2701
|
Tie C, Gao K, Zhang N, Zhang S, Shen J, Xie X, Wang JA. Ezetimibe Attenuates Atherosclerosis Associated with Lipid Reduction and Inflammation Inhibition. PLoS One 2015; 10:e0142430. [PMID: 26555472 PMCID: PMC4640821 DOI: 10.1371/journal.pone.0142430] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/21/2015] [Indexed: 12/13/2022] Open
Abstract
Background Ezetimibe, as a cholesterol absorption inhibitor, has been shown protecting against atherosclerosis when combined with statin. However, side by side comparison has not been made to evaluate the beneficial effects of ezetimibe alone versus statin. Herein, the study aimed to test whether ezetimibe alone would exhibit similar effects as statin and the combination therapy would be necessary in a moderate lesion size. Methods and Results ApoE-/- male mice that were fed a saturated-fat supplemented diet were randomly assigned to different therapeutic regimens: vehicle, ezetimibe alone (10 mg/kg/day), atorvastatin (20 mg/kg/day) or combination of ezetimibe and atorvastatin through the drinking water. On 28 days, mice were sacrificed and aorta and sera were collected to analyze the atherosclerotic lesion and blood lipid and cholesterol levels. As a result, ezetimibe alone exerted similar protective effects on atherosclerotic lesion sizes as atorvastatin, which was mediated by lowering serum cholesterol concentrations, inhibiting macrophage accumulation in the lesions and reducing circulatory inflammatory cytokines, such as monocyte chemoattractant protein (MCP-1) and tumor necrosis factor (TNF-α). In contrast to ezetimibe administration, atorvastatin alone attenuated atherosclerotic lesion which is dependent on its anti-inflammation effects. There were no significance differences in lesion areas and serum concentrations of cholesterol, oxidized LDL and inflammatory cytokines between combination therapy and monotherapy (either ezetimibe or atorvastatin). There were significant correlations between the lesion areas and serum concentrations of cholesterol, MCP-1 and TNF-α, respectively. However, there were no significant correlations between the lesion areas and serum concentrations of TGF-β1 and oxLDL. Conclusions Ezetimibe alone played the same protection against a moderate atherosclerotic lesion as atorvastatin, which was associated with lowering serum cholesterol, decreasing circulating inflammatory cytokines, and inhibiting macrophage accumulation in the lesions.
Collapse
Affiliation(s)
- Chunmiao Tie
- Department of Cardiology, Cardiovascular Key Laboratory of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- Department of Cardiology, Affiliated Boai Hospital of Shaoxing University, Shaoxing, Zhejiang, P.R. China
| | - Kanglu Gao
- Department of Cardiology, Cardiovascular Key Laboratory of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Na Zhang
- Department of Cardiology, Cardiovascular Key Laboratory of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Songzhao Zhang
- Department of Clinical Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Jiali Shen
- Department of Cardiology, Cardiovascular Key Laboratory of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Xiaojie Xie
- Department of Cardiology, Cardiovascular Key Laboratory of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- * E-mail: (XX); (JW)
| | - Jian-an Wang
- Department of Cardiology, Cardiovascular Key Laboratory of Zhejiang Province, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- * E-mail: (XX); (JW)
| |
Collapse
|
2702
|
Laslett L, Anderson HV, Clark B, Dewhurst TA, Waites TF, Wilson S, Erickson S, Smith AM. American College of Cardiology: Environmental Scanning Report Update 2015. J Am Coll Cardiol 2015; 66:D1-44. [PMID: 26542095 DOI: 10.1016/j.jacc.2015.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/05/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Bernard Clark
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | |
Collapse
|
2703
|
Simoons ML, Deckers JW. Intensive LDL lowering therapy for prevention of recurrent cardiovascular events: a word of caution. Eur Heart J 2015; 37:520-3. [PMID: 26537621 DOI: 10.1093/eurheartj/ehv616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/20/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Maarten L Simoons
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Room Ba 593, 's Gravensijkwal 230, PO box 2040, Rotterdam 3000 CA, The Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Room Ba 593, 's Gravensijkwal 230, PO box 2040, Rotterdam 3000 CA, The Netherlands
| |
Collapse
|
2704
|
Frishman WH. Can Clinicians Improve on the Effectiveness of Statins with Additional Lipid-lowering Therapies? Am J Med 2015; 128:1160-1. [PMID: 26184685 DOI: 10.1016/j.amjmed.2015.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
|
2705
|
Jain RK, Laiteerapong N. Strategies for improving cardiovascular health in women with diabetes mellitus: a review of the evidence. Curr Diab Rep 2015; 15:98. [PMID: 26391392 PMCID: PMC4886737 DOI: 10.1007/s11892-015-0665-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knowledge about cardiovascular (CV) disease in women with diabetes mellitus (DM) has changed substantially over the past 20 years. Coronary artery disease, strokes, and peripheral vascular disease affect women with DM at higher rates than the general population of women. Lifestyle therapies, such as dietary changes, physical activity, and smoking cessation, offer substantial benefits to women with DM. Of the pharmacotherapies, statins offer the most significant benefits but may not be well tolerated in some women. Aspirin may also benefit high-risk women. Other pharmacotherapies, such as fibrates, ezetimibe, niacin, fish oil, and hormone replacement therapy, remain unproven and, in some cases, potentially dangerous to women with DM. To reduce CV events, risks to women with DM must be better publicized and additional research must be done. Finally, advancements in health care delivery must target high-risk women with DM to lower risk factors and effectively improve cardiovascular health.
Collapse
Affiliation(s)
- Rajesh K Jain
- Department of Endocrinology, Diabetes, and Metabolism, University of Chicago Medicine, 5841 S Maryland Ave, AMB M267-MC1027, Chicago, IL, 60637, USA.
| | - Neda Laiteerapong
- Department of General Internal Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637, USA.
| |
Collapse
|
2706
|
LDL cholesterol levels and thin cap fibroatheromas: A dynamic and complex puzzle. Atherosclerosis 2015; 243:179-80. [DOI: 10.1016/j.atherosclerosis.2015.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022]
|
2707
|
Ferguson LD, Logue J. Has IMPROVE-IT improved cardiovascular outcome? J R Coll Physicians Edinb 2015; 45:215-7. [PMID: 26517102 DOI: 10.4997/jrcpe.2015.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- L D Ferguson
- LD Ferguson, Chemical Pathology & Metabolic Medicine, Department of Clinical Biochemistry, MacEwen Building, Glasgow Royal Infirmary, Glasgow, UK. Email
| | | |
Collapse
|
2708
|
Orho-Melander M. Genetics of coronary heart disease: towards causal mechanisms, novel drug targets and more personalized prevention. J Intern Med 2015; 278:433-46. [PMID: 26477595 DOI: 10.1111/joim.12407] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Coronary heart disease (CHD) is an archetypical multifactorial disorder that is influenced by genetic susceptibility as well as both modifiable and nonmodifiable risk factors, and their interactions. Advances during recent years in the field of multifactorial genetics, in particular genomewide association studies (GWASs) and their meta-analyses, have provided the statistical power to identify and replicate genetic variants in more than 50 risk loci for CHD and in several hundreds of loci for cardiometabolic risk factors for CHD such as blood lipids and lipoproteins. Although for a great majority of these loci both the causal variants and mechanisms remain unknown, progress in identifying the causal variants and underlying mechanisms has already been made for several genetic loci. Furthermore, identification of rare loss-of-function variants in genes such as PCSK9, NPC1L1, APOC3 and APOA5, which cause a markedly decreased risk of CHD and no adverse side effects, illustrates the power of translating genetic findings into novel mechanistic information and provides some optimism for the future of developing novel drugs, given the many genes associated with CHD in GWASs. Finally, Mendelian randomization can be used to reveal or exclude causal relationships between heritable biomarkers and CHD, and such approaches have already provided evidence of causal relationships between CHD and LDL cholesterol, triglycerides/remnant particles and lipoprotein(a), and indicated a lack of causality for HDL cholesterol, C-reactive protein and lipoprotein-associated phospholipase A2. Together, these genetic findings are beginning to lead to promising new drug targets and novel interventional strategies and thus have great potential to improve prevention, prediction and therapy of CHD.
Collapse
Affiliation(s)
- M Orho-Melander
- Department of Clinical Sciences in Malmö, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| |
Collapse
|
2709
|
Jacobson TA, Maki KC, Orringer CE, Jones PH, Kris-Etherton P, Sikand G, La Forge R, Daniels SR, Wilson DP, Morris PB, Wild RA, Grundy SM, Daviglus M, Ferdinand KC, Vijayaraghavan K, Deedwania PC, Aberg JA, Liao KP, McKenney JM, Ross JL, Braun LT, Ito MK, Bays HE, Brown WV. National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2. J Clin Lipidol 2015; 9:S1-122.e1. [DOI: 10.1016/j.jacl.2015.09.002] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
2710
|
Navar AM, Wang TY, Goldberg AC, Robinson JG, Roger VL, Wilson PF, Virani SS, Elassal J, Lee LV, Webb LE, Peterson E. Design and rationale for the Patient and Provider Assessment of Lipid Management (PALM) registry. Am Heart J 2015; 170:865-71. [PMID: 26542493 DOI: 10.1016/j.ahj.2015.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite improvements in diagnosis and treatment, the prevalence of hyperlipidemia among adults in the United States remains high. Data are limited on treatment patterns and patient perceptions of cardiovascular disease risk since the release of new lipid guidelines. OBJECTIVES The objectives of the PALM registry are to assess contemporary patterns of lipid-lowering therapy use among adults receiving care in a nationally representative cohort of community clinics, determine consistency of treatment with varying lipid guidelines, identify factors affecting use of lipid-lowering therapy including patient-reported statin intolerance, and assess patient and provider knowledge of cardiovascular risk reduction goals. STUDY DESIGN The PALM registry will enroll 7,500 patients likely to be considered for lipid-lowering therapy from 175 cardiology, primary care, and endocrinology practices across the United States. In this cross-sectional, observational registry, a novel tablet-based platform will be used to collect patient-reported knowledge, attitudes, and beliefs regarding cardiovascular risk reduction and lipid management. Chart abstraction and core laboratory lipid levels will describe current lipid management. Provider surveys will assess perception of current lipid-lowering goals and barriers to optimal cardiovascular risk reduction. CONCLUSION The PALM registry will allow for better understanding of current practice patterns, patient experiences, and patient and provider attitudes toward cholesterol management for cardiovascular disease risk reduction. These data can be used to better understand gaps in care and design targeted interventions to improve uptake of lipid-lowering therapies for cardiovascular risk reduction.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Salim S Virani
- Michael E. Debakey Veterans Affaris Hospital and Baylor College of Medicine, Houston, TX
| | | | | | | | | |
Collapse
|
2711
|
Ohshiro T, Ohtawa M, Nagamitsu T, Matsuda D, Yagyu H, Davis MA, Rudel LL, Ishibashi S, Tomoda H. New pyripyropene A derivatives, highly SOAT2-selective inhibitors, improve hypercholesterolemia and atherosclerosis in atherogenic mouse models. J Pharmacol Exp Ther 2015; 355:299-307. [PMID: 26338984 PMCID: PMC4613958 DOI: 10.1124/jpet.115.227348] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/28/2015] [Indexed: 12/26/2022] Open
Abstract
Sterol O-acyltransferase 2 (SOAT2; also known as ACAT2) is considered as a new therapeutic target for the treatment or prevention of hypercholesterolemia and atherosclerosis. Fungal pyripyropene A (PPPA: 1,7,11-triacyl type), the first SOAT2-selective inhibitor, proved orally active in vivo using atherogenic mouse models. The purpose of the present study was to demonstrate that the PPPA derivatives (PRDs) prove more effective in the mouse models than PPPA. Among 196 semisynthetic PPPA derivatives, potent, SOAT2-selective, and stable PRDs were selected. In vivo antiatherosclerotic activity of selected PRDs was tested in apolipoprotein E knockout (Apoe(-/-)) mice or low-density lipoprotein receptor knockout (Ldlr(-/-)) mice fed a cholesterol-enriched diet (0.2% cholesterol and 21% fat) for 12 weeks. During the PRD treatments, no detrimental side effects were observed. Among three PRDs, Apoe(-/-) mice treated with PRD125 (1-,11-O-benzylidene type) at 1 mg/kg/day had significantly lower total plasma cholesterol concentration by 57.9 ± 9.3%; further, the ratio of cholesteryl oleate to cholesteryl linoleate in low-density lipoprotein was lower by 55.6 ± 7.5%, respectively. The hepatic cholesteryl ester levels and SOAT2 activity in the small intestines and livers of the PRD-treated mice were selectively lowered. The atherosclerotic lesion areas in the aortae of PRD125-treated mice were significantly lower at 62.2 ± 13.1%, respectively. Furthermore, both PRDs were also orally active in atherogenic Ldlr(-/-) mice. Among the PRDs tested, PRD125 was the most potent in both mouse models. These results suggest that SOAT2-selective inhibitors such as PRD125 have a high potential as poststatin agents for treatment and/or prevention in patients with atherosclerosis and hypercholesterolemia.
Collapse
Affiliation(s)
- Taichi Ohshiro
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Masaki Ohtawa
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Tohru Nagamitsu
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Daisuke Matsuda
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Hiroaki Yagyu
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Matthew A Davis
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Lawrence L Rudel
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Shun Ishibashi
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| | - Hiroshi Tomoda
- Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan (T.O., M.O., T.N., D.M., H.T.); Department of Medicine, Jichi Medical University, Tochigi, Japan (T.O., H.Y., S.I.); and Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina (T.O., M.A.D., L.L.R.)
| |
Collapse
|
2712
|
Grundy SM. Metabolic syndrome update. Trends Cardiovasc Med 2015; 26:364-73. [PMID: 26654259 DOI: 10.1016/j.tcm.2015.10.004] [Citation(s) in RCA: 528] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/16/2015] [Accepted: 10/16/2015] [Indexed: 11/25/2022]
Abstract
The metabolic syndrome is a multiplex risk factor for atherosclerotic cardiovascular disease and type 2 diabetes. It is composed of atherogenic dyslipidemia, elevated blood pressure, insulin resistance and elevated glucose, a pro-thrombotic state, and a pro-inflammatory state. Excess energy intake and concomitant obesity are the major drivers of the syndrome. Lifestyle intervention can reverse metabolic risk factors, but at times, drug therapies or bariatric surgery may be required to control more overt risk factors.
Collapse
Affiliation(s)
- Scott M Grundy
- Department of Internal Medicine and Center for Human Nutrition, UT Southwestern Medical Center, Dallas, TX; Veterans Affairs Medical Center, Dallas, TX.
| |
Collapse
|
2713
|
Abstract
The combination of next-generation sequencing technologies and high-throughput genotyping platforms has revolutionized the pursuit of genetic variants that contribute towards disease. Furthermore, these technologies have provided invaluable insight into the genetic factors that prevent individuals from developing disease. Exploiting the evolutionary mechanisms that were designed by nature to help prevent disease is an attractive line of enquiry. Such efforts have the potential to generate a therapeutic target roadmap and rejuvenate the current drug-discovery pathway. By delineating the genomic factors that are protective against disease, there is potential to derive highly effective, genomically anchored medicines that assist in maintaining health.
Collapse
|
2714
|
Toth PP. Treatment of Dyslipidemia in Elderly Patients With Coronary Heart Disease: There Are Miles to Go Before We Sleep. J Am Coll Cardiol 2015; 66:1873-5. [PMID: 26493658 DOI: 10.1016/j.jacc.2015.06.1356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Peter P Toth
- CGH Medical Center, Sterling, Illinois, and the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
2715
|
Everett BM, Smith RJ, Hiatt WR. Reducing LDL with PCSK9 Inhibitors--The Clinical Benefit of Lipid Drugs. N Engl J Med 2015; 373:1588-91. [PMID: 26444323 DOI: 10.1056/nejmp1508120] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Brendan M Everett
- From Harvard Medical School and Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital - both in Boston (B.M.E.); the Department of Medicine, Alpert Medical School, and the Department of Health Services, Policy, and Practice, School of Public Health, Brown University; and Ocean State Research Institute, Providence VA Medical Center - all in Providence, RI (R.J.S.); and the Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, and CPC Clinical Research - both in Aurora (W.R.H.). All three authors participated as voting members of the FDA Endocrinologic and Metabolic Drugs Advisory Committee meeting on alirocumab, and Drs. Smith and Hiatt participated as voting members of the Advisory Committee meeting on evolocumab
| | | | | |
Collapse
|
2716
|
Smith BA, Wright C, Davidson M. Role of Ezetimibe in Lipid-Lowering and Cardiovascular Disease Prevention. Curr Atheroscler Rep 2015; 17:72. [DOI: 10.1007/s11883-015-0550-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
2717
|
Le NA, Tomassini JE, Tershakovec AM, Neff DR, Wilson PWF. Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid-Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease. J Am Heart Assoc 2015; 4:e001675. [PMID: 26486166 PMCID: PMC4845107 DOI: 10.1161/jaha.114.001675] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Patients with diabetes mellitus and cardiovascular disease may not achieve adequate low‐density lipoprotein cholesterol (LDL‐C) lowering on statin monotherapy, attributed partly to atherogenic dyslipidemia. More intensive LDL‐C–lowering therapy can be considered for these patients. A previous randomized, controlled study demonstrated greater LDL‐C lowering in diabetic patients with symptomatic cardiovascular disease who switched from simvastatin 20 mg (S20) or atorvastatin 10 mg (A10) to combination ezetimibe/simvastatin 10/20 mg (ES10/20) therapy, compared with statin dose‐doubling (to S40 or A20) or switching to rosuvastatin 10 mg (R10). The effect of these regimens on novel biomarkers of atherogenic dyslipidemia (low‐ and high‐density lipoprotein particle number and lipoprotein‐associated phospholipase A2 [Lp‐PLA2]) was assessed. Methods and Results Treatment effects on low‐ and high‐density lipoprotein particle number (by NMR) and Lp‐PLA2 (by ELISA) were evaluated using plasma samples available from 358 subjects in the study. Switching to ES10/20 reduced low‐density lipoprotein‐particle number numerically more than did statin dose‐doubling and was comparable with R10 (−133.3, −94.4, and −56.3 nmol/L, respectively; P>0.05). Increases in high‐density lipoprotein particle number were significantly greater with switches to ES10/20 versus statin dose‐doubling (1.5 and −0.5 μmol/L; P<0.05) and comparable with R10 (0.7 μmol/L; P>0.05). Percentages of patients attaining low‐density lipoprotein particle number levels <990 nmol/L were 62.4% for ES10/20, 54.1% for statin dose‐doubling, and 57.0% for R10. Switching to ES10/20 reduced Lp‐PLA2 activity significantly more than did statin dose‐doubling (−28.0 versus −3.8 nmol/min per mL, P<0.05) and was comparable with R10 (−28.0 versus −18.6 nmol/min per mL; P>0.05); effects on Lp‐PLA2 concentration were modest. Conclusions In diabetic patients with dyslipidemia, switching from statins to combination ES10/20 therapy generally improved lipoprotein subclass profile and Lp‐PLA2 activity more than did statin dose‐doubling and was comparable with R10, consistent with its lipid effects. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00862251.
Collapse
Affiliation(s)
- Ngoc-Anh Le
- Biomarker Core Laboratory, Atlanta VAMC, Decatur, GA (N.A.L., P.F.W.)
| | | | | | - David R Neff
- Merck Research Laboratories, Kenilworth, NJ (J.E.T., A.M.T., D.R.N.)
| | - Peter W F Wilson
- Biomarker Core Laboratory, Atlanta VAMC, Decatur, GA (N.A.L., P.F.W.) Emory University School of Medicine, Atlanta, GA (P.F.W.)
| |
Collapse
|
2718
|
Stoekenbroek RM, Kastelein JJP, Huijgen R. PCSK9 inhibition: the way forward in the treatment of dyslipidemia. BMC Med 2015; 13:258. [PMID: 26456772 PMCID: PMC4601145 DOI: 10.1186/s12916-015-0503-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023] Open
Abstract
Barely a decade after the discovery of the gene encoding proprotein convertase subtilisin/kexin type 9 (PCSK9) and its recognition as a key player in cholesterol metabolism, PCSK9 inhibition is now considered an exciting approach in the reduction of residual risk of cardiovascular disease. The progress from PCSK9 discovery to the development of targeted treatment has been unprecedented in terms of scale and speed. The first suggestion of a link between PCSK9 and hypercholesterolemia was published in 2003; a decade later, two meta-analyses of clinical trials comparing anti-PCSK9 treatment to placebo or ezetimibe, including >10,000 hypercholesterolemic individuals, were published. Currently, three PCSK9 inhibitors are being evaluated in clinical outcome trials and the results will determine the future of these lipid-lowering therapies by establishing their clinical efficacy in terms of cardiovascular event reduction, safety, and the consequences of prolonged exposure to very low levels of LDL-cholesterol. Irrespective of their outcomes, the exceptionally rapid development of these drugs exemplifies how novel technologies, genetic validation, and rapid clinical progression provide the tools to expedite the development of new drugs.
Collapse
Affiliation(s)
- Robert M Stoekenbroek
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| | - Roeland Huijgen
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.
| |
Collapse
|
2719
|
Leon BM, Maddox TM. Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes 2015; 6:1246-1258. [PMID: 26468341 PMCID: PMC4600176 DOI: 10.4239/wjd.v6.i13.1246] [Citation(s) in RCA: 613] [Impact Index Per Article: 68.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 05/08/2015] [Accepted: 09/18/2015] [Indexed: 02/05/2023] Open
Abstract
The incidence of diabetes mellitus (DM) continues to rise and has quickly become one of the most prevalent and costly chronic diseases worldwide. A close link exists between DM and cardiovascular disease (CVD), which is the most prevalent cause of morbidity and mortality in diabetic patients. Cardiovascular (CV) risk factors such as obesity, hypertension and dyslipidemia are common in patients with DM, placing them at increased risk for cardiac events. In addition, many studies have found biological mechanisms associated with DM that independently increase the risk of CVD in diabetic patients. Therefore, targeting CV risk factors in patients with DM is critical to minimize the long-term CV complications of the disease. This paper summarizes the relationship between diabetes and CVD, examines possible mechanisms of disease progression, discusses current treatment recommendations, and outlines future research directions.
Collapse
|
2720
|
Kedia AW, Lynch E. Effects of switching from omega-3-acid ethyl esters to icosapent ethyl in a statin-treated patient with elevated triglycerides. Postgrad Med 2015; 127:869-73. [DOI: 10.1080/00325481.2015.1100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
2721
|
Yang E. PCSK9 Inhibitors: Are We on the Verge of a Breakthrough? Clin Pharmacol Ther 2015; 98:590-601. [DOI: 10.1002/cpt.263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 01/28/2023]
Affiliation(s)
- E Yang
- Division of Cardiology; University of Washington School of Medicine; Seattle Washington USA
| |
Collapse
|
2722
|
|
2723
|
Bittencourt MS, Cerci RJ. Statin effects on atherosclerotic plaques: regression or healing? BMC Med 2015; 13:260. [PMID: 26449405 PMCID: PMC4599025 DOI: 10.1186/s12916-015-0499-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 01/04/2023] Open
Abstract
Despite the well-documented improved survival of coronary heart disease with the use of statins, their effects on atherosclerotic plaques are not yet fully understood. While some studies suggest statins may reduce plaque volume, the reduction is small even with the use of high-dose statins. Due to this small change in plaque volume, other effects of statin therapy on plaques have been proposed. A large meta-analysis by Banach et al. explored statin effects on plaque composition detected by intravascular ultrasound (IVUS). We discuss the mechanisms of plaque composition modification demonstrated in their study and its implications on atherosclerotic plaque stabilization. Please see related article: http://www.biomedcentral.com/1741-7015/13/229.
Collapse
Affiliation(s)
- Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute; University of São Paulo School of Medicine, Av. Lineu Prestes, 2565, São Paulo, 05508-000, Brazil. .,Preventive Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | |
Collapse
|
2724
|
Yaghi S, Elkind MSV. Lipids and Cerebrovascular Disease: Research and Practice. Stroke 2015; 46:3322-8. [PMID: 26451029 DOI: 10.1161/strokeaha.115.011164] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/09/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Shadi Yaghi
- From the Division of Stroke and Cerebrovascular Disease, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y.); and Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.)
| | - Mitchell S V Elkind
- From the Division of Stroke and Cerebrovascular Disease, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y.); and Department of Neurology, College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
| |
Collapse
|
2725
|
Agouridis AP, Kostapanos MS, Elisaf MS. Statins and their increased risk of inducing diabetes. Expert Opin Drug Saf 2015; 14:1835-44. [PMID: 26437128 DOI: 10.1517/14740338.2015.1096343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
2726
|
Cusi K. Therapy and clinical trials. Curr Opin Lipidol 2015; 26:472-4. [PMID: 26339771 DOI: 10.1097/mol.0000000000000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida and Malcolm Randall veterans Administration medical Center, Gainesville, USA
| |
Collapse
|
2727
|
Affiliation(s)
- Ralph Burkhardt
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig LIFE - Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
| |
Collapse
|
2728
|
Pletcher MJ. Treating elevated LDL cholesterol in patients with low short-term risk: Decision making at the limits of EBM. EVIDENCE-BASED MEDICINE 2015; 20:151-153. [PMID: 26378087 DOI: 10.1136/ebmed-2015-110257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
2729
|
Abstract
Glucose and lipid metabolism are linked to each other in many ways. The most important clinical manifestation of this interaction is diabetic dyslipidemia, characterized by elevated triglycerides, low high density lipoprotein cholesterol (HDL-C), and predominance of small-dense LDL particles. However, in the last decade we have learned that the interaction is much more complex. Hypertriglyceridemia and low HDL-C cannot only be the consequence but also the cause of a disturbed glucose metabolism. Furthermore, it is now well established that statins are associated with a small but significant increase in the risk for new onset diabetes. The underlying mechanisms are not completely understood but modulation of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA)-reductase may play a central role as genetic data indicate that mutations resulting in lower HMG CoA-reductase activity are also associated with obesity, higher glucose concentrations and diabetes. Very interestingly, this statin induced increased risk for new onset type 2 diabetes is not detectable in subjects with familial hypercholesterolemia. Furthermore, patients with familial hypercholesterolemia seem to have a lower risk for type 2 diabetes, a phenomenon which seems to be dose-dependent (the higher the low density lipoprotein cholesterol, the lower the risk). Whether there is also an interaction between lipoprotein(a) and diabetes is still a matter of debate.
Collapse
Affiliation(s)
- Klaus G. Parhofer
- Department of Medicine 2-Grosshadern, University of Munich, Munich, Germany
| |
Collapse
|
2730
|
Seidah NG. The PCSK9 revolution and the potential of PCSK9-based therapies to reduce LDL-cholesterol. Glob Cardiol Sci Pract 2015. [DOI: 10.5339/gcsp.2015.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
2731
|
Michos ED, Martin SS, Blumenthal RS. Bringing back targets to "IMPROVE" atherosclerotic cardiovascular disease outcomes: the duel for dual goals; are two targets better than one? Circulation 2015; 132:1218-20. [PMID: 26330413 DOI: 10.1161/circulationaha.115.018511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Erin D Michos
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Seth S Martin
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- From Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
2732
|
Sando KR, Knight M. Nonstatin therapies for management of dyslipidemia: a review. Clin Ther 2015; 37:2153-79. [PMID: 26412799 DOI: 10.1016/j.clinthera.2015.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/29/2015] [Accepted: 09/01/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States. Recently published cholesterol treatment guidelines emphasize the use of statins as the preferred treatment strategy for both primary and secondary prevention of CVD. However, the optimal treatment strategy for patients who cannot tolerate statin therapy or those who need additional lipid-lowering therapy is unclear in light of recent evidence that demonstrates a lack of improved cardiovascular outcomes with combination therapy. The purpose of this review is to summarize and interpret evidence that evaluates nonstatin drug classes in reducing cardiovascular outcomes, to provide recommendations for use of nonstatin therapies in clinical practice, and to review emerging nonstatin therapies for management of dyslipidemia. METHODS Relevant articles were identified through searches of PubMed, International Pharmaceutical Abstracts, and the Cochrane Database of Systematic Reviews by using the terms niacin, omega-3 fatty acids (FAs), clofibrate, fibrate, fenofibrate, fenofibric acid, gemfibrozil, cholestyramine, colestipol, colesevelam, ezetimibe, proprotein convertase subtilisin/kexin 9 (PCSK9), cholesteryl ester transfer protein (CETP), and cardiovascular outcomes. Only English language, human clinical trials, meta-analyses, and systematic reviews were included. Additional references were identified from citations of published articles. FINDINGS Niacin may reduce cardiovascular events as monotherapy; however, recent trials in combination with statins have failed to show a benefit. Trials with omega-3 FAs have failed to demonstrate significant reductions in cardiovascular outcomes. Fibrates may improve cardiovascular outcomes as monotherapy; however, trials in combination with statins have failed to show a benefit, except in those with elevated triglycerides (>200 mg/dL) or low HDL-C (<40 mg/dL). There is a lack of data that evaluates bile acid sequestrant in combination with statin therapy on reducing cardiovascular events. Ezetimibe-statin combination therapy can reduce cardiovascular outcomes in those with chronic kidney disease and following vascular surgery or acute coronary syndrome. Long-term effects of emerging nonstatin therapies (CETP and PCSK9 inhibitors) are currently being evaluated in ongoing Phase III trials. IMPLICATIONS Nonstatin therapies have a limited role in reducing cardiovascular events in those maintained on guideline-directed statin therapy. In certain clinical situations, such as patients who are unable to tolerate statin therapy or recommended intensities of statin therapy, those with persistent severe elevations in triglycerides, or patients with high cardiovascular risk, some nonstatin therapies may be useful in reducing cardiovascular events. Future research is needed to evaluate the role of nonstatin therapies in those who are unable to tolerate guideline-directed statin doses.
Collapse
Affiliation(s)
- Karen R Sando
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, Florida.
| | - Michelle Knight
- College of Pharmacy, Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, Florida
| |
Collapse
|
2733
|
Blom DJ, Djedjos CS, Monsalvo ML, Bridges I, Wasserman SM, Scott R, Roth E. Effects of Evolocumab on Vitamin E and Steroid Hormone Levels. Circ Res 2015; 117:731-41. [DOI: 10.1161/circresaha.115.307071] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/30/2015] [Indexed: 11/16/2022]
Abstract
Rationale
:
Vitamin E transport and steroidogenesis are closely associated with low-density lipoproteins (LDLs) metabolism, and evolocumab can lower LDL cholesterol (LDL-C) to low levels.
Objective:
To determine the effects of evolocumab on vitamin E and steroid hormone levels.
Methods and Results:
After titration of background lipid-lowering therapy per cardiovascular risk, 901 patients with an LDL-C ≥2.0 mmol/L were randomized to 52 weeks of monthly, subcutaneous evolocumab, or placebo. Vitamin E, cortisol, adrenocorticotropic hormone, and gonadal hormones were analyzed at baseline and week 52. In a substudy (n=100), vitamin E levels were also measured in serum, LDL, high-density lipoprotein, and red blood cell membranes at baseline and week 52. Absolute vitamin E decreased in evolocumab-treated patients from baseline to week 52 by 16% but increased by 19% when normalized for cholesterol. In the substudy, vitamin E level changes from baseline to week 52 mirrored the changes in the lipid fraction, and red blood cell membrane vitamin E levels did not change. Cortisol in evolocumab-treated patients increased slightly from baseline to week 52, but adrenocorticotropic hormone and the cortisol:adrenocorticotropic hormone ratio did not change. No patient had a cortisol:adrenocorticotropic hormone ratio <3.0 (nmol/pmol). Among evolocumab-treated patients, gonadal hormones did not change from baseline to week 52. Vitamin E and steroid changes were consistent across subgroups by minimum postbaseline LDL-C <0.4 and <0.6 mmol/L.
Conclusions:
As expected, vitamin E levels changed similarly to lipids among patients treated for 52 weeks with evolocumab. No adverse effects were observed in steroid or gonadal hormones, even at very low LDL-C levels.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01516879.
Collapse
Affiliation(s)
- Dirk J. Blom
- From the Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa (D.J.B.); Cardiovascular Therapeutic Area, Amgen Inc, Thousand Oaks, CA (C.S.D., M.L.M., S.M.W., R.S.); Biostatistics-International, Amgen Ltd, Uxbridge, United Kingdom (I.B.); and President, Sterling Research Group, Cincinnati, OH (E.R.)
| | - C. Stephen Djedjos
- From the Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa (D.J.B.); Cardiovascular Therapeutic Area, Amgen Inc, Thousand Oaks, CA (C.S.D., M.L.M., S.M.W., R.S.); Biostatistics-International, Amgen Ltd, Uxbridge, United Kingdom (I.B.); and President, Sterling Research Group, Cincinnati, OH (E.R.)
| | - Maria Laura Monsalvo
- From the Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa (D.J.B.); Cardiovascular Therapeutic Area, Amgen Inc, Thousand Oaks, CA (C.S.D., M.L.M., S.M.W., R.S.); Biostatistics-International, Amgen Ltd, Uxbridge, United Kingdom (I.B.); and President, Sterling Research Group, Cincinnati, OH (E.R.)
| | - Ian Bridges
- From the Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa (D.J.B.); Cardiovascular Therapeutic Area, Amgen Inc, Thousand Oaks, CA (C.S.D., M.L.M., S.M.W., R.S.); Biostatistics-International, Amgen Ltd, Uxbridge, United Kingdom (I.B.); and President, Sterling Research Group, Cincinnati, OH (E.R.)
| | - Scott M. Wasserman
- From the Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa (D.J.B.); Cardiovascular Therapeutic Area, Amgen Inc, Thousand Oaks, CA (C.S.D., M.L.M., S.M.W., R.S.); Biostatistics-International, Amgen Ltd, Uxbridge, United Kingdom (I.B.); and President, Sterling Research Group, Cincinnati, OH (E.R.)
| | - Rob Scott
- From the Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa (D.J.B.); Cardiovascular Therapeutic Area, Amgen Inc, Thousand Oaks, CA (C.S.D., M.L.M., S.M.W., R.S.); Biostatistics-International, Amgen Ltd, Uxbridge, United Kingdom (I.B.); and President, Sterling Research Group, Cincinnati, OH (E.R.)
| | - Eli Roth
- From the Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa (D.J.B.); Cardiovascular Therapeutic Area, Amgen Inc, Thousand Oaks, CA (C.S.D., M.L.M., S.M.W., R.S.); Biostatistics-International, Amgen Ltd, Uxbridge, United Kingdom (I.B.); and President, Sterling Research Group, Cincinnati, OH (E.R.)
| |
Collapse
|
2734
|
Almquist T, Mobarrez F, Jacobson SH, Wallén H, Hjemdahl P. Effects of lipid-lowering treatment on circulating microparticles in patients with diabetes mellitus and chronic kidney disease. Nephrol Dial Transplant 2015; 31:944-52. [PMID: 26394646 DOI: 10.1093/ndt/gfv337] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/11/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Elevated levels of circulating microparticles (MPs) may contribute to the high cardiovascular risk in diabetes mellitus (DM) and chronic kidney disease (CKD). Therefore, we investigated the effects of lipid-lowering treatment (LLT) with simvastatin alone (S) or with ezetimibe (S+E) on MPs in DM patients with or without CKD. METHODS After a placebo run-in period, 18 DM patients with an estimated glomerular filtration rate (eGFR) of 15-59 mL/min (CKD stages 3-4) (DM-CKD) and 21 DM patients with eGFR >75 mL/min (DM-only) were treated with S and S+E in a randomized, double-blind, crossover study. MPs from platelets, monocytes and endothelial cells (PMPs, MMPs and EMPs), and their expression of phosphatidylserine (PS), P-selectin, CD40 ligand (CD40L) and tissue factor (TF) were measured by flow cytometry. RESULTS At baseline, all types of MPs, except TF-positive MMPs, were elevated in DM-CKD compared with DM-only patients. All MPs, regardless of origin and phenotype, were inversely correlated with eGFR. S reduced the expression of P-selectin, TF and CD40L on PMPs and of TF on MMPs in both patient groups. S+E had no further effect. S also reduced total PS-positive procoagulant MPs, PMPs and MMPs in DM-CKD but not in DM-only patients. CONCLUSIONS DM patients with CKD stages 3-4 had elevated PMPs, EMPs and MMPs compared with DM patients with normal GFR. Simvastatin reduced procoagulant MPs, MMPs and PMPs in DM-CKD patients, suggesting a beneficial reduction of hypercoagulability in this high-risk patient group. Differences between DM-CKD and DM-only patients were counteracted by LLT.
Collapse
Affiliation(s)
- Tora Almquist
- Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Stockholm, Sweden Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Fariborz Mobarrez
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden Department of Medicine Solna, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Stefan H Jacobson
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Håkan Wallén
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Pharmacology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Stockholm, Sweden
| |
Collapse
|
2735
|
Hegele RA, Gidding SS, Ginsberg HN, McPherson R, Raal FJ, Rader DJ, Robinson JG, Welty FK. Nonstatin Low-Density Lipoprotein-Lowering Therapy and Cardiovascular Risk Reduction-Statement From ATVB Council. Arterioscler Thromb Vasc Biol 2015; 35:2269-80. [PMID: 26376908 DOI: 10.1161/atvbaha.115.306442] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/28/2015] [Indexed: 12/15/2022]
Abstract
Pharmacological reduction of low-density lipoprotein (LDL) cholesterol using statin drugs is foundational therapy to reduce cardiovascular disease (CVD) risk. Here, we consider the place of nonstatin therapies that also reduce LDL cholesterol in prevention of CVD. Among conventional nonstatins, placebo-controlled randomized clinical trials showed that bile acid sequestrants, niacin, and fibrates given as monotherapy each reduce CVD end points. From trials in which patients' LDL cholesterol was already well controlled on a statin, adding ezetimibe incrementally reduced CVD end points, whereas adding a fibrate or niacin showed no incremental benefit. Among emerging nonstatins, monoclonal antibodies against proprotein convertase subtilisin kexin type 9 added to a statin and given for ≤78 weeks showed preliminary evidence of reductions in CVD outcomes. Although these promising early findings contributed to the recent approval of these agents in Europe and in North America, much larger and longer duration outcomes studies are ongoing for definitive proof of CVD benefits. Other nonstatin agents recently approved in the United States include lomitapide and mipomersen, which both act via distinctive LDL receptor independent mechanisms to substantially reduce LDL cholesterol in homozygous familial hypercholesterolemia. We also address some unanswered questions, including measuring alternative biochemical variables to LDL cholesterol, evidence for treating children with monitoring of subclinical atherosclerosis, and potential risks of extremely low LDL cholesterol. As evidence for benefit in CVD prevention accumulates, we anticipate that clinical practice will shift toward more assertive LDL-lowering treatment, using both statins and nonstatins initiated earlier in appropriately selected patients.
Collapse
Affiliation(s)
- Robert A Hegele
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.).
| | - Samuel S Gidding
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Henry N Ginsberg
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Ruth McPherson
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Frederick J Raal
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Daniel J Rader
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Jennifer G Robinson
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| | - Francine K Welty
- From the Department of Medicine, Robarts Research Institute, Schulich School of Medicine, Western University, London, Ontario, Canada (R.A.H.); Nemours Cardiac Center, A. I. duPont Hospital for Children, Wilmington, DE (S.S.G.); Irving Institute for Clinical and Translational Research, Department of Medicine, Columbia University, New York, NY (H.N.G.); Department of Medicine and Biochemistry, Atherogenomics Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa (F.J.R); Department of Genetics (D.J.R.) and Division of Translational Medicine and Human Genetics, Department of Medicine (D.J.R.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Epidemiology and Medicine, University of Iowa, Iowa City (J.G.R.); and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.K.W.)
| |
Collapse
|
2736
|
Raggi P, Boer R, Goodman WG, Kalantar-Zadeh K, Chertow GM, Belozeroff V. Cardiovascular and Renal Outcomes Trials-Is There a Difference? Am J Cardiol 2015. [PMID: 26198118 DOI: 10.1016/j.amjcard.2015.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a general sense that most outcomes trials in patients receiving dialysis failed to yield statistically significant benefits, in contrast to many cardiovascular (CV) trials in the general population. It is unknown whether methodologic reasons caused this discrepancy. We performed a systematic MEDLINE search for randomized trials with mortality end points of the 42 compounds most commonly used for CV indications. In total, 115 trials were selected for review. We further reviewed 9 mortality end point trials in patients receiving dialysis. The CV trials in populations not receiving dialysis enrolled from 66 to 33,357 participants with an average of 4,910; 59% of the trials showed statistically significant results. The average hazard ratio (HR) was 0.77, ranging from 0.10 to 1.65; 10 drugs had ≥5 published trials each. In the population receiving dialysis, most drugs were studied in single trials; the average number of patients was 1,500 with a range of 127 to 3,883. The average HR was 0.77 and ranged from 0.06 to 1.30. Only 22% of the trials showed statistically significant results. The limitations listed in the general population and dialysis studies were similar. In conclusion, no apparent methodologic issues were detected (other than sample size) that could justify the lower frequency of randomized trials with statistically significant results in patients receiving dialysis. The most obvious difference was the paucity of trials with each drug in the dialysis cohorts; this lowers the chances of at least 1 trial being successful.
Collapse
|
2737
|
Borow KM, Nelson JR, Mason RP. Biologic plausibility, cellular effects, and molecular mechanisms of eicosapentaenoic acid (EPA) in atherosclerosis. Atherosclerosis 2015; 242:357-66. [DOI: 10.1016/j.atherosclerosis.2015.07.035] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/06/2015] [Accepted: 07/20/2015] [Indexed: 01/08/2023]
|
2738
|
Bohula EA, Giugliano RP, Cannon CP, Zhou J, Murphy SA, White JA, Tershakovec AM, Blazing MA, Braunwald E. Achievement of dual low-density lipoprotein cholesterol and high-sensitivity C-reactive protein targets more frequent with the addition of ezetimibe to simvastatin and associated with better outcomes in IMPROVE-IT. Circulation 2015; 132:1224-33. [PMID: 26330412 DOI: 10.1161/circulationaha.115.018381] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Statins lower low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP); addition of ezetimibe to statins further reduces LDL-C and hs-CRP. An analysis of the relationship between achieved LDL-C and hs-CRP targets and outcomes for simvastatin and ezetimibe/simvastatin was prespecified in Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT). METHODS AND RESULTS The IMPROVE-IT trial randomly assigned 18 144 patients stabilized after acute coronary syndrome to simvastatin or ezetimibe/simvastatin. LDL-C and hs-CRP were measured at baseline and 1 month after randomization. Outcomes were assessed in those achieving one or both of the prespecified targets of LDL-C<70 mg/dL and hs-CRP<2 mg/L versus achieving neither target, adjusting for differences in baseline characteristics. An exploratory analysis examined targets of LDL-C<50 mg/dL and hs-CRP<1 mg/L. Patients meeting both targets at baseline, with no 1-month values, or with end points before 1 month were excluded. Of 15 179 patients, 39% achieved the dual LDL-C (<70 mg/dL) and hs-CRP (<2 mg/L) targets at 1 month, 14% met neither target, 14% met only the hs-CRP target, and 33% met only the LDL-C target. Those achieving dual targets had lower primary end point rates than those meeting neither target (cardiovascular death, major coronary event, or stroke; 38.9% versus 28.0%; adjusted hazard ratio, 0.73; 0.66-0.81; P<0.001). More patients treated with ezetimibe/simvastatin met dual targets than those treated with simvastatin alone (50% versus 29%, P<0.001). The association of dual-target attainment with improved outcomes was similar irrespective of treatment assignment (P-interaction=0.65). Similar findings were observed using the exploratory targets. CONCLUSIONS Significantly more patients treated with ezetimibe/simvastatin met prespecified and exploratory dual LDL-C and hs-CRP targets than patients treated with simvastatin alone. Reaching both LDL-C and hs-CRP targets was associated with improved outcomes after multivariable adjustment. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov; Unique identifier: NCT00202878.
Collapse
Affiliation(s)
- Erin A Bohula
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.).
| | - Robert P Giugliano
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| | - Christopher P Cannon
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| | - Jing Zhou
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| | - Sabina A Murphy
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| | - Jennifer A White
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| | - Andrew M Tershakovec
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| | - Michael A Blazing
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| | - Eugene Braunwald
- From TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (E.A.B., R.P.G., C.P.C., J.Z., S.A.M., E.B.); Duke Clinical Research Institute, Durham, NC (J.W., M.A.B.); and Merck, Kenilworth, NJ (A.M.T.)
| |
Collapse
|
2739
|
Barkas F, Elisaf M, Milionis H. Statins decrease the risk of stroke in individuals with heterozygous familial hypercholesterolemia: A systematic review and meta-analysis. Atherosclerosis 2015; 243:60-4. [PMID: 26350916 DOI: 10.1016/j.atherosclerosis.2015.08.038] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is undoubtedly associated with premature coronary heart disease, but it is debatable whether FH increases the risk for stroke. OBJECTIVE To meta-analyze available evidence regarding the incidence of stroke in individuals with heterozygous (He) FH. METHODS We conducted a systematic review and a meta-analysis of epidemiological studies, including English-language publications until June 2015; four observational studies, with 3374 participants with HeFH, were included in the analysis. Cerebrovascular disease comprised of ischemic stroke or transient ischemic attack. Since studies did not include any control subjects, the corresponding general population of the same reference area and period of time for each HeFH study served as control group. Analyses were performed according to the period of time during which the studies were conducted: prestatin and statin era (before and after 1987 when lovastatin was launched). RESULTS In the prestatin era, individuals with HeFH exhibited a higher risk for stroke compared with the general population [odds ratio (OR) = 7.658, 95% confidence interval (CI): 6.059-9.678, p < 0.01]. In contrast, FH subjects had a lower odds for stroke following the generalization of statin therapy (OR = 0.251, 95% CI: 0.176-0.358, p < 0.01). CONCLUSIONS Taking into account the small number of studies and methodological issues, HeFH was associated with a higher risk of cerebrovascular disease compared with the general population in the prestatin era, which was significantly reduced after the introduction of statin therapy.
Collapse
Affiliation(s)
- Fotios Barkas
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
| | - Moses Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
| |
Collapse
|
2740
|
Cainzos-Achirica M, Desai CS, Wang L, Blaha MJ, Lopez-Jimenez F, Kopecky SL, Blumenthal RS, Martin SS. Pathways Forward in Cardiovascular Disease Prevention One and a Half Years After Publication of the 2013 ACC/AHA Cardiovascular Disease Prevention Guidelines. Mayo Clin Proc 2015; 90:1262-71. [PMID: 26269108 PMCID: PMC4567417 DOI: 10.1016/j.mayocp.2015.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 01/11/2023]
Abstract
The 2013 American College of Cardiology/American Heart Association cardiovascular disease prevention guidelines represent an important step forward in the risk assessment and management of atherosclerotic cardiovascular disease in clinical practice. Differentiated risk prediction equations for women and black individuals were developed, and convenient 10-year and lifetime risk assessment tools were provided, facilitating their implementation. Lifestyle modification was portrayed as the foundation of preventive therapy. In addition, based on high-quality evidence from randomized controlled trials, statins were prioritized as the first lipid-lowering pharmacologic treatment, and a shared decision-making model between the physician and the patient was emphasized as a key feature of personalized care. After publication of the guidelines, however, important limitations were also identified. This resulted in a constructive scientific debate yielding valuable insights into potential opportunities to refine recommendations, fill gaps in guidance, and better harmonize recommendations within and outside the United States. The latter point deserves emphasis because when guidelines are in disagreement, this may result in nonaction on the part of professional caregivers or nonadherence by patients. In this review, we discuss the key scientific literature relevant to the guidelines published in the year and a half after their release. We aim to provide cohesive, evidence-based views that may offer pathways forward in cardiovascular disease prevention toward greater consensus and benefit the practice of clinical medicine.
Collapse
Affiliation(s)
- Miguel Cainzos-Achirica
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Chintan S Desai
- Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Libin Wang
- Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Michael J Blaha
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Seth S Martin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD.
| |
Collapse
|
2741
|
Lauridsen BK, Stender S, Tybjærg-Hansen A. Genetic Variation in NPC1L1 and Risk of Gallstone Disease. J Am Coll Cardiol 2015; 66:1086. [PMID: 26314540 DOI: 10.1016/j.jacc.2015.05.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 01/17/2023]
|
2742
|
Aguiar C, Alegria E, Bonadonna RC, Catapano AL, Cosentino F, Elisaf M, Farnier M, Ferrières J, Filardi PP, Hancu N, Kayikcioglu M, Mello e Silva A, Millan J, Reiner Ž, Tokgozoglu L, Valensi P, Viigimaa M, Vrablik M, Zambon A, Zamorano JL, Ferrari R. A review of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidaemia: A report from an expert consensus meeting on the role of fenofibrate–statin combination therapy. ATHEROSCLEROSIS SUPP 2015; 19:1-12. [DOI: 10.1016/s1567-5688(15)30001-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
2743
|
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2015; 37:267-315. [PMID: 26320110 DOI: 10.1093/eurheartj/ehv320] [Citation(s) in RCA: 4245] [Impact Index Per Article: 471.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
2744
|
Page MM, Watts GF. Evolocumab in the treatment of dyslipidemia: pre-clinical and clinical pharmacology. Expert Opin Drug Metab Toxicol 2015; 11:1505-15. [DOI: 10.1517/17425255.2015.1073712] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
2745
|
Thomopoulos C, Skalis G, Michalopoulou H, Tsioufis C, Makris T. Effect of Low-Density Lipoprotein Cholesterol Lowering by Ezetimibe/Simvastatin on Outcome Incidence: Overview, Meta-Analyses, and Meta-Regression Analyses of Randomized Trials. Clin Cardiol 2015; 38:763-9. [PMID: 26282344 DOI: 10.1002/clc.22441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/06/2015] [Accepted: 07/09/2015] [Indexed: 01/11/2023] Open
Abstract
This analysis investigated the extent of different outcome reductions from low-density lipoprotein cholesterol (LDL-C) lowering following ezetimibe/simvastatin treatment and the proportionality of outcome to LDL-C reductions. The authors searched PubMed between 1997 and mid-June 2015 (any language) and the Cochrane Library to identify all randomized controlled trials comparing ezetimibe/simvastatin with placebo or less intensive LDL-C lowering. Risk ratios (RR) and 95% confidence intervals (CIs), standardized to 20 mg/dL LDL-C reduction, were calculated for 5 primary outcomes (fatal and nonfatal) and 4 secondary outcomes (non-cardiovascular [CV] death, cancer, myopathy, and hepatopathy). Five ezetimibe/simvastatin RCTs (30 051 individuals) were eligible, 2 comparing ezetimibe/simvastatin vs placebo and 3 vs less intensive treatment. Outcomes reduced almost to the same extent were stroke (RR: -13%, 95% CI: -21% to -3%), coronary heart disease (CHD; RR: -12%, 95% CI: -19% to -5%), and composite of stroke and CHD (RR: -14%, 95% CI: -20% to -8%). Absolute risk reductions: 5 strokes, 10 CHD events, and 16 stroke and CHD events prevented for every 1000 patients treated for 5 years. Residual risk was almost 7× higher than absolute risk reduction for all the above outcomes. All death outcomes were not reduced, and secondary outcomes did not differ between groups. Logarithmic risk ratios were not associated with LDL-C lowering. Our meta-analysis provides evidence that, in patients with different CV disease burden, major CV events are safely reduced by LDL-C lowering with ezetimibe/simvastatin, while raising the hypothesis that the extent of LDL-C lowering might not be accompanied by incremental clinical-event reduction.
Collapse
Affiliation(s)
| | - George Skalis
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | | | - Costas Tsioufis
- First Cardiology Clinic, Hippokration Hospital, Athens University, Athens, Greece
| | - Thomas Makris
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| |
Collapse
|
2746
|
Filippatos TD, Elisaf MS. Statin–Ezetimibe Combination Therapy In Diabetic Individuals. Angiology 2015; 67:507-9. [DOI: 10.1177/0003319715598887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Moses S. Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| |
Collapse
|
2747
|
Khera AV, Natarajan P, Kathiresan S. The future of low-density lipoprotein cholesterol lowering therapy: An end to statin exceptionalism? Eur J Prev Cardiol 2015; 23:1062-4. [PMID: 26268264 DOI: 10.1177/2047487315600818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Amit V Khera
- Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston, USA
| | - Pradeep Natarajan
- Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston, USA
| | - Sekar Kathiresan
- Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston, USA
| |
Collapse
|
2748
|
Savarese G, De Ferrari GM, Rosano GMC, Perrone-Filardi P. Safety and efficacy of ezetimibe: A meta-analysis. Int J Cardiol 2015; 201:247-52. [PMID: 26301648 DOI: 10.1016/j.ijcard.2015.08.103] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/24/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The addition of ezetimibe to statin therapy has been widely demonstrated to significantly reduce low-density lipoprotein cholesterol levels. However, the efficacy of ezetimibe in reducing CV events and its safety has been less investigated. The aim of the current meta-analysis was to report efficacy and safety of ezetimibe from randomized clinical trials. METHODS Randomized clinical trials with a follow-up of at least 24 weeks, enrolling more than 200 patients, comparing ezetimibe versus placebo or ezetimibe plus another hypolipidemic agent versus the same hypolipidemic drug alone and reporting at least one event among all-cause and CV mortality, myocardial infarction (MI), stroke and new onset of cancer were included in the analysis. RESULTS 7 trials enrolling 31,048 patients (median follow-up 34.1 ± 26.3 months; 70% women; mean age 61 ± 8 years) were included in the analysis. Compared to control therapy, ezetimibe significantly reduced the risk of MI by 13.5% (RR: 0.865, 95% CI: 0.801 to 0.934, p<0.001) and the risk of any stroke by 16.0% (RR: 0.840, 95% CI: 0.744 to 0.949, p=0.005), without any effect on all-cause and CV mortality (RR: 1.003, 95% CI: 0.954 to 1.055, p=0.908; RR: 0.958, 95% CI: 0.879 to 1.044, p=0.330; respectively) and risk of new cancer (RR: 1.040, 95% CI: 0.965 to 1.120, p=0.303). CONCLUSIONS Ezetimibe significantly reduces the risk of MI and stroke without any effect on all-cause and CV mortality and risk of cancer.
Collapse
Affiliation(s)
- Gianluigi Savarese
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Giuseppe M C Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy; Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, United Kingdom
| | | |
Collapse
|
2749
|
Mechanistic link between nonalcoholic fatty liver disease and cardiometabolic disorders. Int J Cardiol 2015; 201:408-14. [PMID: 26310987 DOI: 10.1016/j.ijcard.2015.08.107] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/22/2015] [Accepted: 08/09/2015] [Indexed: 02/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a chronic condition characterized by fat accumulation combined with low-grade inflammation in the liver. A large body of clinical and experimental data shows that increased flux of free fatty acids from increased visceral adipose tissue can lead to NAFLD related with insulin resistance. Thus, individuals with obesity, insulin resistance, and dyslipidemia are at the greatest risk of developing NAFLD. Conversely, NAFLD is one of the phenotypes of insulin resistance or metabolic syndrome. Many researchers have discovered a close association between NAFLD and insulin resistance, and focused on the role of NAFLD in the development of type 2 diabetes. Further, substantial evidence has suggested the association between NAFLD and cardiovascular disease (CVD). In the current review, we provide a plausible mechanistic link between NAFLD and CVD and the potential of the former as a therapeutic target based on pathophysiology. We also discuss in detail about the role of insulin resistance, oxidative stress, low-grade inflammation, abnormal lipid metabolism, gut microbiota, changes of biomarkers, and genetic predisposition in the pathological linking between NAFLD and cardiometabolic disorders.
Collapse
|
2750
|
|