated RLP-C was prominently associated with adverse prognosis in the total population [hazard ratio (HR) 1.291 per 1-SD increase, 95% confidence interval (CI) 1.119–1.490, P < 0.001], independent of confounding risk factors. However, subgroup analysis showed that increasing estimated RLP-C was related to a higher risk of adverse events in the diabetic population only [HR 1.385 per 1-SD increase, 95% CI 1.183–1.620, P < 0.001]. Estimated RLP-C failed to be a significant determinant of adverse prognosis in non-diabetic and pre-diabetic subgroups. The addition of estimated RLP-C to a baseline model including traditional risk factors enhanced the predictive performance both in total and diabetic populations. Conclusions High estimated RLP-C level is a significant predictor for recurrent adverse events in patients with diabetes and NSTE-ACS treated with PCI.
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Affiliation(s)
- Qi Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Ting-Yu Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yu-Jing Cheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yue Ma
- Research Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Ying-Kai Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Jia-Qi Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yu-Jie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China. .,Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China.
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214
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Hu W, Zhang P, Su Q, Li D, Hang Y, Ye X, Guan P, Dong J, Lu Y. Peripheral leukocyte counts vary with lipid levels, age and sex in subjects from the healthy population. Atherosclerosis 2020; 308:15-21. [PMID: 32795745 DOI: 10.1016/j.atherosclerosis.2020.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/22/2020] [Accepted: 07/15/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Disorders in blood lipid metabolism and leukocyte-mediated inflammation are considered the main mechanisms of the pathogenesis of atherosclerosis. This study aims to show whether and how peripheral leukocyte counts are associated with serum lipid levels. METHODS This is a cross-sectional study of 175,079 subjects from the healthy population. RESULTS Age and sex are two key factors dictating the relationship between peripheral leukocyte counts and serum lipid levels. The log-transformed level of triglycerides (LnTG) was positively associated with all leukocyte counts in males except monocyte count in younger subjects. LnTG was positively associated with total leukocyte count in females regardless of age, and it was positively associated with lymphocyte and monocyte counts and neutrophil count only in elderly and young women, respectively. Total cholesterol levels were positively associated with total leukocyte, neutrophil and lymphocyte counts only in young males and with lymphocyte counts only in elderly women. LDL-C was negatively associated with monocyte count in males regardless of age; by contrast, it was positively associated with total leukocyte and lymphocyte counts in females regardless of age range and neutrophil and LnEosinophil counts only in young women. HDL-C was negatively associated with total leukocyte, lymphocyte and monocyte counts in both young men and young women; was negatively associated with monocyte count in elderly men and women; and was negatively associated with LnEosinophil count only in older men. CONCLUSIONS Peripheral leukocyte counts are extensively associated with serum lipid levels, with patterns differing by sex, age, lipid and leukocyte subset.
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Affiliation(s)
- Wei Hu
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China.
| | - Peng Zhang
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
| | - Qian Su
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
| | - Dandan Li
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
| | - Yanwen Hang
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
| | - Xiaomiao Ye
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
| | - Ping Guan
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
| | - Jian Dong
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
| | - Yi Lu
- Department of Cardiology, Minhang Hospital, Fudan University, 170 Xinsong Road, Minhang District, Shanghai, 201199, PR China
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215
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Shen S, Zhong C, Wang A, Han L, Zhu Z, Peng Y, Peng H, Guo D, Zheng X, Xu T, Chen J, Ju Z, Geng D, Zhang Y, He J. Influence of lipoprotein-associated phospholipase A 2 mass on prognosis value of baseline platelet count for clinical outcomes after acute ischemic stroke. Atherosclerosis 2020; 306:50-56. [PMID: 32688104 DOI: 10.1016/j.atherosclerosis.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/21/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS We aimed to examine the association between baseline platelet count (PLT) and prognosis of acute ischemic stroke according to lipoprotein-associated phospholipase A2 (Lp-PLA2) mass. METHODS A total of 3254 patients with acute ischemic stroke were included in this analysis. The primary outcome was a combination of major disability and all-cause mortality (modified Rankin Scale score ≥3) at 3 months after stroke. Secondary outcome was major disability and all-cause mortality, respectively. RESULTS The prognosis value of PLT for primary outcome was significantly modified by Lp-PLA2 mass (pinteraction = 0.002). After multivariate adjustment, elevated PLT was associated with the increased risk of primary outcome in patients with high Lp-PLA2 mass (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.09-2.48; ptrend = 0.002), but not in those with low Lp-PLA2 mass (OR, 0.94; 95%CI, 0.62-1.42; ptrend = 0.181), when comparing two extreme PLT quartiles. A similar association was found between elevated PLT and major disability (pinteraction = 0.001). Elevated PLT was associated with increased risk of major disability only in patients with high Lp-PLA2 mass (OR, 1.54; 95%CI, 1.03-2.31; ptrend = 0.007), for the highest quartile vs the lowest quartile. Each 100 × 109/L increment in PLT was associated with 42% (95%CI, 12%-79%) increased risk of primary outcome and 33% (95%CI, 6%-68%) increased risk of major disability in those with high Lp-PLA2 mass. CONCLUSIONS The elevated PLT was associated with poor prognosis of acute ischemic stroke only in patients with high Lp-PLA2 mass. Lp-PLA2 might be an important factor influencing the prognosis value of PLT for clinical outcomes in acute ischemic stroke patients.
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Affiliation(s)
- Suwen Shen
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Daoxia Guo
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Xiaowei Zheng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao, China
| | - Deqin Geng
- Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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216
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Goyal G, Goyal LD, Singla H, Sheenam, Arora K, Kaur H. Subclinical Hypothyroidism and Associated Cardiovascular Risk Factor in Perimenopausal Females. J Midlife Health 2020; 11:6-11. [PMID: 32684720 PMCID: PMC7362983 DOI: 10.4103/jmh.jmh_38_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/15/2019] [Accepted: 05/27/2019] [Indexed: 11/04/2022] Open
Abstract
Background Perimenopause refers to the period around menopause (40-55 years). This includes the period before menopause and the first year after menopause. Perimenopausal age is an important stage in a women's life. Many women are diagnosed with hypothyroidism at midlife. Hypothyroidism - both overt and subclinical are associated with increased risk of CVS diseases. Subclinical hypothyroidism is more important as this stage is usually ignored from treatment point of view and if early intervention is done in SCH worsening of metabolic derangement may be avoided. Objectives The present study was aimed to know the prevalence of subclinical hypothyroidism and associated dyslipidemia in perimenopausal females. Material and Methods In our retrospective study we took 100 perimenopausal females (40-55years) who were investigated for thyroid and lipid profile. Atherogenic indices like TC/HDL-c, LDL-c/HDL-c, TG/HDL-c ratios were calculated from the individual lipid profile parameters. The reference guidelines for lipid profile was according to NCEP ATP III. Result Subclinical hypothyroidism was found to be present in 18% of perimenopausal females The mean TSH levels were found to be higher in SCH as compared to euthyroid females with a mean value of 7.56±3.54(μIU/ ml). Dyslipidemia was seen in patients with SCH. TSH levels were found to be positively correlated with total cholesterol. Conclusion We conclude that subclinical hypothyroidism is present in 18% females of perimenopausal age group. Increased TSH levels are associated with hypertension, hypertriglyceridemia, and elevated TC/HDL-C ratio and non cholesterol HDL. In perimenopausal women the condition is usually underdiagnosed and ignored but subclinical hypothyroidism in these females should be screened and treated timely to decrease the risk of accelerated atherosclerosis and premature coronary artery disease in them.
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Affiliation(s)
- Gitanjali Goyal
- Department of Biochemistry, GGS Medical College, Faridkot, Punjab, India
| | - Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, GGS Medical College, Faridkot, Punjab, India
| | - Heena Singla
- Department of Biochemistry, GGS Medical College, Faridkot, Punjab, India
| | - Sheenam
- Department of Medical Officer, HCMS-I, Haryana, India
| | - Kirti Arora
- Department of Biochemistry, GGS Medical College, Faridkot, Punjab, India
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217
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Chen H, Chen Y, Wu W, Chen Z, Cai Z, Chen Z, Yan X, Wu S. Prolonged hyperlipidemia exposure increases the risk of arterial stiffness in young adults: a cross-sectional study in a cohort of Chinese. BMC Public Health 2020; 20:1091. [PMID: 32652962 PMCID: PMC7353800 DOI: 10.1186/s12889-020-09211-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hyperlipidemia is associated with arterial stiffness. Herein, We examined the effect of prolonged exposure to hyperlipidemia on the risk of arterial stiffness in young adults. METHODS A study cohort (35-55 years old) that received health check-ups in the Kailuan study (2014-2016) were assessed. Hyperlipidemia was defined as a low-density lipoprotein cholesterol ≥160 mg/dL according to the Chinese Guidelines for the Management of Dyslipidemia in Adults. Subjects were divided into three groups based on the number of years with hyperlipidemia: normal (0 years), low exposure (1-5 years), and high exposure (5-10 years) groups. Arterial stiffness was defined as brachial-ankle pulse wave velocity > 1400 cm/s. For all subjects and subjects that did not meet statin treatment criteria under guidelines, logistics regression was used to analyze the effect of prolonged hyperlipidemia exposure on arterial stiffness in different age groups. RESULTS Among 12,431 subjects, the mean age was 46.42 ± 5.34 years with 9000 men (72.4%). Brachial-ankle pulse wave velocity gradually increased with increased exposure duration. Logistic regression analysis showed that hyperlipidemia exposure was a risk factor for arterial stiffness in the low (1.22 times) and high (1.49 times) exposure groups compared with the normal group. In the different age groups, the risk of arterial stiffness increased with the duration of hyperlipidemia exposure, apart for the 35-40-year-old population. The effect of hyperlipidemia exposure duration on arterial stiffness in young adults that did not meet statin treatment criteria under guidelines was similar to the general population. CONCLUSIONS Prolonged exposure to hyperlipidemia in young adults increases the risk of arterial stiffness. Young adults with this condition may benefit from more aggressive primary prevention. TRIAL REGISTRATION Name of the registry: Risk factors and intervention for cardiology, cerebrovascular and related disease (Kailuan Study) Trial registration number: CHiCTR-TNC1100 1489 Date of registration: Aug 24, 2011 URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=8050.
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Affiliation(s)
- Haojia Chen
- Shantou University Medical College, NO.22 Xinling Road, Jinping District, Shantou City, 515041 Guangdong Province China
- Department of Cardiology, First Hospital of Medical College of Shantou University, NO.57 Changping Road, Jinping District, Shantou City, 515041 Guangdong Province China
| | - Youren Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxia North Road, Jinping District, Shantou City, 515041 Guangdong Province China
- School of Foreign Language, Guangdong Polytechnic Normal University, NO.293 Zhongshan Avenue West, Tianhe District, Guangzhou, 510665 Guangdong China
| | - Weiqiang Wu
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxia North Road, Jinping District, Shantou City, 515041 Guangdong Province China
| | - Zekai Chen
- Shantou University Medical College, NO.22 Xinling Road, Jinping District, Shantou City, 515041 Guangdong Province China
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxia North Road, Jinping District, Shantou City, 515041 Guangdong Province China
| | - Zefeng Cai
- Shantou University Medical College, NO.22 Xinling Road, Jinping District, Shantou City, 515041 Guangdong Province China
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxia North Road, Jinping District, Shantou City, 515041 Guangdong Province China
| | - Zhichao Chen
- Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, No. 69 Dongxia North Road, Jinping District, Shantou City, 515041 Guangdong Province China
| | - Xiuzhu Yan
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, NO.57 Xinhua East Road, Lubei District, Tangshan City, 063001 Hebei Province China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, NO.57 Xinhua East Road, Lubei District, Tangshan City, 063001 Hebei Province China
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218
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Tomić M, Vrabec R, Vidas Pauk S, Bulum T, Ljubić S. Systemic inflammation and dyslipidemia are associated with retinopathy in type 2 but not in type 1 diabetes. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:484-490. [PMID: 32644839 DOI: 10.1080/00365513.2020.1789921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The aim of this study was to investigate risk factors and role of systemic inflammation, dyslipidemia and obesity in development of diabetic retinopathy (DR) in type 1 and type 2 diabetes and determine the differences in risk factors between these two types of diabetes. Eighty-four type 1 and 107 type 2 diabetic patients were included in this cross-sectional study. Diabetes duration, body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. C-reactive protein (CRP), fibrinogen (FIB), glycated hemoglobin (HbA1c), fasting and postprandial blood glucose (fBG, ppBG), HDL and LDL cholesterol and triglycerides (TG) were determined using routine methods. HbA1cmedian was obtained by statistical analysis of the CroDiabNet data and used as a marker of long-term glycemic control. Albumin excretion rate (AER) was measured in a 24-hour urine collection. Ophthalmologic retinal examination included indirect slit-lamp fundoscopy, color fundus photography according to EURODIAB (EUROpe and DIABetes) protocol and optical coherence tomography. DR was positively related to diabetes duration (p < .001), HbA1cmedian (p < .001) and AER (p = .008) in type 1, and diabetes duration (p < .001), HbA1cmedian (p = .018), AER (p < .001), CRP (p = .048) and TG (p = .041) in type 2 diabetes. Regression analysis showed that diabetes duration (OR 1.20, p = .005) and HbA1cmedian (OR 6.92, p = .007) were the main predictors of DR in type 1, and diabetes duration (OR 1.17, p < .001), fBG (OR 1.45, p = .024) and TG (OR 2.08, p = .025) in type 2 diabetes. In conclusion, systemic inflammation and dyslipidemia are associated with DR in type 2 but not in type 1 diabetes.
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Affiliation(s)
- Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Romano Vrabec
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Sania Vidas Pauk
- Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia
| | - Tomislav Bulum
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Spomenka Ljubić
- Department of Diabetes, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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219
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Cho JM, Chae J, Jeong SR, Moon MJ, Ha KC, Kim S, Lee JH. The cholesterol-lowering effect of unripe Rubus coreanus is associated with decreased oxidized LDL and apolipoprotein B levels in subjects with borderline-high cholesterol levels: a randomized controlled trial. Lipids Health Dis 2020; 19:166. [PMID: 32646501 PMCID: PMC7350759 DOI: 10.1186/s12944-020-01338-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Rubus coreanus (R. coreanus) possesses properties that may decrease cholesterol levels. METHODS The effects of unripe R. coreanus (uRC) consumption on low-density lipoprotein (LDL) and total cholesterol levels related to decreased circulating apolipoprotein (Apo) B and oxidized LDL levels were evaluated. This randomized, double-blind, placebo-controlled study included subjects with borderline-high cholesterol levels (between 200 and 239 mg/dL) who consumed one capsule daily containing 600 mg of freeze-dried uRC extract (n = 39) or the placebo (n = 38). RESULTS After 12 weeks, the uRC group showed reductions of 21.23 ± 4.36 mg/dL in total cholesterol levels (P = 0.007) and 15.61 ± 4.16 mg/dL in LDL cholesterol levels (P = 0.032). In addition, significantly greater reductions in Apo B levels were observed in the uRC group (- 3.48 ± 3.40 mg/dL), but Apo B levels were increased in the placebo group (6.21 ± 2.84 mg/dL; P = 0.032). Furthermore, a remarkably lower oxidized LDL level was detected in the uRC group (57.76 ± 2.07 U/L) than in the placebo group (66.09 ± 3.47 U/L) after 12 weeks of consumption (P = 0.044). CONCLUSIONS Because of its cholesterol-lowering effect, uRC shows great promise as a therapeutic agent for subjects with borderline-high total blood cholesterol levels. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03649620 (8/28/2018, retrospectively registered).
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Affiliation(s)
- Jung Min Cho
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Jisuk Chae
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Sa Rang Jeong
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Min Jung Moon
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea
| | - Ki-Chan Ha
- Healthcare Claims & Management Incorporation, Jeonju, Republic of Korea
| | - Sunoh Kim
- B&Tech Co., Ltd., R&D Center, Gwangju, 61239, South Korea.
| | - Jong Ho Lee
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, South Korea.
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220
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Bergamin A, Mantzioris E, Cross G, Deo P, Garg S, Hill AM. Nutraceuticals: Reviewing their Role in Chronic Disease Prevention and Management. Pharmaceut Med 2020; 33:291-309. [PMID: 31933188 DOI: 10.1007/s40290-019-00289-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Over half the adult population in many Western countries consume nutraceuticals because of their purported therapeutic benefits, accessibility and convenience. Several studies have demonstrated that they may also serve as a useful adjunct to pharmaceuticals to better manage chronic conditions or offset negative side effects. Individuals are advised to consult their physician before using nutraceuticals, but this advice is often overlooked. Thus, the community pharmacist plays an increasingly important role in assisting consumers with selecting a nutraceutical that is safe and for which there is evidence of therapeutic efficacy. Therefore, the aim of this review is to summarise the clinical evidence, safety and purported mechanisms of action for selected nutraceuticals in the management of chronic diseases, including obesity, diabetes, hypertension, hypercholesterolemia and inflammatory-based diseases.
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Affiliation(s)
- Amanda Bergamin
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Evangeline Mantzioris
- School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Giordana Cross
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Permal Deo
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Sanjay Garg
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Alison M Hill
- School of Pharmacy and Medical Sciences, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia.
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221
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Anderson SL, Marrs JC, Chachas CR, Cichon BS, Cizmic AD, Calderon BB, Vlasimsky TB. Evaluation of a Pharmacist-Led Intervention to Improve Statin Use in Persons with Diabetes. J Manag Care Spec Pharm 2020; 26:910-917. [PMID: 32584671 PMCID: PMC10391234 DOI: 10.18553/jmcp.2020.26.7.910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Statin Use in Persons with Diabetes (SUPD) measure, developed and endorsed by the Pharmacy Quality Alliance and National Quality Forum, has been adopted by the Centers for Medicare & Medicaid Services as part of the star rating measure set. It was added as a display measure in 2015 and, as of 2019, has become a star measure. Clinical pharmacy specialists (CPS) embedded in the patient-centered medical home (PCMH) are well positioned to review and recommend statin therapy for patients with diabetes in order to improve patient care and health plan performance. OBJECTIVE To improve rates of statin prescribing and performance on the SUPD measure in the Denver Health Medical Plan (DHMP) population with diabetes by creating a CPS-led intervention to initiate statin prescriptions in eligible patients. METHODS Between February 1, 2018, and December 31, 2018, DHMP patients who met SUPD measure criteria (aged ≥ 40 and ≤ 75 years, dispensing events for at least 2 diabetes mellitus medication fills, and no statin prescribed) were identified by the health plan chart review and contacted by CPS as appropriate. For patients eligible and agreeable to statin therapy, the CPS initiated the statin prescription. Descriptive statistics were used to summarize outreach and statin prescribing data. Prescription drug event data were also collected from the health plan to verify SUPD measure performance. RESULTS At the start of 2018, DHMP's performance on the SUPD measure was 65.7% (Medicare Advantage Part D national average was 68.5%). Of the 326 patients whose charts were reviewed and who were contacted, 275 (84.4%) were eligible for statin initiation, and of these, 115 (41.8%) were prescribed statin therapy. The increase in statin prescribing and dispensing increased DHMP's performance on the SUPD measure to 87.1% at the end of 2018, which correlates with a 5-star rating based on the 2019 cut points. CONCLUSIONS CPS embedded in the PCMH setting are well positioned to participate in and positively affect population health initiatives such as the SUPD measure. Appropriate prescribing of statin therapy by CPS for patients included in the SUPD measure ensures that they are on key medication therapy for mitigating atherosclerotic cardiovascular disease and may improve a health plan's Medicare star rating. DISCLOSURES This was an unfunded, investigator-initiated project. Anderson owns stock in Merck & Co. All other authors have no conflicts of interest to disclose.
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Affiliation(s)
- Sarah L. Anderson
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora
| | - Joel C. Marrs
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora
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222
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Han B, Jian Y, Xia X, Hu W, Zhang L, Zhou P. Studying the effects of sea cucumber ovum powder on nonalcoholic fatty liver disease by proteomics techniques in a rat model. Food Funct 2020; 11:6139-6147. [PMID: 32573635 DOI: 10.1039/d0fo00741b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sea cucumber is a valuable marine food that has antioxidant, anti-diabetic, and anti-obesity functionalities. Sea cucumber ovum (SCO) may contain functional components, however, it is considered to be a waste product during industrial processing. In order to make good use of SCO, this work investigated the effects of freeze-dried SCO powder on NAFLD, using a rat model, through iBT labeling proteomics techniques, tracking changes in the hepatic protein profiles of rats whose diets were supplemented with SCO powder. Male rats were fed with standard food, a high fat diet (HFD), or a HFD supplemented with 150 mg per kg BW or 450 mg per kg BW SCO powder for 6 weeks. Compared with the HFD, low-dose SCO supplementation in the diet could significantly reduce body weight gain and liver weight. Furthermore, in total, 5922 proteins were identified, and 767 proteins were found to be significantly different proteins (p < 0.05) among all four groups. Most of the significantly different proteins were related to apoptosis and lipid metabolism. Fadd, Dci, and Aif1 have been identified as key proteins in the pathways related to apoptosis, lipid metabolism, and inflammation. The results in this study provide an overview of the SCO-induced changes in the liver proteome of NAFLD, which may help us to understand the molecular mechanism behind the effects of SCO on the alleviation of NAFLD.
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Affiliation(s)
- Binsong Han
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, China.
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223
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Mathew RO, Rosenson RS, Lyubarova R, Chaudhry R, Costa SP, Bangalore S, Sidhu MS. Concepts and Controversies: Lipid Management in Patients with Chronic Kidney Disease. Cardiovasc Drugs Ther 2020; 35:479-489. [PMID: 32556851 DOI: 10.1007/s10557-020-07020-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains an important contributor of morbidity and mortality in patients with chronic kidney disease (CKD). CKD is recognized as an important risk enhancer that identifies patients as candidates for more intensive low-density lipoprotein (LDL) cholesterol lowering. However, there is controversy regarding the efficacy of lipid-lowering therapy, especially in patients on dialysis. Among patients with CKD, not yet on dialysis, there is clinical trial evidence for the use of statins with or without ezetimibe to reduce ASCVD events. Newer cholesterol lowering agents have been introduced for the management of hyperlipidemia to reduce ASCVD, but these therapies have not been tested in the CKD population except in secondary analyses of patients with primarily CKD stage 3. This review summarizes the role of hyperlipidemia in ASCVD and treatment strategies for hyperlipidemia in the CKD population.
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Affiliation(s)
- Roy O Mathew
- Columbia V.A. Health Care System, 6439 Garners Ferry Road, Columbia, SC, 29209, USA. .,University of South Carolina School of Medicine, Columbia, SC, USA.
| | | | | | | | | | | | - Mandeep S Sidhu
- Albany Medical College and Albany Medical Center, Albany, NY, USA
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224
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Dougados M. Treat to target in axial spondyloarthritis: From its concept to its implementation. J Autoimmun 2020; 110:102398. [DOI: 10.1016/j.jaut.2019.102398] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/23/2022]
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225
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Yang YS, Lee SY, Kim JS, Choi KM, Lee KW, Lee SC, Cho JR, Oh SJ, Kim JH, Choi SH. Achievement of LDL-C Targets Defined by ESC/EAS (2011) Guidelines in Risk-Stratified Korean Patients with Dyslipidemia Receiving Lipid-Modifying Treatments. Endocrinol Metab (Seoul) 2020; 35:367-376. [PMID: 32615721 PMCID: PMC7386099 DOI: 10.3803/enm.2020.35.2.367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/14/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study assessed the proportion of risk-stratified Korean patients with dyslipidemia achieving their low-density lipoprotein cholesterol (LDL-C) targets as defined by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) (2011) guidelines while receiving lipid-modifying treatments (LMTs). METHODS In this multicenter, cross-sectional, observational study, we evaluated data from Korean patients aged ≥19 years who were receiving LMTs for ≥3 months and had an LDL-C value within the previous 12 months on the same LMT. Data were collected for demographics, cardiovascular (CV) risk factors, medical history, and healthcare consumption. Patients were risk-stratified according to the ESC Systematic COronary Risk Evaluation (SCORE) chart and LDL-C target achievement rate was assessed. RESULTS Guideline-based risk-stratification of the 1,034 patients showed the majority (72.2%) to be in the very high-risk category. Investigators' assessment of risk was underestimated in 71.6% compared to ESC/EAS guidelines. Overall LDL-C target achievement rate was 44.3%; target achievement was the highest (66.0%) in moderate-risk patients and the lowest (39.0%) in very high-risk patients. Overall 97.1% patients were receiving statin therapy, mostly as a single-agent (89.2%). High-intensity statins and the highest permissible dose of high-intensity statins had been prescribed to only 9.1% and 7.3% patients in the very high-risk group, respectively. Physician satisfaction with patients' LDL-C levels was the primary reason for non-intensification of statin therapy. CONCLUSION Achievement of target LDL-C level is suboptimal in Korean patients with dyslipidemia, especially in those at very high-risk of CV events. Current practices in LMTs need to be improved based on precise CV risk evaluation posed by dyslipidemia.
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Affiliation(s)
- Ye Seul Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Seo Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Seoul,
Korea
| | - Kang Wook Lee
- Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon,
Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jung Rae Cho
- Cardiovascular Division, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul,
Korea
| | - Seung-Jin Oh
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang,
Korea
| | - Ji-Hyun Kim
- Medical Affairs, Sanofi-Aventis Korea, Seoul,
Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
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226
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Omega-3 fatty acid exposure with a low-fat diet in patients with past hypertriglyceridemia-induced acute pancreatitis; an exploratory, randomized, open-label crossover study. Lipids Health Dis 2020; 19:117. [PMID: 32473640 PMCID: PMC7260759 DOI: 10.1186/s12944-020-01295-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Omega-3 fatty acids (OM3-FAs) are recommended with a low-fat diet for severe hypertriglyceridemia (SHTG), to reduce triglycerides and acute pancreatitis (AP) risk. A low-fat diet may reduce pancreatic lipase secretion, which is required to absorb OM3-ethyl esters (OM3-EEs), but not OM3-carboxylic acids (OM3-CAs). METHODS In this exploratory, randomized, open-label, crossover study, 15 patients with SHTG and previous AP were instructed to take OM3-CA (2 g or 4 g) and OM3-EE 4 g once daily for 4 weeks, while adhering to a low-fat diet. On day 28 of each treatment phase, a single dose was administered in the clinic with a liquid low-fat meal, to assess 24-h plasma exposure. Geometric least-squares mean ratios were used for between-treatment comparisons of baseline (day 0)-adjusted area under the plasma concentration versus time curves (AUC0-24) and maximum plasma concentrations (Cmax) for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). RESULTS Before initiating OM3-FA treatment, mean baseline fasting plasma EPA + DHA concentrations (nmol/mL) were 723 for OM3-CA 2 g, 465 for OM3-CA 4 g and 522 for OM3-EE 4 g. At week 4, mean pre-dose fasting plasma EPA + DHA concentrations increased by similar amounts (+ 735 - + 768 nmol/mL) for each treatment. During the 24-h exposure assessment (day 28), mean plasma EPA + DHA increased from pre-dose to the maximum achieved concentration by + 32.7%, + 45.8% and + 3.1% with single doses of OM3-CA 2 g, OM3-CA 4 g and OM3-EE 4 g, respectively. Baseline-adjusted AUC0-24 was 60% higher for OM3-CA 4 g than for OM3-EE 4 g and baseline-adjusted Cmax was 94% higher (both non-significant). CONCLUSIONS Greater 24-h exposure of OM3-CA versus OM3-EE was observed for some parameters when administered with a low-fat meal at the clinic on day 28. However, increases in pre-dose fasting plasma EPA + DHA over the preceding 4-week dosing period were similar between treatments, leading overall to non-significant differences in baseline (day 0)-adjusted AUC0-24 and Cmax EPA + DHA values. It is not clear why the greater 24-h exposure of OM3-CA versus OM3-EE observed with a low-fat meal did not translate into significantly higher pre-dose fasting levels of DHA + EPA with longer-term use. TRIAL REGISTRATION ClinicalTrials.gov, NCT02189252, Registered 23 June 2014.
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227
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Wang HH, Lee DK, Liu M, Portincasa P, Wang DQH. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr 2020; 23:189-230. [PMID: 32483543 PMCID: PMC7231748 DOI: 10.5223/pghn.2020.23.3.189] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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228
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Hirahatake KM, Astrup A, Hill JO, Slavin JL, Allison DB, Maki KC. Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base. Adv Nutr 2020; 11:533-547. [PMID: 31904812 PMCID: PMC7231591 DOI: 10.1093/advances/nmz132] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/17/2019] [Accepted: 12/09/2019] [Indexed: 12/20/2022] Open
Abstract
Since their inception in 1980, the Dietary Guidelines for Americans have promoted low- or fat-free dairy foods. Removing fat from dairy does not reduce putatively beneficial nutrients per serving, including calcium, vitamin D, and potassium. Additionally, links between saturated fat and dietary cholesterol intakes with cardiovascular disease risk have helped to sustain the view that low-fat dairy foods should be recommended. Emerging evidence shows that the consumption of full-fat dairy foods has a neutral or inverse association with adverse cardiometabolic health outcomes, including atherosclerotic cardiovascular disease, type 2 diabetes, and associated risk factors. Thus, although low-fat dairy is a practical, practice-based recommendation, its superiority compared with full-fat dairy is not obviously supported by results from recent prospective cohort studies or intervention trials. To evaluate the emerging science on full-fat dairy, a group of nutrition experts convened to summarize and discuss the scientific evidence regarding the health effects of consuming full-fat dairy foods. Future studies should focus on full-fat dairy foods (milk, yogurt, and cheese) in the context of recommended dietary patterns and consider meal composition and metabolic phenotype in assessing the relation between full-fat dairy consumption and cardiometabolic health.
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Affiliation(s)
- Kristin M Hirahatake
- Department of Epidemiology, College of Health Sciences, University of California, Irvine, Irvine, CA, USA
| | - Arne Astrup
- Department of Nutrition, Exercise, and Sports, Copenhagen University, Copenhagen, Denmark
| | - James O Hill
- Center for Human Nutrition, University of Colorado School of Medicine, Denver, CO, USA
| | - Joanne L Slavin
- Department of Food Science and Nutrition, University of Minnesota, St Paul, MN, USA
| | - David B Allison
- School of Public Health, Indiana University, Bloomington, IN, USA
| | - Kevin C Maki
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA,Midwest Biomedical Research, Center for Metabolic and Cardiovascular Health, Addison, IL, USA,Address correspondence to KCM (e-mail: )
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229
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Dopheide JF, Ramadani H, Adam L, Gahl B, Papac L, Veit J, Kaspar M, Schindewolf M, Baumgartner I, Drexel H. Development of a 3-Dimensional Prognostic Score for Patients With Symptomatic Peripheral Artery Disease: PAD 3D Score. Angiology 2020; 71:658-665. [PMID: 32342699 DOI: 10.1177/0003319720920155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripheral artery disease (PAD) is a high-risk condition for cardiovascular (CV) events, but no specific prognosis assessment tool exists. We developed an individual risk score (PAD3D) based on the combined predictive value for mortality, including (1) age, (2) severity of PAD, and (3) extent of atherosclerosis. Patients (n = 1310) with symptomatic PAD were followed up for a mean of 50 ± 26 months. The cohort was randomly subdivided into a test and validation cohort. All-cause and CV mortality were prospectively analyzed for PAD3D score and in combination with classical risk factors. For the test and validation cohort (n = 655 each), all-cause and CV mortality were predicted (P < .001) by the PAD3D score. Additional inclusion of classical risk factors did not increase discrimination compared with PAD3D as "area under receiver-operating characteristic" curves were similar for both scores at any time point. Thus, the addition of the classical risk factors to PAD3D did not further improve the prognostic value. The PAD3D score provides a risk gradient of a 4.5-fold increase in all-cause and CV mortality. We developed a score for precise prediction of all-cause and CV mortality. The PAD3D score promises to allow for personalized goals in risk intervention.
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Affiliation(s)
- Jörn F Dopheide
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Hana Ramadani
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Luise Adam
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Lucija Papac
- Division of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jonas Veit
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Mathias Kaspar
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, USA
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230
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Yegezu Z, Mollon L, Alshayban DM, Bilal J, Bhattacharjee S. Health-related risk behaviors among myocardial infarction survivors in the United States: A propensity score matched study. Res Social Adm Pharm 2020; 17:307-314. [PMID: 32360124 DOI: 10.1016/j.sapharm.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND According to the American College of Cardiology/the American Heart Association (ACC/AHA) recommendations, health-related risk behaviors for secondary prevention of myocardial infarction (MI) are critical to determine. OBJECTIVE This study aimed to compare health-related risk behaviors between MI survivors and propensity-score-matched non-MI controls using nationally representative data. METHODS This cross-sectional, matched case-control study used publicly available Behavioral Risk Factor Surveillance System (BRFSS) 2017 data. Older adults with MI were propensity-score-matched to their non-MI controls. The 10 dependent variables included body mass index (BMI), smoking status, heavy alcohol consumption, influenza vaccine, length of time since last routine and cholesterol checkup, alcohol consumption, fruit and vegetable consumption, and physical activity. Chi-square tests and binomial logistic regression were used to examine the health-related risk behaviors differences between MI survivors and propensity-score-matched non-MI controls. RESULTS The final study sample consisted of 18,021 MI survivors and 54,063 non-MI controls after propensity score matching. Multivariable logistic regression analysis showed significant differences between MI survivors and matched non-MI controls in terms of cholesterol checkup, smoking status, and alcohol consumption. For example, multivariate analysis of health-related risk behaviors showed MI survivors were more likely to be smokers (AOR = 1.46, 95% CI: 1.28-1.68). CONCLUSION Based on this national survey of adults, MI survivors were more likely to be smokers but less likely to consume alcohol compared to their propensity-score-matched controls. Moreover, MI survivors were more likely to have their cholesterol checkup within the past 2 years compared to matched non-MI controls. Although lower alcohol consumption and greater chances of cholesterol checkups are reassuring health-related behaviors, interventions are needed to minimize the chances of smoking in this population.
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Affiliation(s)
- Zufan Yegezu
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
| | - Lea Mollon
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
| | - Dhafer Mahdi Alshayban
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Jawad Bilal
- Department of Medicine, Division of Rheumatology, University of Arizona, USA.
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
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231
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Shiffman D, Louie JZ, Devlin JJ, Knowles JW, McPhaul MJ. Gaps in Dyslipidemia Care Among Working-Aged Individuals With Employer-Sponsored Health Care. J Am Heart Assoc 2020; 9:e015807. [PMID: 32319337 PMCID: PMC7428576 DOI: 10.1161/jaha.119.015807] [Citation(s) in RCA: 2] [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] [Indexed: 01/21/2023]
Abstract
Background The American Heart Association and American College of Cardiology guidelines defined patient‐management groups that would benefit from lowering of low‐density lipoprotein cholesterol (LDL‐C). We assessed gaps in dyslipidemia care among employees and spouses with health benefits. Methods and Results We studied 17 889 employees and spouses who were covered by an employer‐sponsored health plan and participated in an annual health assessment. Using medical claims, laboratory tests, and risk assessment questionnaires, we found that 43% of participants were in one of 4 patient‐management groups: secondary prevention, severe hypercholesterolemia (LDL‐C ≥190 mg/dL at least once in the preceding 5 years), diabetes mellitus, or elevated 10‐year risk of cardiovascular disease. To assess gaps in dyslipidemia care, we used LDL‐C ≤70 mg/dL as the goal for both the secondary prevention group and those in the elevated 10‐year risk group with >20% risk; LDL‐C ≤100 mg/dL was used for the other groups. Among those in patient‐management groups, 27.3% were in the secondary prevention group, 7.4% were in the severe hypercholesterolemia group, 29.9% were in the diabetes mellitus group, and 35.4% were in the elevated 10‐year risk group. About 74% of those in patient‐management groups had above‐goal LDL‐C levels, whereas only 31% had evidence of a lipid‐lowering therapy in the past 6 months: 45% in the secondary prevention group, 31% in the severe hypercholesterolemia group, 36% in the diabetes mellitus group, and 17% in the elevated 10‐year risk group. Conclusions The substantial gaps in LDL‐C treatment and goal attainment among members of an employer‐sponsored medical plan who were mostly aware of their LDL‐C levels indicate the need for gap‐closure initiatives.
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Affiliation(s)
- Dov Shiffman
- Quest Diagnostics Nichols Institute San Juan Capistrano CA
| | - Judy Z Louie
- Quest Diagnostics Nichols Institute San Juan Capistrano CA
| | - James J Devlin
- Quest Diagnostics Nichols Institute San Juan Capistrano CA
| | - Joshua W Knowles
- Stanford Cardiovascular Medicine and Cardiovascular Institute and the FH Foundation Stanford CA
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232
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Flaxseed ( Linum Usitatissimum L.) Supplementation in Patients Undergoing Lipoprotein Apheresis for Severe Hyperlipidemia-A Pilot Study. Nutrients 2020; 12:nu12041137. [PMID: 32325781 PMCID: PMC7231079 DOI: 10.3390/nu12041137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022] Open
Abstract
Being rich in polyunsaturated fatty acids, flaxseed (Linum usitatissimum L.) is thought to be able to decrease lipid levels and dampen inflammation. In this pilot study, we aimed to determine whether flaxseed supplementation could improve the profiles of lipids and inflammatory mediators in patients with severe hyperlipidemia resistant to conventional lipid-lowering pharmacotherapy and requiring lipoprotein apheresis. To this end, six patients received, blindly—in addition to their normal lipoprotein apheresis regimen—a 10-week dietary supplementation with flaxseed (28 g/d) administered in biscuits. This was followed by a 10-week washed out-period and a 10-week supplementation phase with whole wheat placebo. Blood samples were collected at the end of each phase, before the lipoprotein apheresis session. The primary endpoint was the lipid profile and the secondary endpoints were the concentrations of inflammatory mediators and tolerability. Flaxseed supplementation was well-tolerated and resulted in a consistent and significant decrease in total cholesterol and low-density lipoprotein (LDL) levels. The median (and range) percentage decrease was 11.5% (0–18.8) and 7.3% (4.4–26.6), for cholesterol (p = 0.015) and LDL-C (p = 0.003), respectively. On the other hand, there was no significant effect of flaxseed on lipoprotein(a) (Lp(a)), C-reactive protein (CRP), and interleukin 6 (IL-6) concentrations. These observations indicate that flaxseed can produce a cholesterol- and LDL-lowering effect in patients treated with lipoprotein apheresis. Thus, flaxseed supplementation may help to control cholesterol in this patient population. The flaxseed supplementation protocol applied may be of use for further adequately-powered studies to validate and extend our findings.
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233
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Effect of Chinese herbal medicine on serum lipids in postmenopausal women with mild dyslipidemia: a randomized, placebo-controlled clinical trial. ACTA ACUST UNITED AC 2020; 27:801-807. [PMID: 32301894 DOI: 10.1097/gme.0000000000001539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous studies have shown the association between menopause and dyslipidemia. This study was aimed to evaluate the effect of Chinese herbal medicine, tonifying kidney and descending turbidity (TKDT) granule, on serum lipid profiles in postmenopausal women with dyslipidemia. METHODS A double-blind randomized, placebo-controlled trial was conducted among 104 postmenopausal Chinese women with mild dyslipidemia. Participants were randomized into treatment group (n = 53) and control group (n = 51). The participants in the treatment group received TKDT granule once per day for 24 weeks, whereas the control group received placebo in the same manner. All participants were subjected to healthy lifestyle during the study. Serum lipid profiles, body weight, waist circumference, and safety indicators were measured both at baseline and 24 weeks after admission. RESULTS Compared with placebo, significant improvements in total cholesterol, low-density lipoprotein cholesterol, apolipoprotein-B (Apo-B), weight, and waist circumference in the TKDT group (P < 0.05) were observed after 24 weeks of treatment. Total cholesterol, low-density lipoprotein cholesterol, and Apo-B were decreased by 0.84 (0.77) mmol/L, 0.72 (0.77) mmol/L, and 0.12 (0.27) mmol/L, mean ± SD respectively. The weight, waist circumference, and body mass index were decreased by 4.07 (3.01) kg, 3.10 (2.95) cm, 1.60 (1.13), respectively. There were no significant differences in triglycerides, high-density lipoprotein cholesterol, and Apo-A between the two groups. Seven participants in the treatment group and six participants in the placebo group had mild or moderate adverse reactions. CONCLUSION TKDT granule improved the lipid profile and reduced the related metabolic abnormalities in postmenopausal women with mild dyslipidemia based on lifestyle changes.
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234
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Levy ME, Ma Y, Magnus M, Younes N, Castel AD. Cholesterol-lowering effect of statin therapy in a clinical HIV cohort: an application of double propensity score adjustment. Ann Epidemiol 2020; 44:8-15. [PMID: 32204991 PMCID: PMC7190432 DOI: 10.1016/j.annepidem.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Propensity score matching (PSM) is often used to estimate the average treatment effect among the treated (ATT) using observational data. We demonstrate how the use of "double propensity score adjustment" can reduce residual confounding and avoid bias due to incomplete matching compared with traditional PSM methods. METHODS The DC Cohort is an observational clinical HIV cohort in Washington, DC. We compared the mean percent change in non-high-density lipoprotein cholesterol (non-HDL-C) concentration after 3-12 months between participants treated and participants not treated with statin therapy between 2011 and 2018. We conducted traditional PSM procedures (optimal, nearest neighbor, and nearest neighbor caliper matching) and double propensity score adjustment. RESULTS Among 202 treated and 1252 untreated participants, the ATT was -14.5% (95% CI: -18.4, -10.6) after optimal matching (202 matched pairs; 15/22 covariates balanced), -14.9% (-18.9, -11.0) after nearest neighbor matching (202 matched pairs; 17/22 covariates balanced), and -12.0% (-16.5, -7.5) after nearest neighbor caliper matching (153 matched pairs; 21/22 covariates balanced). After double propensity score adjustment, the ATT was -13.0% (-16.0, -10.1). CONCLUSIONS In PSM analyses, double propensity score adjustment is a readily accessible alternative approach for estimating ATTs when sufficient covariate balance between treatment groups cannot be achieved without excluding treated participants.
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Affiliation(s)
- Matthew E Levy
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC.
| | - Yan Ma
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Naji Younes
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health at the George Washington University, Washington, DC
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC
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235
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Feng L, Nian S, Tong Z, Zhu Y, Li Y, Zhang C, Bai X, Luo X, Wu M, Yan Z. Age-related trends in lipid levels: a large-scale cross-sectional study of the general Chinese population. BMJ Open 2020; 10:e034226. [PMID: 32193266 PMCID: PMC7202729 DOI: 10.1136/bmjopen-2019-034226] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the dynamic trends in total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels with ageing. DESIGN A Chinese population-based cross-sectional study. SETTING A physical examination centre of a general hospital. PARTICIPANTS Adult subjects (178 167: 103 461 men and 74 706 women) without a known medical history or treatments that affect lipid metabolism. MAIN OUTCOME MEASURES Dynamic trends in the above-mentioned lipid parameters with ageing were explored; turning points of age were established using age stratification and validated by fitted multivariate linear regression modelling. RESULTS Age was found to be an independent factor extensively associated with lipid levels in both sexes when adjusted for serum glucose, body mass index, lifestyle, drinking and smoking. Age was positively associated with TC, logarithm-transformed TG (LnTG) and LDL-C levels in men ≤40, ≤40 and ≤60 years old (yo) and in women ≤60, ≤70 and ≤60 yo, respectively. Conversely, age correlated negatively with TC, LnTG and LDL-C levels in men ≥61, ≥41 and ≥61 yo and in women ≥61, ≥71 and ≥61 yo, respectively. TC, TG and LDL-C levels in women were initially lower than those in men but surpassed those in men in 51-55, 61-65 and 51-55 yo age groups. The trends in HDL-C levels with age were relatively irregular, although HDL-C levels in women were higher than in men for all age groups. CONCLUSIONS The definition of dyslipidaemia, the atherosclerotic cardiovascular disease risk assessment and the initiation/goals of statin therapy should fully consider age-related trends in lipid levels and sex differences.
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Affiliation(s)
- Lei Feng
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, Yunnan Province 653100, China
| | - Shiyan Nian
- Department of Critical Care Medicine, People's Hospital of Yuxi City, Yuxi, China
| | - Zongwu Tong
- Department of Nephrology, People's Hospital of Yuxi City, Yuxi, China
| | - Ying Zhu
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, China
| | - Ying Li
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, China
| | - Chunting Zhang
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, China
| | - Xuejing Bai
- Department of Laboratory, Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Xuan Luo
- Department of Laboratory, Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Mengna Wu
- Department of Laboratory, Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
| | - Zefeng Yan
- Department of Laboratory, Sixth Affiliated Hospital of Kunming Medical University, Yuxi, Yunnan, China
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236
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Feng X, Guo Q, Zhou S, Sun T, Liu Y, Zhou Z, Zhou Y. Could remnant-like particle cholesterol become a risk factor in diabetic menopausal women with coronary artery disease? A cross-sectional study of single academic center in China. Lipids Health Dis 2020; 19:44. [PMID: 32178671 PMCID: PMC7076918 DOI: 10.1186/s12944-020-01224-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS It has been confirmed that remnant-like particle cholesterol (RLP-C) mediates the progression of coronary artery disease (CAD). Currently there is limited information on RLP-C in menopausal women. With the special status of diabetes mellitus (DM) combined with the special body changes of the menopausal women, the RLP-C is particularly important when studying the changes that occurred in response to CAD and its associated risk factors. This study discussed whether RLP-C could be an independent risk factor for menopausal women with CAD and DM. METHODS The cohort consisted of 4753 menopausal women who had undergone coronary angiography. Subjects were separated into CAD and non-CAD groups, and univariate and multivariate logistic regression analysis of CAD risk factors were performed. All patients with a history of DM were divided into DM subgroups. Then, the univariate and multivariate logistic regression analysis of the risk factors of CAD and the comparison among age groups in the DM subgroup were performed. After age stratification of the DM group, the Kruskal-Wallis test was used to analyze the differences of various lipid indexes among age groups. RESULTS The multivariate logistic regression showed that RLP-C was an independent risk factor for CAD in menopausal women (OR 1.232, 95%CI 1.070-1.419). In the DM subgroup, it was also found that RLP-C was an independent risk factor for CAD (OR 1.366, 95%CI 1.043-1.791). Kruskal-Wallis test analysis found that RLP-C had no significant difference among three groups (P > 0.05). CONCLUSIONS RLP-C was proved to be an independent risk factor for menopausal women with CAD and DM.
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Affiliation(s)
| | | | - Shu Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Tienan Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yuyang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Zhiming Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical center for coronary heart disease, Capital Medical University, Beijing, 100029, China.
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237
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Toth PP, Jones SR, Monsalvo ML, Elliott‐Davey M, López JAG, Banach M. Effect of Evolocumab on Non-High-Density Lipoprotein Cholesterol, Apolipoprotein B, and Lipoprotein(a): A Pooled Analysis of Phase 2 and Phase 3 Studies. J Am Heart Assoc 2020; 9:e014129. [PMID: 32114889 PMCID: PMC7335559 DOI: 10.1161/jaha.119.014129] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Dyslipidemia guidelines recommend non‐high‐density lipoprotein cholesterol (non‐HDL‐C) and apolipoprotein B (ApoB) as additional targets of therapy and consider lipoprotein(a) a significant cardiovascular risk marker. The current analysis evaluates the effects of evolocumab on these parameters in various patient populations over time. Methods and Results Data from 7690 patients, 4943 of whom received at least 1 dose of evolocumab, in 15 phase 2 and phase 3 studies with a duration ranging from 12 weeks to 5 years were pooled based on study length, patient population, and ezetimibe or placebo comparator groups. Patients could receive intensive statin therapy but not in the statin intolerance and monotherapy studies. The effects of evolocumab on percent change from baseline for non‐HDL‐C, ApoB, and lipoprotein(a) and achievement of treatment goals for non‐HDL‐C and ApoB were examined. Compared with placebo, evolocumab at both approved dosing regimens substantially reduced mean non‐HDL‐C (Q2W dose: −49% to −56%, monthly dose: −48% to −52%), mean ApoB (Q2W dose: −46% to −52%, monthly dose: −40% to −48%), and median lipoprotein(a) (Q2W dose: −22% to −38%, monthly dose: −20% to −33%) at 12 weeks. Effects on all 3 parameters persisted over 5 years. Lipid‐lowering effects were consistent among the patient populations examined (hypercholesterolemia/mixed dyslipidemia, statin intolerance, heterozygous familial hypercholesterolemia, and type 2 diabetes mellitus). Conclusions In this pooled analysis, evolocumab substantially reduced non‐HDL‐C, ApoB, and lipoprotein(a) compared with placebo. The effect was consistent and maintained in various patient populations over 5 years.
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Affiliation(s)
- Peter P. Toth
- Preventive CardiologyCGH Medical CenterSterlingIL
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimoreMD
| | - Steven R. Jones
- The Johns Hopkins Ciccarone Center for the Prevention of Heart DiseaseBaltimoreMD
| | | | | | | | - Maciej Banach
- Polish Mother's Memorial Hospital Research Institute (PMMHRI)LodzPoland
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238
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Jones LK, Gidding SS, Seaton TL, Goldberg A, Gregor C, Sturm AC, Brownson RC, Rahm AK, Williams MS. Developing implementation strategies to improve uptake of guideline-recommended treatments for individuals with familial hypercholesterolemia: A protocol. Res Social Adm Pharm 2020; 16:390-395. [PMID: 31229402 PMCID: PMC6911646 DOI: 10.1016/j.sapharm.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) affects more than one million Americans, and most individuals have not been formally diagnosed with the condition. Individuals with FH have markedly elevated serum low-density lipoprotein cholesterol (LDL-C) levels from birth that substantially increase their risk for early-onset cardiovascular (CV) events. Guideline-recommended treatments exist to lower LDL-C and reduce the risk of CV events in individuals with FH and hypercholesterolemia. This study seeks to address a significant gap in the care of individuals with FH by systematically developing an effective approach to increase the adoption of guideline-recommended treatments for FH. METHODS This developmental study will consist of three aims: 1) determine the barriers to and facilitators of treatment of FH; 2) develop a list of potential implementation strategies to promote the adoption of guideline-recommended treatment of individuals with FH, and 3) pilot one implementation strategy from Aim 2 in one health care system to evaluate implementation outcomes of the strategy. The Practical, Robust Implementation and Sustainability Model will guide this project, including the development of interview questions, implementation strategies, and evaluation of the implementation strategy. The implementation outcomes include: of individuals targeted by the implementation strategy, how many are impacted by it (reach), measure the change in knowledge, attitude, and behavior that is impacted by the implementation strategy (effectiveness), in settings targeted by the implementation strategy, how many adopt it (adoption), and fidelity and cost of the implementation strategy (implementation). Data sources will include electronic health records, administrative databases, surveys, and semi-structured interviews. DISCUSSION The inclusion of patient and organizational stakeholder experiences is a critically important step in developing efficient and effective implementation strategies. Additionally, perspectives from a variety of geographic areas and cultural perspectives should increase feasibility and fidelity of the interventional approach to improve adoption of guideline-recommended practices for FH care.
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Affiliation(s)
- Laney K Jones
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA.
| | | | - Terry L Seaton
- St. Louis College of Pharmacy, St. Louis, MO, USA; Mercy Clinic-East Communities, St. Louis, MO, USA
| | - Anne Goldberg
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Gregor
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Department of Surgery (Division of Public Health Sciences), Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, St. Louis, MO, USA
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239
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Chen S, Yang H, Chen Y, Wang J, Xu L, Miao M, Xu C. Association between serum uric acid levels and dyslipidemia in Chinese adults: A cross-sectional study and further meta-analysis. Medicine (Baltimore) 2020; 99:e19088. [PMID: 32176036 PMCID: PMC7440131 DOI: 10.1097/md.0000000000019088] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the association of serum uric acid (SUA) levels with dyslipidemia and its components and to further explore the age- and gender-specific association of SUA levels with dyslipidemia in Chinese adults.A cross-sectional study was performed among 8642 adults who underwent health examinations. A meta-analysis covering 17 studies was conducted to confirm the results.The prevalence of hyperuricemia and dyslipidemia was 9.25% and 20.44%, respectively. Participants with hyperuricemia had higher prevalence of dyslipidemia than those without hyperuricemia (34.42% vs 19.01%, P < .005). Compared with participants with SUA in the first quintile, the odds ratio (OR) (95% confidence interval) of dyslipidemia in the second, third, fourth, and fifth quintiles of SUA were 1.095 (0.901-1.332), 1.582 (1.315-1.904), 2.095 (1.752-2.505), and 3.212 (2.702-3.818), respectively. Subgroup analysis showed that SUA quintiles were significantly correlated with the likelihood of dyslipidemia in females aged > 50 years and in males, but not in females aged ≤50 years. The meta-analysis also showed that hyperuricemia increased the likelihood of dyslipidemia and the pooled OR for the highest uric acid level vs the lowest uric acid level was 1.84 (1.49-2.28).SUA levels are significantly associated with dyslipidemia, and this association is impacted by age and gender.
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Affiliation(s)
- Shenghui Chen
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Hua Yang
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Yishu Chen
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Jinghua Wang
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Lei Xu
- Department of Gastroenterology, Zhejiang University Ningbo Hospital
| | - Min Miao
- Department of Internal Medicine, Zhenhai Lianhua Hospital, Ningbo, China
| | - Chengfu Xu
- Department of Gastroenterology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
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240
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Okello S, Amir A, Bloomfield GS, Kentoffio K, Lugobe HM, Reynolds Z, Magodoro IM, North CM, Okello E, Peck R, Siedner MJ. Prevention of cardiovascular disease among people living with HIV in sub-Saharan Africa. Prog Cardiovasc Dis 2020; 63:149-159. [PMID: 32035126 PMCID: PMC7237320 DOI: 10.1016/j.pcad.2020.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
As longevity has increased for people living with HIV (PLWH) in the United States and Europe, there has been a concomitant increase in the prevalence of cardiovascular disease (CVD) risk factors and morbidity in this population. Whereas the availability of HIV antiretroviral therapy has resulted in dramatic increases in life expectancy in sub-Saharan Africa (SSA), where over two thirds of PLWH reside, if and how these trends impact the epidemiology of CVD is less clear. In this review, we describe the current state of the science on how both HIV and its treatment impact CVD risk factors and outcomes among PLWH in sub-Saharan Africa, including regional factors (unique to SSA) likely to differentiate these relationships from the global North. We then outline how current regional guidelines address CVD prevention among PLWH and which clinical and structural interventions are best poised to confront the co-epidemics of HIV and CVD in the region. We conclude with a discussion of key research gaps that need to be addressed to optimally develop an actionable public health response.
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Affiliation(s)
- Samson Okello
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Lown Scholars Program, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, University of Virginia Health Systems, Charlottesville, VA, USA.
| | - Abdallah Amir
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Neurology, Mayo Clinic, Phoenix/Scottsdale, AZ, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA; Duke University Medical Center, Durham, NC, USA
| | - Katie Kentoffio
- Department of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Henry M Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zahra Reynolds
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Itai M Magodoro
- Departments of Medicine & Diagnostic Radiology, McGill University Health Center, Montreal, QC, Canada; Division of Cardiology, University of Cape Town, Cape Town, South Africa
| | - Crystal M North
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Robert Peck
- The Center for Global Health, Weill Cornell Medical Center for Global Health, New York, USA; Department of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Mark J Siedner
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Bae HJ, Cho YK, Park HS, Yoon HJ, Kim H, Han S, Hur SH, Kim YN, Kim KB, Ryu JK, Nah DY, Nam CW. Early efficacy and safety of statin therapy in Korean patients with hypercholesterolemia: Daegu and Gyeongbuk Statin Registry. Korean J Intern Med 2020; 35:342-350. [PMID: 31422649 PMCID: PMC7060999 DOI: 10.3904/kjim.2018.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 08/24/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS To date, prospective data are limited on efficacy and safety profiles of statin therapy in Korean hypercholesterolemic patients. Hence, the aim of this study was to evaluate the practice patterns of statin therapy and its efficacy and safety through the prospective Daegu and Gyeongbuk statin registry. METHODS Statin naïve patients who were prescribed statins according to the criteria of Korean Guidelines for Management of Dyslipidemia were enrolled. Clinical and laboratory evaluations were performed at baseline and at week 8, where the efficacy was assessed with the same guidelines. RESULTS Of 908 patients, atorvastatin and rosuvastatin were most frequently prescribed statins (63.1% and 29.3%, respectively). High intensity statins (atorvastatin 40 mg or rosuvastatin 20 mg) were prescribed in 24.7% of all patients and in 79.5% of high and very high risk groups. The total and low density lipoprotein (LDL) cholesterol levels decreased from 203.7 ± 43.0 to 140.6 ± 28.6 mg/dL and 134.4 ± 35.7 to 79.5 ± 21.3 mg/dL, respectively. The achievement rate of the LDL target goal was 98.6% in low risk, 95.0% in moderate risk, 88.1% in high risk, and 42.1% in very high risk patients (59.7% in overall). There was no significant difference in the efficacy between atorvastatin and rosuvastatin. Adverse events were observed in 12.0% of patients and led to 1.4% of treatment cessation. CONCLUSION The efficacy of the usual starting dose of statins in daily practice was relatively insufficient for Korean hypercholesterolemic patients with high or very high risks. Short-term adverse events of statin therapy were not common in Korean patients with a low discontinuation rate.
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Affiliation(s)
- Han Joon Bae
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Seongwook Han
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Yoon-Nyun Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Kwon-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jae-Kean Ryu
- Division of Cardiology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Deug Young Nah
- Division of Cardiology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
- Correspondence to Chang-Wook Nam, M.D. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42061, Korea Tel: +82-53-258-7051 Fax: +82-53-258-7008 E-mail:
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Abstract
If undiagnosed and untreated, familial hypercholesterolemia can lead to serious cardiac complications, such as premature atherosclerotic cardiovascular disease. NPs should be familiar with the clinical presentation of this inherited metabolic disease to diagnose patients as early as possible and promptly begin treatment that may include lifestyle changes, statin therapy, and/or nonstatin therapy.
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243
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Vallejo-Vaz AJ, Leiter LA, Del Prato S, Taskinen MR, Müller-Wieland D, Bujas-Bobanovic M, Letierce A, Mandel J, Samuel R, Ray KK. Triglyceride concentrations and non-high-density lipoprotein cholesterol goal attainment in the ODYSSEY phase 3 trials with alirocumab. Eur J Prev Cardiol 2020; 27:1663-1674. [PMID: 32089006 PMCID: PMC7549294 DOI: 10.1177/2047487320905185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims Guidelines recommend targeting non-high-density lipoprotein cholesterol to reduce
cardiovascular risk. We assessed the impact of baseline triglycerides on
non-high-density lipoprotein cholesterol goal attainment in 10 phase 3 trials with
alirocumab versus control (n = 4983). Methods Trials were grouped into four pools based on alirocumab dose (75–150 mg every 2 weeks),
control (placebo/ezetimibe) and statin use. Baseline triglyceride quintiles were built
within each pool. Non-high-density lipoprotein cholesterol goal attainment (very high
risk: <100 mg/dl; moderate/high risk: <130 mg/dl), low-density lipoprotein
cholesterol goal attainment (very high risk: <70 mg/dl; moderate/high risk:
<100 mg/dl) and changes from baseline in lipid parameters were assessed at Week 24
among baseline triglyceride quintiles. Results Higher baseline triglycerides were associated with a worse cardiovascular risk profile.
Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol
increased with higher triglycerides, but the magnitude in non-high-density lipoprotein
cholesterol was three- to four-fold higher compared with the increase in low-density
lipoprotein cholesterol. Non-high-density lipoprotein cholesterol and low-density
lipoprotein cholesterol percentage reductions from baseline with alirocumab were similar
regardless of baseline triglycerides. A greater proportion of alirocumab-treated
patients attained non-high-density lipoprotein cholesterol and low-density lipoprotein
cholesterol goals compared with placebo or ezetimibe. Unlike low-density lipoprotein
cholesterol goal attainment, non-high-density lipoprotein cholesterol goal attainment
significantly declined with increasing baseline triglycerides
(p < 0.05 for trend tests). A single standard deviation increase in
baseline log(triglycerides) was significantly associated with lower odds ratios of
attaining non-high-density lipoprotein cholesterol goals in the different pools and
treatment (alirocumab/placebo/ezetimibe) groups, unlike low-density lipoprotein
cholesterol goal attainment. Conclusion Individuals with increased triglycerides have higher non-high-density lipoprotein
cholesterol levels and lower rates of non-high-density lipoprotein cholesterol goal
attainment (unlike low-density lipoprotein cholesterol goal attainment). Alirocumab
improves non-high-density lipoprotein cholesterol goal attainment in this population.
These results highlight the impact of triglycerides on non-high-density lipoprotein
cholesterol and the need for novel therapies targeting triglyceride-related
pathways.
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Affiliation(s)
| | | | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | | | | | | | | | - Jonas Mandel
- Sanofi, Chilly-Mazarin, France.,IviData Stats, France
| | | | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Imperial College, UK
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244
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Wang Y, Song Q, Cheng Y, Wei C, Ye C, Liu J, Wu B, Liu M. Association between non-high-density lipoprotein cholesterol and haemorrhagic transformation in patients with acute ischaemic stroke. BMC Neurol 2020; 20:47. [PMID: 32033596 PMCID: PMC7007671 DOI: 10.1186/s12883-020-1615-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/14/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether non-high-density lipoprotein cholesterol (Non-HDL-C) is associated with haemorrhagic transformation (HT) after acute ischaemic stroke (AIS). We aimed to explore the association between Non-HDL-C and HT, as well as compare the predictive values of Non-HDL-C and low-density lipoprotein cholesterol (LDL-C) for HT. METHODS We consecutively enrolled AIS patients within 7 days of stroke onset. Participants were divided into four categories according to quartiles of Non-HDL-C. HT was assessed by follow-up brain imaging. We assessed the association between Non-HDL-C, LDL-C and HT in multivariate logistic regression analysis. RESULTS A total of 2043 patients were included, among whom 232 were identified as HT. Compared with the highest quartiles, the first, second and third quartiles of Non-HDL-C were associated with increased risk of HT (adjusted odds ratios [ORs] 1.74 [95% confidence interval [CI] 1.09-2.78], 2.01[95% CI 1.26-3.20], and 1.76 [95% CI 1.10-2.83], respectively, P for trend = 0.024). Similar results were found for LDL-C. There was significant interaction between Non-HDL-C and age (P for interaction = 0.021). The addition of Non-HDL-C and LDL-C to conventional factors significantly improved predictive values [Non-HDL-C, net reclassification index (NRI) 0.24, 95%CI 0.17-0.31, P < 0.001; LDL-C, NRI 0.15, 95%CI 0.08-0.22, P = 0.03]. CONCLUSIONS Low Non-HDL-C was associated with increased risks of HT. In addition, Non-HDL-C has similar effects as LDL-C for predicting HT.
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Affiliation(s)
- Yanan Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Quhong Song
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Yajun Cheng
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chenchen Wei
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
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245
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German CA, Shapiro MD. Assessing Atherosclerotic Cardiovascular Disease Risk with Advanced Lipid Testing: State of the Science. Eur Cardiol 2020; 15:e56. [PMID: 32742310 PMCID: PMC7387892 DOI: 10.15420/ecr.2019.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/17/2020] [Indexed: 11/06/2022] Open
Abstract
Cardiovascular disease is the number one cause of death and disability worldwide. While substantial gains have been made in reducing cardiovascular mortality, future projections suggest that we have reached a nadir and may be at an inflection point, given the rising tide of obesity and diabetes. Evaluation and management of plasma lipids is central to the prevention of atherosclerotic cardiovascular disease. Although the standard lipid panel represents a well-established platform to assess risk, this test alone can be insufficient and/or misleading. Advances in our understanding of atherosclerosis have led to the development of lipid-based biomarkers that help to discriminate the risk of cardiovascular disease when it is unclear. While these biomarkers provide novel information, their implementation into clinical medicine remains difficult given discrepancies in the literature, lack of assay standardisation, poor accessibility and high cost. However, additional measures of atherogenic lipoproteins or their surrogates may offer insight beyond the standard lipid panel, providing a more precise assessment of risk and more accurate assessment of lipid-lowering therapy.
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Affiliation(s)
- Charles Amir German
- Division of Cardiovascular Disease, Center for Preventive Cardiology, Wake Forest Baptist Medical Center Winston-Salem, NC, US
| | - Michael David Shapiro
- Division of Cardiovascular Disease, Center for Preventive Cardiology, Wake Forest Baptist Medical Center Winston-Salem, NC, US
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246
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Ganetsky VS, Long JA, Mitra N, Chaiyachati KH, Kaufman ST. Impact of a Multidisciplinary, Endocrinologist-Led Shared Medical Appointment Model on Diabetes-Related Outcomes in an Underserved Population. Diabetes Spectr 2020; 33:74-81. [PMID: 32116457 PMCID: PMC7026762 DOI: 10.2337/ds19-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A multidisciplinary endocrinologist-led shared medical appointment (SMA) model showed statistically significant reductions in A1C from baseline over 3 years that were not significantly different from appointments with endocrinologists or primary care providers alone within a resource-poor population. Similarly, the SMA model achieved clinical outcomes on par with endocrinologist-only visits with the added benefit of improving endocrine provider productivity and specialty access for patients. Greater patient engagement with the SMA model was associated with significantly lower A1C.
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Affiliation(s)
| | - Judith A. Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA
| | - Krisda H. Chaiyachati
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven T. Kaufman
- Cooper University Hospital, Urban Health Institute, Camden, NJ
- Cooper Medical School of Rowan University, Camden, NJ
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247
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Kohli R, Ratziu V, Fiel MI, Waldmann E, Wilson DP, Balwani M. Initial assessment and ongoing monitoring of lysosomal acid lipase deficiency in children and adults: Consensus recommendations from an international collaborative working group. Mol Genet Metab 2020; 129:59-66. [PMID: 31767214 DOI: 10.1016/j.ymgme.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lysosomal acid lipase (LAL) deficiency is an ultra-rare, progressive, autosomal recessive disorder. Functional mutations in LIPA, the gene that encodes LAL, result in accumulation of cholesteryl esters and triglycerides in hepatocytes and in the macrophages of the intestines, vascular endothelial system, and numerous other organs. LAL deficiency has a broad clinical spectrum; children and adults can present with dyslipidemia, liver enzyme elevations, hepatosplenomegaly, hepatic steatosis, liver fibrosis and/or cirrhosis, and vascular disease, which may lead to significant morbidity and premature mortality in some patients. Given the systemic involvement and the wide range of healthcare specialists who manage patients with LAL deficiency, there is a need for guidelines to assess and monitor disease involvement. OBJECTIVES To provide a set of recommendations for the initial assessment and ongoing monitoring of patients with LAL deficiency to help physicians in various disciplines effectively manage the disease based on the observed presentation and progression in each case. METHODS A group of internationally recognized healthcare specialists with expertise in clinical genetics, pathology, hepatology, gastroenterology, cardiology, and lipidology convened to develop an evidence-based consensus of best practices for the initial assessment and ongoing monitoring of children and adults with LAL deficiency, regardless of treatment status; infants with LAL deficiency have been excluded from these guidelines because they require specialized care. RESULTS The authors present guidance for the assessment and monitoring of patients with LAL deficiency based on age and disease manifestations that include the hepatic, cardiovascular, and gastrointestinal systems. A schedule for ongoing monitoring of disease progression is provided. In addition, the need to establish an interdisciplinary and integrated care team to optimize the approach to managing this systemic disease is highlighted. CONCLUSIONS There is currently no published guidance on the assessment and monitoring of patients with LAL deficiency. These consensus recommendations for the initial assessment and ongoing monitoring of children and adults with LAL deficiency are intended to help improve the management of these patients.
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Affiliation(s)
- Rohit Kohli
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Vlad Ratziu
- Department of HepaGastroenterology, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France
| | - Maria Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, NY, New York, USA
| | - Elisa Waldmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Don P Wilson
- Division of Pediatric Endocrinology & Diabetes, Cook Children's Medical Center, Fort Worth, TX, USA
| | - Manisha Balwani
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai Hospital, NY, New York, USA.
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248
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Ceballos-Macías JJ, Madriz-Prado R, Vázquez Cárdenas NA, Aguilar-Salinas C, Tusié-Luna MT, Flores-Real JA, Ortega-Gutiérrez G, Vargas-Sánchez J, Lara-Sánchez C, Hernández-Moreno A. Use of PCSK9 Inhibitor in a Mexican Boy with Compound Heterozygous Familial Hypercholesterolemia: A Case Report. J Endocr Soc 2020; 4:bvz018. [PMID: 32104752 PMCID: PMC7035209 DOI: 10.1210/jendso/bvz018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/14/2019] [Indexed: 01/01/2023] Open
Abstract
We report on the case of an 8-year-old Mexican male, with a 3-year-old clinical diagnosis of familial hypercholesterolemia, and the difficulties encountered in his treatment while in our care. His treatment started with a regimen consisting of ezetimibe/simvastatin, cholestyramine, and a dietary plan of 1600 calories, with a limited intake of 200 mg of cholesterol per day. Problems arose when the patient's low-density lipoprotein cholesterol (LDL) levels did not meet ideal targets, which prompted the use of LDL cholesterol apheresis (not available in Mexico) for 6 months. As a last resort, PCSK9 inhibitors were administered but the LDL levels remained in the 600 mg/dL range. AmbryGenetics conducted a genetic test employing the Sanger method. The results suggested that there were 2 different mutations for each allele of the same LDL receptor gene (c.249delTinsGG and p.(Cys109Arg)), located in exons 3 and 4, respectively. We identified compound heterozygous mutations in our index case, with him having both the p.C109R mutation (from the maternal lineage), as well as a c.249delTinsGG mutation (from the paternal lineage). The p.C109R mutation has been previously reported, not only in Mexico, but in European regions (Germany, Czech Republic, Ireland, Italy) as well. Functional studies indicated a residual enzymatic activity of 15% to 30% for heterozygotes. To date, the variant c.249delTinsGG has not been reported. This case study illustrates the fact that in Mexico there are limited options available for treatment in such a scenario. As medical professionals, we are limited by the tools at our disposal.
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Affiliation(s)
- José Juan Ceballos-Macías
- Servicio de Endocrinología, Unidad de Especialidades Médicas de la Secretaria de Defensa Nacional, Edo MX, Mexico
| | - Ramón Madriz-Prado
- Servicio de Endocrinología, Unidad de Especialidades Médicas de la Secretaria de Defensa Nacional, Edo MX, Mexico
| | | | - Carlos Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.,Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX. Mexico
| | - Maria Teresa Tusié-Luna
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.,Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, CDMX. Mexico
| | | | | | | | - Carolina Lara-Sánchez
- Servicio de Endocrinología, Unidad de Especialidades Médicas de la Secretaria de Defensa Nacional, Edo MX, Mexico
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249
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Chylomicronemia syndrome: Familial or not? J Clin Lipidol 2020; 14:201-206. [PMID: 32107181 DOI: 10.1016/j.jacl.2020.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Chylomicronemia syndrome (CS) is a metabolic condition characterized by severely elevated plasma triglycerides (>880 mg/dL) and high rates of morbidity and mortality. The syndrome can be classified into two major groups: monogenic familial chylomicronemia syndrome (FCS) and multifactorial chylomicronemia syndrome (MCS), the frequencies of which are ill-defined. OBJECTIVE The objective of the study was to characterize the prevalence of the most common and rarest subsets of this syndrome, MCS and FCS, respectively, in a single-center, real-world setting. METHODS This was a retrospective cross-sectional study of patients with plasma triglycerides ≥880 mg/dL. The criteria used for identification of patients with FCS were modeled after a Food and Drug Administration endorsed set of parameters. Less stringent criteria that removed the requirement for pancreatitis were used to classify MCS. Full criteria are described in detail in the article. RESULTS Of the 2,342,136 patient records queried, 578 had triglycerides ≥880 mg/dL (0.025%), of which 86 had a documented history of pancreatitis. Five patients who met the criteria for FCS were identified (three genetically confirmed), resulting in an estimated prevalence of ~1-2 per 1,000,000. On the other hand, MCS was identified in 186 patients, corresponding to an estimated prevalence of ~1 in 12,000. There were 5181 cases of pancreatitis (0.22% of the entire cohort), 86 of which occurred in subjects with triglycerides≥880 mg/dL (1.7% of cases of pancreatitis). Rates of pancreatitis in this subset were elevated at 6.5%, 100%, and 17.8%, among patients with MCS, FCS, and secondary hypertriglyceridemia, respectively. CONCLUSIONS CS is an uncommon condition, but it is associated with significant complications, regardless of etiology. Among patients with CS, MCS was 40- to 60-fold more prevalent than FCS and associated with frequent morbidity. Therefore, disease recognition and treatment should extend to all forms of CS pursuant to the clinical presentation.
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250
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Familial hypercholesterolaemia: evolving knowledge for designing adaptive models of care. Nat Rev Cardiol 2020; 17:360-377. [DOI: 10.1038/s41569-019-0325-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2019] [Indexed: 01/05/2023]
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