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Bagheri Kholenjani F, Shahidi S, Vaseghi G, Ashoorion V, Sarrafzadegan N. First Iranian guidelines for the diagnosis, management, and treatment of hyperlipidemia in adults. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:18. [PMID: 38808220 PMCID: PMC11132424 DOI: 10.4103/jrms.jrms_318_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/10/2023] [Accepted: 11/08/2023] [Indexed: 05/30/2024]
Abstract
This guideline is the first Iranian guideline developed for the diagnosis, management, and treatment of hyperlipidemia in adults. The members of the guideline developing group (GDG) selected 9 relevant clinical questions and provided recommendations or suggestions to answer them based on the latest scientific evidence. Recommendations include the low-density lipoprotein cholesterol (LDL-C) threshold for starting drug treatment in adults lacking comorbidities was determined to be over 190 mg/dL and the triglyceride (TG) threshold had to be >500 mg/dl. In addition to perform fasting lipid profile tests at the beginning and continuation of treatment, while it was suggested to perform cardiovascular diseases (CVDs) risk assessment using valid Iranian models. Some recommendations were also provided on lifestyle modification as the first therapeutic intervention. Statins were recommended as the first line of drug treatment to reduce LDL-C, and if its level was high despite the maximum allowed or maximum tolerated drug treatment, combined treatment with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, or bile acid sequestrants was suggested. In adults with hypertriglyceridemia, pharmacotherapy with statin or fibrate was recommended. The target of drug therapy in adults with increased LDL-C without comorbidities and risk factors was considered an LDL-C level of <130 mg/dl, and in adults with increased TG without comorbidities and risk factors, TG levels of <200 mg/dl. In this guideline, specific recommendations and suggestions were provided for the subgroups of the general population, such as those with CVD, stroke, diabetes, chronic kidney disease, elderly, and women.
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Affiliation(s)
- Fahimeh Bagheri Kholenjani
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahla Shahidi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Golnaz Vaseghi
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Ashoorion
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nizal Sarrafzadegan
- Address for correspondence: Dr. Nizal Sarrafzadegan, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Michaeli DT, Michaeli JC, Albers S, Boch T, Michaeli T. Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention. Am J Cardiovasc Drugs 2023; 23:477-495. [PMID: 37486464 PMCID: PMC10462544 DOI: 10.1007/s40256-023-00594-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 07/25/2023]
Abstract
Despite treatment with statins, patients with elevated low-density lipoprotein cholesterol (LDL-C) and triglycerides remain at increased risk for adverse cardiovascular events. Consequently, novel pharmaceutical drugs have been developed to control and modify the composition of blood lipids to ultimately prevent fatal cardiovascular events in patients with dyslipidaemia. This article reviews established and emerging lipid-lowering drugs regarding their mechanism of action, development stage, ongoing clinical trials, side effects, effect on blood lipids and reduction in cardiovascular morbidity and mortality. We conducted a keyword search to identify studies on established and emerging lipid modifying drugs. Results were summarized in a narrative overview. Established pharmaceutical treatment options include the Niemann-Pick-C1 like-1 protein (NPC1L1) inhibitor ezetimibe, the protein convertase subtilisin-kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab, fibrates as peroxisome proliferator receptor alpha (PPAR-α) activators, and the omega-3 fatty acid icosapent ethyl. Statins are recommended as the first-line therapy for primary and secondary cardiovascular prevention in patients with hypercholesterinaemia and hypertriglyceridemia. For secondary prevention in hypercholesterinaemia, second-line options such as statin add-on or statin-intolerant treatments are ezetimibe, alirocumab and evolocumab. For secondary prevention in hypertriglyceridemia, second-line options such as statin add-on or statin-intolerant treatments are icosapent ethyl and fenofibrate. Robust data for these add-on therapeutics in primary cardiovascular prevention remains scarce. Recent biotechnological advances have led to the development of innovative small molecules (bempedoic acid, lomitapide, pemafibrate, docosapentaenoic and eicosapentaenoic acid), antibodies (evinacumab), antisense oligonucleotides (mipomersen, volanesorsen, pelcarsen, olezarsen), small interfering RNA (inclisiran, olpasiran), and gene therapies for patients with dyslipidemia. These molecules specifically target new cellular pathways, such as the adenosine triphosphate-citrate lyase (bempedoic acid), PCSK9 (inclisiran), angiopoietin-like 3 (ANGPTL3: evinacumab), microsomal triglyceride transfer protein (MTP: lomitapide), apolipoprotein B-100 (ApoB-100: mipomersen), apolipoprotein C-III (ApoC-III: volanesorsen, olezarsen), and lipoprotein (a) (Lp(a): pelcarsen, olpasiran). The authors are hopeful that the development of new treatment modalities alongside new therapeutic targets will further reduce patients' risk of adverse cardiovascular events. Apart from statins, data on new drugs' use in primary cardiovascular prevention remain scarce. For their swift adoption into clinical routine, these treatments must demonstrate safety and efficacy as well as cost-effectiveness in randomized cardiovascular outcome trials.
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Affiliation(s)
- Daniel Tobias Michaeli
- Department of Medical Oncology, National Center for Tumour Diseases, Heidelberg University Hospital, Heidelberg, Germany.
| | - Julia Caroline Michaeli
- Department of Obstetrics and Gynaecology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Albers
- Department of Orthopaedics and Sport Orthopaedics, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Boch
- Department of Medical Oncology, National Center for Tumour Diseases, Heidelberg University Hospital, Heidelberg, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
| | - Thomas Michaeli
- Department of Medical Oncology, National Center for Tumour Diseases, Heidelberg University Hospital, Heidelberg, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Heidelberg, Germany
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Al Mousa E, Al-Azzam S, Araydah M, Karasneh R, Ghnaimat M, Al-Makhamreh H, Al Khawaldeh A, Ali Abu Al-Samen M, Haddad J, Al Najjar S, Alsalaheen Abbadi H, Hammoudeh AJ. A Jordanian Multidisciplinary Consensus Statement on the Management of Dyslipidemia. J Clin Med 2023; 12:4312. [PMID: 37445345 DOI: 10.3390/jcm12134312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/12/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the primary contributor to global mortality rates, which significantly escalates healthcare expenditures. Risk factors for ASCVD (including dyslipidemia) frequently present in clusters rather than separately. Addressing these risk factors is crucial in the early initiation of a comprehensive management plan that involves both lifestyle modifications and pharmacotherapy to reduce the impact of ASCVD. A team of Jordanian professionals from various medical organizations and institutes took the initiative to create a set of guidelines for dyslipidemia screening and therapy. A detailed, comprehensive literature review was undertaken utilizing several databases and keywords. This consensus statement provides recommendations for dyslipidemia management in Jordanians on several issues including cardiovascular risk estimation, screening eligibility, risk categories, treatment goals, lifestyle changes, and statin and non-statin therapies. It is recommended that all Jordanian individuals aged 20 years old or older undergo lipid profile testing. This should be followed by determining the level of cardiovascular risk depending on the presence or absence of ASCVD and cardiovascular risk factors, eligibility for lipid-lowering therapy, and the target low-density cholesterol serum level to be achieved. In conclusion, prioritizing the management of dyslipidemia is of the utmost importance in improving public health and reducing the burden of cardiovascular diseases.
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Affiliation(s)
- Eyas Al Mousa
- Jordanian Atherosclerosis and Hypertension Society, Amman 11942, Jordan
| | - Sayer Al-Azzam
- Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | | | - Reema Karasneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Mohammad Ghnaimat
- Jordan Society of Internal Medicine, Amman 11942, Jordan
- Jordan Society of Nephrology, Amman 11942, Jordan
| | - Hanna Al-Makhamreh
- Cardiology Division, School of Medicine, University of Jordan, Amman 11942, Jordan
| | | | | | - Jihad Haddad
- Scientific Committee, Jordanian Atherosclerosis and Hypertension Society, Amman 11942, Jordan
| | - Said Al Najjar
- Cardiology Department at Albasheer Hospital (MOH), Amman 11942, Jordan
| | | | - Ayman J Hammoudeh
- Scientific Committee, Cardiovascular Academy Group of the Jordan Cardiac Society, Amman 11942, Jordan
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Novel Target Study to Cure Cardiovascular Disease regarding Proprotein Converse Subtilisin/Kexin Type 9. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9039377. [PMID: 36267835 PMCID: PMC9578827 DOI: 10.1155/2022/9039377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022]
Abstract
Objective This study is aimed at screening the potential ideal lead compounds from natural drug library (ZINC database), which had potential inhibition effects against proprotein converse subtilisin/kexin type 9 (PCSK9), and contributing to enrich the practical basis of PCSK9 inhibitor screening. Methods A series of computer-aided virtual screening techniques were used to identify potential inhibitors of PCSK9. Structure-based virtual screening by LibDock was carried out to calculate the LibDock scores, followed by ADME (absorption, distribution, metabolism, and excretion) and toxicity predictions. Molecule docking was next employed to demonstrate the binding affinity and mechanism between the candidate ligands and PCSK9 macromolecule. Finally, molecular dynamics simulation was performed to evaluate the stability of ligand-PCSK9 complex under natural circumstance. Results Two novel natural compounds ZINC000004099069 and ZINC000014952116 from the ZINC database were found to bind with PCSK9 with a higher binging affinity together with more favorable interaction energy. Also, they were predicted to be non-CYP2D6 inhibitors, together with low rodent carcinogenicity and AMES mutagenicity as well as hepatotoxicity. Molecular dynamics simulation analysis demonstrated that these two complex ZINC000004099069- and ZINC000014952116-PCSK9 had more favorable potential energy compared to the reference ligand, which could exist stably whether in vivo or in vitro. Conclusion This study elucidated that ZINC000004099069 and ZINC000014952116 were finally screened as safe and potential drug candidates, which may have great significance in the development of PCSK9 inhibitor development.
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Lee C, Park JT, Chang TI, Kang EW, Nam KH, Joo YS, Sung SA, Kim YH, Chae DW, Park SK, Ahn C, Oh KH, Yoo TH, Kang SW, Han SH. Low-density lipoprotein cholesterol levels and adverse clinical outcomes in chronic kidney disease: Results from the KNOW-CKD. Nutr Metab Cardiovasc Dis 2022; 32:410-419. [PMID: 34893405 DOI: 10.1016/j.numecd.2021.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The optimal low-density lipoprotein cholesterol (LDL-C) level to prevent cardiovascular disease in chronic kidney disease (CKD) patients remains unknown. This study aimed to explore the association of LDL-C levels with adverse cardiovascular and kidney outcomes in Korean CKD patients and determine the validity of "the lower, the better" strategy for statin intake. METHODS AND RESULTS A total of 1886 patients from the KoreaN cohort study for Outcome in patients With CKD (KNOW-CKD) were included. Patients were classified into four LDL-C categories: <70, 70-99, 100-129, and ≥130 mg/dL. The primary outcome was extended major adverse cardiovascular events (eMACEs). Secondary outcomes included all-cause mortality, and CKD progression. During the follow-up period, the primary outcome events occurred in 136 (7.2%) patients (16.9 per 1000 person-years). There was a graded association between LDL-C and the risk of eMACEs. The hazard ratios (95% confidence intervals) for LDL-C categories of 70-99, 100-129, and ≥130 mg/dL were 2.06 (1.14-3.73), 2.79 (1.18-6.58), and 4.10 (1.17-14.3), respectively, compared to LDL-C <70 mg/dL. Time-varying analysis showed consistent findings. The predictive performance of LDL-C for eMACEs was affected by kidney function. Higher LDL-C levels were also associated with significantly higher risks of CKD progression. However, LDL-C level was not associated with all-cause mortality. CONCLUSIONS This study showed a graded relationship between LDL-C and the risk of adverse cardiovascular outcome in CKD patients. The lowest risk was observed with LDL-C <70 mg/dL, suggesting that a lower LDL-C target may be acceptable.
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Affiliation(s)
- Changhyun Lee
- Division of Nephrology, Department of Internal Medicine, Yeongju Red Cross Hospital, Yeongju-si, Gyeongsangbuk-do, South Korea; Division of Integrated Medicine, Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Ik Chang
- Division of Nephrology, Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Ea Wha Kang
- Division of Nephrology, Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Ki Heon Nam
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea; Division of Hospital Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Su Joo
- Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, South Korea
| | - Su-Ah Sung
- Division of Nephrology, Department of Internal Medicine, Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Yeong Hoon Kim
- Division of Nephrology, Department of Internal Medicine, Inje University, Pusan Paik Hospital, Pusan, South Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
| | - Su Kyung Park
- Department of Preventive Medicine, Seoul National University, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea.
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Ziaei R, Ghavami A, Khalesi S, Ghiasvand R, Mokari Yamchi A. The effect of probiotic fermented milk products on blood lipid concentrations: A systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2021; 31:997-1015. [PMID: 33612379 DOI: 10.1016/j.numecd.2020.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
AIM Fermented milk products are suggested as a supplementary therapy to help reduce blood lipid levels. However, the results of clinical studies are conflicting. DATA SYNTHESIS This study systematically reviewed 39 randomized controlled trials (n = 2237 participants) to investigate the effect of probiotic fermented milk products on blood lipids. A meta-analysis was performed using random effects models, with weighted mean differences (WMDs) and 95% confidence interval (CI). Statistically significant reductions in blood low-density lipoprotein cholesterol (LDL-C) (WMD: -7.34 mg/dL, 95% CI: from -10.04 to -4.65, and P < 0.001) and total cholesterol (TC) concentrations (WMD: -8.30 mg/dL, 95% CI: from -11.42 to -5.18, and P < 0.001) were observed. No statistically significant effect of probiotic fermented milk was observed on blood high-density lipoprotein cholesterol (HDL-C) and triacylglycerol (TAG) levels. The effect on TC and LDL-C level was more pronounced in men, and a greater reduction in TAG was observed in trials with longer interventions (≥8 weeks) as compared to their counterparts. CONCLUSIONS Available evidence suggests that probiotic fermented milk products may help to reduce serum TC and LDL-C cholesterol levels, particularly in men and when they are consumed for ≥8 weeks.
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Affiliation(s)
- Rahele Ziaei
- Student Research Committee, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abed Ghavami
- Student Research Committee, Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saman Khalesi
- Appleton Institute & School of Health Medical and Applied Sciences, CQUniversity, Brisbane, Australia
| | - Reza Ghiasvand
- Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amin Mokari Yamchi
- Student Research Committee, Department of Community Nutrition, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2020; 290:140-205. [PMID: 31504418 DOI: 10.1016/j.atherosclerosis.2019.08.014] [Citation(s) in RCA: 584] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-188. [PMID: 31504418 DOI: 10.1093/eurheartj/ehz455] [Citation(s) in RCA: 4490] [Impact Index Per Article: 1122.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Shukla AK, Mehani R. Safety and efficacy of alirocumab: A meta analysis of 12 randomized controlled trials. J Family Med Prim Care 2019; 8:2249-2257. [PMID: 31463238 PMCID: PMC6691459 DOI: 10.4103/jfmpc.jfmpc_406_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Objective: Hypercholesterolemia is one of the major risk factor for atherosclerotic coronary heart disease, especially coronary heart disease. Most effective class of medications for prevention of cardiovascular events and LDL-C reduction are the statins. Approximately only one fourth of these high risk patients had achieved LDL-C levels <70 mg/dL with statins. Monoclonal antibody targeting PCSK9 is a novel class of drug used in the treatment of Hypercholesterolemia. Alirocumab is one such human monoclonal antibody directed against PCSK9. Binding of PCSK9 to the LDL-R on the hepatocytes promotes LDL-R degradation. Inhibition of PCSK9 binding to LDL-R leads to increased number of LDL-Rs to clear LDL, thus decreasing LDL-C levels. The purpose of this systematic study is to assess the safety and efficacy of Alirocumab in adults with hypercholesterolemia and Familial hypercholesterolemia. Materials and Methods: We searched Medline, PubMed Central database, Google scholar, EBSCO, Wiley library, conference proceedings and Clinical trials.gov registry through March 2017. Phase 3 randomized, controlled trials (RCTs) using Alirocumab in adults with hypercholesterolemia and Familial Hypercholesterolemia were selected. Results: In twelve RCTs comprising of 6019 patients included in the meta-analysis, significant favorable changes in LDL-C and HDL-C were found. Limitations: Results were derived from study level data rather than patient level data. Conclusions: Alirocumab substantially reduced the LDL-C level by over 50 %, increased the HDL-C level, and resulted in favorable changes in other lipids.
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Affiliation(s)
- Ajay K Shukla
- Department of Pharmacology, AIIMS, Bhopal, Madhya Pradesh, India
| | - Rekha Mehani
- Department of Pharmacology, RKDF MCH/RC, Bhopal, Madhya Pradesh, India
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Chae CW, Kwon YW. Cell signaling and biological pathway in cardiovascular diseases. Arch Pharm Res 2019; 42:195-205. [PMID: 30877558 DOI: 10.1007/s12272-019-01141-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/04/2019] [Indexed: 12/12/2022]
Abstract
Currently, coronary artery disease accounts for a large proportion of deaths occurring worldwide. Damage to the heart muscle over a short period of time leads to myocardial infarction (MI). The biological mechanisms of atherosclerosis, one of the causes of MI, have been well studied. Resistin, a type of adipokine, is closely associated with intravascular level of low-density lipoprotein cholesterol and augmentation of the expression of adhesion molecules in endothelial cells. Therefore, resistin, which is highly associated with inflammation, can progress into coronary artery disease. Adenylyl cyclase associated protein 1, a binding partner of resistin, also plays an important role in inducing pro-inflammatory cytokines. The induction of these cytokines can aggravate atherosclerosis by promoting severe plaque rupture of the lesion site. Recently, drugs, such as statins that can inhibit inflammation have been extensively studied. The development of effective new drugs that can directly or indirectly block pro-inflammatory cytokines may have a great potential in the treatment of coronary artery disease in the future.
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Affiliation(s)
- Cheong-Whan Chae
- National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, 110-744, Republic of Korea
| | - Yoo-Wook Kwon
- National Research Laboratory for Stem Cell Niche, Center for Medical Innovation, Seoul National University Hospital, Seoul, 110-744, Republic of Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Cortese F. Statins: Are they really all the same? Curr Vasc Pharmacol 2019; 17:211-212. [DOI: 10.2174/1570161116666180713120217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Vitale M, Masulli M, Calabrese I, Rivellese AA, Bonora E, Signorini S, Perriello G, Squatrito S, Buzzetti R, Sartore G, Babini AC, Gregori G, Giordano C, Clemente G, Grioni S, Dolce P, Riccardi G, Vaccaro O. Impact of a Mediterranean Dietary Pattern and Its Components on Cardiovascular Risk Factors, Glucose Control, and Body Weight in People with Type 2 Diabetes: A Real-Life Study. Nutrients 2018; 10:nu10081067. [PMID: 30103444 PMCID: PMC6115857 DOI: 10.3390/nu10081067] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022] Open
Abstract
This study evaluates the relation of a Mediterranean dietary pattern and its individual components with the cardiovascular risk factors profile, plasma glucose and body mass index (BMI) in people with type 2 diabetes. We studied 2568 participants at 57 diabetes clinics. Diet was assessed with the EPIC (European Prospective Investigation into Cancer and Nutrition) questionnaire, adherence to the Mediterranean diet was evaluated with the relative Mediterranean diet score (rMED). A high compared to a low score was associated with a better quality of diet and a greater adherence to the nutritional recommendations for diabetes. However, even in the group achieving a high score, only a small proportion of participants met the recommendations for fiber and saturated fat (respectively 17% and 30%). Nonetheless, a high score was associated with lower values of plasma lipids, blood pressure, glycated hemoglobin, and BMI. The relationship of the single food items components of the rMED score with the achievement of treatment targets for plasma lipids, blood pressure, glucose, and BMI were also explored. The study findings support the Mediterranean dietary model as a suitable model for type 2 diabetes and the concept that the beneficial health effects of the Mediterranean diet lie primarily in its synergy among various nutrients and foods rather than on any individual component.
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Affiliation(s)
- Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Masulli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Ilaria Calabrese
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | | | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, 37134 Verona, Italy.
| | - Stefano Signorini
- University Department Laboratory Medicine, Hospital of Desio, 20832 Monza, Italy.
| | - Gabriele Perriello
- Endocrinology and Metabolism, University of Perugia, 06126, Perugia, Italy.
| | - Sebastiano Squatrito
- Diabetes Unit, University Hospital Garibaldi-Nesima of Catania, 95122 Catania, Italy.
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University, 04100 Rome, Italy.
| | - Giovanni Sartore
- Department of Medicine, University of Padua, 35100 Padova, Italy.
| | | | - Giovanna Gregori
- Diabetes Unit, Azienda Sanitaria Toscana Nord-Ovest, Massa Carrara, 54100 Massa Carrara, Italy.
| | - Carla Giordano
- Section of Endocrinology, Diabetology and Metabolic Diseases, University of Palermo, 90127 Palermo, Italy.
| | - Gennaro Clemente
- Institute for Research on Population and Social Policies-National Research Council, 84084 Fisciano, Italy.
| | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, 20133 Milano, Italy.
| | - Pasquale Dolce
- Department of Public Health, Federico II University of Naples, 80131 Naples, Italy.
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Olga Vaccaro
- Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
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Stather P, Muscara F. Cardiovascular risk reduction in referrals to outpatient vascular clinics. Ann R Coll Surg Engl 2018; 100:194-198. [PMCID: PMC5930089 DOI: 10.1308/rcsann.2017.0204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2017] [Indexed: 11/16/2023] Open
Abstract
Introduction Patients with peripheral arterial disease (PAD), aneurysmal disease (AD) or carotid atherosclerosis are at high cardiovascular risk, necessitating secondary cardiovascular protection. The aim of this study was to determine compliance with cardiovascular risk reduction guidelines in new patients referred to vascular clinics. Methods A multicentre collaborative national observational audit of new patients referred to eight tertiary general vascular clinics over a three-month period in England and Wales was conducted by the Vascular and Endovascular Research Network (VERN). Referral letters, case notes and investigations were reviewed by local investigators, and data analysed by VERN. Results A total of 656 patients were included in the study: 73.2% had PAD, 23.2% had AD and 3.7% had carotid atherosclerosis. A third (37.5%) were current smokers, two-thirds (61.7%) were on antiplatelet therapy and two-thirds (61.5%) were on statin therapy. Smoking was more prevalent in the PAD cohort (PAD 41.4%, AD 27.5%, p =0.003). However, more PAD patients were on antiplatelet therapy (PAD 63.9%, AD 53.3%, p =0.024). Both antiplatelet and statin prescription significantly increased with the number of cardiovascular risk factors. Patients with a previous cardiac or cerebrovascular history were more likely to have stopped smoking, and to be on antiplatelet and statin therapy (p <0.0001 for each). Overall, 47.3% of patients were on both antiplatelet and statin therapy, and 28.9% were on antiplatelet and statin therapy and not smoking. Conclusions This study highlights deficiencies in cardiovascular risk minimisation in patients with established vascular disease. Patients with concomitant cardiac or cerebrovascular disease were more likely to be on best medical therapy.
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Affiliation(s)
- P Stather
- on behalf of the Vascular and Endovascular Research Network
| | - F Muscara
- on behalf of the Vascular and Endovascular Research Network
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14
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Dubois A, Dubé MP, Tardif JC. Precision medicine to change the landscape of cardiovascular drug development. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1392826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anick Dubois
- Montreal Heart Institute, Montreal, Canada
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Canada
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Gu L, Wang Y, Xu Y, Tian Q, Lei G, Zhao C, Gao Z, Pan Q, Zhao W, Nong L, Tan S. Lunasin functionally enhances LDL uptake via inhibiting PCSK9 and enhancing LDLR expression in vitro and in vivo. Oncotarget 2017; 8:80826-80840. [PMID: 29113347 PMCID: PMC5655242 DOI: 10.18632/oncotarget.20590] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 08/04/2017] [Indexed: 11/25/2022] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease which regulates serum low-density lipoprotein cholesterol (LDL-C) levels by promoting the degradation of the hepatic low-density lipoprotein receptor (LDLR), and has become an attractive therapeutic target for cholesterol lowering intervention. Lunasin, a 43-amino acid polypeptide initially isolated from soybean, has been previously proven to possess cholesterol lowering activity. Here we identified the down-regulation of PCSK9 expression by lunasin as one new mechanism that increased cell-surface LDLR level and enhanced LDL uptake in vitro and in vivo. Treatment of HepG2 cells with lunasin inhibited the expression of PCSK9 at mRNA and protein levels in a dose-and-time dependent manner via down-regulating hepatocyte nuclear factor-1α (HNF-1α), thereby contributing to increasing LDLR level and functionally enhancing LDL uptake. ApoE-/- mice receiving lunasin administration by intraperitoneal injection at doses of 0.125∼0.5 μmol/kg·day for 4 weeks had significantly lower PCSK9 and higher LDLR levels in hepatic tissue, as well as remarkably reduced total-cholesterol (T-CHO) and LDL-C in blood as compared to mice in vehicle control group. Furthermore, we identified that LDLR expression was up-regulated by lunasin via PI3K/Akt-mediated activation of SREBP-2 in HepG2 cells. Taken together, our findings suggest that lunasin inhibits PCSK9 expression by down-regulating HNF-1α and enhances LDLR expression via PI3K/Akt-mediated activation of SREBP-2 pathway, thereby functionally enhances LDL uptake in HepG2 cells and in ApoE-/- mice.
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Affiliation(s)
- Lili Gu
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Yue Wang
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Yaqiong Xu
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Qinghua Tian
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Gaoxin Lei
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Cheng Zhao
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Zhan Gao
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Qin Pan
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Wenfeng Zhao
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Liu Nong
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
| | - Shuhua Tan
- State Key Laboratory of Natural Medicines, School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, China
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He NY, Li Q, Wu CY, Ren Z, Gao Y, Pan LH, Wang MM, Wen HY, Jiang ZS, Tang ZH, Liu LS. Lowering serum lipids via PCSK9-targeting drugs: current advances and future perspectives. Acta Pharmacol Sin 2017; 38:301-311. [PMID: 28112180 PMCID: PMC5342665 DOI: 10.1038/aps.2016.134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/18/2016] [Indexed: 12/12/2022] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9), also known as neural apoptosis regulated convertase (NARC1), is a key modulator of cholesterol metabolism. PCSK9 increases the serum concentration of low-density lipoprotein cholesterol by escorting low-density lipoprotein receptors (LDLRs) from the membrane of hepatic cells into lysosomes, where the LDLRs are degraded. Owing to the importance of PCSK9 in lipid metabolism, considerable effort has been made over the past decade in developing drugs targeting PCSK9 to lower serum lipid levels. Nevertheless, some problems and challenges remain. In this review we first describes the structure and function of PCSK9 and its gene polymorphisms. We then discuss the various designs of pharmacological targets of PCSK9, including those that block the binding of PCSK9 to hepatic LDLRs (mimetic peptides, adnectins, and monoclonal antibodies), inhibit PCSK9 expression (the clustered regularly interspaced short palindromic repeats/Cas9 platform, small molecules, antisense oligonucleotides, and small interfering RNAs), and interfere with PCSK9 secretion. Finally, this review highlights future challenges in this field, including safety concerns associated with PCSK9 monoclonal antibodies, the limited utility of PCSK9 inhibitors in the central nervous system, and the cost-effectiveness of PCSK9 inhibitors.
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Affiliation(s)
- Ni-ya He
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Qing Li
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Chun-yan Wu
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Zhong Ren
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Ya Gao
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Li-hong Pan
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Mei-mei Wang
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Hong-yan Wen
- Medical College, Hunan University of Chinese Medicine, Changsha 410208, China
| | - Zhi-sheng Jiang
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Zhi-han Tang
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
| | - Lu-shan Liu
- Institute of Cardiovascular Disease, Key Lab for Arteriosclerology of Hunan Province, University of South China, Hengyang 421001, China
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Burke AC, Dron JS, Hegele RA, Huff MW. PCSK9: Regulation and Target for Drug Development for Dyslipidemia. Annu Rev Pharmacol Toxicol 2017; 57:223-244. [DOI: 10.1146/annurev-pharmtox-010716-104944] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Amy C. Burke
- Department of Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5B7; , , ,
| | - Jacqueline S. Dron
- Department of Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5B7; , , ,
| | - Robert A. Hegele
- Department of Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5B7; , , ,
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5B7
| | - Murray W. Huff
- Department of Biochemistry, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5B7; , , ,
- Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada N6A 5B7
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18
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Vitale M, Vaccaro O, Masulli M, Bonora E, Del Prato S, Giorda CB, Nicolucci A, Squatrito S, Auciello S, Babini AC, Bani L, Buzzetti R, Cannarsa E, Cignarelli M, Cigolini M, Clemente G, Cocozza S, Corsi L, D'Angelo F, Dall'Aglio E, Di Cianni G, Fontana L, Gregori G, Grioni S, Giordano C, Iannarelli R, Iovine C, Lapolla A, Lauro D, Laviola L, Mazzucchelli C, Signorini S, Tonutti L, Trevisan R, Zamboni C, Riccardi G, Rivellese AA. Polyphenol intake and cardiovascular risk factors in a population with type 2 diabetes: The TOSCA.IT study. Clin Nutr 2016; 36:1686-1692. [PMID: 27890487 DOI: 10.1016/j.clnu.2016.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of polyphenol intake on cardiovascular risk factors is little explored, particularly in people with diabetes. AIM To evaluate the association between the intake of total polyphenols and polyphenol classes with the major cardiovascular risk factors in a population with type 2 diabetes. METHODS Dietary habits were investigated in 2573 males and females participants of the TOSCA.IT study. The European Prospective Investigation on Cancer and Nutrition (EPIC) questionnaire was used to assess dietary habits. In all participants, among others, we assessed anthropometry, plasma lipids, blood pressure, C-reactive protein and HbA1c following a standard protocol. The USDA and Phenol-Explorer databases were used to estimate the polyphenol content of the habitual diet. RESULTS Average intake of polyphenols was 683.3 ± 5.8 mg/day. Flavonoids and phenolic acids were the predominant classes (47.5% and 47.4%, respectively). After adjusting for potential confounders, people with the highest intake of energy-adjusted polyphenols (upper tertile) had a more favorable cardiovascular risk factors profile as compared to people with the lowest intake (lower tertile) (BMI was 30.7 vs 29.9 kg/m2, HDL-cholesterol was 45.1 vs 46.9 mg/dl, LDL-cholesterol was 103.2 vs 102.1 mg/dl, triglycerides were 153.4 vs 148.0 mg/dl, systolic and diastolic blood pressure were respectively 135.3 vs 134.3 and 80.5 vs 79.6 mm/Hg, HbA1c was 7.70 vs 7.67%, and C-reactive Protein was 1.29 vs 1.25 mg/dl, p < .001 for all). The findings were very similar when the analysis was conducted separately for flavonoids or phenolic acids, the two main classes of polyphenols consumed in this population. CONCLUSIONS Polyphenol intake is associated with a more favorable cardiovascular risk factors profile, independent of major confounders. These findings support the consumption of foods and beverages rich in different classes of polyphenols particularly in people with diabetes. CLINICAL TRIAL http://www.clinicaltrials.gov; Study ID number: NCT00700856.
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Affiliation(s)
- Marilena Vitale
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Olga Vaccaro
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Maria Masulli
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Enzo Bonora
- Dipartimento di Endocrinologia, Diabetologia e Metabolismo, Università di Verona, Italy
| | - Stefano Del Prato
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Italy
| | | | - Antonio Nicolucci
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - Stefania Auciello
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | | | - Laura Bani
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - Raffaella Buzzetti
- UOC di Diabetologia Universitaria, Ospedale Santa Maria Goretti, Latina, Italy
| | | | - Mauro Cignarelli
- UO Endocrinologia e Malattie del Metabolismo, AOU di Foggia, Italy
| | - Massimo Cigolini
- Dipartimento di Endocrinologia, Diabetologia e Metabolismo, Università di Verona, Italy
| | - Gennaro Clemente
- IRPPS Research National Council, Penta di Fisciano, Salerno, Italy
| | - Sara Cocozza
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Laura Corsi
- SSD Diabetologia e Malattie del Metabolismo, ASL 4 Chiavarese, Genova, Italy
| | - Federica D'Angelo
- UOC Malattie Metaboliche e Diabetologia, INRCA-IRCCS Institute, Ancona, Italy
| | | | | | - Lucia Fontana
- UOC Diabetologia e Dietologia, Ospedale Pertini, Roma, Italy
| | - Giovanna Gregori
- UO Diabetologia e Malattie del Metabolismo, USL1 di Massa e Carrara, Italy
| | - Sara Grioni
- Unità di Epidemiologia e Prevenzione, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
| | - Carla Giordano
- Dipartimento di Endocrinologia e Malattie Metaboliche, Università di Palermo, Italy
| | - Rossella Iannarelli
- UOSD Diabetologia e Malattie del Metabolismo, Ospedale San Salvatore, L'Aquila, Italy
| | - Ciro Iovine
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | | | - Davide Lauro
- Dipartimento di Medicina Interna, Università di Tor Vergata, Roma, Italy
| | - Luigi Laviola
- Dipartimento Emergenza e Trapianti di Organi, Università"Aldo Moro", Bari, Italy
| | | | - Stefano Signorini
- Dipartimento di Patologia Sperimentale, Ospedale di Desio, Università di Milano Bicocca, Italy
| | - Laura Tonutti
- SOC di Endocrinologia e Malattie del Metabolismo, AOU S. Maria della Misericordia, Udine, Italy
| | - Roberto Trevisan
- USC Malattie Endocrine-Diabetologia, ASST "Papa Giovanni XXIII", Bergamo, Italy
| | - Chiara Zamboni
- UO Malattie Metaboliche, Dietologia e Nutrizione Clinica, AOU Arcispedale S. Anna, Ferrara, Italy
| | - Gabriele Riccardi
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy
| | - Angela A Rivellese
- Dipartimento di Medicina Clinica e Chirurgia, Università"Federico II", Naples, Italy.
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Lu Y, Cheng Z, Zhao Y, Chang X, Chan C, Bai Y, Cheng N. Efficacy and safety of long-term treatment with statins for coronary heart disease: A Bayesian network meta-analysis. Atherosclerosis 2016; 254:215-227. [DOI: 10.1016/j.atherosclerosis.2016.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/06/2016] [Accepted: 10/13/2016] [Indexed: 01/11/2023]
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20
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999-3058. [PMID: 27567407 DOI: 10.1093/eurheartj/ehw272] [Citation(s) in RCA: 1912] [Impact Index Per Article: 239.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Decreasing low-density lipoprotein cholesterol (LDL-C) is one of the few established and proven principles for the prevention and treatment of atherosclerosis. The higher the individual cardiovascular risk, the higher the benefit of lipid-lowering pharmacotherapy. Therefore, treatment options are chosen based on a patient's total cardiovascular risk. The latter depends not only on the levels of LDL-C but also on the presence of cardiovascular disease (CVD) and on the number and severity of other risk factors. Current guidelines recommend the lowering of LDL-C to 115 mg/dl (3 mmol/l) in patients with low and moderate risk. The LDL-C treatment target is <100 mg/dl (2.6 mmol/l) for patients at high risk and <70 mg/dl (1.8 mmol/l) for patients at very high risk. Although lifestyle measures remain a fundamental part of treatment, many patients require drug therapy to achieve their LDL-C targets. Statins are the drugs of choice, with other options including ezetimibe and the newly available monoclonal antibodies against PCSK9 (proprotein convertase subtilisin/kexin type 9). In some cases, bile acid-binding sequestrants and fibrates can also be considered. Nicotinic acid is no longer available in Germany. PCSK9 antibodies decrease LDL-C about 50-60 % and are well tolerated. Their effects on clinical endpoints are being investigated in large randomized trials. The aim of the present review is to summarize the current guidelines and treatment options for hypercholesterolemia. Moreover, we provide an appraisal of PCSK9 antibodies and propose their use in selected patient populations, particularly in those at very high cardiovascular risk whose LDL-C levels under maximally tolerated lipid-lowering therapy are significantly over their treatment target.
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Atherosclerosis 2016; 253:281-344. [DOI: 10.1016/j.atherosclerosis.2016.08.018] [Citation(s) in RCA: 558] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Atorvastatin treatment and LDL cholesterol target attainment in patients at very high cardiovascular risk. Clin Res Cardiol 2016; 105:783-90. [PMID: 27120330 PMCID: PMC4989032 DOI: 10.1007/s00392-016-0991-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/19/2016] [Indexed: 10/28/2022]
Abstract
The use of atorvastatin is rapidly increasing among statins since the introduction of generics. However, only limited data are available on its current use and the effectiveness outside of randomised trials. The aim of the study was to assess low-density lipoprotein (LDL-C) levels in ambulatory patients at very high cardiovascular risk on atorvastatin therapy in physician's offices. A total of 2625 high-risk patients on atorvastatin were included into this cross-sectional study by 539 office-based physicians between June and December 2014. 47.0 % of the patients had documented coronary heart disease (CHD), 25.1 % type 2 diabetes mellitus (DM), and 27.9 % CHD plus concomitant DM. The mean age was 66.1 ± 10.8 years, 62.1 % were male. Atorvastatin at the dose of 10, 20, 40 and 80 mg/day was administered in 15.6, 45.7, 33.9, and 4.8 % of the patients, respectively. The treatment duration was 92.6 ± 109.6 weeks. The mean atorvastatin dose at therapy start was 24.8 ± 15.2 mg/day and at time of documentation 27.9 ± 15.8 mg/day. Low-density lipoprotein cholesterol (LDL-C) <70 mg/dL was achieved by 10.5 % of the total cohort (7.5 % in DM, 9.3 % in CHD, and 15.2 % in CHD + DM). In contrast, according to physicians' subjective assessment, 62.7 % of patients (with small differences between groups) had reached their individual LDL-C target. In summary, higher doses of atorvastatin are not frequently used in clinical practice. The LDL-C target level <70 mg/dL as recommended by current guidelines is achieved only in a minority of atorvastatin treated patients at very high cardiovascular risk.
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Lipid Paradox in Acute Myocardial Infarction—The Association With 30-Day In-Hospital Mortality. Crit Care Med 2015; 43:1255-64. [DOI: 10.1097/ccm.0000000000000946] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Shimada YJ, Cannon CP. PCSK9 (Proprotein convertase subtilisin/kexin type 9) inhibitors: past, present, and the future. Eur Heart J 2015; 36:2415-24. [PMID: 25971287 DOI: 10.1093/eurheartj/ehv174] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/22/2015] [Indexed: 01/19/2023] Open
Abstract
Reduction in low-density lipoprotein cholesterol (LDL-C), mainly with statins, has decreased the risk of cardiovascular events over the last few decades. However, there are several patient populations that warrant further decrease in LDL-C by additional cholesterol-lowering therapy other than statins. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a new class of drugs that have been shown to further decrease LDL-C by 50-70% when administered as a monotherapy or on a background therapy with statins. Proprotein convertase subtilisin/kexin type 9 inhibitors are also an excellent example of drug development in which discovery of gene mutations and its clinical effects have rapidly progressed into successful preclinical and clinical studies with multiple Phases 1-3 clinical trials completed or ongoing to date. This review summarizes the rapid evolution of the drug from genetic discovery to identification of targets for the drugs, to animal and human testing, and to large clinical outcomes trials, followed by discussion on foreseeable challenges of PCSK9 inhibitors.
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Affiliation(s)
- Yuichi J Shimada
- Harvard Clinical Research Institute, Boston, MA, USA Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher P Cannon
- Harvard Clinical Research Institute, Boston, MA, USA Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Statins are the most-effective therapy currently available for lowering the LDL-cholesterol (LDL-C) level and preventing cardiovascular events. Additional therapies are necessary for patients who cannot reach the target LDL-C level when taking the maximum-tolerated dose of a statin. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an enzyme with an important role in lipoprotein metabolism. Rare gain-of-function mutations in PCSK9 lead to a high LDL-C level and premature coronary heart disease, whereas loss-of-function variants lead to a low LDL-C level and a reduced incidence of coronary heart disease. Furthermore, the PCSK9 level is increased with statin therapy through negative feedback, which promotes LDL-receptor degradation and decreases the efficacy of LDL-C lowering with statins. PCSK9 inhibition is, therefore, a rational therapeutic target, and several approaches are being pursued. In phase I, II, and III trials, inhibition of PCSK9 with monoclonal antibodies has produced an additional 50-60% decrease in the LDL-C level when used in combination with statin therapy, compared with statin monotherapy. In short-term trials, PCSK9 inhibitors were well tolerated and had a low incidence of adverse effects. Ongoing phase III trials will provide information about the long-term safety of these drugs, and their efficacy in preventing cardiovascular events.
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Affiliation(s)
- Razvan T Dadu
- Sections of Cardiovascular Research and Cardiology, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS A601, Houston, TX 77030, USA
| | - Christie M Ballantyne
- Sections of Cardiovascular Research and Cardiology, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS A601, Houston, TX 77030, USA
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Reichert RG, Lyon MR, Kacinik V, Gahler RJ, Manjoo P, Purnama M, Wood S. Decreasing cardiovascular risk factors in obese individuals using a combination of PGX® meal replacements and PGX® granules in a 12-week clinical weight modification program. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2013; 10:/j/jcim.2013.10.issue-1/jcim-2012-0003/jcim-2013-0003.xml. [PMID: 23652638 DOI: 10.1515/jcim-2013-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 02/01/2013] [Indexed: 01/15/2023]
Abstract
In this open, clinically based, weight modification program, we determined in six sedentary obese adults (five women; one male; age range 30-62 years) that the combination of a modified calorie diet plus PGX® meal replacement and PGX® supplementation resulted in a significant reduction in several cardiovascular risk factors over a 12-week time period. This included a significant improvement in lipids (-0.98 mmol/l LDL-C), reduction in average weight (-9.2 kg), mean reduction in fat (-4.1%) and an increase in fat-free mass (2.8%).
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Chen Z, Wang X, Ding Z, Fan P, Ma G. Differences in statin usage and target-goal achievement between departments at the same hospital. PLoS One 2012; 7:e50466. [PMID: 23251371 PMCID: PMC3519451 DOI: 10.1371/journal.pone.0050466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/23/2012] [Indexed: 11/21/2022] Open
Abstract
Objective To compare use of statins and target-goal achievement in patients with type 2 diabetes mellitus (T2DM), with or without stable coronary artery disease (CAD), between cardiology and endocrinology departments at a tertiary hospital. Methods A total of 966 patients with T2DM were enrolled, including 553 with stable CAD, from the departments of endocrinology and cardiology. Baseline characteristics, prescription of statins, and target-goal achievement of low-density lipoprotein cholesterol (LDL-C) during a 6-month follow-up period were analyzed. Results There was lower ratio of statin use in patients with T2DM, with or without CAD, in the department of endocrinology than in the department of cardiology (all P<0.05). At the 6-month follow-up, compared to patients with T2DM in the endocrinology department, target-goal achievement among patients with T2DM in the department of cardiology was higher (52.90% vs. 41.46%, P<0.01), indicating a significant improvement among patients in the department of cardiology but not for those in the department of endocrinology when compared to baseline. According to the new Chinese guidelines, the goal attainment rate was higher among patients with T2DM combined with CAD in the department of cardiology than in the department of endocrinology (27.62% vs. 19.05%, P<0.05). However, with regard to ATP III 2004, the goal attainment rate was similar for patients with T2DM combined with CAD in both departments during the 6-month follow-up (9.21% vs. 8.84%, P>0.05), with no apparent improvement compared to baseline. Conclusions There was differential and sub-optimal use of statins as well as low target-goal achievement among patients with T2DM, with or without CAD, in the departments of cardiology and endocrinology at the same tertiary hospital, with a lower rate of statin prescription and target-goal achievement of LDL-C in the department of endocrinology.
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Affiliation(s)
- Zhong Chen
- Department of Cardiology, The Affiliated Zhongda Hospital and School of Medicine, Southeast University, Nanjing, PR China.
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Kuklina EV, Tong X, George MG, Bansil P. Epidemiology and prevention of stroke: a worldwide perspective. Expert Rev Neurother 2012; 12:199-208. [PMID: 22288675 DOI: 10.1586/ern.11.99] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper reviews how epidemiological studies during the last 5 years have advanced our knowledge in addressing the global stroke epidemic. The specific objectives were to review the current evidence supporting management of ten major modifiable risk factors for prevention of stroke: hypertension, current smoking, diabetes, obesity, poor diet, physical inactivity, atrial fibrillation, excessive alcohol consumption, abnormal lipid profile and psychosocial stress/depression.
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Affiliation(s)
- Elena V Kuklina
- Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Powell JP, Leonard JS. A nutritional program improved lipid profiles and weight in 28 chiropractic patients: a retrospective case series. J Chiropr Med 2011; 7:94-100. [PMID: 19646370 DOI: 10.1016/j.jcm.2008.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 04/16/2008] [Accepted: 05/04/2008] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study retrospectively examined the effects of a 21-day nutritional intervention program, which included fruit and vegetable consumption, energy restriction, and nutritional supplements, on serum lipid measures in 28 chiropractic patients. METHODS Medical records were reviewed for 28 chiropractic patients who had completed a commercially available 21-day nutritional intervention program between April 2005 and August 2007 and for whom complete serum lipid and weight measures immediately pre- and postintervention were available. The primary outcome was change in serum lipids, and change in body weight was a secondary outcome variable. RESULTS Significant reductions in total, low-density lipoprotein, very low-density lipoprotein, and high-density lipoprotein cholesterol, and triglycerides were observed. Serum triglycerides decreased from 116.3 +/- 54.6 (mean +/- SD) to 88.6 +/- 40.5 mg/dL (P < .01). Total cholesterol decreased from 223.3 +/- 40.7 to 176.2 +/- 30.0 mg/dL (P < .0001). Low-density lipoprotein cholesterol decreased from 145.7 +/- 36.8 to 110.9 +/- 25.3 mg/dL (P < .0001). High-density lipoprotein cholesterol decreased from 54.3 +/- 14.6 to 47.6 +/- 10.5 mg/dL (P < .001). Weight for patients decreased from 191.2 +/- 38.8 to 182.2 +/- 36.3 lb (P < .0001). CONCLUSIONS This retrospective case series supports the hypothesis that a nutritional purification intervention program emphasizing fruit and vegetable consumption, energy restriction, and nutritional supplements reduces serum lipids and weight.
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Affiliation(s)
- James P Powell
- Director, Powell Chiropractic Clinic Inc, Canton, OH 44718
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März W, Genser B, Drechsler C, Krane V, Grammer TB, Ritz E, Stojakovic T, Scharnagl H, Winkler K, Holme I, Holdaas H, Wanner C. Atorvastatin and low-density lipoprotein cholesterol in type 2 diabetes mellitus patients on hemodialysis. Clin J Am Soc Nephrol 2011; 6:1316-25. [PMID: 21493741 PMCID: PMC3109927 DOI: 10.2215/cjn.09121010] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 01/23/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing maintenance hemodialysis are at high cardiovascular risk. Lowering LDL-cholesterol with statins reduces the incidence rate of cardiovascular events in patients with chronic kidney disease. In contrast, two randomized, prospective, placebo-controlled trials have been completed in hemodialysis patients that showed no significant effects of statins on cardiovascular outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A post hoc analysis was conducted of the 4D (Die Deutsche Diabetes Dialyze) study to investigate whether LDL-cholesterol at baseline is predictive of cardiovascular events and whether the effect of atorvastatin on clinical outcomes depends on LDL-cholesterol at baseline. RESULTS High concentrations of LDL-cholesterol by tendency increased the risks of cardiac endpoints and all-cause mortality. Concordantly, atorvastatin significantly reduced the rates of adverse outcomes in the highest quartile of LDL-cholesterol (≥145 mg/dl, 3.76 mmol/L). The hazard ratios and 95% confidence intervals were 0.69 (0.48 to 1.00) for the composite primary endpoint, 0.58 (0.34 to 0.99) for cardiac death, 0.48 (0.25 to 0.94) for sudden cardiac death, 0.62 (0.33 to 1.17) for nonfatal myocardial infarction, 0.68 (0.47 to 0.98) for all cardiac events combined, and 0.72 (0.52 to 0.99) for death from all causes, respectively. No such decrease was seen in any of the other quartiles of LDL-cholesterol at baseline. CONCLUSIONS In patients with type 2 diabetes mellitus undergoing hemodialysis, atorvastatin significantly reduces the risk of fatal and nonfatal cardiac events and death from any cause if pretreatment LDL-cholesterol is >145 mg/dl (3.76 mmol/L).
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Affiliation(s)
- Winfried März
- Synlab Center of Laboratory Diagnostics Heidelberg, Heidelberg, Germany.
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MTD-comsia modelling of HMG-CoA reductase inhibitors. JOURNAL OF THE SERBIAN CHEMICAL SOCIETY 2011. [DOI: 10.2298/jsc100601019d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The 3D quantitative structure-activity relationship for a series of
hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors based on the
pyrrolylethyl-tetrahydropyranone scaffold was examined using the Minimal
Topological Difference (MTD) method and comparative molecular similarity
index analysis (CoMSIA). The studied compounds were of the
tetrahydro-4-hydroxy-6-[2-(1H)-pyrrol-1-yl]ethyl-2H-pyran-2-one type. In
clinical practice, HMG-CoA reductase inhibitors are usually referred to by
the generic name statins. The analysis performed using the MTD method showed
that voluminous substituents produce a significant biological activity ( 2
R2CV=0.677>0.5; SEECV=0.319 ), while the CoMSIA method added useful
information regarding the influence of the steric, electrostatic,
hydrophobic, hydrogen bond donor, and acceptor properties on biological
activity (R2CV=0.60; r2=0.98).
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Colesevelam added to combination therapy with a statin and ezetimibe in patients with familial hypercholesterolemia: a 12-week, multicenter, randomized, double-blind, controlled trial. Clin Ther 2010; 32:615-25. [PMID: 20435231 DOI: 10.1016/j.clinthera.2010.04.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) has been associated with increased cardiovascular risk when untreated or when normal LDL-C concentrations are not reached. Some patients with FH do not reach LDL-C goals despite intensive combination therapy. OBJECTIVE This study assessed the efficacy and tolerability of colesevelam added to maximally tolerated, stable-dose combination treatment with a statin + ezetimibe. METHODS This Phase IV, multicenter, randomized, double-blind, placebo-controlled trial enrolled patients aged 18 to 75 years with FH and an LDL-C concentration >2.5 mmol/L who were receiving a maximally tolerated and stable regimen of a statin + ezetimibe. Patients were randomly assigned to receive colesevelam 3.75 g/d or placebo added to the statin + ezetimibe for 12 weeks. The primary efficacy outcome was the difference in LDL-C between the colesevelam and placebo groups after 6 weeks. Secondary efficacy outcomes were between-group differences in LDL-C, total cholesterol (TC), HDL-C, triglyceride (Tg), apolipoprotein (apo) B, and apoA-I concentrations, as well as apoB/apoA-I ratio after 12 weeks. Tolerability was assessed based on the prevalences of adverse events by organ system class in each treatment group. RESULTS Eighty-six patients were randomized (45 colesevelam, 41 placebo), of whom 84 (44 colesevelam, 40 placebo) were included in the primary analysis. The mean (SD) age of the participants was 52.8 (10.8) years, and 51 (59%) were men. The difference (95% CI) in LDL-C between colesevelam and placebo after 6 weeks was -18.5% (-25.3 to -11.8). Between-group differences in LDL-C, TC, HDL-C, Tg, and apoB/apoA-I ratio after 12 weeks were -12.0% (-17.8 to -6.3), -7.3% (-12.0 to -2.6), +3.3% (-2.4 to +9.0), +2.8% (-10.4 to +15.9), and -12.2% (-20.2 to -4.2), respectively. Colesevelam was generally well tolerated, with gastrointestinal adverse events in 12 of 45 patients (27%) versus 7 of 40 (18%) in the placebo group (P = NS). CONCLUSION In these patients with FH, colesevelam added to a combination of a statin + ezetimibe was associated with significantly improved LDL-C concentrations compared with placebo during the 12-week study period and was generally well tolerated.
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Regional variation of mortality from ischemic heart disease in Germany from 1998 to 2007. Clin Res Cardiol 2010; 99:511-8. [DOI: 10.1007/s00392-010-0150-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 03/11/2010] [Indexed: 10/19/2022]
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Trends in age-standardised and age-specific mortality from ischaemic heart disease in Germany. Clin Res Cardiol 2010; 99:545-51. [DOI: 10.1007/s00392-010-0151-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 03/11/2010] [Indexed: 12/21/2022]
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Rosuvastatin zur Primärprävention vaskulärer Komplikationen. Internist (Berl) 2010; 51:103-106. [DOI: 10.1007/s00108-009-2570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Goto S. Is a "Pharmacogenomic Algorithm" Helpful for Adjusting the Initial Dose of Warfarin in Patients to Be Treated by Warfarin Therapy? Circ J 2010; 74:850-1. [DOI: 10.1253/circj.cj-10-0176] [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: 11/09/2022]
Affiliation(s)
- Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine
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Stacy JN, Schwartz SM, Ershoff D, Shreve MS. Incorporating Tailored Interactive Patient Solutions Using Interactive Voice Response Technology to Improve Statin Adherence: Results of a Randomized Clinical Trial in a Managed Care Setting. Popul Health Manag 2009; 12:241-54. [DOI: 10.1089/pop.2008.0046] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The year in Clinical Research in Cardiology. Clin Res Cardiol 2009; 98:205-7. [DOI: 10.1007/s00392-009-0762-1] [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: 10/21/2022]
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Rozner S, Kogan A, Mehta S, Somasundaran P, Aserin A, Garti N, Ottaviani MF. Characterization of Nonionic Microemulsions by EPR. Part II. The Effect of Competitive Solubilization of Cholesterol and Phytosterols on the Nanostructure. J Phys Chem B 2008; 113:700-7. [DOI: 10.1021/jp807163t] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Shoshana Rozner
- Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel, NSF IUCR Center for Advanced Studies in Novel Surfactants, Columbia University, New York, New York 10027, and Institute of Chemical Sciences, University of Urbino, Piazza Rinascimento 6, 61029 Urbino, Italy
| | - Anna Kogan
- Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel, NSF IUCR Center for Advanced Studies in Novel Surfactants, Columbia University, New York, New York 10027, and Institute of Chemical Sciences, University of Urbino, Piazza Rinascimento 6, 61029 Urbino, Italy
| | - Somil Mehta
- Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel, NSF IUCR Center for Advanced Studies in Novel Surfactants, Columbia University, New York, New York 10027, and Institute of Chemical Sciences, University of Urbino, Piazza Rinascimento 6, 61029 Urbino, Italy
| | - Ponisseril Somasundaran
- Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel, NSF IUCR Center for Advanced Studies in Novel Surfactants, Columbia University, New York, New York 10027, and Institute of Chemical Sciences, University of Urbino, Piazza Rinascimento 6, 61029 Urbino, Italy
| | - Abraham Aserin
- Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel, NSF IUCR Center for Advanced Studies in Novel Surfactants, Columbia University, New York, New York 10027, and Institute of Chemical Sciences, University of Urbino, Piazza Rinascimento 6, 61029 Urbino, Italy
| | - Nissim Garti
- Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel, NSF IUCR Center for Advanced Studies in Novel Surfactants, Columbia University, New York, New York 10027, and Institute of Chemical Sciences, University of Urbino, Piazza Rinascimento 6, 61029 Urbino, Italy
| | - Maria Francesca Ottaviani
- Casali Institute of Applied Chemistry, The Institute of Chemistry, The Hebrew University of Jerusalem, Jerusalem 91904, Israel, NSF IUCR Center for Advanced Studies in Novel Surfactants, Columbia University, New York, New York 10027, and Institute of Chemical Sciences, University of Urbino, Piazza Rinascimento 6, 61029 Urbino, Italy
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Highlights of the hotline sessions presented at the scientific sessions 2008 of the American Heart Association. Clin Res Cardiol 2008; 98:1-7. [DOI: 10.1007/s00392-008-0742-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022]
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Affiliation(s)
- Genovefa D Kolovou
- 1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
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Yang X, So WY, Ma R, Ko G, Kong A, Lam C, Ho CS, Cockram C, Chow CC, Tong P, Chan J. Effects of albuminuria and renal dysfunction on development of dyslipidaemia in type 2 diabetes--the Hong Kong Diabetes Registry. Nephrol Dial Transplant 2008; 23:2834-40. [PMID: 18372388 DOI: 10.1093/ndt/gfn149] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is uncertain whether albuminuria precedes the future development of high total cholesterol (TC > 6.2 mmol/l) and high LDL-C (>4.1 mmol/l) while renal dysfunction precedes the future development of low HDL-C (<0.9 mmol/l) in type 2 diabetes. METHODS A prospective cohort of 2761 type 2 diabetic patients without significant dyslipidaemia and having at least one measurement of TC, LDL-C and HDL-C during 2.8 years of follow-up was analysed. The spline Cox regression model was used to derive hazard ratio (HR) curves of the spot urinary albumin:creatinine ratio (ACR) and the estimated glomerular filtration rate (eGFR) for dyslipidaemia, followed by standard Cox models to confirm the findings from the HR curves. RESULTS Seven percent of the cohort developed high TC, 4.6% developed high LDL-C and 5.7% developed low HDL-C during follow-up. In multivariate analysis, the HR of ACR for high TC and high LDL-C increased rapidly and linearly from zero with no apparent threshold. Patients with macroalbuminuria (ACR >/=25 mg/mmol) were, respectively, 1.6- and 2.4 folds more likely to develop high TC and high LDL-C than those with normoalbuminuria at baseline. The HR of eGFR for low HDL-C increased rapidly with declining eGFR at <110 ml/min/ 1.73 m(2). Subjects with eGFR <60 ml/min/1.73 m(2) and >/=60-<110 ml/min/1.73 m(2), respectively, had 3.0-fold and 1.8-fold risks of low HDL-C compared to those with eGFR >/=110-<140 ml/min/1.73 m(2). CONCLUSIONS In type 2 diabetes, macroalbumninuria predicts high TC and high LDL-C, while reduced renal function, even within normal range, predicts low HDL-C.
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Affiliation(s)
- Xilin Yang
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Harley CR, Gandhi SK, Heien H, McDonough K, Nelson SP. Lipid levels and low-density lipoprotein cholesterol goal attainment in diabetic patients: rosuvastatin compared with other statins in usual care. Expert Opin Pharmacother 2008; 9:669-76. [DOI: 10.1517/14656566.9.5.669] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Clinical Trial Updates and Hotline Sessions presented at the Scientific Session 2007 of the American heart association. Clin Res Cardiol 2007; 97:1-11. [DOI: 10.1007/s00392-008-0625-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 12/01/2007] [Indexed: 10/22/2022]
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Tabas I, Williams KJ, Borén J. Subendothelial lipoprotein retention as the initiating process in atherosclerosis: update and therapeutic implications. Circulation 2007; 116:1832-44. [PMID: 17938300 DOI: 10.1161/circulationaha.106.676890] [Citation(s) in RCA: 958] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The key initiating process in atherogenesis is the subendothelial retention of apolipoprotein B-containing lipoproteins. Local biological responses to these retained lipoproteins, including a chronic and maladaptive macrophage- and T-cell-dominated inflammatory response, promote subsequent lesion development. The most effective therapy against atherothrombotic cardiovascular disease to date--low density lipoprotein-lowering drugs--is based on the principle that decreasing circulating apolipoprotein B lipoproteins decreases the probability that they will enter and be retained in the subendothelium. Ongoing improvements in this area include more aggressive lowering of low-density lipoprotein and other atherogenic lipoproteins in the plasma and initiation of low-density lipoprotein-lowering therapy at an earlier age in at-risk individuals. Potential future therapeutic approaches include attempts to block the interaction of apolipoprotein B lipoproteins with the specific subendothelial matrix molecules that mediate retention and to interfere with accessory molecules within the arterial wall that promote retention such as lipoprotein lipase, secretory sphingomyelinase, and secretory phospholipase A2. Although not the primary focus of this review, therapeutic strategies that target the proatherogenic responses to retained lipoproteins and that promote the removal of atherogenic components of retained lipoproteins also hold promise. The finding that certain human populations of individuals who maintain lifelong low plasma levels of apolipoprotein B lipoproteins have an approximately 90% decreased risk of coronary artery disease gives hope that our further understanding of the pathogenesis of this leading killer could lead to its eradication.
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Affiliation(s)
- Ira Tabas
- Department of Medicine, Columbia University Medical Center, 630 W 168th St, New York, NY 10032, USA.
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The case for statin therapy in chronic heart failure. Clin Res Cardiol 2007; 97:139-46. [DOI: 10.1007/s00392-007-0610-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/14/2007] [Indexed: 11/26/2022]
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de Rougemont A, Normand S, Nazare JA, Skilton MR, Sothier M, Vinoy S, Laville M. Beneficial effects of a 5-week low-glycaemic index regimen on weight control and cardiovascular risk factors in overweight non-diabetic subjects. Br J Nutr 2007; 98:1288-98. [PMID: 17617942 DOI: 10.1017/s0007114507778674] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The glycaemic index (GI) has been developed in order to classify food according to the postprandial glycaemic response. This parameter is of interest, especially for people prone to glucose intolerance; however, the effects of a low-GI (LGI) diet on body weight, carbohydrate and lipid metabolism remain controversial. We studied the effects of either a LGI or high-GI (HGI) diet on weight control and cardiovascular risk factors in overweight, non-diabetic subjects. The study was a randomized 5-week intervention trial. The thirty-eight subjects (BMI 27.3 (sem 0.2) kg/m2) followed an intervention diet in which usual starch was replaced ad libitum with either LGI or HGI starch. Mean body weight decrease was significant in the LGI group ( - 1.1 (sEM 0.3) kg, P = 0.004) and was significantly greater than in the HGI group ( - 0.3 (sEM 0.2) kg, P = 0.04 between groups). Hunger sensation scales showed a trend towards a decrease in hunger sensation before lunch and dinner in the LGI group when compared with the HGI group (P = 0.09). No significant increase in insulin sensitivity was noticed. The LGI diet also decreased total cholesterol by 9.6 % (P < 0.001), LDL-cholesterol by 8.6 % (P = 0.01) and both LDL-:HDL-cholesterol ratio (10.1 %, P = 0.003) and total:HDL-cholesterol ratio (8.5 %, P = 0.001) while no significant changes were observed in the HGI group. Lowering the GI of daily meals with simple dietary recommendations results in increased weight loss and improved lipid profile and is relatively easy to implement with few constraints. These potential benefits of consuming a LGI diet can be useful to develop practical dietetic advice.
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Affiliation(s)
- Alexis de Rougemont
- Centre de Recherche en Nutrition Humaine Rhône-Alpes, INSERM U 449, INRA 1235, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France.
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Pfützner A, Forst T, März W, Jacob S. Evidenzbasierte Medizin. Internist (Berl) 2007; 48:426-35. [PMID: 17364168 DOI: 10.1007/s00108-007-1830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Founded on evidence based medicine (EBM), medical decisions should involve the best possible external scientific evidence as well as the expertise of the individual physician, while taking into consideration the subjective perspective of the patient. The Institute for Quality and Cost Effectiveness (Institut für Qualität und Wirtschaftlichkeit, IQWIG), which is financed through membership contributions to the statutory health insurance, deviates drastically in its evaluations for innovative medications from this concept. All publications on a medication are reduced to only a few "relevant" studies so that the statistics from the resulting meta-analysis are invalid. The resulting method dependent lack of statistical significance is considered by IQWIG authors to show the non-superiority of the test products, which are then speculatively discredited in terms of their safety. The "recommendations" of the IQWIG are accepted uncritically by the cost carriers. The aim of this article is to evaluate IQWIG-EBM in comparison with international standards on the basis of published IQWIG reports on metabolically active medications. The example of the reports on statins, short-term insulin analogues and inhaled insulin shows a methodology which suggests the misuse of study results and can best be characterized by the term "evidently biased medicine."
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Affiliation(s)
- A Pfützner
- IKFE Institut für Klinische Forschung und Entwicklung, Mainz, Deutschland
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