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Kim KA, Park HJ. New Therapeutic Approaches to the Treatment of Dyslipidemia 2: LDL-C and Lp(a). J Lipid Atheroscler 2023; 12:37-46. [PMID: 36761062 PMCID: PMC9884549 DOI: 10.12997/jla.2023.12.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/07/2022] [Indexed: 01/26/2023] Open
Abstract
Dyslipidemia is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). There are abundant and unequivocal data to indicate that low-density lipoproteins (LDL) are a cause of ASCVD. Reduction of plasma low-density lipoprotein cholesterol (LDL-C) by medical therapy such as statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have proven to significantly reduce the risk of cardiovascular events. However, for many reasons, many patients are not able to achieve LDL-C levels recommended by guidelines on currently available therapies. This has led to the development of new drugs lowering LDL-C, such as inclisiran, bempedoic acid, and evinacumab, in the hope of reducing cardiovascular (CV) risk. Drugs targeting lipoprotein (a) (Lp[a]) also have a role in the prevention of atherosclerosis, with genetic studies having established that 20%-30% of the human population inherits plasma Lp(a) levels in the atherogenic range. In this paper, we will review the recent progress made in the approaches to LDL-C and Lp(a) therapeutic modulation.
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Affiliation(s)
- Kyung An Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hun-Jun Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Hovland A, Narverud I, Lie Øyri LK, Bogsrud MP, Aagnes I, Ueland T, Mulder M, Leijten F, Langslet G, Wium C, Svilaas A, Arnesen KE, Roeters van Lennep J, Aukrust P, Halvorsen B, Retterstøl K, Holven KB. Subjects with familial hypercholesterolemia have lower aortic valve area and higher levels of inflammatory biomarkers. J Clin Lipidol 2021; 15:134-141. [PMID: 33358307 DOI: 10.1016/j.jacl.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Reduction of the aortic valve area (AVA) may lead to aortic valve stenosis with considerable impact on morbidity and mortality if not identified and treated. Lipoprotein (a) [Lp(a)] and also inflammatory biomarkers, including platelet derived biomarkers, have been considered risk factor for aortic stenosis; however, the association between Lp(a), inflammatory biomarkers and AVA among patients with familial hypercholesterolemia (FH) is not clear. OBJECTIVE We aimed to investigate the relation between concentration of Lp(a), measurements of the aortic valve including velocities and valve area and circulating inflammatory biomarkers in adult FH subjects and controls. METHODS In this cross-sectional study aortic valve measures were examined by cardiac ultrasound and inflammatory markers were analyzed in non-fasting blood samples. The study participants were 64 FH subjects with high (n = 29) or low (n = 35) Lp(a), and 14 healthy controls. RESULTS Aortic valve peak velocity was higher (p = 0.02), and AVA was lower (p = 0.04) in the FH patients compared to controls; however, when performing multivariable linear regression, there were no significant differences. Furthermore, there were no significant differences between the high and low FH Lp(a) groups regarding the aortic valve. FH subjects had higher levels of platelet-derived markers CD40L, PF4, NAP2 and RANTES compared to controls (0.003 ≤ P ≤ 0.03). This result persisted after multiple linear regression. CONCLUSIONS Middle-aged, intensively treated FH subjects have higher aortic valve velocity, lower AVA, and higher levels of the platelet-derived markers CD40L, PF4, NAP2 and RANTES compared to healthy control subjects. The aortic valve findings were not significant after multiple linear regression, whereas the higher levels of platelet-derived markers were maintained.
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Affiliation(s)
- Anders Hovland
- Division of Internal Medicine, Nordland Hospital, Norway; Department of Clinical Medicine, University of Tromsø, Norway.
| | - Ingunn Narverud
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | - Linn Kristin Lie Øyri
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Martin Prøven Bogsrud
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway; Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Norway
| | - Inger Aagnes
- Division of Internal Medicine, Nordland Hospital, Norway
| | - Thor Ueland
- Research Institute for Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; K.G. Jebsen Thrombosis Research and Expertise Centre, University of Tromsø, Norway
| | - Monique Mulder
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank Leijten
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gisle Langslet
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | - Cecilie Wium
- Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Arne Svilaas
- Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | - Kjell Erik Arnesen
- Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | | | - Pål Aukrust
- Research Institute for Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Norway
| | - Bente Halvorsen
- Research Institute for Internal Medicine, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
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Incidence of elevated lipoprotein (a) levels in a large cohort of patients with cardiovascular disease. Clin Res Cardiol Suppl 2017; 12:55-59. [PMID: 28229283 PMCID: PMC5352766 DOI: 10.1007/s11789-017-0087-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Recently it has been demonstrated that elevated lipoprotein (a) (LPA) levels are associated with an increased risk of cardiovascular disease across multiple ethnic groups. However, there is only scanty data about the incidence of elevated LPA levels in different patient cohorts. As a consequence, we aimed to examine whether patients with elevated LPA levels might be seen more often in a cardiovascular center in comparison to the general population. Methods We reviewed LPA concentrations of 52,898 consecutive patients who were admitted to our hospital between January 2004 and December 2014. We subdivided them into different groups according to their LPA levels. Data was compared to available information in medical literature. Results 26.4% of the patients had LPA levels >30 mg/dl which is in line with the data from literature. Mean level of LPA concentration in our study was twice as high in comparison to the general population (25.8% vs. 13.3%). 4.6% had LPA levels >98 mg/dl (general population <0.3%). Conclusion In patients admitted to a cardiovascular center the proportion of LPA >30 mg/dl is comparable to the general population but mean levels over all are twice as high and the proportion of patients with LPA levels of >98 mg/dl is extremely higher.
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Wenping S, Ying L, Song L, Yuzhong L, Hui L. Objective assessment of health or pre-chronic disease state based on a health test index derived from routinely measured clinical laboratory parameters. J Transl Med 2015; 13:127. [PMID: 25896310 PMCID: PMC4423109 DOI: 10.1186/s12967-015-0487-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/13/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To develop a quantitative system to enable the objective assessment of health or pre-chronic disease state. METHODS On the basis of measured values and reference ranges, we obtained the organ function index (mean of the cut-off ratios of albumin and creatinine), blood lipid index (mean of the cut-off ratios of triglycerides, cholesterol, high-density lipoproteins and low-density lipoproteins), stress index (mean of the cut-off ratios of neutrophils and glucose), and the health test index (mean of the above three indexes, HTI). Elderly populations, individuals with nonalcoholic fatty liver disease and administrators were included in the groups of observed subjects to verify the organ function index, blood lipid index and stress index. RESULTS The scores of the three indexes were all statistically higher in the observed group than in the control group (p < 0.05). The mean HTI score was 0.7 ± 0.07 and was normally distributed in the control population. The rates of hypertension, obesity, fatty liver disease and health (undetectable organic diseases) increased with increasing HTI scores in a random population. CONCLUSIONS The HTI is easily derived from routinely measured clinical laboratory parameters. It can reflect the health status of an individual and may be a useful tool for the quantitative differentiation of health status.
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Affiliation(s)
- Sun Wenping
- College of Medical Laboratory, Dalian Medical University, Dalian, 116044, China.
| | - Liu Ying
- Second Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Leng Song
- Second Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Li Yuzhong
- College of Medical Laboratory, Dalian Medical University, Dalian, 116044, China. .,Second Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Liu Hui
- College of Medical Laboratory, Dalian Medical University, Dalian, 116044, China.
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Quantitatively plotting the human face for multivariate data visualisation illustrated by health assessments using laboratory parameters. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:390212. [PMID: 24454533 PMCID: PMC3878768 DOI: 10.1155/2013/390212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 11/28/2013] [Accepted: 12/09/2013] [Indexed: 11/18/2022]
Abstract
Objective. The purpose of this study was to describe a new data visualisation system by plotting the human face to observe the comprehensive effects of multivariate data. Methods. The Graphics Device Interface (GDI+) in the Visual Studio.NET development platform was used to write a program that enables facial image parameters to be recorded, such as cropping and rotation, and can generate a new facial image according to Z values from sets of normal data (Z > 3 was still counted as 3). The measured clinical laboratory parameters related to health status were obtained from senile people, glaucoma patients, and fatty liver patients to illustrate the facial data visualisation system. Results. When the eyes, nose, and mouth were rotated around their own axes at the same angle, the deformation effects were similar. The deformation effects for any abnormality of the eyes, nose, or mouth should be slightly higher than those for simultaneous abnormalities. The facial changes in the populations with different health statuses were significant compared with a control population. Conclusions. The comprehensive effects of multivariate may not equal the sum of each variable. The 3Z facial data visualisation system can effectively distinguish people with poor health status from healthy people.
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