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Wu Y, Shen P, Xu L, Yang Z, Sun Y, Yu L, Zhu Z, Li T, Luo D, Lin H, Shui L, Tang M, Jin M, Chen K, Wang J. Association between visit-to-visit lipid variability and risk of ischemic heart disease: a cohort study in China. Endocrine 2024; 84:914-923. [PMID: 38159173 DOI: 10.1007/s12020-023-03661-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
AIMS To explore the associations between visit-to-visit lipid variability and risk of ischemic heart disease (IHD) in a population-based cohort in China. METHODS We evaluated lipid variability in 30,217 individuals from the Yinzhou Health Information System who had ≥3 recorded lipid measurements during 2010-2014. We used various indicators including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV) to quantify the variability in triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Overall, a total of 1305 participants with IHD were identified during the follow-up of 194,421 person-years. Subjects in Q4 had a 21% elevated risk of IHD (HR = 1.21, 95% CI: 1.03-1.41) for LDL-C variability (CV) compared with the reference (Q1). The HRs for Q4 vs Q1 were 1.21 (95% CI: 1.04-1.42) for HDL-C variability, and 1.28 (95% CI: 1.10-1.50) for TC variability. However, no association was observed between triglycerides variability and risk of IHD. CONCLUSIONS Higher variability in LDL-C, HDL-C, and TC levels was associated with an elevated risk of IHD, suggesting that lipid variability could be considered as an independent risk factor of IHD.
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Affiliation(s)
- Yonghao Wu
- Department of Public Health, and Department of Endocrinology of the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children's Health, Hangzhou, 310058, China
| | - Peng Shen
- Data Center, Yinzhou District Center for Disease Control and Prevention, Ningbo, 315040, China
| | - Lisha Xu
- Department of Public Health, and Department of Endocrinology of the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children's Health, Hangzhou, 310058, China
| | - Zongming Yang
- Department of Public Health, and Department of Endocrinology of the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children's Health, Hangzhou, 310058, China
| | - Yexiang Sun
- Data Center, Yinzhou District Center for Disease Control and Prevention, Ningbo, 315040, China
| | - Luhua Yu
- Department of Public Health, and Department of Endocrinology of the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children's Health, Hangzhou, 310058, China
| | - Zhanghang Zhu
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Tiezheng Li
- Department of Public Health, and Department of Endocrinology of the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children's Health, Hangzhou, 310058, China
| | - Dan Luo
- Hangzhou Medical College, Hangzhou, 310053, China
| | - Hongbo Lin
- Data Center, Yinzhou District Center for Disease Control and Prevention, Ningbo, 315040, China
| | - Liming Shui
- Yinzhou District Health Bureau of Ningbo, Ningbo, 315040, China
| | - Mengling Tang
- Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Mingjuan Jin
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Kun Chen
- Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China.
| | - Jianbing Wang
- Department of Public Health, and Department of Endocrinology of the Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children's Health, Hangzhou, 310058, China.
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Ebenbichler C, Drexel H, Hanusch U, Toplak H, Dhalwani NN, Bridges I, Hoelzl R, Hemetsberger M, Ray KK. Evolocumab effectiveness in the real-world setting: Austrian data from the pan-European observational HEYMANS study. Wien Klin Wochenschr 2024; 136:77-86. [PMID: 37525072 PMCID: PMC10837260 DOI: 10.1007/s00508-023-02245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/16/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND This real-world study examined clinical characteristics and dyslipidemia management among patients initiating evolocumab across 12 European countries. Austrian data are reported. METHODS Data of consenting adults were collected for ≤ 6 months prior to evolocumab initiation (baseline) and ≤ 30 months post-initiation. Patient characteristics, lipid lowering therapy (LLT, i.e. statin and/or ezetimibe) and lipid values were collected from medical records. RESULTS In Austria, 363 patients were enrolled. At baseline, 52% of patients initiated evolocumab without background LLT; the median (Q1, Q3) initial low-density lipoprotein cholesterol (LDL-C) level was 142 (111, 187) mg/dL. Within 3 months of evolocumab treatment, median LDL‑C decreased by 59% to 58 (37, 91) mg/dL. This reduction was maintained over time, despite consistently infrequent use of background LLT. LDL-C < 55 mg/dL was attained by 65% of patients (76% with, 55% without background LLT). Evolocumab persistence was ≥ 90% at month 12 and month 30. CONCLUSION In Austria, patients were initiated on evolocumab at LDL‑C levels almost 3‑times higher than the guideline-recommended clinical goal (< 55 mg/dL). Persistence with evolocumab was very high. Evolocumab led to a rapid and sustained LDL‑C reduction with 65% attaining the LDL‑C goal. Patients using evolocumab in combination with statins and/or ezetimibe were more likely to attain their LDL‑C goal and thus decrease cardiovascular risk.
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Affiliation(s)
- Christoph Ebenbichler
- Department of Internal Medicine I, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation & Treatment (VIVIT) at Feldkirch Academic Teaching Hospital, Feldkirch, Austria
| | - Ursula Hanusch
- Center for Clinical Studies, Dr. Hanusch GmbH, Vienna, Austria
| | - Hermann Toplak
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | | | | | | | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College London, London, UK
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3
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Zhan C, Tang T, Wu E, Zhang Y, He M, Wu R, Bi C, Wang J, Zhang Y, Shen B. From multi-omics approaches to personalized medicine in myocardial infarction. Front Cardiovasc Med 2023; 10:1250340. [PMID: 37965091 PMCID: PMC10642346 DOI: 10.3389/fcvm.2023.1250340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023] Open
Abstract
Myocardial infarction (MI) is a prevalent cardiovascular disease characterized by myocardial necrosis resulting from coronary artery ischemia and hypoxia, which can lead to severe complications such as arrhythmia, cardiac rupture, heart failure, and sudden death. Despite being a research hotspot, the etiological mechanism of MI remains unclear. The emergence and widespread use of omics technologies, including genomics, transcriptomics, proteomics, metabolomics, and other omics, have provided new opportunities for exploring the molecular mechanism of MI and identifying a large number of disease biomarkers. However, a single-omics approach has limitations in understanding the complex biological pathways of diseases. The multi-omics approach can reveal the interaction network among molecules at various levels and overcome the limitations of the single-omics approaches. This review focuses on the omics studies of MI, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, and other omics. The exploration extended into the domain of multi-omics integrative analysis, accompanied by a compilation of diverse online resources, databases, and tools conducive to these investigations. Additionally, we discussed the role and prospects of multi-omics approaches in personalized medicine, highlighting the potential for improving diagnosis, treatment, and prognosis of MI.
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Affiliation(s)
- Chaoying Zhan
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Tong Tang
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Erman Wu
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxin Zhang
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- KeyLaboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Mengqiao He
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Rongrong Wu
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Bi
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- KeyLaboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences, Sichuan University, Chengdu, China
| | - Jiao Wang
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Yingbo Zhang
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
- Tropical Crops Genetic Resources Institute, Chinese Academy of Tropical Agricultural Sciences, Haikou, China
| | - Bairong Shen
- Department of Cardiology and Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
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Manemann SM, Bielinski SJ, Moser ED, St Sauver JL, Takahashi PY, Roger VL, Olson JE, Chamberlain AM, Remaley AT, Decker PA, Killian JM, Larson NB. Variability in Lipid Levels and Risk for Cardiovascular Disease: An Electronic Health Record-Based Population Cohort Study. J Am Heart Assoc 2023; 12:e027639. [PMID: 36870945 PMCID: PMC10111433 DOI: 10.1161/jaha.122.027639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background Larger within-patient variability of lipid levels has been associated with increased risk of cardiovascular disease (CVD); however, measures of lipid variability require ≥3 measurements and are not currently used clinically. We investigated the feasibility of calculating lipid variability within a large electronic health record-based population cohort and assessed associations with incident CVD. Methods and Results We identified all individuals ≥40 years of age who resided in Olmsted County, MN, on January 1, 2006 (index date), without prior CVD, defined as myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, or CVD death. Patients with ≥3 measurements of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or triglycerides during the 5 years before the index date were retained. Lipid variability was calculated using variability independent of the mean. Patients were followed through December 31, 2020 for incident CVD. We identified 19 652 individuals (mean age 61 years; 55% female), who were CVD-free and had variability independent of the mean calculated for at least 1 lipid type. After adjustment, those with highest total cholesterol variability had a 20% increased risk of CVD (Q5 versus Q1 hazard ratio, 1.20 [95% CI, 1.06-1.37]). Results were similar for low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Conclusions In a large electronic health record-based population cohort, high variability in total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was associated with an increased risk of CVD, independent of traditional risk factors, suggesting it may be a possible risk marker and target for intervention. Lipid variability can be calculated in the electronic health record environment, but more research is needed to determine its clinical utility.
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Affiliation(s)
| | | | - Ethan D Moser
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
| | | | - Paul Y Takahashi
- Division of Community Internal Medicine, Department of Medicine Mayo Clinic Rochester MN
| | - Véronique L Roger
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN.,Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Epidemiology and Community Health Branch National Institutes of Health Bethesda MD
| | - Janet E Olson
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN.,Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute National Institutes of Health Bethesda MD
| | - Paul A Decker
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
| | - Jill M Killian
- Department of Quantitative Health Sciences Mayo Clinic Rochester MN
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5
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Ray KK, Bruckert E, Peronne-Filardi P, Ebenbichler C, Vogt A, Bridges I, Sibartie M, Dhalwani N. Long-term persistence with evolocumab treatment and sustained reductions in LDL-cholesterol levels over 30 months: Final results from the European observational HEYMANS study. Atherosclerosis 2023; 366:14-21. [PMID: 36696747 DOI: 10.1016/j.atherosclerosis.2023.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Variability in low-density lipoprotein-cholesterol (LDL-C) level control at a population level is associated with poor cardiovascular outcomes. Limited data exist on LDL-C level variability or long-term persistence with the monoclonal antibody evolocumab in routine clinical practice. Using data from the HEYMANS registry, this analysis aimed to assess evolocumab persistence and discontinuation over 30 months of evolocumab treatment and to evaluate at a population level the variability in LDL-C level reductions during the study period. METHODS HEYMANS was a prospective registry of adults initiating evolocumab in routine clinical practice in 12 European countries. Data were collected for up to and including 6 months before evolocumab initiation and up to 30 months after. Evolocumab discontinuation was analysed for two time periods: 0-12 months and 12-30 months. RESULTS In total, 1951 patients were included in the study. The median reduction in LDL-C levels was 58% within 3 months after evolocumab initiation; this reduction was maintained over 30 months. More than 90% of patients continued receiving evolocumab at 12 months and 30 months of follow-up. Of patients with an LDL-C level measurement during follow-up, approximately 85% achieved a ≥30% reduction from baseline at each follow-up visit and approximately 60% achieved a ≥50% reduction. CONCLUSIONS Evolocumab therapy was associated with sustained LDL-C level reductions up to 30 months, and persistence with evolocumab remained high, both at 12 and 30 months. Expanding the use of monoclonal antibodies such as evolocumab could provide improvements in LDL-C level control at a population level in European clinical practice.
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Affiliation(s)
- Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College London, London, UK.
| | - Eric Bruckert
- Department of Medicine, Sorbonne University of Paris, Paris, France
| | | | | | - Anja Vogt
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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Nishikido T. Clinical potential of inclisiran for patients with a high risk of atherosclerotic cardiovascular disease. Cardiovasc Diabetol 2023; 22:20. [PMID: 36717882 PMCID: PMC9887852 DOI: 10.1186/s12933-023-01752-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Elevated low-density lipoprotein cholesterol (LDL-C) level is associated with an increased risk of atherosclerotic cardiovascular disease. Although high-intensity lipid-lowering therapies with statins and ezetimibe are highly effective for reducing LDL-C levels, over half of high-risk patients do not achieve guideline-recommended LDL-C goals. Thus, there is a significant gap between treatment guidelines and their implementation in daily clinical practice. The major causes are individual variability in the response to lipid-lowering therapies and variation in treatment adherence. Proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies combined with statins provide marked and consistent reduction in LDL-C levels; however, poor adherence due to the need for subcutaneous injections every 2 or 4 weeks and high cost are major obstacles to their use in real-world clinical settings. Inclisiran, a recently approved novel small interfering ribonucleic acid (siRNA) molecule that inhibits PCSK9 synthesis, provides robust and long-term reduction in LDL-C levels with a low inter-individual variability in the LDL-C-lowering response. Moreover, its administration by biannual injection is expected to greatly improve treatment adherence. Clinical trials of this drug lasting for up to 4 years showed acceptable safety profiles, and ongoing studies accumulate evidence of its longer-term safety. This narrative review summarizes the available evidence on the efficacy and safety of inclisiran and analyzes its potential to overcome the gap between guideline recommendations and real-world clinical practice in current LDL-C-lowering therapies, with a focus on reduced LDL-C level variability and improved treatment adherence.
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Affiliation(s)
- Toshiyuki Nishikido
- Department of Cardiovascular Medicine, National Hospital Organization Kobe Medical Center, Nishiochiai 3-1-1, Suma-ku, Kobe City, Japan. .,Department of Cardiovascular Medicine, Saga University, Nabeshima 5-1-1, Saga City, Japan.
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7
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Chang CH, Yeh ST, Ooi SW, Li CY, Chen HF. The relationship of low-density lipoprotein cholesterol and all-cause or cardiovascular mortality in patients with type 2 diabetes: a retrospective study. PeerJ 2023; 11:e14609. [PMID: 36643628 PMCID: PMC9835695 DOI: 10.7717/peerj.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Background The optimal levels of low-density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes (T2D) are not currently clear. In this study, we determined the relationship between various mean LDL-C and all-cause or cardiovascular mortality risks in patients with T2D, stratifying by albumin level, age, sex, and antilipid medication use. We also evaluated the association of LDL-C standard deviation (LDL-C-SD) and all-cause and cardiovascular mortality by type of antilipid medication use. Methods A total of 46,675 T2D patients with a prescription for antidiabetic agents >6 months from outpatient visits (2003-2018) were linked to Taiwan's National Death Registry to identify all-cause and cardiovascular mortality. The Poisson assumption was used to estimate mortality rates, and the Cox proportional hazard regression model was used to assess the relative hazards of respective mortality in relation to mean LDL-C in patient cohorts by albumin level, age, sex, and antilipid use adjusting for medications, comorbidities, and laboratory results. We also determined the overall, and anti-lipid-specific mortality rates and relative hazards of all-cause and cardiovascular mortality associated with LDL-C-SD using the Poisson assumption and Cox proportional hazard regression model, respectively. Results All-cause and cardiovascular mortality rates were the lowest in T2D patients with a mean LDL-C > 90-103.59 mg/dL in the normal albumin group (≥ 3.5 g/dL). Compared to T2D patients with a mean LDL-C > 90-103.59 mg/dL, those with a mean LDL-C ≤ 77 mg/dL had an elevated risk of all-cause mortality in both the normal and lower albumin groups. T2D patients with a mean LDL-C ≤ 90 and > 103.59-119 mg/dL had relatively higher risk of cardiovascular mortality in the normal albumin group, but in the lower albumin group (<3.5 g/dL), any level of mean LDL-C ≤ 119 mg/dL was not significantly associated with cardiovascular mortality. Increased risks of all-cause and cardiovascular mortality were observed in patients with a mean LDL-C ≤ 77 mg/dL in both sexes and in all age groups except in those aged <50 years, a lower mean LDL-C was not associated with cardiovascular mortality. Similarly, patients with an LDL-C-SD <10th and > 90th percentiles were associated with significant risks of all-cause and cardiovascular mortality. In statin users, but not fibrate users, lower and higher levels of mean LDL-C and LDL-C-SD were both associated with elevated risks of all-cause and cardiovascular mortality. Conclusions The optimal level of LDL-C was found to be >90-103.59 mg/dL in T2D patients. Lower and higher levels of mean LDL-C and LDL-C-SD were associated with all-cause and cardiovascular mortality, revealing U-shaped associations. Further studies are necessary to validate the relationship between optimal LDL-C levels and all-cause and cardiovascular mortality in patients with diabetes.
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Affiliation(s)
- Chin-Huan Chang
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Tin Yeh
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Seng-Wei Ooi
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan,Department of Public Health, College of Public Health, China Medical University, Taichung City, Taiwan,Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung City, Taiwan
| | - Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan,School of Medicine and Department of Public Health, College of Medicine, Fujen Catholic University, New Taipei City, Taiwan
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8
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Li S, Hou L, Zhu S, Yi Q, Liu W, Zhao Y, Wu F, Li X, Pan A, Song P. Lipid Variability and Risk of Cardiovascular Diseases and All-Cause Mortality: A Systematic Review and Meta-Analysis of Cohort Studies. Nutrients 2022; 14:nu14122450. [PMID: 35745179 PMCID: PMC9231112 DOI: 10.3390/nu14122450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
No consensus has yet been reached on the associations of lipid variability (LV) with cardiovascular diseases (CVDs) and all-cause mortality. We aimed to quantify the associations of different types and metrics of LV with CVDs and all-cause mortality. PubMed, Medline, and Embase databases were searched for eligible cohort studies published until 14 December 2021. Lipids included total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). Metrics of variability included standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM). The primary outcomes were CVDs and all-cause mortality. Random-effects meta-analysis was used to generate a summary of the relative risks (SRRs). Sources of heterogeneity were explored by subgroup analysis and meta-regression. A total of 11 articles based on seven cohorts were included. Participants in the top quartile of TC variability had an increased risk of CVDs (vs. bottom quartile: TC-CV: SRR 1.29, 95% CI 1.15-1.45; TC-SD: 1.28, 1.15-1.43; TC-VIM: 1.26, 1.13-1.41, respectively) and all-cause mortality (vs. bottom quartile: TC-CV: 1.28, 1.15-1.42; TC-SD: 1.32, 1.22-1.44; TC-VIM: 1.32, 1.25-1.40, respectively). Participants in the top quartile of HDL-C variability had an increased risk of CVDs (vs. bottom quartile: HDL-C-CV: 1.11, 1.07-1.15; HDL-C-SD: 1.18, 1.02-1.38; HDL-C-VIM: 1.18, 1.09-1.27, respectively) and all-cause mortality (vs. bottom quartile: HDL-C-CV: 1.29, 1.27-1.31; HDL-C-SD: 1.24, 1.09-1.41; HDL-C-VIM: 1.25, 1.22-1.27, respectively). LDL-C variability was also associated with an increased risk of CVDs (for top vs. bottom quartile; LDL-C-SD: 1.09, 1.02-1.17; LDL-C-VIM: 1.16, 1.02-1.32, respectively) and all-cause mortality (for top vs. bottom quartile; LDL-C-CV: 1.19, 1.04-1.36; LDL-C-SD: 1.17, 1.09-1.26, respectively). The relationships of TG variability with the risk of CVDs and all-cause mortality were inconclusive across different metrics. The effects of SRR became stronger when analyses were restricted to studies that adjusted for lipid-lowering medication and unadjusted for mean lipid levels. These findings indicate that the measurement and surveillance of lipid variability might have important clinical implications for risk assessment of CVDs and all-cause mortality.
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Affiliation(s)
- Shuting Li
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China; (S.L.); (L.H.); (S.Z.); (Q.Y.); (W.L.)
| | - Leying Hou
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China; (S.L.); (L.H.); (S.Z.); (Q.Y.); (W.L.)
| | - Siyu Zhu
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China; (S.L.); (L.H.); (S.Z.); (Q.Y.); (W.L.)
| | - Qian Yi
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China; (S.L.); (L.H.); (S.Z.); (Q.Y.); (W.L.)
| | - Wen Liu
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China; (S.L.); (L.H.); (S.Z.); (Q.Y.); (W.L.)
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia;
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia;
| | - Xue Li
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China;
| | - An Pan
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China;
| | - Peige Song
- School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou 310058, China; (S.L.); (L.H.); (S.Z.); (Q.Y.); (W.L.)
- Correspondence: ; Tel.: +86-571-88981368
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9
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Abstract
PURPOSE OF REVIEW Lipid registry-based research is a valuable tool for assessing current lipid management in patients at risk of cardiovascular disease (CVD). Results of several registries are useful for improving clinical practice highlight gaps between guidelines and their implementation and potential impact on population health. We summarize recent clinical studies based on lipid registries. RECENT FINDINGS Current guidelines for lipid management recommend high-intensity statins and concomitant therapies such as ezetimibe and proprotein convertase subtilisin-kexin type 9 inhibitors for high-risk patients. However, recent observational studies show that the majority of patients received inadequate lipid-lowering therapy (LLT), and the low-density lipoprotein-cholesterol (LDL-C) goal attainment rates are still unsatisfactory. SUMMARY There is a clear gap between lipid guidelines and lipid management in clinical practice. Clinical studies based on registry databases represent real-world conditions, as opposed to clinical trials. Contemporary registry data reveal that only half of the patients received high-intensity statins, and less than half achieve the LDL-C <70 mg/dL in secondary prevention. In addition, the major reasons for insufficient therapy have been shown to be not only side effects of LLT, but poor adherence by patients to medication regimens and low use of combination therapies by physicians. The real-world evidence from lipid registries clarifies gaps, areas for focus for implementation, to improve CVD prevention.
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Affiliation(s)
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Binder CJ, Borén J, Catapano A, Kronenberg F, Mallat Z, Negrini S, Öörni K, Raggi P, von Eckardstein A. The year 2020 in Atherosclerosis. Atherosclerosis 2021; 326:35-44. [PMID: 33958158 DOI: 10.1016/j.atherosclerosis.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Jan Borén
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS Multimedica Hospital, Milan, Italy
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Department of Genetics and Pharmacology, Medical University of Innsbruck, Austria
| | - Ziad Mallat
- Department of Medicine, Division of Cardiovascular Medicine, University of Cambridge, Cambridge, United Kingdom; University of Paris, PARCC, INSERM, Paris, France
| | - Simona Negrini
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | - Katariina Öörni
- Atherosclerosis Research Laboratory, Wihuri Research Institute, Helsinki, Finland
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada; Department of Medicine, University of Alberta, Edmonton, AB, Canada; Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University of Zurich and University Hospital of Zurich, Zurich, Switzerland.
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Ge B, Lu SQ, Lei SF. The obesity indices mediate the relationships of blood lipids and bone mineral density in Chinese elders. Mol Cell Probes 2021; 56:101705. [PMID: 33556474 DOI: 10.1016/j.mcp.2021.101705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/17/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE It is unclear what role does obesity (OB) index play between blood lipid and bone mineral density (BMD). SUBJECTS This study recruited a total of 4,558 Chinese elders >65 years. OB indices: waist circumference (WC), body mass index (BMI), waist-hip-ratio (WHR); blood lipid parameters: low density lipoprotein (LDL); total cholesterol (TC), triglyceride (TG), and BMDs at femur neck (FN), total hip (TH), and lumbar spine (LS) were measured. The t-test and multiple linear regression analysis were used to detect the differences of variables. Casual inference test (CIT) were performed to test potential mediators underlying the associations between blood lipid and BMD. RESULTS The blood lipids were positively associated with BMD (p < 0.05) after adjustment of age and sex (Model 1) both in total subjects and in sex-stratified subjects. The CIT showed that OB indices had significant mediation effects on the associations between blood lipid (TG and LDL) and BMD in total subjects and males. Comparably, the correlations of TG and BMD are most likely mediated by BMI and WC. CONCLUSIONS This study represented the first effort to report that OB indices, especially BMI and WC, served as significant mediators between blood lipid (TG and LDL) and BMD in Chinese elderly.
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Affiliation(s)
- Bing Ge
- Department of Orthopedics, Sihong People's Hospital, Suqian, Jiangsu, 223900, PR China; Collaborative Innovation Center of Clinical Immunology Between Sihong People's Hospital and Soochow University, Jiangsu, PR China
| | - Si-Qi Lu
- Collaborative Innovation Center of Clinical Immunology Between Sihong People's Hospital and Soochow University, Jiangsu, PR China; Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, PR China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, 215123, PR China
| | - Shu-Feng Lei
- Collaborative Innovation Center of Clinical Immunology Between Sihong People's Hospital and Soochow University, Jiangsu, PR China; Center for Genetic Epidemiology and Genomics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, 215123, PR China; Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, 215123, PR China.
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Huang X, Zhan H, Yang J, Peng L, Piao S, Wang L, Lan T, Rong X, Guo J. Long-Term Effect of Zhenzhu Tiaozhi Capsule (FTZ) on Hyperlipidemia: 2-Year Results from a Retrospective Study Using Electronic Medical Records. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:6264414. [PMID: 34707672 PMCID: PMC8545570 DOI: 10.1155/2021/6264414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022]
Abstract
The objective of this work was to study the lipid profile (LDL, TC, TG, and HDL) over 2 years in patients with hyperlipidemia in a real-world clinical setting and to describe the dynamical trajectory of lipid profile change in response to lipid-lowering treatment (Zhenzhu Tiaozhi capsule (FTZ) vs. general lipid-lowering treatment, i.e., statins, fibrates, and Xuezhikang). We conducted a retrospective study that included people aged ≥18 years with hyperlipidemia that initiated lipid-lowering treatment between January 2010 and December 2020. Demographic, diagnosis, and laboratory data were retrieved from hospital's electronic medical records, including hospital information system (HIS) and the laboratory information system (LIS). Follow-up trajectories of lipid profile were plotted in a generalized additive mixed model (GAMM) with smooth splines. A total of 839 patients with hyperlipidemia were included. Within 2 years, LDL, TC, and TG descended steadily and gently in the FTZ group (N = 99), while the general lipid-lowering treatment (N = 740) shortly improved LDL, TC, and TG before 11 weeks and was no longer present around 30 weeks. After 30 weeks, the trajectory of LDL, TC, and TG fluctuated up and down. Also, for HDL, a similar trajectory was observed before 40 weeks between 2 groups, but the FTZ group showed an increasing trend after 40 weeks, while a similar trend was not seen in the general lipid-lowering group. In this study, FTZ was shown to have similar long-term effectiveness as an alternative lipid-lowering treatment to the general lipid-lowering treatment. The findings of this study provide observational evidence for further studies of FTZ, but more prospective studies are needed to determine the impacts of FTZ on lipid profile.
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Affiliation(s)
- Xiaoqiang Huang
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Guangzhou 510006, China
- Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China, Guangzhou 510006, China
- Key Unit of Modulating Liver to Treat Hyperlipemia SATCM (State Administration of Traditional Chinese Medicine), Guangzhou 510006, China
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Huixia Zhan
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Guangzhou 510006, China
- Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China, Guangzhou 510006, China
- Key Unit of Modulating Liver to Treat Hyperlipemia SATCM (State Administration of Traditional Chinese Medicine), Guangzhou 510006, China
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, China
| | - Jin Yang
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Liufen Peng
- School of Medical Information and Engineering, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Shenghua Piao
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Guangzhou 510006, China
- Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China, Guangzhou 510006, China
- Key Unit of Modulating Liver to Treat Hyperlipemia SATCM (State Administration of Traditional Chinese Medicine), Guangzhou 510006, China
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Lexun Wang
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Guangzhou 510006, China
- Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China, Guangzhou 510006, China
- Key Unit of Modulating Liver to Treat Hyperlipemia SATCM (State Administration of Traditional Chinese Medicine), Guangzhou 510006, China
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Tian Lan
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Guangzhou 510006, China
- Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China, Guangzhou 510006, China
- Key Unit of Modulating Liver to Treat Hyperlipemia SATCM (State Administration of Traditional Chinese Medicine), Guangzhou 510006, China
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Xianglu Rong
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Guangzhou 510006, China
- Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China, Guangzhou 510006, China
- Key Unit of Modulating Liver to Treat Hyperlipemia SATCM (State Administration of Traditional Chinese Medicine), Guangzhou 510006, China
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Jiao Guo
- Guangdong Metabolic Diseases Research Center of Integrated Chinese and Western Medicine, Guangzhou 510006, China
- Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education of China, Guangzhou 510006, China
- Key Unit of Modulating Liver to Treat Hyperlipemia SATCM (State Administration of Traditional Chinese Medicine), Guangzhou 510006, China
- Institute of Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
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Why might visit-to visit variability of lipoproteins have an effect on cardiovascular events? Atherosclerosis 2020; 312:99-100. [DOI: 10.1016/j.atherosclerosis.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023]
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