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Deffert F, Vilela APO, Cobre ADF, Furlan LHP, Tonin FS, Fernandez-Lllimos F, Pontarolo R. Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools. Fam Pract 2024; 41:649-661. [PMID: 38831566 DOI: 10.1093/fampra/cmae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. METHODS A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. RESULTS Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. CONCLUSION High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.
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Affiliation(s)
- Flávia Deffert
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Ana Paula Oliveira Vilela
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | - Alexandre de Fátima Cobre
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
| | | | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Avenida D. João II, Lote 4.69.01, Parque das Nações, Lisboa 1990-096, Portugal
| | - Fernando Fernandez-Lllimos
- Applied Molecular Biosciences Unit (UCIBIO), Institute for Health and Bioeconomy (i4HB), Laboratory of Pharmacology Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto 4050-313, Portugal
| | - Roberto Pontarolo
- Pharmaceutical Sciences Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
- Pharmaceutical Assistance Postgraduate Program, Universidade Federal do Paraná, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR 80210-170, Brazil
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Nambiar M, Bee YM, Chan YE, Ho Mien I, Guretno F, Carmody D, Lee PC, Chia SY, Salim NNM, Krishnaswamy P. A drug mix and dose decision algorithm for individualized type 2 diabetes management. NPJ Digit Med 2024; 7:254. [PMID: 39289474 PMCID: PMC11408718 DOI: 10.1038/s41746-024-01230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 08/19/2024] [Indexed: 09/19/2024] Open
Abstract
Pharmacotherapy guidelines for type 2 diabetes (T2D) emphasize patient-centered care, but applying this approach effectively in outpatient practice remains challenging. Data-driven treatment optimization approaches could enhance individualized T2D management, but current approaches cannot account for drug-specific and dose-dependent variations in safety and efficacy. We developed and evaluated an AI Drug mix and dose Advisor (AIDA) for glycemic management, using electronic medical records from 107,854 T2D patients in the SingHealth Diabetes Registry. Given a patient's medical profile, AIDA leverages a predict-then-optimize approach to identify the minimal drug mix and dose changes required to optimize glycemic control, subject to clinical knowledge-based guidelines. On unseen data from large internal, external, and temporal validation sets, AIDA recommendations were estimated to improve post-visit glycated hemoglobin (HbA1c) by an average of 0.40-0.68% over standard of care (P < 0.0001). In qualitative evaluations on 60 diverse cases by a panel of three endocrinologists, AIDA recommendations were mostly rated as reasonable and precise. Finally, AIDA's ability to account for drug-dose specifics offered several advantages over competing methods, including greater consistency with practice preferences and clinical guidelines for practical but effective options, indication-based treatments, and renal dosing. As AIDA provides drug-dose recommendations to improve outcomes for individual T2D patients, it could be used for clinical decision support at point-of-care, especially in resource-limited settings.
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Grants
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
- H19/01/a0/023 - Diabetes Clinic of the Future Agency for Science, Technology and Research (A*STAR)
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Affiliation(s)
- Mila Nambiar
- Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | - Yu En Chan
- Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Ivan Ho Mien
- Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Feri Guretno
- Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - David Carmody
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Sing Yi Chia
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | | | - Pavitra Krishnaswamy
- Institute for Infocomm Research, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
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3
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Jain AB, Lai V. Medication-Induced Hyperglycemia and Diabetes Mellitus: A Review of Current Literature and Practical Management Strategies. Diabetes Ther 2024; 15:2001-2025. [PMID: 39085746 PMCID: PMC11330434 DOI: 10.1007/s13300-024-01628-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
With the increasing global incidence of diabetes mellitus, physicians may encounter more patients with acute and chronic complications of medication-induced hyperglycemia and diabetes. Moreover, medication-induced diabetes may be an important contributing factor to the high rates of diabetes, and recognizing its impact and risk is a critical step in curtailing its effect on the global population. It has long been recognized that multiple classes of medications are associated with hyperglycemia through various mechanisms, and the ability to foresee this and implement adequate management strategies are important. Moreover, different antihyperglycemic medications are better suited to combat the hyperglycemia encountered with different classes of medications, so it is critical that physicians can recognize which agents should be used, and which medications to avoid in certain types of medication-induced hyperglycemia. In this review, we will discuss the evidence behind the main classes of medications that cause hyperglycemia, their mechanism of action, specific agents that are associated with worsened glycemic control, and, most importantly, management strategies that are tailored to each specific class.
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Affiliation(s)
- Akshay B Jain
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Valerie Lai
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, AB, Canada
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4
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Hong SJ, Lee YJ, Kang WC, Hong BK, Lee JY, Lee JB, Yang TH, Yoon J, Lee SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Effect of rosuvastatin versus atorvastatin on new-onset diabetes mellitus in patients treated with high-intensity statin therapy for coronary artery disease: a post-hoc analysis from the LODESTAR randomized clinical trial. Cardiovasc Diabetol 2024; 23:287. [PMID: 39113067 PMCID: PMC11304915 DOI: 10.1186/s12933-024-02386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/01/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND The impact of rosuvastatin versus atorvastatin on new-onset diabetes mellitus (NODM) among patients treated with high-intensity statin therapy for coronary artery disease (CAD) remains to be clarified. This study aimed to evaluate the risk of NODM in patients with CAD treated with rosuvastatin compared to atorvastatin in the randomized LODESTAR trial. METHODS In the LODESTAR trial, patients with CAD were randomly assigned to receive either rosuvastatin or atorvastatin using a 2-by-2 factorial randomization. In this post-hoc analysis, the 3-year incidence of NODM was compared between rosuvastatin and atorvastatin treatment in the as-treated population with high-intensity statin therapy as the principal population of interest. RESULTS Among 2932 patients without diabetes mellitus at baseline, 2377 were included in the as-treated population analysis. In the as-treated population with high-intensity statin therapy, the incidence of NODM was not significantly different between the rosuvastatin and atorvastatin groups (11.4% [106/948] versus 8.8% [73/856], hazard ratio [HR] = 1.32, 95% confidence interval [CI] = 0.98 to 1.77, P = 0.071). When the risk of NODM with rosuvastatin versus atorvastatin was assessed according to the achieved low-density lipoprotein cholesterol (LDL-C) level, the risk of NODM began to increase at a LDL-C level below 70 mg/dL. The incidence of NODM was significantly greater in the rosuvastatin group than it was in the atorvastatin group when the achieved LDL-C level was < 70 mg/dL (13.9% versus 8.0%; HR = 1.79, 95% CI 1.18 to 2.73, P = 0.007). CONCLUSIONS Among CAD patients receiving high-intensity statin therapy, the incidence of NODM was not significantly different between rosuvastatin and atorvastatin. However, a drug effect of the statin type on NODM was observed when the achieved LDL-C level was < 70 mg/dL. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02579499.
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Affiliation(s)
- Sung-Jin Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Joon Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Bae Lee
- Daegu Catholic University Medical Center, Daegu, Korea
| | | | - Junghan Yoon
- Wonju Severance Christian Hospital, Wonju, Korea
| | - Seung-Jun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- CHA University College of Medicine, Seongnam, Korea
| | - Myeong-Ki Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei- ro, Seodaemun-gu, Seoul, 03722, South Korea.
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5
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Grant JK, Orringer CE. High-intensity statins vs. moderate-intensity statin-ezetimibe combination therapy: A patient centered approach. J Clin Lipidol 2024:S1933-2874(24)00216-2. [PMID: 39304431 DOI: 10.1016/j.jacl.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/09/2024] [Accepted: 07/22/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Jelani K Grant
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA (Dr Grant)
| | - Carl E Orringer
- Naples Comprehensive Health System Rooney Heart Institute, Naples, FL, USA (Dr Orringer).
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6
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Lee SJ, Lee JB, Yang TH, Kang WC, Lee JY, Lee YJ, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Hong BK, Choi D, Yoon J, Jang Y, Hong MK. Treat-to-target or high-intensity statin treatment in older adults with coronary artery disease: a post hoc analysis of the LODESTAR trial. Age Ageing 2024; 53:afae132. [PMID: 38965031 DOI: 10.1093/ageing/afae132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The optimal statin treatment strategy that is balanced for both efficacy and safety has not been clearly determined in older adults with coronary artery disease (CAD). METHODS In the post hoc analysis of the LODESTAR (low-density lipoprotein cholesterol-targeting statin therapy versus intensity-based statin therapy in patients with coronary artery disease) trial, the impact between a treat-to-target strategy versus a high-intensity statin therapy strategy was compared in older adults (aged 75 years or older). The goal of treat-to-target low-density lipoprotein cholesterol (LDL-C) level was 50-70 mg/dl. The primary endpoint comprised the three-year composite of all-cause death, myocardial infarction, stroke or coronary revascularisation. RESULTS Among 4,400 patients with CAD enrolled in the LODESTAR trial, 822 (18.7%) were aged 75 years or older. Poor clinical outcomes and risk factors for atherosclerosis were more frequently observed in older adults than in younger population (<75 years old). Among these older adults with CAD, the prescription rate of high-intensity statin was significantly lower in the treat-to-target strategy group throughout the study period (P < 0.001). The mean LDL-C level for three years was 65 ± 16 mg/dl in the treat-to-target strategy group and 64 ± 18 mg/dl in the high-intensity statin group (P = 0.34). The incidence of primary endpoint occurrence was 10.9% in the treat-to-target strategy group and 12.0% in the high-intensity statin group (hazard ratio 0.92, 95% confidence interval 0.61-1.38, P = 0.69). CONCLUSIONS High-intensity statin therapy is theoretically more necessary in older adults because of worse clinical outcomes and greater number of risk factors for atherosclerosis. However, the primary endpoint occurrence with a treat-to-target strategy with an LDL-C goal of 50-70 mg/dl was comparable to that of high-intensity statin therapy and reduced utilisation of a high-intensity statin. Taking efficacy as well as safety into account, adopting a tailored approach may be considered for this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov, NCT02579499.
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Affiliation(s)
- Seung-Jun Lee
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Jin-Bae Lee
- Daegu Catholic University Medical Center, Duryugongwon-ro 17-gil, Nam-gu, 42472, Daegu, Korea
| | - Tae-Hyun Yang
- Inje University Busan Paik Hospital, Bokji-ro 75, Busanjin-gu, 47392, Busan, Korea
| | - Woong Chol Kang
- Gachon University College of Medicine, Namdong-daero 774 beon-gil, Namdong-gu, 21565, Incheon, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Saemunan-ro, Jongno-gu, 03181, Seoul, Korea
| | - Yong-Joon Lee
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Sung-Jin Hong
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Chul-Min Ahn
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Jung-Sun Kim
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Young-Guk Ko
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Bum-Kee Hong
- Gangnam Severance Hospital, Eonju-ro, Gangnam-gu, 06273, Seoul, Korea
| | - Donghoon Choi
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
| | - Junghan Yoon
- Wonju Severance Christian Hospital, Ilsan-ro, 26426, Wonju, Korea
| | - Yangsoo Jang
- CHA University College of Medicine, Yatap-ro, Bundang-gu, 13497, Seongnam, Korea
| | - Myeong-Ki Hong
- Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Korea
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Wang J, Chen Y. The Year in Asian Cardiovascular Field 2023: The Top 10 Papers in Asian Cardiovascular Research. JACC. ASIA 2024; 4:502-506. [PMID: 39100701 PMCID: PMC11291336 DOI: 10.1016/j.jacasi.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Affiliation(s)
- Jian’an Wang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
| | - Yuwen Chen
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China
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Cheng Q, Sun J, Zhong H, Wang Z, Liu C, Zhou S, Deng J. Research trends in lipid-lowering therapies for coronary heart disease combined with hyperlipidemia: a bibliometric study and visual analysis. Front Pharmacol 2024; 15:1393333. [PMID: 38828451 PMCID: PMC11140088 DOI: 10.3389/fphar.2024.1393333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Background Cardiovascular disease (CVD) poses a significant global health and economic challenge, with atherosclerosis being a primary cause. Over the past 40 years, substantial research has been conducted into the prevention and reversal of atherosclerosis, resulting in the development of lipid-lowering agents such as statins and fibrates. Despite the extensive literature and formulation of numerous therapeutic guidelines in this domain, a comprehensive bibliometric analysis of the current research landscape and trends has not been performed. This study aimed to elucidate the evolution and milestones of research into lipid-lowering treatments for coronary heart disease (CHD) in conjunction with hyperlipidemia through bibliometric analysis, offering insights into future directions for treatment strategies. Methods This study examined publications from 1986 to 2023 retrieved from the Web of Science database (Core Collection). Utilizing tools such as VOSviewer, Pajek, and CiteSpace, we analyzed publication and citation numbers, H-indexes, contributions by countries and institutions, authorship, journal sources, and keyword usage to uncover research trajectories and areas of focus. Results Our analysis of 587 publications revealed a recent surge in research output, particularly post-2003. The American Journal of Cardiology published the highest number of studies, with 40 articles, whereas Circulation received the highest number of citations (6,266). Key contributors included the United States, Japan, and China, with the United States leading in citation numbers and the H-index. Harvard University and Leiden University emerged as pivotal institutions, and Professors J. Wouter Jukema and Robert P. Giugliano were identified as leading experts. Keyword analysis disclosed five thematic clusters, indicating a shift in research towards new drug combinations and strategies, signaling future research directions. Conclusion The last 4 decades have seen a notable rise in publications on lipid-lowering therapies for CHD and hyperlipidemia, with the United States retaining world-leading status. The increase in international collaboration aids the shift towards research into innovative lipid-lowering agents and therapeutic approaches. PCSK9 inhibitors and innovative combination therapies, including antisense oligonucleotides and angiopoietin-like protein 3 inhibitors, provide avenues for future research, intending to maximize the safety and efficacy of treatment approaches.
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Affiliation(s)
- Quankai Cheng
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jingjing Sun
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Haicheng Zhong
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ziming Wang
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chang Liu
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Sheng Zhou
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jie Deng
- Department of Cardiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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9
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Pang S, Geng C, Fan Z, Hou M, Mao H, Tao S, Wang J, Wu Y, Wei K, Li Y, Yan L, Yang Q, Chen C, Wang W. Synergistic Effect of Layered Double Hydroxides Nanodosage Form to Induce Apoptosis and Ferroptosis in Breast Cancer. Int J Nanomedicine 2024; 19:4199-4215. [PMID: 38766657 PMCID: PMC11102185 DOI: 10.2147/ijn.s455427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
Background Breast cancer is the most common cancer in women and one of the leading causes of cancer death worldwide. Ferroptosis, a promising mechanism of killing cancer cells, has become a research hotspot in cancer therapy. Simvastatin (SIM), as a potential new anti-breast cancer drug, has been shown to cause ferroptosis of cancer cells and inhibit breast cancer metastasis and recurrence. The purpose of this study is to develop a novel strategy boosting ferroptotic cascade for synergistic cancer therapy. Methods In this paper, iron base form of layered double hydroxide supported simvastatin (LDHs-SIM) was synthesized by hydrothermal co-precipitation method. The characterization of LDHs-SIM were assessed by various analytical techniques, including ultraviolet-visible (UV-vis) spectroscopy, X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, and transmission electron microscopy (TEM). Biological activity, ferroptosis mechanism and biocompatibility were analyzed through in vivo and in vitro analysis, so as to evaluate its therapeutic effect on breast cancer. Results The constructed LDHs-SIM nanosystem can not only release SIM through mevalonate (MVA) pathway, inhibit the expression of glutathione peroxidase 4 (GPX4), inhibit the expression of SLC7A11 and reduce the synthesis efficiency of GSH, but also promote the accumulation of Fe2+ in cells through the release of Fe3+, and increase the intracellular ROS content. In addition, LDHs-SIM nanosystem can induce apoptosis of breast cancer cells to a certain extent, and achieve the synergistic effect of apoptosis and ferroptosis. Conclusion In the present study, we demonstrated that nanoparticles of layered double hydroxides (LDHs) loaded with simvastatin were more effective than a free drug at inhibiting breast cancer cell growth, In addition, superior anticancer therapeutic effects were achieved with little systemic toxicity, indicating that LDHs-SIM could serve as a safe and high-performance platform for ferroptosis-apoptosis combined anticancer therapy.
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Affiliation(s)
- Siyan Pang
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
| | - Chenchen Geng
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
| | - Zihan Fan
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
| | - Min Hou
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- School of Basic Courses, Bengbu Medical University, Anhui, People’s Republic of China
| | - Huilan Mao
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
| | - Shuang Tao
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Clinical Testing and Diagnose Experimental Center, Bengbu Medical University, Anhui, People’s Republic of China
| | - Jing Wang
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Clinical Testing and Diagnose Experimental Center, Bengbu Medical University, Anhui, People’s Republic of China
| | - Yulun Wu
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
| | - Ke Wei
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Clinical Testing and Diagnose Experimental Center, Bengbu Medical University, Anhui, People’s Republic of China
| | - Yunhao Li
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
| | - Liuyang Yan
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
| | - Qingling Yang
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Clinical Testing and Diagnose Experimental Center, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Biochemistry and Molecular Biology, Bengbu Medical University, Anhui, People’s Republic of China
| | - Changjie Chen
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Clinical Testing and Diagnose Experimental Center, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Biochemistry and Molecular Biology, Bengbu Medical University, Anhui, People’s Republic of China
| | - Wenrui Wang
- Anhui Province Key Laboratory of Translational Cancer Research, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Life Sciences, Bengbu Medical University, Anhui, People’s Republic of China
- Department of Biotechnology, Bengbu Medical University, Anhui, People’s Republic of China
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10
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Tamargo J, Agewall S, Borghi C, Ceconi C, Cerbai E, Dan GA, Ferdinandy P, Grove EL, Rocca B, Magavern E, Sulzgruber P, Semb AG, Sossalla S, Niessner A, Kaski JC, Dobrev D. New pharmacological agents and novel cardiovascular pharmacotherapy strategies in 2023. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:219-244. [PMID: 38379024 PMCID: PMC11121198 DOI: 10.1093/ehjcvp/pvae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 02/22/2024]
Abstract
Although cardiovascular diseases (CVDs) are the leading cause of death worldwide, their pharmacotherapy remains suboptimal. Thus, there is a clear unmet need to develop more effective and safer pharmacological strategies. In this review, we summarize the most relevant advances in cardiovascular pharmacology in 2023, including the approval of first-in-class drugs that open new avenues for the treatment of atherosclerotic CVD and heart failure (HF). The new indications of drugs already marketed (repurposing) for the treatment of obstructive hypertrophic cardiomyopathy, hypercholesterolaemia, type 2 diabetes, obesity, and HF; the impact of polypharmacy on guideline-directed drug use is highlighted as well as results from negative clinical trials. Finally, we end with a summary of the most important phase 2 and 3 clinical trials assessing the efficacy and safety of cardiovascular drugs under development for the prevention and treatment of CVDs.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto De Investigación Sanitaria Gregorio Marañón, 28040 Madrid, Spain
| | - Stefan Agewall
- Institute of Clinical Science, Oslo University, 0318 Oslo, Norway
- Institute of Clinical Sciences, Karolinska Institute, Danderyd Hospital, 171 77 Stockholm, Sweden
| | - Claudio Borghi
- Department of Cardiovascular Medicine, University of Bologna-IRCCS AOU S. Orsola, 40138 Bologna, Italy
| | | | - Elisabetta Cerbai
- Department Neurofarba, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy
| | - Gheorghe A Dan
- Carol Davila. University of Medicine, Colentina University Hospital, 0221 Bucharest, Romania
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, H-1089, Hungary
- Pharmahungary Group, Budapest, H-1031, Hungary
| | - Erik Lerkevang Grove
- Department of Cardiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus N, Denmark
| | - Bianca Rocca
- Department Neurofarba, Section of Pharmacology and Toxicology, University of Florence, 50139 Florence, Italy
- Section of Pharmacology, Department of Safety and Bioethics, Catholic University School of Medicine, 00168 Roma, Italy
| | - Emma Magavern
- William Harvey Research Institute, Centre of Clinical Pharmacology and Precision Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Patrick Sulzgruber
- Department of Medicine, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Anne Grete Semb
- Preventive Cario-Rheuma clinic, Division of Research and Innovation, REMEDY centre, Diakonhjemmet Hospital, 0370 Oslo, Norway
| | - Samuel Sossalla
- Cardiology and Angiology, Justus-Liebig-University, D-35392 Giessen, Germany
- Department of Cardiology, Kerckhoff-Clinic/DZHK, D-61234 Bad Nauheim, Germany
| | - Alexander Niessner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Dobromir Dobrev
- Institute of Pharmacology, West-German Heart and Vascular Centre, University Duisburg-Essen, DE-45122 Essen, Germany
- Department of Medicine, Montreal Heart Institute and Université de Montréal, H1Y 3N1 Montréal, Canada
- Department of Integrative Physiology, Baylor College of Medicine, 77030 Houston, TX, USA
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11
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Gao Y, Li W, Huang X, Lyu Y, Yue C. Advances in Gut Microbiota-Targeted Therapeutics for Metabolic Syndrome. Microorganisms 2024; 12:851. [PMID: 38792681 PMCID: PMC11123306 DOI: 10.3390/microorganisms12050851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024] Open
Abstract
Previous investigations have illuminated the significant association between the gut microbiome and a broad spectrum of health conditions, including obesity, diabetes, cardiovascular diseases, and psychiatric disorders. Evidence from certain studies suggests that dysbiosis of the gut microbiota may play a role in the etiology of obesity and diabetes. Moreover, it is acknowledged that dietary habits, pharmacological interventions, psychological stress, and other exogenous factors can substantially influence the gut microbial composition. For instance, a diet rich in fiber has been demonstrated to increase the population of beneficial bacteria, whereas the consumption of antibiotics can reduce these advantageous microbial communities. In light of the established correlation between the gut microbiome and various pathologies, strategically altering the gut microbial profile represents an emerging therapeutic approach. This can be accomplished through the administration of probiotics or prebiotics, which aim to refine the gut microbiota and, consequently, mitigate the manifestations of associated diseases. The present manuscript evaluates the recent literature on the relationship between gut microbiota and metabolic syndrome published over the past three years and anticipates future directions in this evolving field.
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Affiliation(s)
- Yu Gao
- Yan’an Key Laboratory of Microbial Drug Innovation and Transformation, School of Basic Medicine, Yan’an University, Yan’an 716000, China; (Y.G.); (W.L.); (X.H.); (Y.L.)
| | - Wujuan Li
- Yan’an Key Laboratory of Microbial Drug Innovation and Transformation, School of Basic Medicine, Yan’an University, Yan’an 716000, China; (Y.G.); (W.L.); (X.H.); (Y.L.)
| | - Xiaoyu Huang
- Yan’an Key Laboratory of Microbial Drug Innovation and Transformation, School of Basic Medicine, Yan’an University, Yan’an 716000, China; (Y.G.); (W.L.); (X.H.); (Y.L.)
| | - Yuhong Lyu
- Yan’an Key Laboratory of Microbial Drug Innovation and Transformation, School of Basic Medicine, Yan’an University, Yan’an 716000, China; (Y.G.); (W.L.); (X.H.); (Y.L.)
- Shaanxi Engineering and Technological Research Center for Conversation and Utilization of Regional Biological Resources, Yan’an University, Yan’an 716000, China
| | - Changwu Yue
- Yan’an Key Laboratory of Microbial Drug Innovation and Transformation, School of Basic Medicine, Yan’an University, Yan’an 716000, China; (Y.G.); (W.L.); (X.H.); (Y.L.)
- Shaanxi Engineering and Technological Research Center for Conversation and Utilization of Regional Biological Resources, Yan’an University, Yan’an 716000, China
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12
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Thomas BS. Top studies of 2023 relevant to primary care: From the PEER team. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:245-248. [PMID: 38626998 PMCID: PMC11280662 DOI: 10.46747/cfp.7004245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To provide a summary of the noteworthy medical articles published in 2023 that are relevant to family physicians. SELECTING THE EVIDENCE Articles were chosen and ranked by the PEER (Patients, Experience, Evidence, Research) team, a group of primary care health professionals focused on evidence-based medicine. The selection process involved routine surveillance of tables of contents in high-impact medical journals and continuous monitoring of EvidenceAlerts. Articles were prioritized based on their direct applicability to and potential to influence primary care practice. MAIN MESSAGE Selected articles addressed various clinical areas of primary care. The topics included a comparison of a treat-to-target approach versus a high-intensity statins prescription for lipid management; semaglutide and its impact on cardiovascular outcomes; respiratory syncytial virus vaccine for older adults; chlorthalidone versus hydrochlorothiazide in preventing cardiovascular events; amitriptyline for irritable bowel syndrome; the role of opioids in acute back pain; safety of oral penicillin challenges in patients allergic to penicillin; spironolactone for facial acne; strategies to reverse frailty in older adults; and identifying the provider of chronic disease management. Two "up and coming" medications are also mentioned: retatrutide for weight loss and fezolinetant for vasomotor symptoms of menopause. CONCLUSION Research published in 2023 yielded several high-quality articles with topics relevant to primary care, including cardiovascular care, irritable bowel syndrome, care of the elderly, and acne management.
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Affiliation(s)
- Betsy S. Thomas
- Clinical Evidence Expert for the College of Family Physicians of Canada (CFPC) and Assistant Adjunct Professor in the Department of Family Medicine at the University of Alberta (U of A) in Edmonton
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13
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Minotti G, Camilli M. LDL Cholesterol and Cardiovascular Events in a Population Network: One More Twist of an Endless Story. J Pharmacol Exp Ther 2024; 388:739-741. [PMID: 38360802 DOI: 10.1124/jpet.123.001963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 02/17/2024] Open
Affiliation(s)
- Giorgio Minotti
- University and Fondazione Policlinico Universitario Campus Bio-Medico (G.M.) and Fondazione Policlinico Universitario Agostino Gemelli (M.C.), Rome, Italy
| | - Massimiliano Camilli
- University and Fondazione Policlinico Universitario Campus Bio-Medico (G.M.) and Fondazione Policlinico Universitario Agostino Gemelli (M.C.), Rome, Italy
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14
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Xiao S, Qi M, Zhou Q, Gong H, Wei D, Wang G, Feng Q, Wang Z, Liu Z, Zhou Y, Ma X. Macrophage fatty acid oxidation in atherosclerosis. Biomed Pharmacother 2024; 170:116092. [PMID: 38157642 DOI: 10.1016/j.biopha.2023.116092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
Atherosclerosis significantly contributes to the development of cardiovascular diseases (CVD) and is characterized by lipid retention and inflammation within the artery wall. Multiple immune cell types are implicated in the pathogenesis of atherosclerosis, macrophages play a central role as the primary source of inflammatory effectors in this pathogenic process. The metabolic influences of lipids on macrophage function and fatty acid β-oxidation (FAO) have similarly drawn attention due to its relevance as an immunometabolic hub. This review discusses recent findings regarding the impact of mitochondrial-dependent FAO in the phenotype and function of macrophages, as well as transcriptional regulation of FAO within macrophages. Finally, the therapeutic strategy of macrophage FAO in atherosclerosis is highlighted.
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Affiliation(s)
- Sujun Xiao
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Mingxu Qi
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Qinyi Zhou
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Huiqin Gong
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Duhui Wei
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Guangneng Wang
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Qilun Feng
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Zhou Wang
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Zhe Liu
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yiren Zhou
- The Affiliated Nanhua Hospital, Department of Emergency, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Xiaofeng Ma
- The Affiliated Nanhua Hospital, Department of Cardiology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
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15
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Amin K, Bethel G, Jackson LR, Essien UR, Sloan CE. Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity. Curr Atheroscler Rep 2023; 25:1113-1127. [PMID: 38108997 PMCID: PMC11044811 DOI: 10.1007/s11883-023-01180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia. RECENT FINDINGS Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.
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Affiliation(s)
- Krunal Amin
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Garrett Bethel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Utibe R Essien
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
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16
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Doi T, Langsted A, Nordestgaard BG. Lipoproteins, Cholesterol, and Atherosclerotic Cardiovascular Disease in East Asians and Europeans. J Atheroscler Thromb 2023; 30:1525-1546. [PMID: 37704428 PMCID: PMC10627775 DOI: 10.5551/jat.rv22013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
One fifth of the world population live in East Asia comprising Japan, Korea, and China where ischemic heart disease, a major component of atherosclerotic cardiovascular disease (ASCVD), is the second most frequent cause of death. Each of low-density lipoproteins (LDL), remnant lipoproteins, and lipoprotein(a), summarized as non-high-density lipoproteins (non-HDL) or apolipoprotein B (apoB) containing lipoproteins, causes ASCVD. However, a significant proportion of the evidence on lipoproteins and lipoprotein cholesterol with risk of ASCVD came from White people mainly living in Europe and North America and not from people living in East Asia or of East Asian descent. With a unique biological, geohistorical, and social background in this world region, East Asians have distinctive characteristics that might have potential impact on the association of lipoproteins and lipoprotein cholesterol with risk of ASCVD. Considering the movement across national borders in the World, understanding of lipoprotein and lipoprotein cholesterol evidence on ASCVD in East Asia is important for both East Asian and non-East Asian populations wherever they live in the World.In this review, we introduce the biological features of lipoproteins and lipoprotein cholesterol and the evidence for their association with risk of ASCVD in East Asian and European populations. We also provide an overview of guideline recommendations for prevention of ASCVD in these two different world regions. Finally, specific preventive strategies and future perspectives are touched upon.
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Affiliation(s)
- Takahito Doi
- Department of Clinical Biochemistry, Copenhagen University Hospital . Herlev Gentofte, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital . Herlev Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Langsted
- Department of Clinical Biochemistry, Copenhagen University Hospital . Herlev Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital . Herlev Gentofte, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital . Herlev Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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17
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Lee YJ, Hong SJ, Kang WC, Hong BK, Lee JY, Lee JB, Cho HJ, Yoon J, Lee SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial. BMJ 2023; 383:e075837. [PMID: 37852649 PMCID: PMC10583134 DOI: 10.1136/bmj-2023-075837] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To compare the long term efficacy and safety of rosuvastatin with atorvastatin treatment in adults with coronary artery disease. DESIGN Randomised, open label, multicentre trial. SETTING 12 hospitals in South Korea, September 2016 to November 2019. PARTICIPANTS 4400 adults (age ≥19 years) with coronary artery disease. INTERVENTIONS Participants were assigned to receive either rosuvastatin (n=2204) or atorvastatin (n=2196) using 2×2 factorial randomisation. MAIN OUTCOME MEASURES The primary outcome was a three year composite of all cause death, myocardial infarction, stroke, or any coronary revascularisation. Secondary outcomes were safety endpoints: new onset diabetes mellitus; hospital admissions due to heart failure; deep vein thrombosis or pulmonary thromboembolism; endovascular revascularisation for peripheral artery disease; aortic intervention or surgery; end stage kidney disease; discontinuation of study drugs owing to intolerance; cataract surgery; and a composite of laboratory detected abnormalities. RESULTS 4341 of the 4400 participants (98.7%) completed the trial. Mean daily dose of study drugs was 17.1 mg (standard deviation (SD) 5.2 mg) in the rosuvastatin group and 36.0 (12.8) mg in the atorvastatin group at three years (P<0.001). The primary outcome occurred in 189 participants (8.7%) in the rosuvastatin group and 178 (8.2%) in the atorvastatin group (hazard ratio 1.06, 95% confidence interval 0.86 to 1.30; P=0.58). The mean low density lipoprotein (LDL) cholesterol level during treatment was 1.8 mmol/L (SD 0.5 mmol/L) in the rosuvastatin group and 1.9 (0.5) mmol/L in the atorvastatin group (P<0.001). The rosuvastatin group had a higher incidence of new onset diabetes mellitus requiring initiation of antidiabetics (7.2% v 5.3%; hazard ratio 1.39, 95% confidence interval 1.03 to 1.87; P=0.03) and cataract surgery (2.5% v 1.5%; 1.66, 1.07 to 2.58; P=0.02). Other safety endpoints did not differ between the two groups. CONCLUSIONS In adults with coronary artery disease, rosuvastatin and atorvastatin showed comparable efficacy for the composite outcome of all cause death, myocardial infarction, stroke, or any coronary revascularisation at three years. Rosuvastatin was associated with lower LDL cholesterol levels but a higher risk of new onset diabetes mellitus requiring antidiabetics and cataract surgery compared with atorvastatin. TRIAL REGISTRATION ClinicalTrials.gov NCT02579499.
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Affiliation(s)
- Yong-Joon Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | | | | | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Bae Lee
- Daegu Catholic University Medical Centre, Daegu, Korea
| | | | - Junghan Yoon
- Wonju Severance Christian Hospital, Wonju, Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
| | - Yangsoo Jang
- CHA University College of Medicine, Seongnam, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seodaemun-gu, 03722, Seoul, Korea
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18
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Kawada T. Statin Use and Risk of Clinical Outcomes With Special Reference to Kidney Disease and Concurrent Medications in Patients With Diabetes Mellitus. Am J Cardiol 2023; 205:523-524. [PMID: 37620205 DOI: 10.1016/j.amjcard.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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19
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Raschi E, Casula M, Cicero AFG, Corsini A, Borghi C, Catapano A. Beyond statins: New pharmacological targets to decrease LDL-cholesterol and cardiovascular events. Pharmacol Ther 2023; 250:108507. [PMID: 37567512 DOI: 10.1016/j.pharmthera.2023.108507] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
The pharmacological treatment of dyslipidemia, a major modifiable risk factor for developing atherosclerotic cardiovascular disease (ASCVD), remains a debated and controversial issue, not only in terms of the most appropriate therapeutic range for lipid levels, but also with regard to the optimal strategy and sequence approach (stepwise vs upstream therapy). Current treatment guidelines for the management of dyslipidemia focus on the intensity of low-density lipoprotein cholesterol (LDL-C) reduction, stratified according to risk for developing ASCVD. Beyond statins and ezetimibe, different medications targeting LDL-C have been recently approved by regulatory agencies with potential innovative mechanisms of action, including proprotein convertase subtilisin/kexin type 9 modulators (monoclonal antibodies such as evolocumab and alirocumab; small interfering RNA molecules such as inclisiran), ATP-citrate lyase inhibitors (bempedoic acid), angiopoietin-like 3 inhibitors (evinacumab), and microsomal triglyceride transfer protein inhibitors (lomitapide). An understanding of their pharmacological aspects, benefit-risk profile, including impact on hard cardiovascular endpoints beyond LDL-C reduction, and potential advantages from the patient perspective (e.g., adherence) - the focus of this evidence-based review - is crucial for practitioners across medical specialties to minimize therapeutic inertia and support clinical practice.
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Affiliation(s)
- Emanuel Raschi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy; IRCCS AOU S. Orsola-Malpighi, Bologna, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy; IRCCS AOU S. Orsola-Malpighi, Bologna, Italy
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20
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Kolber MR. PEER simplified lipid guideline 2023 update: Prevention and management of cardiovascular disease in primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:675-686. [PMID: 37833089 PMCID: PMC10575658 DOI: 10.46747/cfp.6910675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
OBJECTIVE To update the 2015 clinical practice guideline and provide a simplified approach to lipid management in the prevention of cardiovascular disease (CVD) for primary care. METHODS Following the Institute of Medicine's Clinical Practice Guidelines We Can Trust, a multidisciplinary, pan-Canadian guideline panel was formed. This panel was represented by primary care providers, free from conflicts of interest with industry, and included the patient perspective. A separate scientific evidence team performed evidence reviews on statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, fibrates, bile acid sequestrants, niacin, and omega-3 supplements (docosahexaenoic acid with eicosapentaenoic acid [EPA] or EPA ethyl ester alone [icosapent]), as well as on 11 supplemental questions. Recommendations were finalized by the guideline panel through use of the Grading of Recommendations Assessment, Development and Evaluation methodology. RECOMMENDATIONS All recommendations are presented in a patient-centred manner designed with the needs of family physicians and other primary care providers in mind. Many recommendations are similar to those published in 2015. Statins remain first-line therapy for both primary and secondary CVD prevention, and the Mediterranean diet and physical activity are recommended to reduce cardiovascular risk (primary and secondary prevention). The guideline panel recommended against using lipoprotein a, apolipoprotein B, or coronary artery calcium levels when assessing cardiovascular risk, and recommended against targeting specific lipid levels. The team also reviewed new evidence pertaining to omega-3 fatty acids (including EPA ethyl ester [icosapent]) and proprotein convertase subtilisin-kexin type 9 inhibitors, and outlined when to engage in informed shared decision making with patients on interventions to lower cardiovascular risk. CONCLUSION These updated evidence-based guidelines provide a simplified approach to lipid management for the prevention and management of CVD. These guidelines were created by and for primary health care professionals and their patients.
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Affiliation(s)
- Michael R. Kolber
- Professor in the Department of Family Medicine at the University of Alberta in Edmonton
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Lee SJ, Kang WC, Lee JY, Lee JB, Yang TH, Yoon J, Lee YJ, Hong SJ, Ahn CM, Kim JS, Kim BK, Ko YG, Choi D, Hong BK, Jang Y, Hong MK. Treat-to-target versus high-intensity statin treatment in patients with or without diabetes mellitus: a pre-specified analysis from the LODESTAR trial. EClinicalMedicine 2023; 64:102227. [PMID: 37767195 PMCID: PMC10520306 DOI: 10.1016/j.eclinm.2023.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background The impact of titrated versus fixed intensity statin therapy in patients with coronary artery disease (CAD) and diabetes mellitus (DM) remains to be elucidated. Methods This was a pre-specified analysis of patients with and without DM from the LODESTAR trial. Patients with CAD were randomly assigned to receive either a treat-to-target strategy with a target LDL-C level of 50-70 mg/dL or a high-intensity statin treatment. Primary outcome was the 3-year composite of all-cause death, myocardial infarction, stroke, or coronary revascularization. Secondary outcomes were safety endpoints. This trial is registered with ClinicalTrials.gov, NCT02579499. Findings Between September 9, 2016 and November 27, 2019, 4400 patients with CAD were enrolled in the LODESTAR trial. The median age was 65 years (interquartile range, 59-73 years), 3172 (72%) were male, and 1468 (33%) had DM at baseline. There was no significant difference in the occurrence of the primary outcome between the treat-to-target group and high-intensity statin group among patients with DM (10.5% versus 11.1%, hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.69-1.29, p = 0.70) and those without DM (6.9% versus 7.5%, HR 0.93, 95% CI 0.71-1.21, p = 0.58). Among patients without DM, there was a trend towards a lower risk of new-onset DM in the treat-to-target group (8.4% versus 10.4% in the high-intensity statin group, HR 0.79, 95% CI 0.62-1.01; p = 0.06). Interpretation In patients with CAD, a treat-to-target LDL-C strategy of 50-70 mg/dL as the goal was comparable to high-intensity statin therapy in terms of 3-year clinical efficacy and safety outcomes regardless of the presence of DM. Funding Sam Jin Pharmaceutical, Seoul, Korea and Chong Kun Dang Pharmaceutical, Seoul, Korea.
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Affiliation(s)
- Seung-Jun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University Scholl of Medicine, Seoul, Korea
| | - Jin-Bae Lee
- Daegu Catholic University Medical Center, Daegu, Korea
| | | | - Junghan Yoon
- Wonju Severance Christian Hospital, Wonju, Korea
| | - Yong-Joon Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jin Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul-Min Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung-Sun Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Keuk Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Yangsoo Jang
- CHA University College of Medicine, Seongnam, Korea
| | - Myeong-Ki Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kolber MR. Lignes directrices simplifiées de PEER sur les lipides : actualisation 2023. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2023; 69:e189-e201. [PMID: 37833093 PMCID: PMC10575651 DOI: 10.46747/cfp.6910e189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Objectif Actualiser le guide de pratique clinique de 2015 et présenter une approche simplifiée de la prise en charge des lipides dans la prévention des maladies cardiovasculaires (MCV) en première ligne. Méthodes Conformément aux recommandations de l’Institute of Medicine dans Clinical Practice Guidelines We Can Trust , un panel pancanadien d’experts multidisciplinaires en lignes directrices a été formé. Ce panel était représentatif des cliniciens en soins primaires, libre de tout conflit d’intérêts avec l’industrie, et il tenait compte des points de vue des patients. Une équipe distincte, responsable des données probantes scientifiques, a passé en revue l’information sur les statines, l’ézétimibe, les inhibiteurs de la proprotéine convertase subtilisine-kexine de type 9, les fibrates, les chélateurs des acides biliaires, la niacine et les suppléments d’omega-3 (acide docosahexaénoïque avec acide eicosapentaénoïque [EPA] ou ester éthylique de l’EPA seul [icosapent]), ainsi que sur la réponse à 11 questions supplémentaires. Le panel des lignes directrices a finalisé les recommandations en utilisant la méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation). Recommandations Toutes les recommandations sont présentées de manière à être centrées sur le patient et conçues en ayant à l’esprit les besoins des médecins de famille et des autres cliniciens des soins primaires. De nombreuses recommandations sont semblables à celles publiées en 2015. Les statines demeurent le traitement de première intention pour la prévention tant primaire que secondaire des MCV, et le régime méditerranéen et l’activité physique sont recommandés pour réduire le risque cardiovasculaire (en prévention primaire et secondaire). Le panel des lignes directrices a recommandé de ne pas utiliser le dosage des lipoprotéines a, des apolipoprotéines B ou le score calcique coronarien (SCC) dans l’évaluation du risque cardiovasculaire, et de ne pas cibler de seuils précis de taux lipidiques. L’équipe a aussi passé en revue de nouvelles données concernant les acides gras omega-3 (y compris l’ester éthylique d’EAP [icosapent]) et les inhibiteurs de la proprotéine convertase subtilisine-kexine de type 9, et a précisé les moments où il convient de procéder à une prise de décision partagée avec les patients sur les interventions pour diminuer le risque cardiovasculaire. Conclusion Ces lignes directrices actualisées et fondées sur des données probantes présentent une approche simplifiée de la prise en charge des lipides pour la prévention et le traitement des MCV. Ce guide de pratique clinique a été conçu par et pour des professionnels de la santé en soins primaires et leurs patients.
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Affiliation(s)
- Michael R. Kolber
- Professeur au Département de médecine familiale de l’Université de l’Alberta à Edmonton
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