251
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Koh KK. Letter by Koh Regarding Article, "Benefit of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes and Safety in Patients With Versus Without Diabetes Mellitus: Results From IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)". Circulation 2018; 138:1914-1915. [PMID: 30354661 DOI: 10.1161/circulationaha.118.035512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kwang Kon Koh
- Department of Cardiovascular Medicine, Heart Center, Gachon University, Incheon, Korea. Gil Medical Center, Incheon, Korea. Gachon Cardiovascular Research Institute, Incheon, Korea
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252
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Mirzaee S, Thein PM, Nogic J, Nerlekar N, Nasis A, Brown AJ. The effect of combined ezetimibe and statin therapy versus statin therapy alone on coronary plaque volume assessed by intravascular ultrasound: A systematic review and meta-analysis. J Clin Lipidol 2018; 12:1133-1140.e15. [PMID: 30318063 DOI: 10.1016/j.jacl.2018.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Current guidelines recommend an intensive lipid-lowering therapy to achieve the low-density lipoprotein cholesterol (LDL-C) target in patients with high risk of cardiovascular disease. Former studies suggested adding ezetimibe to statin therapy in the above setting may promote plaque changes; however, this effect has not been consistently reported. METHODS Electronic searches were performed in MEDLINE, EMBASE, and Cochrane library on November 30, 2017 to identify prospective trials assessing the effects of combined ezetimibe and statin therapy versus statin therapy alone on atheroma volume using intravascular ultrasound. The effect size between treatment groups within individual studies was assessed by weighted mean difference (MD) using a random-effects model. RESULTS Eight studies were obtained for systematic review and 6 of them compromising total of 583 subjects that meet the criteria were meta-analyzed. There was a significant reduction from baseline to follow-up in total atheroma volume with an MD of -3.71 mm3 (95% confidence interval: -5.98 to -1.44, P < .001), whereas analysis for percent atheroma volume demonstrated weighted MD of - 0.77% (-1.68 to 0.14, P = .10). A substantial decrease in LDL-C was observed with MD -16.75 mg/dL (-20.89 to -12.60, P < .00001). CONCLUSION The addition of ezetimibe to statin therapy is effective in reducing total atheroma volume assessed by intravascular ultrasound and also resulted in effective reduction of plasma LDL-C levels.
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Affiliation(s)
- Sam Mirzaee
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Monash University, Melbourne, Australia.
| | - Paul M Thein
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Monash University, Melbourne, Australia
| | - Jason Nogic
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Monash University, Melbourne, Australia
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Monash University, Melbourne, Australia
| | - Arthur Nasis
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Monash University, Melbourne, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Monash University, Melbourne, Australia
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253
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Abstract
PURPOSE OF REVIEW Statins are the most evidence-based therapy to target LDL-C to reduce atherosclerotic events. Yet, many people are unable to achieve adequate reduction in this key atherogenic factor. Moreover, residual risk of cardiovascular events may persist even after "optimal" LDL-C due to elevations in triglyceride-rich lipoproteins. Therefore, additional therapies beyond statins are needed, particularly in patients with diabetes. RECENT FINDINGS Clinical trials with ezetimibe and PCSK9 inhibitors have reported further reductions in cardiovascular events, beyond statins. The latter are particularly effective in lowering LDL-cholesterol and in reducing event rates. However, they are not effective in lowering triglycerides. Currently available fibrates and niacin have not proven effective in combination with statins in clinical trials, while the top line results of the REDUCE-IT trial with EPA, a pure omega-3 fatty acid, reporting 25% relative risk reduction in primary endpoints are of great interest. Recently approved agents have the promise to improve cardiovascular outcomes beyond statins. Many novel drugs in development have the potential to further improve prognosis.
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Affiliation(s)
- Om Ganda
- Adult Diabetes and Clinical Research, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA.
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254
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Diabetic Dyslipidemia: Epidemiology and Prevention of Cardiovascular Disease and Implications of Newer Therapies. Curr Cardiol Rep 2018; 20:125. [PMID: 30311078 DOI: 10.1007/s11886-018-1068-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Dyslipidemia in patients with T2DM confers significant additional risk of adverse outcomes to patients with cardiovascular disease (CVD). These patients carry residual risk of adverse outcomes despite optimal management with conventional therapy such as lifestyle changes and statin therapy. The role of both nonstatin monotherapy in statin-intolerant patients and combination therapy with statins in patients with high risk of CVD events has been well studied. We sought to review the role of newer therapies in risk reduction in these patients. RECENT FINDINGS Traditionally, non-statin options have included medications such as niacin, ezetimibe, fenofibrate, and n-3 fatty acids. Recently, drugs such as ezetimibe, inclisiran, and PCSK9 inhibitors have been studied with favorable results without an increased risk of developing new-onset diabetes. These medications hold the promise of increasing options to reduce cardiovascular risk in patients with T2DM. The role of newer non-statin therapies in patients with diabetic dyslipidemia in combination with statins needs to be further explored.
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255
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Ganda OP, Plutzky J, Sanganalmath SK, Bujas‐Bobanovic M, Koren A, Mandel J, Letierce A, Leiter LA. Efficacy and safety of alirocumab among individuals with diabetes mellitus and atherosclerotic cardiovascular disease in the ODYSSEY phase 3 trials. Diabetes Obes Metab 2018; 20:2389-2398. [PMID: 29802688 PMCID: PMC6175384 DOI: 10.1111/dom.13384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022]
Abstract
AIMS Individuals with both diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD) are at very high risk of cardiovascular events. This post-hoc analysis evaluated efficacy and safety of the PCSK9 inhibitor alirocumab among 984 individuals with DM and ASCVD pooled from 9 ODYSSEY Phase 3 trials. MATERIALS AND METHODS Changes in low-density lipoprotein cholesterol (LDL-C) and other lipids from baseline to Week 24 were analysed (intention-to-treat) in four pools by alirocumab dosage (150 mg every 2 weeks [150] or 75 mg with possible increase to 150 mg every 2 weeks [75/150]), control (placebo/ezetimibe) and background statin usage (yes/no). RESULTS At Week 24, LDL-C changes from baseline in pools with background statins were -61.5% with alirocumab 150 (vs -1.0% with placebo), -46.4% with alirocumab 75/150 (vs +6.3% with placebo) and -48.7% with alirocumab 75/150 (vs -20.6% with ezetimibe), and -54.9% with alirocumab 75/150 (vs +4.0% with ezetimibe) without background statins. A greater proportion of alirocumab recipients achieved LDL-C < 70 and < 55 mg/dL at Week 24 vs controls. Alirocumab also resulted in significant reductions in non-high-density lipoprotein cholesterol, apolipoprotein B and lipoprotein(a) vs controls. Alirocumab did not appear to affect glycaemia over 78-104 weeks. Overall safety was similar between treatment groups, with a higher injection-site reaction frequency (mostly mild) with alirocumab. CONCLUSION Alirocumab significantly reduced LDL-C and other atherogenic lipid parameters, and was generally well tolerated in individuals with DM and ASCVD.
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Affiliation(s)
- Om P. Ganda
- Clinical Research and Adult Diabetes Sections, Joslin Diabetes Center, Harvard Medical SchoolBostonMassachusetts
| | - Jorge Plutzky
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusetts
| | | | | | | | - Jonas Mandel
- Biostatistics and Programming, SanofiChilly‐MazarinFrance
- IviData StatsLevallois‐PerretFrance
| | | | - Lawrence A. Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of TorontoToronto, OntarioCanada
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256
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Abstract
PURPOSE OF REVIEW Treatment of diabetic dyslipidemia is necessary because of its impact on cardiovascular disease, which is the leading cause of death in patients with diabetes. In the past, standard treatment of diabetic dyslipidemia focused only on correcting lipids. Although this remains the mainstay of treatment, because new antihyperglycemic treatments reduce cardiovascular events with minimal effect on dyslipidemia, a new approach is both timely and relevant. RECENT FINDINGS LDL-lowering remains the focus of treatment for diabetic dyslipidemia, especially in patients with both diabetes and cardiovascular disease (CVD). Higher intensity statin therapy or lower LDL cholesterol goals are recommended in these patients. Combination therapy, especially with ezetimibe, fibrates, bile acid sequestrants, PCSK9 inhibitors and omega 3 fatty acids should be considered along with selected new agents to reduce glycemia. SUMMARY As diabetic dyslipidemia plays a key role in CVD, aggressive treatment is indicated. New research targets include apo-CIII and lipoprotein(a) [Lp(a)]. In addition, new antihyperglycemic therapy is changing diabetes care and altering treatment guidelines. The most recent American Diabetes Association Standards of Care has expanded its recommendations for people with CVD and diabetes, suggesting that medications validated to improve cardiac health should be strongly considered.
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Affiliation(s)
- Valentina Rodriguez
- Division of Endocrinology, Diabetes and Metabolism, New York University School of Medicine, New York, USA
| | - Jonathan D. Newman
- Division of Cardiology, New York University School of Medicine, New York, USA
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257
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Handelsman Y, Lepor NE. PCSK9 Inhibitors in Lipid Management of Patients With Diabetes Mellitus and High Cardiovascular Risk: A Review. J Am Heart Assoc 2018; 7:JAHA.118.008953. [PMID: 29934421 PMCID: PMC6064883 DOI: 10.1161/jaha.118.008953] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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258
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Wong NKP, Nicholls SJ, Tan JTM, Bursill CA. The Role of High-Density Lipoproteins in Diabetes and Its Vascular Complications. Int J Mol Sci 2018; 19:E1680. [PMID: 29874886 PMCID: PMC6032203 DOI: 10.3390/ijms19061680] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
Almost 600 million people are predicted to have diabetes mellitus (DM) by 2035. Diabetic patients suffer from increased rates of microvascular and macrovascular complications, associated with dyslipidaemia, impaired angiogenic responses to ischaemia, accelerated atherosclerosis, and inflammation. Despite recent treatment advances, many diabetic patients remain refractory to current approaches, highlighting the need for alternative agents. There is emerging evidence that high-density lipoproteins (HDL) are able to rescue diabetes-related vascular complications through diverse mechanisms. Such protective functions of HDL, however, can be rendered dysfunctional within the pathological milieu of DM, triggering the development of vascular complications. HDL-modifying therapies remain controversial as many have had limited benefits on cardiovascular risk, although more recent trials are showing promise. This review will discuss the latest data from epidemiological, clinical, and pre-clinical studies demonstrating various roles for HDL in diabetes and its vascular complications that have the potential to facilitate its successful translation.
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Affiliation(s)
- Nathan K P Wong
- Immunobiology Research Group, The Heart Research Institute, 7 Eliza Street, Newtown, NSW 2042, Australia.
- Discipline of Medicine, The University of Sydney School of Medicine, Camperdown, NSW 2006, Australia.
- Heart Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.
| | - Stephen J Nicholls
- Heart Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.
- Adelaide Medical School, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia.
| | - Joanne T M Tan
- Immunobiology Research Group, The Heart Research Institute, 7 Eliza Street, Newtown, NSW 2042, Australia.
- Discipline of Medicine, The University of Sydney School of Medicine, Camperdown, NSW 2006, Australia.
- Heart Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.
- Adelaide Medical School, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia.
| | - Christina A Bursill
- Immunobiology Research Group, The Heart Research Institute, 7 Eliza Street, Newtown, NSW 2042, Australia.
- Discipline of Medicine, The University of Sydney School of Medicine, Camperdown, NSW 2006, Australia.
- Heart Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.
- Adelaide Medical School, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia.
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259
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Sugiyama K, Saisho Y. Management of Dyslipidemia in Type 2 Diabetes: Recent Advances in Nonstatin Treatment. Diseases 2018; 6:E44. [PMID: 29794992 PMCID: PMC6023493 DOI: 10.3390/diseases6020044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
Dyslipidemia is a major risk factor for cardiovascular disease (CVD), which is the leading cause of morbidity and mortality in type 2 diabetes (T2DM). Statins have played a crucial role in its management, but residual risk remains since many patients cannot achieve their desired low-density lipoprotein cholesterol (LDL-C) level and up to 20% of patients are statin-intolerant, experiencing adverse events perceived to be caused by statins, most commonly muscle symptoms. Recently, great advances have been made in nonstatin treatment with ezetimibe, a cholesterol absorption inhibitor, and proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs), all showing a proven benefit with an excellent safety profile in cardiovascular outcome trials. This review summarizes the key aspects and the evolving role of these agents in the management of dyslipidemia in patients with T2DM, along with a brief introduction of novel drugs currently in development.
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Affiliation(s)
- Kazutoshi Sugiyama
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Yoshifumi Saisho
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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260
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Kuller LH. Reducing Low-Density Lipoprotein Cholesterol After Myocardial Infarction in Older Individuals, Levels Versus Change: Can Observational Studies Answer the Questions? J Am Heart Assoc 2018; 7:JAHA.118.009430. [PMID: 29754126 PMCID: PMC6015323 DOI: 10.1161/jaha.118.009430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, PA
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261
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Brotons Cuixart C, Alemán Sánchez JJ, Banegas Banegas JR, Fondón León C, Lobos-Bejarano JM, Martín Rioboó E, Navarro Pérez J, Orozco-Beltrán D, Villar Álvarez F. Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2018. Aten Primaria 2018; 50 Suppl 1:4-28. [PMID: 29866357 PMCID: PMC6836998 DOI: 10.1016/s0212-6567(18)30360-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Carlos Brotons Cuixart
- Especialista en Medicina Familiar y Comunitaria, Equipo de Atención Primaria Sardenya, Barcelona
| | - José Juan Alemán Sánchez
- Especialista en Medicina Familiar y Comunitaria, Dirección General de Salud Pública, Servicio Canario de la Salud
| | - José Ramón Banegas Banegas
- Especialista en Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid
| | - Carlos Fondón León
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud Colmenar de Oreja, Madrid
| | | | | | - Jorge Navarro Pérez
- Especialista en Medicina Familiar y Comunitaria, Hospital Clínico Universitario, Valencia
| | - Domingo Orozco-Beltrán
- Especialista en Medicina Familiar y Comunitaria, Unidad de Investigación CS Cabo Huertas, Departamento San Juan de Alicante, Alicante
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262
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Affiliation(s)
- William G Herrington
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - David Preiss
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Jane Armitage
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
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263
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Affiliation(s)
- Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Diabetes & Vascular Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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