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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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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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253
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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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254
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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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255
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Xu RX, Wu YJ. Lipid-Modifying Drugs: Pharmacology and Perspectives. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1177:133-148. [PMID: 32246446 DOI: 10.1007/978-981-15-2517-9_5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Coronary artery disease (CAD) is one of the leading causes of death worldwide. It is well known that dyslipidemia is a major pathogenic risk factor for atherosclerosis and CAD, which results in cardiac ischemic injury and myocardial infarction. Lipid-modifying drugs can effectively improve lipid abnormalities including reducing low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) or increasing high-density lipoprotein cholesterol (HDL-C), and eventually decrease the incidence of cardiovascular events. This chapter will review basic principles of lipid metabolism and focus on the therapeutic strategies of lipids modifying drugs (statins, proprotein convertase subtilisin/kexin type 9 inhibitors, ezetimibe, niacin, polyunsaturated fatty acids, and so on) in patients with arteriosclerotic cardiovascular disease. Meanwhile, the challenges and perspectives of the lipid-lowering agents currently in clinical practice as well as their limitations will be outlined.
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Affiliation(s)
- Rui-Xia Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China
| | - Yong-Jian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037, China.
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Đurašević S, Nikolić G, Zaletel I, Grigorov I, Memon L, Mitić-Ćulafić D, Vujović P, Đorđević J, Todorović Z. Distinct effects of virgin coconut oil supplementation on the glucose and lipid homeostasis in non-diabetic and alloxan-induced diabetic rats. J Funct Foods 2020. [DOI: 10.1016/j.jff.2019.103601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Huang YQ, Liu L, Huang C, Yu YL, Lo K, Huang JY, Chen CL, Zhou YL, Feng YQ. Impacts of Pre-Diabetes or Prehypertension on Subsequent Occurrence of Cardiovascular and All-Cause Mortality among Population without Cardiovascular Diseases. Diabetes Metab Syndr Obes 2020; 13:1743-1752. [PMID: 32547136 PMCID: PMC7247721 DOI: 10.2147/dmso.s255842] [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: 03/27/2020] [Accepted: 05/02/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Among the population without cardiovascular diseases (CVD), it is unclear whether pre-diabetes and/or prehypertension elevated the risk of all-cause and cardiovascular mortality. METHODS All participants without CVD at baseline were recruited from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), with survival status being updated until 31 December 2015. Cox proportional hazards models and subgroup analyses were performed to estimate hazard ratios (HRs) and 95% confidence interval (CI). RESULTS There were 23,622 participants (11,233 [47.6%] male) with mean age of 37.2 years. Compared to participants without prehypertension or pre-diabetes, the HRs for all-cause mortality among participants with prehypertension alone, pre-diabetes alone, and combined pre-diabetes and prehypertension were 1.04 (95% CI: 0.88, 1.24), 0.96 (95% CI:0.76, 1.21), and 1.19 (95% CI:0.98, 1.46), respectively. The corresponding HRs for cardiovascular mortality were 1.51 (95% CI: 0.83, 2.77), 1.40 (95% CI: 0.64, 3.06), and 1.70 (95% CI: 0.88, 3.27), respectively. A subgroup analysis showed that participants with combined pre-diabetes and prehypertension had a higher risk of all-cause mortality among younger participants, higher BMI, white population, and people with elevated non-HDLC. Moreover, the association between combined pre-diabetes and prehypertension and cardiovascular death was only significant among people with elevated non-HDLC. CONCLUSION Pre-diabetes combined with prehypertension might elevate the risk of all-cause mortality among subjects, particularly for those with elevated body weight, high non-HDLC, younger participants or white population.
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Affiliation(s)
- Yu-qing Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
| | - Lin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
| | - Cheng Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
| | - Yu-ling Yu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
| | - Kenneth Lo
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
- Department of Epidemiology, Centre for Global Cardio-Metabolic Health, Brown University, Providence, Rhode Island, NY, USA
| | - Jia-yi Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
| | - Chao-lei Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
| | - Ying-ling Zhou
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
| | - Ying-qing Feng
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China
- Correspondence: Ying-qing Feng; Ying-ling Zhou Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou510080, People’s Republic of China Tel/Fax +86-20-83827812 Email ;
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259
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An Y, Zhang X, Wang Y, Wang Y, Liu W, Wang T, Qin Z, Xiao R. Longitudinal and nonlinear relations of dietary and Serum cholesterol in midlife with cognitive decline: results from EMCOA study. Mol Neurodegener 2019; 14:51. [PMID: 31888696 PMCID: PMC6937942 DOI: 10.1186/s13024-019-0353-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background Previous studies regarding the cholesterol-cognition relationship in midlife have generated conflicting results. We thus investigated whether dietary and blood cholesterol were associated with cognitive decline. Methods Participants were drawn from a large cohort study entitled the Effects and Mechanism Investigation of Cholesterol and Oxysterol on Alzheimer’s disease (EMCOA) study. We included 2514 participants who completed a selection of comprehensive cognitive tests and were followed for an average of 2.3 years. Blood concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were assessed and dietary intakes were investigated by food frequency questionnaire (FFQ) at baseline. Apolipoprotein E (APOE) was genotyped by Kompetitive Allele Specific PCR (KASP) sequencing. Non-high-density lipoprotein cholesterol (Non-HDL-C) and LDL-C/HDL-C ratio were calculated. The longitudinal effects of dietary and blood cholesterol on risk of global cognitive decline (decrease in Montreal Cognitive Assessment (MoCA) > 2 points) were examined using Cox proportional hazards models. The nonlinear associations with global and domain-specific cognitive decline was evaluated with mixed effect linear models. Results In Cox proportional hazards models, neither cholesterol nor egg intake was associated with a higher risk of accelerated global cognitive decline. In contrast, the higher serum concentrations of TC, LDL-C, non-HDL-C and LDL-C/HDL-C ratio were positively associated with accelerated global cognitive decline regardless of being evaluated continuously or categorically while higher HDL-C was positively associated with accelerated global cognitive decline only when being evaluated categorically (all P < 0.05). In mixed effect linear models, quadratic and longitudinal relations of dietary cholesterol and egg intakes to global cognition, processing speed and executive function were observed. Moreover, there were inverted U-shaped relations of HDL-C, with processing speed and executive function but U-shaped relations of HDL-C and LDL-C/HDL-C ratio with verbal memory. Adverse linear associations of higher LDL-C and LDL-C/HDL-C ratio with multiple cognitive comes were also revealed. Additionally adjusting for APOE genotype did not modify cholesterol-cognition associations. Dietary and serum cholesterol had variable associations with global and domain-specific cognitive decline across educational groups. Conclusion Differential associations between dietary/serum cholesterol and cognitive decline across different domains of function were observed in a particular population of middle-aged and elderly Chinese. Interventions to improve cognitive reserve regarding dietary instruction and lipid management should be tailored according to specific target. Trial registration EMCOA, ChiCTR-OOC-17011882, Registered 5th, July 2017-Retrospectively registered, http://www.medresman.org/uc/project/projectedit.aspx?proj=2610
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Affiliation(s)
- Yu An
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Xiaona Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Ying Wang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Yushan Wang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Wen Liu
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Tao Wang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China
| | | | - Rong Xiao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.
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260
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Abstract
Objectives The objective of this study is to report the dose response in ODYSSEY phase 3 clinical trials of proprotein convertase subtilisin kexin type 9 inhibition with alirocumab in patients not at prespecified lipid goals who received a per-protocol dose increase from 75 every 2 weeks (Q2W) to 150 mg Q2W. Methods Patients (n=2181) receiving statins were enrolled in six phase 3 randomized, double-blind, double-dummy trials (24–104 weeks): alirocumab versus placebo or ezetimibe 10 mg/day. The 75 mg subcutaneous Q2W dose was increased to 150 mg at week 12 if week 8 LDL cholesterol (LDL-C) was greater than or equal to 70 mg/dl (>100 mg/dl in OPTIONS studies for patients without previous coronary heart disease, but with other risk factors). LDL-C percentage reductions from baseline (on-treatment data, n=1291) were compared at week 12 versus week 24. Results Most patients (n=951; 73.7%) with 75 mg Q2W dose plus background statin achieved LDL-C less than 70 or less than 100 mg/dl at week 8. In 340 (26.3%) patients, alirocumab dose was increased to 150 mg Q2W at week 12, and 60.9% of these patients achieved LDL-C goals at week 24, with an additional 14.2% reduction in LDL-C from week 12 to week 24. Adverse event rates were comparable in patients with versus without a dose increase (72.4 vs. 71.8% in placebo-controlled trials; 67.0 vs. 67.6% in ezetimibe-controlled trials). Conclusion Most patients achieved LDL-C goals with alirocumab 75 mg Q2W plus statins. Of those (26.3%) receiving a dose increase, 60.9% achieved LDL-C goals at week 24 with an additional 14.2% reduction in LDL-C.
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261
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Dopheide JF, Veit J, Ramadani H, Adam L, Papac L, Vonbank A, Kaspar M, Rastan A, Baumgartner I, Drexel H. Adherence to statin therapy favours survival of patients with symptomatic peripheral artery disease. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 7:263-270. [PMID: 31886861 DOI: 10.1093/ehjcvp/pvz081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/20/2019] [Accepted: 12/07/2019] [Indexed: 12/18/2022]
Abstract
AIMS We hypothesized that adherence to statin therapy determines survival in patients with peripheral artery disease (PAD). METHODS AND RESULTS Single-centre longitudinal observational study with 691 symptomatic PAD patients. Mortality was evaluated over a mean follow-up of 50 ± 26 months. We related statin adherence and low-density lipoprotein cholesterol (LDL-C) target attainment to all-cause mortality. Initially, 73% of our PAD patients were on statins. At follow-up, we observed an increase to 81% (P < 0.0001). Statin dosage, normalized to simvastatin 40 mg, increased from 50 to 58 mg/day (P < 0.0001), and was paralleled by a mean decrease of LDL-C from 97 to 82 mg/dL (P < 0.0001). The proportion of patients receiving a high-intensity statin increased over time from 38% to 62% (P < 0.0001). Patients never receiving statins had a significant higher mortality rate (31%) than patients continuously on statins (13%) or having newly received a statin (8%; P < 0.0001). Moreover, patients on intensified statin medication had a low mortality of 9%. Those who terminated statin medication or reduced statin dosage had a higher mortality (34% and 20%, respectively; P < 0.0001). Multivariate analysis showed that adherence to or an increase of the statin dosage (both P = 0.001), as well as a newly prescribed statin therapy (P = 0.004) independently predicted reduced mortality. CONCLUSION Our data suggest that adherence to statin therapy is associated with reduced mortality in symptomatic PAD patients. A strategy of intensive and sustained statin therapy is recommended.
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Affiliation(s)
- Jörn F Dopheide
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Jonas Veit
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Hana Ramadani
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Luise Adam
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lucija Papac
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Alexander Vonbank
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Mathias Kaspar
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Aljoscha Rastan
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Heinz Drexel
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.,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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Brea A, Hernández-Mijares A, Millán J, Ascaso JF, Blasco M, Díaz A, Mantilla T, Pedro-Botet JC, Pintó X. Non-HDL cholesterol as a therapeutic goal. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31 Suppl 2:28-33. [PMID: 31806265 DOI: 10.1016/j.arteri.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 01/08/2023]
Abstract
Although cholesterol linked to low-density lipoproteins (c-LDL) is well established as a risk factor for cardiovascular disease, there is often a more complex dyslipidaemia pattern that contributes to the formation of atherosclerotic plaque. Non-HDL cholesterol (c-NO-HDL) is used to estimate the total amount of atherogenic lipoproteins in plasma, some of which are not usually determined in daily clinical practice. c-NO-HDL is easily calculated from the subtraction of total plasma cholesterol from the cholesterol content carried by high density lipoproteins. The c-NO-HDL has a predictive value superior to that of C-LDL to estimate the risk of major cardiovascular events in epidemiological studies. Genetic studies by analysis of the complete genome, together with those based on Mendelian randomisation, point to the aetiological character of c-NO-HDL on ischaemic heart disease (IHD). Intervention studies, and the meta-analyses derived from them, close the causal circle between c-NO-HDL and IHD, by demonstrating that any intervention that decreases the concentrations of the former reduces the incidence of arteriosclerotic heart disease. The European ESC/EAS 2016 guide for the management of dyslipidaemia considers c-NO-HDL as a therapeutic target with a Class IIa recommendation (should be performed) Level B (data from a single randomised clinical trial [RCT]) or from several non-RCTs), and sets its target at less than 100 or 130mg/dL for those patients with very high risk or high risk, respectively. These achievable c-NO-HDL values are easily calculated by adding 30mg/dL to the c-LDL targets.
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Affiliation(s)
- Angel Brea
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, La Rioja, España.
| | - Antonio Hernández-Mijares
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Servicio de Endocrinología, Hospital Universitario Dr. Peset, Universitat de Valencia, Valencia, España
| | - Jesús Millán
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos, Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
| | - Juan F Ascaso
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Servicio de Endocrinología, Hospital Clínico, Valencia, España
| | - Mariano Blasco
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Área Sanitaria de Delicias, Atención Primaria, Zaragoza, España
| | - Angel Díaz
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Centro de Salud de Bembibre, Bembibre, León, España
| | - Teresa Mantilla
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Centro de Salud de Prosperidad, Atención Primaria, Madrid, España
| | - Juan C Pedro-Botet
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Grupo de Trabajo sobre la Dislipidemia Aterogénica de la Sociedad Española de Arteriosclerosis, España; Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Institut d'Investigació Biomèdica de Bellvitge (Idibell), Centre d'Investigació Biomèdica en Xarxa-Fisiopatologia de l'Obesitat i la Nutrició (CiberObn), L'Hospitalet de Llobregat, Barcelona, España
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Abstract
PURPOSE OF REVIEW To review randomized interventional clinical and imaging trials that support lower targeted atherogenic lipoprotein cholesterol goals in "extreme" and "very high" atherosclerotic cardiovascular disease (ASCVD) risk settings. Major atherosclerotic cardiovascular event (MACE) prevention among the highest risk patients with ASCVD requires aggressive management of global risks, including lowering of the fundamental atherogenic apolipoprotein B-associated lipoprotein cholesterol particles [i.e., triglyceride-rich lipoprotein remnant cholesterol, low-density lipoprotein cholesterol (LDL-C), and lipoprotein(a)]. LDL-C has been the long-time focus of imaging studies and randomized clinical trials (RCTs). The 2004 adult treatment panel (ATP-III) update recognized that the long-standing targeted LDL-C goal of < 100 mg/dL potentially fostered substantial undertreatment of the very highest coronary heart disease (CHD) risk individuals and was lowered to < 70 mg/dL as an "optional" goal for "very high" 10-year CHD [CHD death + myocardial infarction (MI)] risk exceeding 20%. This evidence-based guideline change was supported by the observed benefits demonstrated in the high-risk primary and secondary prevention populations in the Heart Protection Study (HPS), the acute coronary syndrome (ACS) population in the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 trial (PROVE-IT), and the secondary prevention population in the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) intravascular ultrasound (IVUS) study. Subsequent national and international guidelines maintained a targeted LDL-C goal < 70 mg/dL, or a threshold for management of > 70 mg/dL for patients with CHD, CHD risk equivalency, or ASCVD. RECENT FINDINGS Subgroup or meta-analyses of several RCTs, IVUS imaging studies, and the ACS population in IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) supported the evidence-based 2017 American Association Clinical Endocrinologist (AACE) guideline change establishing a targeted LDL-C goal < 55 mg/dL, non-HDL-C < 80 mg/dl, and apolipoprotein B (apo B) < 70 mg/dL for patients at "Extreme" ASCVD risk, i.e., 10-year 3-point-MACE-composite (CV death, non-fatal MI, or ischemic stroke) risk exceeding 30%. Moreover, with no recognized lower-limit-associated intolerance or safety issues, even more intensive lowering of atherogenic cholesterol levels is supported by the following evidence base: (1) analysis of eight high-intensity statin-based prospective secondary prevention IVUS atheroma volume regression trials; (2) a distribution analysis of on-treatment, ezetimibe and background-statin, of the very low LDL-C levels reached and CVD event risk in the IMPROVE-IT ACS population; (3) the secondary prevention Global Assessment of Pl\aque Regression With a PCSK9 Antibody as Measured by Intravascular Ultrasound (GLAGOV) on background-statin; and (4) the secondary prevention population of Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER). By example, in FOURIER, the population on background-statin at a baseline median 92 mg/dL achieved median LDL-C level of 30 mg/dL and non-HDL-C to < 65 mg/dl, and apo B to < 50 mg/dL, and subgroup and post hoc analyses all demonstrated additional ASCVD event reduction benefits as LDL-C was further reduced. The level of ASCVD risk determines the degree, urgency, and persistence in global risk management, including fundamental atherogenic lipoprotein cholesterol particle lowering. "Extreme" risk patients may require extremely low targeted LDL-C, non-HDL-C and apo B goals; such efforts, implied by more recent interventional trials and analyses, are aimed at maximal atheroma plaque regression, stabilization, and MACE event reduction with the aspiration of improved quality lifespan.
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Affiliation(s)
- Paul D Rosenblit
- Department of Medicine, Division of Endocrinology, Diabetes, & Metabolism, University California, Irvine (UCI), School of Medicine, Irvine, CA, 92697, USA.
- Diabetes Out-Patient Clinic, UCI Medical Center, Orange, CA, 92868, USA.
- Diabetes/Lipid Management & Research Center, 18821 Delaware St., Suite 202, Huntington Beach, CA, 92648, USA.
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264
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Rosenson RS, Colantonio LD, Burkholder GA, Chen L, Muntner P. Trends in Utilization of Statin Therapy and Contraindicated Statin Use in HIV--Infected Adults Treated With Antiretroviral Therapy From 2007 Through 2015. J Am Heart Assoc 2019; 7:e010345. [PMID: 30526249 PMCID: PMC6405602 DOI: 10.1161/jaha.118.010345] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background HIV is associated with an increased risk for atherosclerotic cardiovascular disease, which may result in many people living with HIV taking a statin. Some statins are contraindicated with certain antiretroviral therapies ( ART ) and other medications commonly used by HIV -infected patients. Methods and Results We analyzed trends in the use of statins, including contraindicated statins, between 2007 and 2015 among HIV -infected patients aged ≥19 years taking ART who had employer-sponsored or Medicare supplemental health insurance in the Marketscan database (n=186 420). Statin use was identified using pharmacy claims. Contraindicated statin use was defined by a pharmacy claim for HIV protease inhibitors, cobicistat, hepatitis C protease inhibitors, anti-infectives, calcium channel blockers, amiodarone, gemfibrozil, or nefazodone followed by a fill for a contraindicated statin type and dosage within 90 days. The percentage of beneficiaries with HIV taking a statin remained unchanged between 2007 (24.6%) and 2015 (24.7%). Among those taking a statin, the percentage taking a contraindicated statin declined from 16.3% in 2007 to 9.0% in 2014 and then increased to 9.8% in 2015. The proportion of contraindicated statin fills attributable to HIV protease inhibitors declined from 63.9% in 2007 to 51.0% in 2015, while those attributable to cobicistat increased from 0% before 2012 to 20.6% in 2015. Conclusions Changes in ART regimens resulted in a decline in contraindicated statin use from 2007 to 2014, but this favorable trend was attenuated in 2015 because of increased use of cobicistat-containing ART regimens.
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Han Y, Chen J, Chopra VK, Zhang S, Su G, Ma C, Huang Z, Ma Y, Yao Z, Yuan Z, Zhao Q, Kuanprasert S, Baccara-Dinet MT, Manvelian G, Li J, Chen R. ODYSSEY EAST: Alirocumab efficacy and safety vs ezetimibe in high cardiovascular risk patients with hypercholesterolemia and on maximally tolerated statin in China, India, and Thailand. J Clin Lipidol 2019; 14:98-108.e8. [PMID: 31882376 DOI: 10.1016/j.jacl.2019.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab significantly reduces low-density lipoprotein cholesterol (LDL-C). OBJECTIVE This study (ODYSSEY EAST) assessed the efficacy and safety of alirocumab vs ezetimibe in high cardiovascular risk patients from Asia. METHODS Patients (n = 615) from China, India, and Thailand with hypercholesterolemia at high cardiovascular risk on maximally tolerated statin were randomized (2:1) to alirocumab (75 mg every 2 weeks [Q2W]; with dose increase to 150 mg Q2W at week 12 if week 8 LDL-C was >1.81 mmol/L [>70 mg/dL]) or ezetimibe (10 mg daily) for 24 weeks. The primary efficacy endpoint was percentage change in calculated LDL-C from baseline to week 24. Safety was assessed throughout. RESULTS Baseline data were similar in both groups. LDL-C levels were reduced from baseline to week 24 by 56.0% and 20.3% in the alirocumab and ezetimibe groups, respectively (P < .0001 vs ezetimibe). Overall, 18.8% of alirocumab-treated patients received a dose increase to 150 mg Q2W. At week 24, 85.1% of alirocumab-treated and 40.5% of ezetimibe-treated patients reached LDL-C <1.81 mmol/L (<70 mg/dL, P < .0001 vs ezetimibe). Treatment-emergent adverse events occurred in 68.5% of alirocumab-treated and 63.1% of ezetimibe-treated patients, with upper respiratory tract infection the most common (alirocumab: 13.3%; ezetimibe: 14.1%). Injection-site reactions occurred more frequently in alirocumab-treated patients (2.7%) than in ezetimibe-treated patients (1.0%). CONCLUSIONS Alirocumab significantly reduced LDL-C vs ezetimibe in high cardiovascular risk patients from Asia and was generally well tolerated. These findings are consistent with previous ODYSSEY studies.
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Affiliation(s)
- Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China.
| | - Jiyan Chen
- Department of Cardiology, Guangdong General Hospital, Guangdong, China
| | | | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Guohai Su
- Institute of Translational Medicine, Jinan Central Hospital, Jinan, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhouqing Huang
- Division of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingyan Ma
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhuhua Yao
- Department of Cardiology, Tianjin Union Medical Center, Tianjin, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Zhao
- Department of Cardiac Surgery, Ruijin Hospital of Shanghai, Jiaotong University School of Medicine, Shanghai, China
| | - Srun Kuanprasert
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai Hospital, Chiang Mai, Thailand
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266
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Sun CJ, McCudden C, Brisson D, Shaw J, Gaudet D, Ooi TC. Calculated Non-HDL Cholesterol Includes Cholesterol in Larger Triglyceride-Rich Lipoproteins in Hypertriglyceridemia. J Endocr Soc 2019; 4:bvz010. [PMID: 32010872 PMCID: PMC6986683 DOI: 10.1210/jendso/bvz010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023] Open
Abstract
Context Calculated non–high-density lipoprotein (HDL) cholesterol (non-HDLC) should selectively include cholesterol from atherogenic lipoproteins to be a reliable risk marker of cardiovascular disease. In hypertriglyceridemia (HTG), there is increased abundance of larger and less atherogenic triglyceride-rich lipoproteins (TRL), namely, larger very-low-density lipoproteins (VLDL), and chylomicrons. Objective We aim to demonstrate that serum triglyceride (TG) level has a substantial impact on non-HDLC’s ability to represent cholesterol from atherogenic lipoproteins, even though TG is not part of the calculation for non-HDLC. Design Analysis of lipid profile data Settings Lipid Clinic patient cohort, and Biochemistry Laboratory patient cohort Patients or Other Participants 7,492 patients in the Lipid Clinic cohort with baseline lipid profiles documented prior to starting lipid-lowering medications and 156,311 lipid profiles from The Ottawa Hospital Biochemistry Laboratory cohort. Intervention None Main Outcome Measure Our modeling process includes derivation of TG-interval–specific lipoprotein composition factor (LCF) for TRL, which represents the mass ratio of cholesterol to TG in TRL. A high LCF indicates that the TRLs are mainly the cholesterol-rich atherogenic remnant lipoproteins. A low LCF indicates that the TRLs are mainly the TG-rich larger VLDL and chylomicrons. Results As serum TG increases, there is progressive decline in the LCF for TRL, which indicates that the calculated non-HDLC level reflects progressive inclusion of cholesterol from larger TRL. This is shown in both cohorts. Conclusions Calculated non-HDLC is influenced by TG level. As TG increases, non-HDLC gradually includes more cholesterol from larger TRL, which are less atherogenic than LDL and remnant lipoproteins.
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Affiliation(s)
- Cathy J Sun
- Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christopher McCudden
- Division of Biochemistry, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Diane Brisson
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Quebec, Canada
| | - Julie Shaw
- Division of Biochemistry, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel Gaudet
- Clinical Lipidology and Rare Lipid Disorders Unit, Department of Medicine, Université de Montréal Community Gene Medicine Center, Lipid Clinic Chicoutimi Hospital and ECOGENE-21 Clinical and Translational Research Center, Chicoutimi, Quebec, Canada
| | - Teik C Ooi
- Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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267
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Nam CW, Kim DS, Li J, Baccara-Dinet MT, Li I, Kim JH, Kim CJ. Efficacy and safety of alirocumab in Korean patients with hypercholesterolemia and high cardiovascular risk: subanalysis of the ODYSSEY-KT study. Korean J Intern Med 2019; 34:1252-1262. [PMID: 30257549 PMCID: PMC6823573 DOI: 10.3904/kjim.2018.133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS Efficacy and safety data of alirocumab, a fully human monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), is not yet well established in the Korean population. We assessed them in ODYSSEY-KT through the pre-specified Korean subanalysis. METHODS In the ODYSSEY-KT study, South Korean and Taiwanese patients with hypercholesterolemia and high cardiovascular risks were randomized (1:1) to alirocumab or placebo. Alirocumab was self-administered subcutaneously at 75 mg every 2 weeks with a maximally tolerated statin dose with or without other lipid-modifying therapies. Alirocumab dose was increased to 150 mg every 2 weeks at week 12 if low density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dL at week 8. Primary endpoint was percent change in LDL-C from baseline to week 24. Results from Korean cohort (n = 83: 40 for alirocumab and 43 for placebo, respectively) analyses are reported here. RESULTS In alirocumab group, the least square of mean change percent in LDL-C levels was -65.7% (placebo: 11.1%; p < 0.0001) and 92.0% of them achieved LDL-C < 70 mg/dL (placebo: 12.7%; p < 0.0001) at week 24. Alirocumab also showed significantly greater improvements in high density lipoprotein cholesterol (HDL-C), non-HDL-C, total cholesterol, lipoprotein(a), and apolipoprotein B than placebo (p < 0.05). Two consecutive calculated LDL-C values < 25 mg/dL were observed in 37.5% of alirocumab-treated patients. Overall, 45.0% alirocumab-treated and 51.2% placebo-treated patients experienced treatment-emergent adverse events (TEAEs) without discontinuation of treatment due to TEAEs. CONCLUSION Alirocumab has demonstrated to be effective in improvement of LDL-C and related lipid profiles in Korean cohort. Alirocumab was generally well tolerated with no significant safety signals.
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Affiliation(s)
- Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- Correspondence to Chang-Wook Nam, M.D. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea Tel: +82-53-250-8015 Fax: +82-53-250-7034 E-mail:
| | - Dong-Soo Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | | | | | - Ivy Li
- Sanofi R&D, Shanghai, China
| | | | - Chong-Jin Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Correspondence to Chong-Jin Kim, M.D. Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea Tel: +82-2-440-6106 Fax: +82-2-440-7699 E-mail:
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268
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Orringer CE, Jacobson TA, Maki KC. National Lipid Association Scientific Statement on the use of icosapent ethyl in statin-treated patients with elevated triglycerides and high or very-high ASCVD risk. J Clin Lipidol 2019; 13:860-872. [DOI: 10.1016/j.jacl.2019.10.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
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269
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Yao Q, Zhang X, Huang Y, Wang H, Hui X, Zhao B. Moxibustion for treating patients with hyperlipidemia: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e18209. [PMID: 31770280 PMCID: PMC6890273 DOI: 10.1097/md.0000000000018209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hyperlipidemia has been a root cause of atherosclerosis, which leads to a high risk to serious cardio-cerebrovascular disease. Many trials have reported that moxibustion therapy is effective in lowering blood lipid levels when treating hyperlipidemia. The aim of this systematic review is to assess the effectiveness and safety of moxibustion therapy for hyperlipidemia. METHODS Two reviewers will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIP database); and Wan-Fang Database from the inception, without restriction of publication status and languages. Additional searching including researches in progress, the reference lists and the citation lists of identified publications. Study selection, data extraction, and assessment of study quality will be performed independently by 2 reviewers. Changes of blood lipid levels from baseline to the end of the treatment, including low-density lipoprotein cholesterol (LDL-C) level, total cholesterol (TC) level, triglycerides (TG) level and high-density lipoprotein cholesterol (HDL-C) level will be assessed as the primary outcomes. Quality of life, long-term effect and safety will be evaluated as secondary outcomes. If it is appropriate for a meta-analysis, RevMan 5.3 statistical software will be used; otherwise, a descriptive analysis will be conducted. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data. RESULTS This study will provide a comprehensive review of the available evidence for the treatment of moxibustion with hyperlipidemia. CONCLUSIONS The conclusions of our study will provide an evidence to judge whether moxibustion is an effective and safe intervention for patients with hyperlipidemia. ETHICS AND DISSEMINATION This systematic review will be disseminated in a peer-reviewed journal or presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualized. TRIAL REGISTRATION NUMBER PROSPERO CRD42019130545.
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270
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Baum SJ, Sampietro T, Datta D, Moriarty PM, Knusel B, Schneider J, Somaratne R, Kurtz C, Hohenstein B. Effect of evolocumab on lipoprotein apheresis requirement and lipid levels: Results of the randomized, controlled, open-label DE LAVAL study. J Clin Lipidol 2019; 13:901-909.e3. [DOI: 10.1016/j.jacl.2019.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/09/2019] [Accepted: 10/01/2019] [Indexed: 12/22/2022]
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Mo L, Gupta V, Modi R, Munnur K, Cameron JD, Seneviratne S, Edwards BA, Landry SA, Joosten SA, Hamilton GS, Wong DTL. Severe obstructive sleep apnea is associated with significant coronary artery plaque burden independent of traditional cardiovascular risk factors. Int J Cardiovasc Imaging 2019; 36:347-355. [PMID: 31637622 DOI: 10.1007/s10554-019-01710-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 01/27/2023]
Abstract
Obstructive Sleep Apnea (OSA) is strongly associated with adverse cardiovascular events. In these patients, increased oxidative stress has been associated with accelerated coronary atherosclerosis. However, it is unclear if OSA is associated with significant coronary artery plaque burden. Our aim is to determine whether OSA and/or markers of hypoxemia are associated with coronary plaque burden (CPB). Patients who had coronary computed tomography angiography (CCTA) and a polysomnogram within 1 year of each other between 2011 and 2016 were analyzed. Apnea-Hypopnea Index (AHI) and hypoxemic burden (ODI3%, ODI4%, nadir SpO2, average spO2 and time of spO2 < 88%) were obtained from the polysomnogram. Total CPB was assessed using the prognostically validated CT-Leaman score (CT-LeSc). Significant CPB was defined as CT-LeSc ≥ 8.3. There were 119 patients with mean (± SD) age of 59 ± 12 years. Using logistical regression analysis; AHI, ODI4% and ODI3% were the only parameters associated with significant CPB. Severe OSA (AHI ≥ 30 events/h) was associated with significant CPB with adjusted OR of 3.21 (p = 0.010) independent of traditional cardiovascular risk factors. Mechanisms associated with apnea and hypopnea events (as measured by AHI, ODI3% and ODI4%), but not the severity of arterial desaturation (nadir SpO2, burden of SpO2 < 88%) were associated with significant CPB.
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Affiliation(s)
- Lin Mo
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Vivek Gupta
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Rohan Modi
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia
| | - Kiran Munnur
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - James D Cameron
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Sujith Seneviratne
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia.,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Bradley A Edwards
- Department of Physiology, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Shane A Landry
- Department of Physiology, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Simon A Joosten
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Garun S Hamilton
- Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia.,Department of Lung and Sleep Medicine, Monash Health, Clayton, VIC, Australia
| | - Dennis T L Wong
- Monash Heart, Monash Health, Monash Medical Centre Clayton, Clayton, VIC, Australia. .,Department of Medicine at Monash Health, Monash Cardiovascular Research Centre and School of Clinical Sciences, Monash University, Melbourne, Australia. .,South Australian Health & Medical Research Institute, Adelaide, Australia.
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272
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Michos ED, McEvoy JW, Blumenthal RS. Lipid Management for the Prevention of Atherosclerotic Cardiovascular Disease. N Engl J Med 2019; 381:1557-1567. [PMID: 31618541 DOI: 10.1056/nejmra1806939] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Erin D Michos
- From the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (E.D.M., R.S.B), and the National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway (J.W.M.)
| | - John W McEvoy
- From the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (E.D.M., R.S.B), and the National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway (J.W.M.)
| | - Roger S Blumenthal
- From the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (E.D.M., R.S.B), and the National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway (J.W.M.)
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Abstract
PURPOSE OF REVIEW Recently, a high level of triglycerides has attracted much attention as an important residual risk factor of cardiovascular events. We will review and show the mechanisms underlying the association of endothelial dysfunction with hypertriglyceridemia and present clinical evidence for a relationship between endothelial function and triglycerides. RECENT FINDINGS Clinical studies have shown that hypertriglyceridemia is associated with endothelial dysfunction. It is likely that hypertriglyceridemia impairs endothelial function through direct and indirect mechanisms. Therefore, hypertriglyceridemia is recognized as a therapeutic target in the treatment of endothelial dysfunction. Although experimental and clinical studies have shown that fibrates and omega-3 fatty acids not only decrease triglycerides but also improve endothelial function, the effects of these therapies on cardiovascular events are controversial. SUMMARY Accumulating evidence suggests that hypertriglyceridemia is an independent risk factor for endothelial dysfunction. Triglycerides should be considered more seriously as a future target to reduce cardiovascular events. Results of ongoing studies may show the benefit of lowering triglycerides and provide new standards of care for patients with hypertriglyceridemia possibly through improvement in endothelial function.
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Affiliation(s)
- Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
| | - Yukihito Higashi
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Impact of dyslipidemia on estimated glomerular filtration rate in apparently healthy children and adolescents: the CASPIAN-V study. World J Pediatr 2019; 15:471-475. [PMID: 31240635 DOI: 10.1007/s12519-019-00270-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a leading risk factor for development of cardiovascular disease (CVD). Dyslipidemia is also known as risk factor for CVD development. However, the association of dyslipidemia with glomerular injury among healthy children and adolescents remains controversial. We aimed to investigate the relationship between estimated glomerular filtration rate (eGFR) and lipid profile risk factors among healthy children and adolescents. METHODS In this nationwide survey, 3808 participants (1992 males, 1816 females), aged 7-18 years, were selected by cluster random sampling method from 30 provinces in Iran. Body mass index (BMI) and systolic and diastolic blood pressures were measured. Blood samples were obtained for serum creatinine, fasting blood glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) determinations. GFR was estimated using Schwartz equation. RESULTS Girls had higher eGFR than boys (P = 0.04). In a multiple regression analysis, eGFR demonstrated a positive correlation with systolic blood pressure, BMI, fasting glucose, TC, HDL-C, and TG. By the analysis of covariance, TC, HDL-C, and TG showed a negative correlation with eGFR after adjustments for BMI, systolic and diastolic blood pressures, and fasting glucose (OR = 0.56, 95% CI = 0.29-0.89). CONCLUSION The study showed that dyslipidemia is associated with reduced eGFR among the healthy children and adolescents.
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Abstract
PURPOSE OF REVIEW Drugs to lower LDL-C levels are very widely used. In this brief review, I will use selected recent studies to delineate several important principles that provide a rationale for how to maximize the benefits of using LDL-C lowering drugs to reduce cardiovascular disease. The focus will be on using statins, ezetimibe, and PCSK9 monoclonal antibodies as recent studies have predominantly utilized these agents. RECENT FINDINGS The key principles to consider when using LDL-C-lowering drugs to reduce cardiovascular disease are: the lower the LDL-C the better; the sooner and the longer one lowers LDL-C the better; the higher the risk of cardiovascular disease the greater the absolute benefit; the higher the baseline LDL-C the greater the absolute benefit; and compared with the benefits of cholesterol-lowering drugs on reducing cardiovascular disease the risk of side effects is very modest. SUMMARY Understanding and employing these key concepts in caring for patients will allow one to use cholesterol-lowering drugs wisely to maximize the reduction of cardiovascular events.
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Affiliation(s)
- Kenneth R Feingold
- Department of Medicine, University of California, San Francisco, California, USA
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Jones LK, Kulchak Rahm A, Manickam K, Butry L, Lazzeri A, Corcoran T, Komar D, Josyula NS, Pendergrass SA, Sturm AC, Murray MF. Healthcare Utilization and Patients' Perspectives After Receiving a Positive Genetic Test for Familial Hypercholesterolemia. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 11:e002146. [PMID: 30354341 DOI: 10.1161/circgen.118.002146] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The MyCode Community Health Initiative (MyCode) is returning actionable results from whole exome sequencing. Familial hypercholesterolemia (FH) is an inherited condition characterized by premature cardiovascular disease. METHODS We used multiple methods to assess care in 28 MyCode participants who received FH results. Chart reviews were conducted on 23 individuals in the sample and 7 individuals participated semistructured interviews. RESULTS Chart reviews for 23 individuals with a Geisinger primary care provider found that 4 individuals (17% of 23) were at LDL-C (low-density lipoprotein cholesterol) goal (of either LDL-C <100 mg/dL for primary prevention and LDL-C <70 mg/dL for secondary prevention) and 17 individuals (74% of 23) were prescribed lipid-lowering therapy before genetic result disclosure. After disclosure of the genetic test result, 5 individuals (22% of 23) met their LDL-C goal and 18 individuals (78% of 23) were prescribed lipid-lowering therapy. Follow-up care about this result was not documented for 4 individuals (17% of 23). Changes to intensity of medication management were made for 8 individuals (47% of 17 individuals previously prescribed lipid-lowering therapy). Interviewed individuals (n=7) were not surprised by their result as all knew they had high cholesterol; however, individuals did not seem to discern FH as a separate condition from their high cholesterol. CONCLUSIONS Among individuals receiving genetic diagnosis of FH, >25% had no changes to lipid-lowering therapy, despite not being at LDL-C goal and learning their high cholesterol is related to a genetic condition requiring more aggressive treatment. Individuals and clinicians may have an inadequate understanding of FH as a distinct condition requiring enhanced medical management.
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Affiliation(s)
- Laney K Jones
- Center for Pharmacy Innovation and Outcomes (L.K.J.)
| | - Alanna Kulchak Rahm
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Kandamurugu Manickam
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Loren Butry
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Amanda Lazzeri
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Timothy Corcoran
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Daniel Komar
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Navya S Josyula
- Biomedical and Translational Informatics Institute (N.S.J., S.A.P.)
| | | | - Amy C Sturm
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.)
| | - Michael F Murray
- Genomic Medicine Institute (A.K.R., K.M., L.B., A.L., T.C., D.K., A.C.S., M.F.M.).,Geisinger, Danville, PA. Yale Center for Genomic Health, New Haven, CT (M.F.M.)
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Vani A, Underberg JA. Lowering LDL-Cholesterol and CV Benefits: Is There a Limit to How Low LDL-C Needs to be for Optimal Health Benefits? Clin Pharmacol Ther 2019; 104:290-296. [PMID: 29882959 DOI: 10.1002/cpt.1133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the number one cause of morbidity and mortality worldwide. Low-density lipoprotein cholesterol (LDL-C) has been implicated as one of the major risk factors causing ASCVD based on multiple hierarchical levels of evidence. The advent of powerful LDL-C lowering therapies, such as the proprotein convertase subtilisin/kexin type 9 inhibitor, have raised the question of how low to target LDL-C and whether there are any adverse safety events associated with a very low LDL-C level. The present review summarizes the available evidence and concludes that even a very low LDL-C is associated with cardiovascular benefit, although the magnitude of benefit depends on baseline ASCVD risk and the absolute change in LDL-C with pharmacologic therapy. The safety data in patients treated for very low LDL-C is reassuring, although it is inconsistent and requires longer term follow-up.
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Affiliation(s)
- Anish Vani
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - James A Underberg
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
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Bian Y, Li X, Li X, Ju J, Liang H, Hu X, Dong L, Wang N, Li J, Zhang Y, Yang B. Daming capsule, a hypolipidaemic drug, lowers blood lipids by activating the AMPK signalling pathway. Biomed Pharmacother 2019; 117:109176. [DOI: 10.1016/j.biopha.2019.109176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 02/01/2023] Open
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Effects of Icosapent Ethyl (Eicosapentaenoic Acid Ethyl Ester) on Atherogenic Lipid/Lipoprotein, Apolipoprotein, and Inflammatory Parameters in Patients With Elevated High-Sensitivity C-Reactive Protein (from the ANCHOR Study). Am J Cardiol 2019; 124:696-701. [PMID: 31277790 DOI: 10.1016/j.amjcard.2019.05.057] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 11/21/2022]
Abstract
Icosapent ethyl is pure prescription eicosapentaenoic acid approved at 4 g/day as an adjunct to diet to reduce triglycerides (TG) in adults with TG ≥500 mg/dl. Elevated high-sensitivity C-reactive protein (hsCRP) is associated with increased cardiovascular risk. The 12-week ANCHOR study randomized 702 statin-treated patients at increased cardiovascular risk with TG 200 to 499 mg/dl despite low-density lipoprotein cholesterol (LDL-C) control (40 to 99 mg/dl). This post hoc analysis assessed 246 ANCHOR patients with baseline hsCRP ≥ 2.0 mg/L randomized to icosapent ethyl 4 g/day (n = 126; approved dose) or placebo (n = 120). Without increasing LDL-C, icosapent ethyl significantly reduced median TG (-20%; p < 0.0001), non-high-density lipoprotein cholesterol (-12.3%; p < 0.0001), total cholesterol (-11.1%; p < 0.0001), high-density lipoprotein cholesterol (-5.2%; p = 0.0042), very LDL-C (-21.0%; p < 0.0001), very low-density lipoprotein TG (-22.9%; p < 0.0001), remnant lipoprotein cholesterol (-23.0%; p = 0.0125), apolipoprotein B (-7.4%; p = 0.0021), apolipoprotein C-III (-16%; p < 0.0001), oxidized LDL (-13.7%; p = 0.0020), lipoprotein-associated phospholipase A2 (-19.6%; p < 0.0001), and hsCRP (-17.9%; p = 0.0213) versus placebo, while interleukin-6 and intercellular adhesion molecule-1 were not significantly changed. Eicosapentaenoic acid increased with icosapent ethyl 4 g/day +637% in plasma and +632% in red blood cells versus placebo (both p < 0.0001). Icosapent ethyl exhibited a safety profile similar to placebo. In conclusion, in statin-treated patients with hsCRP ≥ 2.0 mg/L and TG 200 to 499 mg/dl at baseline, icosapent ethyl 4 g/day significantly and safely reduced TG and other atherogenic and inflammatory parameters without increasing LDL-C versus placebo.
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280
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Annemans L, Stock JK, Chapman MJ. PCSK9 inhibition, atherosclerotic cardiovascular disease, and health economics: Challenges at the crossroads. J Clin Lipidol 2019; 13:714-720. [DOI: 10.1016/j.jacl.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022]
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Abstract
The American Association of Clinical Endocrinology and the American College of Endocrinology Clinical Practice Guideline is a comprehensive, practical tool that can be used to diagnose and manage dyslipidemia, a major risk for the development and progression of atherosclerotic cardiovascular disease. Effective therapies are available to improve lipid profiles and reduce cardiovascular events.
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Gao L, Jiang Y, Wei S, Shang S, Li P, Chen C, Dang L, Wang J, Huo K, Deng M, Wang J, Zhang R, Qu Q. The Level of Plasma Amyloid-β40 Is Correlated with Peripheral Transport Proteins in Cognitively Normal Adults: A Population-Based Cross-Sectional Study. J Alzheimers Dis 2019; 65:951-961. [PMID: 30103331 DOI: 10.3233/jad-180399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Transport proteins, soluble low-density lipoprotein receptor-related protein-1 (sLRP1), and soluble receptor of advanced glycation end products (sRAGE), play an important role in the clearance of plasma amyloid-β (Aβ). However, their relationship is not clear. OBJECTIVE The aim was to explore the relationship between plasma levels of sLRP1, sRAGE, and Aβ in a cross-sectional study. METHODS A total of 1,185 cognitively normal participants (age above 40) from a village in the suburbs of Xi'an, China were enrolled from October 8, 2014 to March 30, 2015. Plasma Aβ40, Aβ42, sLRP1, and sRAGE were tested using a commercial ELISA. Apolipoprotein E (APOE) genotyping was conducted using PCR and sequencing. The relationship between plasma levels of sLRP1, sRAGE, and Aβ was analyzed using Pearson's correlation analysis and multiple linear regression. RESULTS In the total population, Log sLRP1 and Log sRAGE were positively correlated with plasma Aβ40 (r= 0.103, p < 0.001; r= 0.064, p = 0.027, respectively), but neither were associated with plasma Aβ42. After multivariable adjustment in the regression model, Log sLRP1 and Log sRAGE were still positively related with plasma Aβ40 (β= 2.969, p < 0.001; β= 1.936, p = 0.017, respectively) but not Aβ42. Furthermore, the positive correlations between transport proteins and plasma Aβ40 remained significant only in APOEɛ4 non-carriers after Pearson's analysis and multiple regression analysis after stratification by gene status. CONCLUSION The concentrations of plasma sLRP1 and sRAGE had a significant impact on the level of plasma Aβ40 in cognitively normal adults, especially in APOEɛ4 non-carriers. However, the mechanism by which the transport proteins are involved in peripheral Aβ clearance and the relationship between transporters and amyloid burden in the brain needs further validation.
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Affiliation(s)
- Ling Gao
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yu Jiang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shan Wei
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Suhang Shang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pei Li
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chen Chen
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liangjun Dang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Wang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kang Huo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Meiying Deng
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingyi Wang
- Huxian Hospital of Traditional Chinese Medicine, Xi'an, China
| | - Rong Zhang
- Cerebrovascular Laboratory, Institute for Exercise and Environmental Medicine, UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Qiumin Qu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Welsh C, Celis-Morales CA, Brown R, Mackay DF, Lewsey J, Mark PB, Gray SR, Ferguson LD, Anderson JJ, Lyall DM, Cleland JG, Jhund PS, Gill JM, Pell JP, Sattar N, Welsh P. Comparison of Conventional Lipoprotein Tests and Apolipoproteins in the Prediction of Cardiovascular Disease. Circulation 2019; 140:542-552. [PMID: 31216866 PMCID: PMC6693929 DOI: 10.1161/circulationaha.119.041149] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Total cholesterol and high-density lipoprotein cholesterol (HDL-C) measurements are central to cardiovascular disease (CVD) risk assessment, but there is continuing debate around the utility of other lipids for risk prediction. METHODS Participants from UK Biobank without baseline CVD and not taking statins, with relevant lipid measurements (n=346 686), were included in the primary analysis. An incident fatal or nonfatal CVD event occurred in 6216 participants (1656 fatal) over a median of 8.9 years. Associations of nonfasting lipid measurements (total cholesterol, HDL-C, non-HDL-C, direct and calculated low-density lipoprotein cholesterol [LDL-C], and apolipoproteins [Apo] A1 and B) with CVD were compared using Cox models adjusting for classical risk factors, and predictive utility was determined by the C-index and net reclassification index. Prediction was also tested in 68 649 participants taking a statin with or without baseline CVD (3515 CVD events). RESULTS ApoB, LDL-C, and non-HDL-C were highly correlated (r>0.90), while HDL-C was strongly correlated with ApoA1 (r=0.92). After adjustment for classical risk factors, 1 SD increase in ApoB, direct LDL-C, and non-HDL-C had similar associations with composite fatal/nonfatal CVD events (hazard ratio, 1.23, 1.20, 1.21, respectively). Associations for 1 SD increase in HDL-C and ApoA1 were also similar (hazard ratios, 0.81 [both]). Adding either total cholesterol and HDL-C, or ApoB and ApoA, to a CVD risk prediction model (C-index, 0.7378) yielded similar improvement in discrimination (C-index change, 0.0084; 95% CI, 0.0065, 0.0104, and 0.0089; 95% CI, 0.0069, 0.0109, respectively). Once total and HDL-C were in the model, no further substantive improvement was achieved with the addition of ApoB (C-index change, 0.0004; 95% CI, 0.0000, 0.0008) or any measure of LDL-C. Results for predictive utility were similar for a fatal CVD outcome, and in a discordance analysis. In participants taking a statin, classical risk factors (C-index, 0.7118) were improved by non-HDL-C (C-index change, 0.0030; 95% CI, 0.0012, 0.0048) or ApoB (C-index change, 0.0030; 95% CI, 0.0011, 0.0048). However, adding ApoB or LDL-C to a model already containing non-HDL-C did not further improve discrimination. CONCLUSIONS Measurement of total cholesterol and HDL-C in the nonfasted state is sufficient to capture the lipid-associated risk in CVD prediction, with no meaningful improvement from addition of apolipoproteins, direct or calculated LDL-C.
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Affiliation(s)
- Claire Welsh
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Carlos A. Celis-Morales
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Rosemary Brown
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Daniel F. Mackay
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - James Lewsey
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Patrick B. Mark
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Stuart R. Gray
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Lyn D. Ferguson
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Jana J. Anderson
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Donald M. Lyall
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - John G. Cleland
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Pardeep S. Jhund
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Jason M.R. Gill
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Jill P. Pell
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
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Raal FJ, Tuomilehto J, Sposito AC, Fonseca FA, Averna M, Farnier M, Santos RD, Ferdinand KC, Wright RS, Navarese EP, Lerch DM, Louie MJ, Lee LV, Letierce A, Robinson JG. Treatment effect of alirocumab according to age group, smoking status, and hypertension: Pooled analysis from 10 randomized ODYSSEY studies. J Clin Lipidol 2019; 13:735-743. [PMID: 31377052 DOI: 10.1016/j.jacl.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/24/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Age, smoking, hypercholesterolemia, and hypertension are major risk factors for atherosclerotic cardiovascular disease. OBJECTIVE We examined whether the effects of alirocumab on low-density lipoprotein cholesterol (LDL-C) differed according to age, hypertension, or smoking status. METHODS Data were pooled from 10 Phase 3 ODYSSEY randomized trials (24-104 weeks' duration) in 4983 people with heterozygous familial hypercholesterolemia (FH) or non-familial hypercholesterolemia (3188 on alirocumab, 1795 on control [620 on ezetimibe and 1175 on placebo]). Most participants received concomitant maximum tolerated statin therapy. In 8 trials, the alirocumab dose was increased from 75 mg every 2 weeks (Q2W) to 150 mg Q2W at Week 12 if predefined risk-based LDL-C goals were not achieved at Week 8 (≥70 mg/dL in very high cardiovascular risk; ≥100 mg/dL in moderate or high cardiovascular risk). Two trials compared alirocumab 150 mg Q2W vs placebo. The efficacy and safety of alirocumab were assessed post hoc in subgroups stratified by age (<65, ≥65 to <75, ≥75 years) and baseline hypertension or smoking status. RESULTS Alirocumab reduced LDL-C by 23.7% (75/150 mg vs ezetimibe + statin) to 65.4% (150 mg vs placebo + statin) from baseline to Week 24 vs control. Subgroup analyses confirmed no significant interactions in response to alirocumab between age group, hypertension, or smoking status. Overall rates of treatment-emergent adverse events were similar between alirocumab and control groups. CONCLUSIONS In this pooled analysis from 10 trials, alirocumab led to substantial LDL-C reductions vs control in every age group and regardless of hypertension or smoking status. Alirocumab was well tolerated in all subgroups.
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Affiliation(s)
- Frederick J Raal
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
| | - Jaakko Tuomilehto
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Andrei C Sposito
- Cardiology Division, State University of Campinas School of Medicine (FCM Unicamp), Campinas, Brazil
| | - Francisco A Fonseca
- Cardiology Division, Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Maurizio Averna
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), School of Medicine, University of Palermo, Palermo, Italy
| | - Michel Farnier
- Department of Cardiology, Lipid Clinic, Point Médical, CHU Dijon Bourgogne, Dijon, France
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Keith C Ferdinand
- Department of Medicine, Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Scott Wright
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Eliano Pio Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, Bari, Italy; Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland; SIRIO MEDICINE Network, VA, USA
| | | | | | | | - Alexia Letierce
- Sanofi, Biostatistics and Programming, Chilly-Mazarin, France
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Zhou H, Zhang S, Sun X, Yang D, Zhuang X, Guo Y, Hu X, Du Z, Zhang M, Liao X. Lipid management for coronary heart disease patients: an appraisal of updated international guidelines applying Appraisal of Guidelines for Research and Evaluation II-clinical practice guideline appraisal for lipid management in coronary heart disease. J Thorac Dis 2019; 11:3534-3546. [PMID: 31559060 PMCID: PMC6753419 DOI: 10.21037/jtd.2019.07.71] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/28/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) provide many recommendations for hyperlipidemia management, but some of them are still debatable. METHODS We applied the six-domain Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate the quality of guidelines with lipid management recommendations for coronary heart disease (CHD), including dyslipidemia and CHD guidelines published from 2009 to 2019. Meanwhile, we synthesized and compared major recommendations and present the consistency and controversy in current dyslipidemia management. RESULTS Among 19 guidelines included, ten guidelines ("strongly recommended" with AGREE scores 61-94%) performed better than the other nine (38-65% as "recommended with some modification") For blood lipid tests, most CHD guidelines simply required fasting sample while dyslipidemia guidelines preferred non-fasting sample except in high triglycerides state. Most guidelines consistently chose low-density lipoprotein cholesterol (LDL-C) as the primary lipid-lowering target (LLT), while non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B were mainly selected as secondary LLTs. The specific goals of LDL-C lowering were either to lower than 70 mg/dL or with at least 50% reduction. All guidelines recommended high intensity or maximally tolerable doses of statins, while ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were recommended as second-line therapy. CONCLUSIONS The general quality of guidelines for lipid management is satisfactory. Consensus has been reached on the specific goal of lipid reduction and the intensity of statins therapy. Further research is needed to validate the application of non-fasting sample and non-HDL-C target, as well as the efficacy and safety of ezetimibe and PCSK9 inhibitors.
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Affiliation(s)
- Huimin Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xiuting Sun
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
- Center for Information Technology & Statistics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xun Hu
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Zhimin Du
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou 510080, China
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
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286
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Abstract
PURPOSE OF REVIEW To distinguish extreme and very high atherosclerotic cardiovascular disease (ASCVD) event risk based on prospective epidemiological studies and clinical trial results. RECENT FINDINGS Clinical practice guidelines have categorized patients with either a history of one or more "clinical ASCVD" events or "coronary heart disease (CHD) risk equivalency" to be at "very high risk" for a recurrence or a first event, respectively. A 20% or greater 10-year ASCVD risk for a composite 3-point "major" atherosclerotic cardiovascular event (MACE) of non-fatal myocardial infarction (MI), non-fatal stroke, or cardiovascular death can serve as an arbitrary definition of those at "very high risk." Exclusion of stroke may underestimate risk of "hard" endpoint 10-year ASCVD risk and addition of other potential endpoints, e.g., hospital admission for unstable angina or revascularization, a 5-point composite MACE, may overinflate the risk definitions and categorization. "Extreme" risk, a descriptor for even higher morbidity and mortality potential, defines a 30% or greater 10-year 3-point MACE (ASCVD) risk. In prospective, epidemiological studies and randomized clinical trial (RCT) participants with an initial acute coronary syndrome (ACS) within several months of entry into the study meet the inclusion criteria assignment for extreme risk. In survivors beyond the first year of an ASCVD event, "extreme" risk persists when one or more comorbidities are present, including diabetes, heart failure (HF), stage 3 or higher chronic kidney disease (CKD), familial hypercholesterolemia (FH), and poorly controlled major risk factors such as hypertension and persistent tobaccoism. "Extreme" risk particularly applies to those with progressive or multiple clinical ASCVD events in the same artery, same arterial bed, or polyvascular sites, including unstable angina and transient ischemic events. Identifying asymptomatic individuals with extensive subclinical ASCVD at "extreme" risk is a challenge, as risk engine assessment may not be adequate; individuals with genetic FH or those with diabetes and Agatston coronary artery calcification (CAC) scores greater than 1000 exemplify such threatening settings and opportunities for aggressive primary prevention. Heterogeneity exists among individuals at risk for clinical ASCVD events; identifying those at "extreme" risk, a more ominous ASCVD category, associated with greater morbidity and mortality, should prompt the most effective global cardiometabolic risk reduction.
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Affiliation(s)
- Paul D Rosenblit
- Department Medicine, Division Endocrinology, Diabetes, Metabolism, University California, Irvine (UCI), School of Medicine, Irvine, CA, 92697, USA.
- Diabetes Out-Patient Clinic, UCI Medical Center, Orange, CA, 92868, USA.
- Diabetes/Lipid Management & Research Center, 18821 Delaware St., Suite 202, Huntington Beach, CA, 92648, USA.
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287
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Dansinger ML, Williams PT, Superko HR, Schaefer EJ. Effects of weight change on apolipoprotein B-containing emerging atherosclerotic cardiovascular disease (ASCVD) risk factors. Lipids Health Dis 2019; 18:154. [PMID: 31311555 PMCID: PMC6636168 DOI: 10.1186/s12944-019-1094-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 07/01/2019] [Indexed: 01/05/2023] Open
Abstract
Background and aims Non-high-density (HDL)-cholesterol, low-density lipoprotein (LDL)-particle number, apolipoprotein B, lipoprotein(a) (Lp(a)), and small-dense (sdLDL) and large-buoyant (lbLDL) LDL-subfractions are emerging apo B-containing atherosclerotic cardiovascular disease (ASCVD) risk factors. Current guidelines emphasize lifestyle, including weight loss, for ASCVD risk management. Whether weight change affects these emerging risk factors beyond that predicted by traditional triglyceride and LDL-cholesterol measurements remains to be determined. Method Regression analyses of fasting ∆apo B-containing lipoproteins vs. ∆BMI were examined in a large anonymized clinical laboratory database of 33,165 subjects who did not report use of lipid-lowering medications. Regression slopes (±SE) were estimated as: *∆mmol/L per ∆kg/m2, †∆g/L per ∆kg/m2, ‡∆% per ∆kg/m2, and §∆μmol/L per ∆kg/m2. Results When adjusted for age, ∆BMI was significantly related to ∆nonHDL-cholesterol (males: 0.0238 ± 0.0041, P = 7.9 × 10− 9; females: 0.0330 ± 0.0037, P < 10− 16)*, ∆LDL-particles (males: 0.0128 ± 0.0024, P = 2.1 × 10− 7; females: 0.0114 ± 0.0022, P = 3.2 × 10− 7)*, ∆apo B (males: 0.0053 ± 0.0010, P = 7.9 × 10− 8; females: 0.0073 ± 0.0009, P = 2.2 × 10− 16)†, ∆sdLDL (males: 0.0125 ± 0.0015, P = 2.2 × 10− 16; females: 0.0128 ± 0.0012, P < 10− 16)*, ∆percent LDL carried on small dense particles (%sdLDL, males: 0.296 ± 0.035, P < 10− 16; females: 0.221 ± 0.023, P < 10− 16)‡, ∆triglycerides (males: 0.0358 ± 0.0049, P = 2.0 × 10− 13; females: 0.0304 ± 0.0029, P < 10− 16)*, and ∆LDL-cholesterol (males: 0.0128 ± 0.0034, P = 0.0002; females: 0.0232 ± 0.0031, P = 1.2 × 10− 13)* in both males and females. Age-adjusted ∆BMI was significantly related to ∆lbLDL in females (0.0098 ± 0.0024, P = 3.9 × 10− 5)* but not males (0.0007 ± 0.0026, P = 0.78)*. Female showed significantly greater increases in ∆LDL-cholesterol (P = 0.02) and ∆lbLDL (P = 0.008) per ∆BMI than males. ∆BMI had a greater effect on ∆LDL-cholesterol measured directly than indirect estimate of ∆LDL-cholesterol from the Friedewald equation. When sexes were combined and adjusted for age, sex, ∆triglycerides and ∆LDL-cholesterol, ∆BMI retained residual associations with ∆nonHDL-cholesterol (0.0019 ± 0.0009, P = 0.03)*, ∆LDL-particles (0.0032 ± 0.0010, P = 0.001)*, ∆apo B (0.0010 ± 0.0003, P = 0.0008)†, ∆Lp(a) (− 0.0091 ± 0.0021, P = 1.2 × 10− 5)§, ∆sdLDL (0.0001 ± 0.0000, P = 1.6 × 10− 11)* and ∆%sdLDL (0.151 ± 0.018, P < 10− 16) ‡. Conclusions Emerging apo B-containing risk factors show associations with weight change beyond those explained by the more traditional triglyceride and LDL-cholesterol measurements. Electronic supplementary material The online version of this article (10.1186/s12944-019-1094-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael L Dansinger
- Boston Heart Diagnostics, 175 Crossing Boulevard, Suite 100, Framingham, MA, 01702, USA. .,Tufts Medical Center, 800 Washington St, Boston, MA, 02111, USA.
| | - Paul T Williams
- Boston Heart Diagnostics, 175 Crossing Boulevard, Suite 100, Framingham, MA, 01702, USA
| | - H Robert Superko
- Boston Heart Diagnostics, 175 Crossing Boulevard, Suite 100, Framingham, MA, 01702, USA
| | - Ernst J Schaefer
- Boston Heart Diagnostics, 175 Crossing Boulevard, Suite 100, Framingham, MA, 01702, USA.,Cardiovascular Nutrition Laboratory, USDA Human Nutrition Research Center at Tufts University, 711 Washington St., Boston, MA, 02111, USA
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288
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Ahmad Z, Banerjee P, Hamon S, Chan KC, Bouzelmat A, Sasiela WJ, Pordy R, Mellis S, Dansky H, Gipe DA, Dunbar RL. Inhibition of Angiopoietin-Like Protein 3 With a Monoclonal Antibody Reduces Triglycerides in Hypertriglyceridemia. Circulation 2019; 140:470-486. [PMID: 31242752 PMCID: PMC6686956 DOI: 10.1161/circulationaha.118.039107] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Hypertriglyceridemia is associated with increased cardiovascular risk and may be caused by impaired lipoprotein clearance. Angiopoietin-like protein 3 (ANGPTL3) inhibits lipoprotein lipase activity, increasing triglycerides and other lipids. Evinacumab, an ANGPTL3 inhibitor, reduced triglycerides in healthy human volunteers and in homozygous familial hypercholesterolemic individuals. Results from 2 Phase 1 studies in hypertriglyceridemic subjects are reported here. Methods: Subjects with triglycerides >150 but ≤450 mg/dL and low-density lipoprotein cholesterol ≥100 mg/dL (n=83 for single ascending dose study [SAD]; n=56 for multiple ascending dose study [MAD]) were randomized 3:1 to evinacumab:placebo. SAD subjects received evinacumab subcutaneously at 75/150/250 mg, or intravenously at 5/10/20 mg/kg, monitored up to day 126. MAD subjects received evinacumab subcutaneously at 150/300/450 mg once weekly, 300/450 mg every 2 weeks, or intravenously at 20 mg/kg once every 4 weeks up to day 56 with 6 months of follow-up. The primary outcomes were incidence and severity of treatment-emergent adverse events. Efficacy analyses included changes in triglycerides and other lipids over time. Results: In the SAD, 32 (51.6%) versus 9 (42.9%) subjects on evinacumab versus placebo reported treatment-emergent adverse events. In the MAD, 21 (67.7%) versus 9 (75.0%) subjects on subcutaneously evinacumab versus placebo and 6 (85.7%) versus 1 (50.0%) on intravenously evinacumab versus placebo reported treatment-emergent adverse events. No serious treatment-emergent adverse events or events leading to death or treatment discontinuation were reported. Elevations in alanine aminotransferase (7 [11.3%] SAD), aspartate aminotransferase (4 [6.5%] SAD), and creatinine phosphokinase (2 [3.2%) SAD, 1 [14.3%] MAD) were observed with evinacumab (none in the placebo groups), which were single elevations and were not dose-related. Dose-dependent reductions in triglycerides were observed in both studies, with maximum reduction of 76.9% at day 3 with 10 mg/kg intravenously (P<0.0001) in the SAD and of 83.1% at day 2 with 20 mg/kg intravenously once every 4 weeks (P=0.0003) in the MAD. Significant reductions in other lipids were observed with most evinacumab doses versus placebo. Conclusion: Evinacumab was well-tolerated in 2 Phase 1 studies. Lipid changes in hypertriglyceridemic subjects were similar to those observed with ANGPTL3 loss-of-function mutations. Because the latter is associated with reduced cardiovascular risk, ANGPTL3 inhibition may improve clinical outcomes. Clinical Trial Registration: https://www.clinicaltrials.gov. Unique identifiers: NCT01749878 and NCT02107872.
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Affiliation(s)
- Zahid Ahmad
- Division of Nutrition and Metabolic Diseases, Department of Internal Medicine, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas (Z.A.)
| | - Poulabi Banerjee
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Sara Hamon
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Kuo-Chen Chan
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Aurelie Bouzelmat
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - William J Sasiela
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Robert Pordy
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Scott Mellis
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Hayes Dansky
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Daniel A Gipe
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (P.B., S.H., K.-C.C., A.B., W.JS., R.P., S.M., H.D., D.A.G.)
| | - Richard L Dunbar
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (R.L.D.)
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289
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Su X, Luo M, Tang X, Luo Y, Zheng X, Peng D. Goals of non-high density lipoprotein cholesterol need to be adjusted in Chinese acute coronary syndrome patients: Findings from the CCC-ACS project. Clin Chim Acta 2019; 496:48-54. [PMID: 31255567 DOI: 10.1016/j.cca.2019.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Guidelines recommended non-high density lipoprotein cholesterol (non-HDL-C) as a co-primary target, and set non-HDL-C goals as 30 mg/dl higher than low-density lipoprotein cholesterol (LDL-C) goals. However, the value is largely uncertain in Chinese patients. METHODS We assigned non-HDL-C values at the same percentiles correspondent to LDL-C goals for patients from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project. We calculated the differences between non-HDL-C and LDL-C and proposed appropriate adding values according to LDL-C and TG concentrations. RESULTS Among 73,495 patients, 17.7% used lipid-lowering agents before admission. Of these, 27.2% achieved LDL-C <70 mg/dl while 39.4% achieved non-HDL-C <100 mg/dl. The mean difference between non-HDL-C and LDL-C was 23.2 mg/dl, which could be affected by LDL-C and TG concentrations. Importantly, of patients with LDL-C concentrations ≤100 mg/dl, the mean differences were 19.1 mg/dl in patients with TG ≤150 mg/dl and 24.6 mg/dl in patients with TG >150 mg/dl. CONCLUSIONS There are significant differences between LDL-C and non-HDL-C in Chinese ACS patients. For secondary prevention, on average, the adding values should be 20 mg/dl for patients with TG ≤150 mg/dl and 25 mg/dl for patients with TG >150 mg/dl when LDL-C goals of 70 mg/dl is achieved.
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Affiliation(s)
- Xin Su
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mengdie Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoyu Tang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yonghong Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoyan Zheng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Daoquan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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290
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Shen Y, Chen S, Dai Y, Wang XQ, Zhang RY, Yang ZK, Hu J, Lu L, Ding FH, Shen WF. Lipoprotein (a) interactions with cholesterol-containing lipids on angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion. Cardiovasc Diabetol 2019; 18:82. [PMID: 31234867 PMCID: PMC6589890 DOI: 10.1186/s12933-019-0888-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background We investigated whether or to what extent the interaction of lipoprotein (a) [Lp(a)] with cholesterol-containing lipids was associated with angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion. Methods Serum levels of Lp(a), total cholesterol, low-density lipoprotein–cholesterol (LDL-C), high-density lipoprotein–cholesterol (HDL-C), and triglyceride were determined and non-HDL-C was calculated in 706 type 2 diabetic and 578 non-diabetic patients with stable coronary artery disease and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3). Results For diabetic and non-diabetic patients, Lp(a), total cholesterol, LDL-C, and non-HDL-C levels were higher in patients with poor coronary collateralization than in those with good collateralization, whereas HDL-C and triglyceride levels were similar. After adjustment for potential confounding factors, tertiles of Lp(a), total cholesterol, LDL-C and non-HDL-C remained independent determinants for poor collateralization. A significant interaction between Lp(a) and total cholesterol, LDL-C or non-HDL-C was observed in diabetic patients (all P interaction < 0.001) but not in non-diabetics. At high tertile of total cholesterol (≥ 5.35 mmol/L), LDL-C (≥ 3.36 mmol/L) and non-HDL-C (≥ 4.38 mmol/L), diabetic patients with high tertile of Lp(a) (≥ 30.23 mg/dL) had an increased risk of poor collateralization compared with those with low tertile of Lp(a) (< 12.66 mg/dL) (adjusted OR = 4.300, 3.970 and 4.386, respectively, all P < 0.001). Conclusions Increased Lp(a) confers greater risk for poor coronary collateralization when total cholesterol, LDL-C or non-HDL-C are elevated especially for patients with type 2 diabetes. Electronic supplementary material The online version of this article (10.1186/s12933-019-0888-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Shuai Chen
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Yang Dai
- Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Xiao Qun Wang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Rui Yan Zhang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhen Kun Yang
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jian Hu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Lin Lu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China
| | - Feng Hua Ding
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
| | - Wei Feng Shen
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China. .,Institute of Cardiovascular Diseases, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Road II, Shanghai, 200025, People's Republic of China.
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291
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Zykov MV. [The problem of safety of lipid-lowering therapy]. ACTA ACUST UNITED AC 2019; 59:13-26. [PMID: 31221072 DOI: 10.18087/cardio.2505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 11/18/2022]
Abstract
This study focused on analysis of current publications evaluating safety of lipid-lowering therapy. Search for literature was performed on websites of cardiological societies and online databases, including PubMed, EMBASE, and eLibrary by the following key words: statins, statin intolerance, lipid-lowering therapy, statin safety, and statin аdverse effects. The focus is on statins, in view of the fact that they are the most commonly prescribed, highly effective and safe drugs for primary and secondary cardiovascular prophylaxis. This review consistently summarized information about myopathies, hepatic and renal dysfunction, potentiation of DM, and other possible adverse effects of lipid-lowering therapy. The author concluded that despite the high safety of statins acknowledged by all international cardiological societies, practicing doctors still continue unreasonably cancel statins, exposing the patient under even greater danger. Information about the corresponding author.
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Affiliation(s)
- M V Zykov
- Research Institute for Complex Issues of Cardiovascular Diseases
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292
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Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139:e1082-e1143. [PMID: 30586774 PMCID: PMC7403606 DOI: 10.1161/cir.0000000000000625] [Citation(s) in RCA: 1194] [Impact Index Per Article: 238.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Scott M Grundy
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Neil J Stone
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Alison L Bailey
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Craig Beam
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Kim K Birtcher
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Roger S Blumenthal
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Lynne T Braun
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Sarah de Ferranti
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Joseph Faiella-Tommasino
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Daniel E Forman
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Ronald Goldberg
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Paul A Heidenreich
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Mark A Hlatky
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Daniel W Jones
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Donald Lloyd-Jones
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Nuria Lopez-Pajares
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Chiadi E Ndumele
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Carl E Orringer
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Carmen A Peralta
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Joseph J Saseen
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Sidney C Smith
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Laurence Sperling
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Salim S Virani
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
| | - Joseph Yeboah
- ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention Subcommittee Liaison. ‖PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM Representative. §§ACPM Representative. ‖‖NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC Representative
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293
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Association between different lipid parameters and aortic stiffness: clinical and therapeutic implication perspectives. J Hypertens 2019; 37:2240-2246. [PMID: 31188165 DOI: 10.1097/hjh.0000000000002161] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Recommendations about lipid parameters varied from different guidelines. Aortic stiffness is a marker of vascular aging and may reflect occurrence of cardiovascular diseases. Aortic pulse wave velocity (PWV), a marker of aortic stiffness, can be measured by applanation tonometry. The purpose of our study was to test the associations between lipid parameters and aortic stiffness. METHODS A cross-sectional study was conducted from 2012 to 2017, 603 participants were included: 517 patients and 86 'healthy' individuals used to calculate the theoretical PWV. Lipid parameters, including total cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL, total cholesterol/HDL ratio, triglycerides/HDL ratio and LDL/HDL ratio were measured. Theoretical PWV can be calculated according to age, sex, mean blood pressure and heart rate, allowing to form an individual PWV index [(measured PWV - theoretical PWV)/theoretical PWV]. PWV index [(measured PWV - theoretical PWV)/theoretical PWV] greater than 0 defined aortic stiffness. RESULTS In multiple linear regression analyses, total cholesterol (P = 0.03), LDL (P = 0.04), non-HDL (P = 0.03), total cholesterol/HDL (P = 0.01) and LDL/HDL (P = 0.03) were significantly correlated with PWV. In multiple logistic regression analyses, non-HDL [OR = 1.12 (1.04-1.20), P = 0.01, R value: 0.224], total cholesterol/HDL [OR = 1.12 (1.02-1.22), P = 0.03, R value: 0.219] and total cholesterol [OR = 1.11 (1.01-1.23), P = 0.03, R value: 0.209] were significantly associated with aortic stiffness. CONCLUSION Non-HDL, total cholesterol and total cholesterol/HDL were significantly associated with aortic stiffness than others and especially individually lipid parameters. This result should be considered in future clinical lipid-lowering trials.
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294
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Xu X, Pandit RU, Han L, Li Y, Guo X. Remnant Lipoprotein Cholesterol Independently Associates With In-Stent Restenosis After Drug-Eluting Stenting for Coronary Artery Disease. Angiology 2019; 70:853-859. [PMID: 31167539 DOI: 10.1177/0003319719854296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study evaluated the prognostic value of remnant lipoprotein cholesterol (RLP-C) as a predictor of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation in patients with coronary artery disease (CAD). Consecutive patients with CAD (n = 612) who underwent both successful coronary DES implantation and follow-up angiography ranging from 6 to 24 months were enrolled. The independent predictors of ISR were explored by multivariate logistic regression analysis; 95 (15.52%) patients were identified to have ISR. Multivariate logistic regression analysis showed that RLP-C concentration (odds ratio [OR]: 4.245, 95% confidence interval [CI]: 2.493-7.229), age (OR: 1.026, 95% CI: 1.002-1.051), diabetes mellitus (DM; OR: 1.811, 95% CI: 1.134-2.892), and lesion length (OR: 1.013, 95% CI: 1.002-1.024) were associated with ISR. Via subgroup analysis, we found that RLP-C was independently associated with ISR in both CAD with DM (OR: 4.154, 95% CI: 1.895-9.104) and CAD without DM (OR: 4.455, 95% CI: 2.097-9.464) groups. In the analysis of the receiver operating characteristics curve, RLP-C level >0.515 mmol/L exhibited 77.9% sensitivity and 56.5% specificity (area under the curve: 0.705, 95% CI: 0.648-0.762) in predicting ISR. In conclusion, RLP-C is independently associated with the development of ISR in patients with CAD after DES implantation.
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Affiliation(s)
- Xiangyu Xu
- 1 Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ram Udgar Pandit
- 1 Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Le Han
- 2 Department of Lung Function, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Yan Li
- 2 Department of Lung Function, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Xiaomei Guo
- 1 Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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295
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Fastenau J, Kolotkin RL, Fujioka K, Alba M, Canovatchel W, Traina S. A call to action to inform patient-centred approaches to obesity management: Development of a disease-illness model. Clin Obes 2019; 9:e12309. [PMID: 30977293 PMCID: PMC6594134 DOI: 10.1111/cob.12309] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/25/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023]
Abstract
Patient-centred care is an essential component of high-quality health care, shown to improve clinical outcomes and patient satisfaction, and reduce costs. While there are several authoritative models of obesity pathophysiology and treatment algorithms, a truly patient-centred model is lacking. We describe the development of a patient-centric obesity model. A disease-illness framework was selected because it emphasizes each patient's unique experience while capturing biomedical aspects of the disease. Model input was obtained from an accumulation of research including contributions from experts in obesity and patient-reported outcomes, qualitative research with adults living in the United States, and two targeted literature searches. The model places the patient with obesity at its core and links pathologic imbalances of energy intake and expenditure to environmental, sociodemographic, psychological, behavioural, physiological and medical health determinants. It highlights relationships between obesity signs and symptoms, comorbid conditions, impacts on health-related quality of life, and some barriers to obesity management that must be considered to attain better outcomes. Providers need to evaluate patients holistically, understand what changes each patient is motivated to make, and recognize what challenges might impede weight reduction, improvements in comorbid conditions, signs and symptoms, and health-related quality of life before pursuing individualized treatment goals. Patients living with obesity who do lose weight perceive benefits beyond weight loss. Ideally, this model will increase awareness of the complex, heterogeneous impacts of obesity on patients' well-being and recognition of obesity as a chronic disease, and prompt a call to action among stakeholders to improve quality of care.
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Affiliation(s)
- John Fastenau
- Janssen Research & Development, LLCRaritanNew Jersey
| | - Ronette L. Kolotkin
- Quality of Life Consulting, PLLCDurhamNorth Carolina
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNorth Carolina
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFørdeNorway
- Centre of Health ResearchFørde Hospital TrustFørdeNorway
- Morbid Obesity CentreVestfold Hospital TrustTønsbergNorway
| | - Ken Fujioka
- Department of Diabetes and EndocrineScripps ClinicSan DiegoCalifornia
| | - Maria Alba
- Janssen Research & Development, LLCRaritanNew Jersey
| | | | - Shana Traina
- Janssen Research & Development, LLCRaritanNew Jersey
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296
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Johnston EA, Beasley JM, Jay MR, Wiedemer JP, Kris-Etherton PM. Practical Nutrition for the Primary Care Provider: A Pilot Test. MEDICAL SCIENCE EDUCATOR 2019; 29:363-373. [PMID: 32832196 PMCID: PMC7439974 DOI: 10.1007/s40670-019-00700-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dynamic nutrition education strategies may help prepare physicians to provide nutrition guidance to patients. ACTIVITY We pilot tested a nutrition-focused iBook chapter with a group of medical students and residents (June 2017) through pre and post-test Qualtrics surveys. RESULTS All 29 respondents recognized the role of nutrition in medical care. Two-thirds reported some nutrition training in their medical education; nearly 90% reported this training was inadequate. Few (17%) reported reading scholarly nutrition articles; 84% reported they would recommend the iBook to their peers. CONCLUSIONS An iBook is a resource that could be used to teach nutrition to medical trainees.
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Affiliation(s)
- Emily A. Johnston
- Department of Nutritional Sciences, The Pennsylvania State University, 317 Chandlee Laboratory, University Park, PA USA
| | - Jeannette M. Beasley
- Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY USA
| | - Melanie R. Jay
- Departments of Medicine and Population Health, Veterans Health Affairs, NYU School of Medicine, New York, NY USA
| | - Joseph P. Wiedemer
- Penn State Family and Community Medicine Residency, Mount Nittany Medical Center, State College, PA USA
| | - Penny M. Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, 317 Chandlee Laboratory, University Park, PA USA
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297
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Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. J Am Coll Cardiol 2019; 73:e285-e350. [DOI: 10.1016/j.jacc.2018.11.003] [Citation(s) in RCA: 1113] [Impact Index Per Article: 222.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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298
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Kwon YJ, Chung TH, Lee HS, Park J, Chung JY, Lee BK, Lee JW. Association between circadian preference and blood lipid levels using a 1:1:1 propensity score matching analysis. J Clin Lipidol 2019; 13:645-653.e2. [PMID: 31126864 DOI: 10.1016/j.jacl.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/01/2019] [Accepted: 04/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies indicate that circadian preference is associated with various energy metabolism and metabolic disorders. However, little is known about the associations between a circadian rhythm and blood lipid levels, especially in humans. OBJECTIVE The aim of the study was to investigate whether the circadian rhythm affects serum lipid levels in Korean adults. METHODS We designed a cross-sectional study to evaluate the associations between circadian preference and blood lipid levels in Korean adults. A total of 1984 participants (range of age 19-81 years) were included in this study. Propensity scores were calculated using logistic regression with age, sex, and body mass index. A total of 435 subjects were evaluated by propensity score matching analysis, equally distributed into morningness, intermediate, and eveningness groups, each with 145 subjects. Circadian preference was evaluated by the Morningness-Eveningness Questionnaire. RESULTS Participants with the evening preference had significantly higher levels of total cholesterol, triglyceride, low-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol (non-HDL-C) when compared with those with morning or intermediate preference, after adjusting for confounding variables. Regarding other lipid parameters, both total cholesterol/HDL-C and low-density lipoprotein cholesterol/HDL-C in the evening preference are significantly higher than those of other circadian preferences. Evening preference was also significantly associated with a higher atherogenic index of plasma. CONCLUSION Our study demonstrates that there is a significant association between circadian preference and blood lipid levels. Our findings suggest that individuals with evening preference could have a greater risk of atherosclerotic cardiovascular diseases.
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Affiliation(s)
- Yu-Jin Kwon
- Department of Family Medicine, Yong-In Severance Hospital, Yonsei University College of Medicine, Gyoung-gi, Republic of Korea; Department of Medicine, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Tae-Ha Chung
- Department of Health Medicine, Severance Hospital, Severance check-up, Yonsei University Health System, Seoul, Republic of Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - JuYoung Park
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Youn Chung
- Department of Family Medicine, Gangnam Severance Health Check-up, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung-Kwon Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Ji-Won Lee
- Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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299
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The PCSK9 revolution: Current status, controversies, and future directions. Trends Cardiovasc Med 2019; 30:179-185. [PMID: 31151804 DOI: 10.1016/j.tcm.2019.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023]
Abstract
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) has revolutionized our understanding of cholesterol homeostasis and added to our arsenal against atherosclerotic cardiovascular disease (ASCVD). In a span of approximately 15 years, PCSK9 has morphed from an esoteric and rare cause of familial hypercholesterolemia (FH) into the most efficient cholesterol-lowering target ever known, with the completion of two large scale cardiovascular outcome trials showing positive results. Current Food and Drug Administration (FDA) approved modalities to inhibit PCSK9 are in the form of monoclonal antibodies which display an unparalleled degree of low-density lipoprotein cholesterol (LDL-C) lowering and expand upon the notion that lower LDL-C is better for ASCVD risk reduction. However, the accelerated pace of discovery and therapeutic development has left large gaps in our knowledge regarding the physiology and function of PCSK9. The aim of this review is to provide context to the discovery, history, treatment and current status of PCSK9 and its therapeutic inhibitors and highlight areas of controversy and future directions.
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300
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Garshick MS, Vaidean GD, Vani A, Underberg JA, Newman JD, Berger JS, Fisher EA, Gianos E. Cardiovascular Risk Factor Control and Lifestyle Factors in Young to Middle-Aged Adults with Newly Diagnosed Obstructive Coronary Artery Disease. Cardiology 2019; 142:83-90. [PMID: 31079098 DOI: 10.1159/000498891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND While progress in the prevention of cardiovascular disease (CVD) has been noted over the past several decades, there are still those who develop CVD earlier in life than others. OBJECTIVE We investigated traditional and lifestyle CVD risk factors in young to middle-aged patients compared to older ones with obstructive coronary artery disease (CAD). METHODS A retrospective analysis of patients with a new diagnosis of obstructive CAD undergoing coronary intervention was performed. Young to middle-aged patients were defined as those in the youngest quartile (n = 281, mean age 50 ± 6 years, 81% male) compared to the other three older quartiles combined (n = 799, mean age 69 ± 7.5 years, 71% male). Obstructive CAD was determined by angiography. RESULTS Young to middle-aged patients compared to older ones were more likely to be male (p < 0.01), smokers (21 vs. 9%, p < 0.001), and have a higher body mass index (31 ± 6 vs. 29 ± 6 kg/m2, p < 0.001). Younger patients were less likely to eat fruits, vegetables, and fish and had fewer controlled CVD risk factors (2.7 ± 1.2 vs. 3.0 ± 1.0, p < 0.001). Compared to older patients, higher levels of psychological stress (aOR 1.6, 95% CI 1.1-2.4), financial stress (aOR 1.8, 95% CI 1.3-2.5), and low functional capacity (aOR 3.3, 95% CI 2.4-4.5) were noted in the young to middle-aged population as well. CONCLUSION Lifestyle in addition to traditional CVD risk factors should be taken into account when evaluating risk for development of CVD in a younger population.
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Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA,
| | - Georgeta D Vaidean
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA.,Fairleigh Dickinson University School of Pharmacy and Health Sciences, Florham Park, New Jersey, USA
| | - Anish Vani
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - James A Underberg
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Jonathan D Newman
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Jeffrey S Berger
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Edward A Fisher
- Center for the Prevention of Cardiovascular Disease, New York University Langone Health, New York City, New York, USA
| | - Eugenia Gianos
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
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