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de Isla LP, Vallejo-Vaz AJ, Watts GF, Muñiz-Grijalvo O, Alonso R, Diaz-Diaz JL, Arroyo-Olivares R, Aguado R, Argueso R, Mauri M, Romero MJ, Álvarez-Baños P, Mañas D, Cepeda JM, Gonzalez-Bustos P, Casañas M, Michan A, Muñoz-Torrero JFS, Faedo C, Barba MA, Dieguez M, de Andrés R, Hernandez AM, Gonzalez-Estrada A, Padró T, Fuentes F, Badimon L, Mata P. Long-term sex differences in atherosclerotic cardiovascular disease in individuals with heterozygous familial hypercholesterolaemia in Spain: a study using data from SAFEHEART, a nationwide, multicentre, prospective cohort study. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00192-X. [PMID: 39098315 DOI: 10.1016/s2213-8587(24)00192-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Sex differences in atherosclerotic cardiovascular disease (ASCVD) in familial hypercholesterolaemia have been reported but are not fully established. We aimed to assess sex differences in the risk of ASCVD and life-time burden of ASCVD in patients with heterozygous familial hypercholesterolaemia. METHODS SAFEHEART is a nationwide, multicentre, long-term prospective cohort study conducted in 25 tertiary care hospitals and one regional hospital in Spain. Participants in the SAFEHEART study aged 18 years or older with genetically confirmed familial hypercholesterolaemia were included in our analysis. Data were obtained between Jan 26, 2004, and Nov 30, 2022. ASCVD and age at onset were documented at enrolment and at follow-up. Our aim was to investigate the differences by sex in the risk and burden of ASCVD in patients with heterozygous familial hypercholesterolaemia, over the study follow-up and over the life course. The SAFEHEART study is registered with ClinicalTrials.gov, NCT02693548. FINDINGS Of the 5262 participants in SAFEHEART at the time of analysis, 3506 (1898 [54·1%] female and 1608 [45·9%] male participants) met the inclusion criteria and were included in the current study. Mean age was 46·1 years (SD 15·5) and median follow-up was 10·3 years (IQR 6·4-13·0). Mean on-treatment LDL-cholesterol at follow-up was 3·1 mmol/L (SD 1·4) in females and 3·0 mmol/L (1·5) in males. LDL-cholesterol reductions over time were similar in both sexes (1·39 mmol/L [95% CI 1·30-1·47] absolute reduction in females vs 1·39 mmol/L [1·29-1·48] in males; p=0·98). At enrolment, 130 (6·8%) females and 304 (18·9%) males (p<0·0001) had cardiovascular disease. During follow-up, 134 (7·1%) females and 222 (13·8%) males (p<0·0001) had incident cardiovascular events. Median age at first ASCVD event (mostly due to coronary artery disease) was 61·6 years (IQR 50·0-71·4) in females and 50·6 years (42·0-58·6) in males (p<0·0001). The adjusted hazard ratio for ASCVD in males compared with females during follow-up was 1·90 (95% CI 1·49-2·42) and for cardiovascular death was 1·74 (1·11-2·73). Major adverse cardiovascular disease event (MACE)-free survival from birth was lower in males than females (hazard ratio 3·52 [95% CI 2·98-4·16]; p<0·0001). Median MACE-free survival time was 90·1 years (95% CI 86·5-not estimable) in females and 71·0 years (69·2-74·6) in males. The age at which 25% of female participants have had a MACE event was 74·9 years, this figure was 55·5 years in male participants. INTERPRETATION Our findings suggest that the burden and risk of ASCVD are markedly lower in females than males with familial hypercholesterolaemia. The impact of sex needs to be considered to improve risk stratification and personalised management in patients with heterozygous familial hypercholesterolaemia. FUNDING Fundación Hipercolesterolemia Familiar, the Instituto de Salud Carlos III, and Next Generation EU funds from the Recovery and Resilience Mechanism Program. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Leopoldo Pérez de Isla
- Cardiology Department, Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain.
| | - Antonio J Vallejo-Vaz
- Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain; Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla (IBiS), IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Perth, WA, Australia; Cardiometabolic Services, Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Ovidio Muñiz-Grijalvo
- Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla (IBiS), IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC, Seville, Spain; Department of Internal Medicine, Hospital Virgen del Rocío, Seville, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile
| | - Jose L Diaz-Diaz
- Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain
| | | | - Rocio Aguado
- Department of Endocrinology, Hospital General de Leon, Leon, Spain
| | - Rosa Argueso
- Department of Endocrinology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Marta Mauri
- Department of Internal Medicine, Hospital de Terrassa, Terrassa, Spain
| | - Manuel J Romero
- Department of Internal Medicine, Hospital Infanta Elena, Huelva, Spain
| | - Pilar Álvarez-Baños
- Department of Endocrinology, Hospital Universitario de Burgos, Burgos, Spain
| | - Dolores Mañas
- Department of Internal Medicine, Hospital Universitario de Ciudad Real, Ciudad Real, Spain
| | - José María Cepeda
- Department of Internal Medicine, Hospital Comarcal Vega Baja, Orihuela, Spain
| | - Pablo Gonzalez-Bustos
- Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Casañas
- Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain
| | - Alfredo Michan
- Department of Internal Medicine, Hospital de Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | - Ceferino Faedo
- Department of Endocrinology, Hospital Central de Asturias, Oviedo, Spain
| | - Miguel A Barba
- Department of Internal Medicine, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Marta Dieguez
- Department of Endocrinology, Hospital de Cabueñes, Gijón, Spain
| | | | - Antonio M Hernandez
- Department of Endocrinology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Aurora Gonzalez-Estrada
- Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla (IBiS), IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC, Seville, Spain; Department of Internal Medicine, Hospital Virgen del Rocío, Seville, Spain
| | - Teresa Padró
- Research Institute-Hospital de la Santa Creu i Sant Pau, IIBSant Pau, CiberCV, Barcelona, Spain
| | - Francisco Fuentes
- Lipids and Atherosclerosis Unit, CIBERObn, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - Lina Badimon
- Research Institute-Hospital de la Santa Creu i Sant Pau, IIBSant Pau, CiberCV, Barcelona, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain.
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Lee E, Amadi C, Williams MC, Agarwal PP. Coronary Artery Disease: Role of Computed Tomography and Recent Advances. Radiol Clin North Am 2024; 62:385-398. [PMID: 38553176 DOI: 10.1016/j.rcl.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
In this review, the authors summarize the role of coronary computed tomography angiography and coronary artery calcium scoring in different clinical presentations of chest pain and preventative care and discuss future directions and new technologies such as pericoronary fat inflammation and the growing footprint of artificial intelligence in cardiovascular medicine.
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Affiliation(s)
- Elizabeth Lee
- Department of Radiology, Michigan Medicine, 1500 East Medical Center Drive, TC B1-148, Ann Arbor, MI 48109-5030, USA.
| | - Chiemezie Amadi
- Department of Radiology, Michigan Medicine, 1500 Medical Center Drive, Room 5481, Ann Arbor, MI 48109-5868, USA
| | - Michelle C Williams
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, The Queen's Medical Research Institute, Edinburg BioQuarter, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - Prachi P Agarwal
- Department of Radiology, Division of Cardiothoracic Radiology, Michigan Medicine, 1500 East Medical Center Drive SPC 5868, Ann Arbor, MI 48109, USA
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Escate R, Padró T, Pérez de Isla L, Fuentes F, Alonso R, Mata P, Badimon L. Circulating miR-6821-5p levels and coronary calcification in asymptomatic familial hypercholesterolemia patients. Atherosclerosis 2024; 392:117502. [PMID: 38513437 DOI: 10.1016/j.atherosclerosis.2024.117502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Premature atherosclerotic cardiovascular disease (CVD) is a clinic characteristic of familial hypercholesterolemia (FH). Coronary calcium score (CCS) is a highly used imaging modality to evidence atherosclerotic plaque burden. microRNAs (miRNAs) are non-coding RNAs that epigenetically regulate gene expression. Here, we investigated whether CCS associates with a specific miRNA-signature in FH-patients. METHODS Patients with genetic diagnosis of FH (N = 86) from the nationwide SAFEHEART-cohort were investigated by computed tomography angiography imaging and classified depending on the presence of coronary calcification in FH-CCS (+) and FH-CCS (-) groups by the Agatston score. Differential miRNA profiling was performed in two stages: first by Affymetrix microarray technology (high-throughput differential profiling-studies) and second by RT-PCR using TaqMan-technology (analytical RT-qPCR study) in plasma of the two patient groups. RESULTS miR-193a-5p, miR-30e-5p and miR-6821-5p levels were significantly higher in FH-CCS (+) compared to FH-CCS (-). miR-6821-5p was the best miRNA to discriminate FH-patients CCS(+), according to receiver operating characteristic (ROC) analysis (AUC: 0.70 ± 0.06, p = 0.006). High miR-6821-5p levels were associated with older age (p = 0.03) and high LDL-burden (p = 0.014) using a ROC-derived cut-off value. However, miR-6821-5p did not correlate with age in either the CCS- or CCS + group. Genes involved in calcification processes were identified by in silico analysis. The relation of cell-calcification and expression levels of miR-6821-5p, BMP2 and SPP1 was validated experimentally in human vascular smooth muscle cell cultures. CONCLUSIONS Up-regulated levels of miR-6821-5p are found in the plasma of asymptomatic FH-patients with coronary calcified atherosclerotic plaques, as well as in isolated human vascular smooth muscle cells expressing the pro-calcification genes BMP2 and SPP1. These findings highlight the impact of epigenetic regulation on the development of subclinical atherosclerosis.
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Affiliation(s)
- Rafael Escate
- Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Padró
- Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain
| | - Leopoldo Pérez de Isla
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Francisco Fuentes
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Center for Advanced Metabolic Medicine and Nutrition, Santiago de Chile, Chile
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Lina Badimon
- Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Cardiovascular Research Chair, UAB, Barcelona, Spain.
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Gidding SS. Addressing Knowledge Gaps in the Primary Prevention of Atherosclerotic Heart Disease. J Am Heart Assoc 2024; 13:e033991. [PMID: 38456421 PMCID: PMC11009992 DOI: 10.1161/jaha.123.033991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024]
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Nasir K, Mszar R, Cainzos-Achirica M, Grandhi GR, Tromp TR, Alonso R, Bittencourt MS, Bruckert E, Díaz-Díaz JL, Gallo A, Hovingh GK, Miname MH, Muñiz-Grijalvo O, Pang J, de Isla LP, Sijbrands EJ, Watts GF, Mata P, Santos RD. Age- and sex-based heterogeneity in coronary artery plaque presence and burden in familial hypercholesterolemia: A multi-national study. Am J Prev Cardiol 2024; 17:100611. [PMID: 38125206 PMCID: PMC10730992 DOI: 10.1016/j.ajpc.2023.100611] [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: 01/24/2023] [Revised: 09/05/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Individuals with familial hypercholesterolemia (FH) are at an increased risk for coronary artery disease (CAD). While prior research has shown variability in coronary artery calcification (CAC) among those with FH, studies with small sample sizes and single-center recruitment have been limited in their ability to characterize CAC and plaque burden in subgroups based on age and sex. Understanding the spectrum of atherosclerosis may result in personalized risk assessment and tailored allocation of costly add-on, non-statin lipid-lowering therapies. We aimed to characterize the presence and burden of CAC and coronary plaque on computed tomography angiography (CTA) across age- and sex-stratified subgroups of individuals with FH who were without CAD at baseline. Methods We pooled 1,011 patients from six cohorts across Brazil, France, the Netherlands, Spain, and Australia. Our main measures of subclinical atherosclerosis included CAC ranges (i.e., 0, 1-100, 101-400, >400) and CTA-derived plaque burden (i.e., no plaque, non-obstructive CAD, obstructive CAD). Results Ninety-five percent of individuals with FH (mean age: 48 years; 54% female; treated LDL-C: 154 mg/dL) had a molecular diagnosis and 899 (89%) were on statin therapy. Overall, 423 (42%) had CAC=0, 329 (33%) had CAC 1-100, 160 (16%) had CAC 101-400, and 99 (10%) had CAC >400. Compared to males, female patients were more likely to have CAC=0 (48% [n = 262] vs 35% [n = 161]) and no plaque on CTA (39% [n = 215] vs 26% [n = 120]). Among patients with CAC=0, 85 (20%) had non-obstructive CAD. Females also had a lower prevalence of obstructive CAD in CAC 1-100 (8% [n = 15] vs 18% [n = 26]), CAC 101-400 (32% [n = 22] vs 40% [n = 36]), and CAC >400 (52% [n = 16] vs 65% [n = 44]). Female patients aged 50-59 years were less likely to have obstructive CAD in CAC >400 (55% [n = 6] vs 70% [n = 19]). Conclusion In this large, multi-national study, we found substantial age- and sex-based heterogeneity in CAC and plaque burden in a cohort of predominantly statin-treated individuals with FH, with evidence for a less pronounced increase in atherosclerosis among female patients. Future studies should examine the predictors of resilience to and long-term implications of the differential burden of subclinical coronary atherosclerosis in this higher risk population.
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Affiliation(s)
- Khurram Nasir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | - Gowtham R. Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA
| | - Tycho R. Tromp
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Rodrigo Alonso
- Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Márcio S. Bittencourt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Eric Bruckert
- Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, Paris, France
| | - José Luis Díaz-Díaz
- Complejo Hospitalario Universitario, Hospital Abente y Lago, A Corūna, Spain
| | - Antonio Gallo
- Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, Paris, France
| | - G. Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - Marcio H. Miname
- Heart Institute (INCOR), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | | | - Jing Pang
- School of Medicine, University of Western Australia, Department of Cardiology, Royal Perth Hospital, Western Australia, Australia
| | - Leopoldo Perez de Isla
- Cardiology Department, Hospital Clinico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Eric J.G. Sijbrands
- Department of Internal Medicine, Section Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerald F. Watts
- School of Medicine, University of Western Australia, Department of Cardiology, Royal Perth Hospital, Western Australia, Australia
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Raul D. Santos
- Heart Institute (INCOR), University of São Paulo Medical School Hospital, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Cundari G, Marchitelli L, Pambianchi G, Catapano F, Conia L, Stancanelli G, Catalano C, Galea N. Imaging biomarkers in cardiac CT: moving beyond simple coronary anatomical assessment. LA RADIOLOGIA MEDICA 2024; 129:380-400. [PMID: 38319493 PMCID: PMC10942914 DOI: 10.1007/s11547-024-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
Cardiac computed tomography angiography (CCTA) is considered the standard non-invasive tool to rule-out obstructive coronary artery disease (CAD). Moreover, several imaging biomarkers have been developed on cardiac-CT imaging to assess global CAD severity and atherosclerotic burden, including coronary calcium scoring, the segment involvement score, segment stenosis score and the Leaman-score. Myocardial perfusion imaging enables the diagnosis of myocardial ischemia and microvascular damage, and the CT-based fractional flow reserve quantification allows to evaluate non-invasively hemodynamic impact of the coronary stenosis. The texture and density of the epicardial and perivascular adipose tissue, the hypodense plaque burden, the radiomic phenotyping of coronary plaques or the fat radiomic profile are novel CT imaging features emerging as biomarkers of inflammation and plaque instability, which may implement the risk stratification strategies. The ability to perform myocardial tissue characterization by extracellular volume fraction and radiomic features appears promising in predicting arrhythmogenic risk and cardiovascular events. New imaging biomarkers are expanding the potential of cardiac CT for phenotyping the individual profile of CAD involvement and opening new frontiers for the practice of more personalized medicine.
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Affiliation(s)
- Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090, Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089, Milano, Italy
| | - Luca Conia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giuseppe Stancanelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
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Pérez de Isla L, Díaz-Díaz JL, Romero MJ, Muñiz-Grijalvo O, Mediavilla JD, Argüeso R, de Andrés R, Fuentes F, Sánchez Muñoz-Torrero JF, Rubio P, Álvarez-Baños P, Mañas D, Suárez Gutierrez L, Saltijeral Cerezo A, Mata P. Characteristics of Coronary Atherosclerosis Related to Plaque Burden Regression During Treatment With Alirocumab: The ARCHITECT Study. Circ Cardiovasc Imaging 2024; 17:e016206. [PMID: 38205656 DOI: 10.1161/circimaging.123.016206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Intensive lipid-lowering therapy may induce coronary atherosclerosis regression. Nevertheless, the factors underlying the effect of lipid-lowering therapy on disease regression remain poorly characterized. Our aim was to determine which characteristics of atherosclerotic plaque are associated with a greater reduction in coronary plaque burden (PB) after treatment with alirocumab in patients with familial hypercholesterolemia. METHODS The ARCHITECT study (Effect of Alirocumab on Atherosclerotic Plaque Volume, Architecture and Composition) is a phase IV, open-label, multicenter, single-arm clinical trial to assess the effect of the treatment with alirocumab for 78 weeks on the coronary atherosclerotic PB and its characteristics in subjects with familial hypercholesterolemia without clinical atherosclerotic cardiovascular disease. Participants underwent a coronary computed tomographic angiography at baseline and a final one at 78 weeks. Every patient received alirocumab 150 mg subcutaneously every 14 days in addition to high-intensity statin therapy. RESULTS One hundred and four patients were enrolled. Median age was 53.3 (46.2-59.4) years and 54 were women (51.9%). The global coronary PB changed from 34.6% (32.5%-36.8%) at entry to 30.4% (27.4%-33.4%) at follow-up, which is -4.6% (-7.7% to -1.9%; P<0.001) reduction. A decrease in the percentage of unstable core (fibro-fatty+necrotic plaque; from 14.1 [7.9-22.3] to 8.0 [6.4-10.6]; -6.6%; P<0.001) was found. A greater PB (β, 0.36 [0.13-0.59]; P=0.002) and a higher proportion of unstable core (β, 0.15 [0.08-0.22]; P<0.001) were significantly related to PB regression. CONCLUSIONS Treatment with alirocumab in addition to high-intensity statin therapy might produce a greater PB regression in patients with familial hypercholesterolemia with higher baseline PB and in those with larger unstable core. Further studies are needed to corroborate the hypothesis raised by these results. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05465278.
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Affiliation(s)
| | - Jose L Díaz-Díaz
- Internal Medicine Department, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.)
| | - Manuel J Romero
- Internal Medicine Department, Hospital Infanta Elena, Huelva, Spain (M.J.R.)
| | | | - Juan D Mediavilla
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.D.M.)
| | - Rosa Argüeso
- Endocrinology Department, Hospital Universitario Lucus Augusti, Lugo, Spain (R.A.)
| | - Raimundo de Andrés
- Internal Medicine Department, Fundación Jiménez Díaz, Madrid, Spain (R.d.A.)
| | - Francisco Fuentes
- Lipid and Atherosclerosis Unit, CIBERObn, IMBIC, Hospital Universitario Reina Sofia, Córdoba, Spain (F.F.)
| | | | - Patricia Rubio
- Internal Medicine Department, Hospital Universitario Jerez de la Frontera, Spain (P.R.)
| | | | - Dolores Mañas
- Internal Medicine Department, Hospital General Universitario de Ciudad Real, Spain (D.M.)
| | | | | | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (P.M.)
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Corral P, Aguilar Salinas CA, Matta MG, Zago V, Schreier L. Stratification in Heterozygous Familial Hypercholesterolemia: Imaging, Biomarkers, and Genetic Testing. Curr Atheroscler Rep 2023; 25:899-909. [PMID: 37921916 DOI: 10.1007/s11883-023-01160-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/05/2023]
Abstract
PURPOSE OF REVIEW Heterozygous familial hypercholesterolemia (HeFH) is the most common monogenic autosomal dominant disorder. However, the condition is often underdiagnosed and undertreated. The objective of this review is to provide an update on the risk stratification in patients with HeFH, incorporating new cardiovascular imaging techniques, various biomarkers, and genetic studies. RECENT FINDINGS The diagnosis of HeFH places patients in a high cardiovascular risk category due to the increased incidence of premature atherosclerotic cardiovascular disease. However, the level of risk varies significantly among different individuals with HeFH. Achieving an optimal stratification of cardiovascular risk is crucial for establishing appropriate and accurate treatment and management strategies. Different new tools such as risk scores have emerged in recent years, aiding physicians in assessing the risk stratification for HeFH using imaging, biomarkers, and genetics. This review emphasizes that not all patients with HeFH face the same cardiovascular risk. By utilizing different assessment tools, we can identify those who require more intensive monitoring, follow-up, and treatment.
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Affiliation(s)
- Pablo Corral
- Universidad FASTA, Facultad de Medicina, Cátedra de Farmacología Especial y Toxicología, Mar del Plata, Argentina.
| | - Carlos A Aguilar Salinas
- Direction of Nutrition Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - María Gabriela Matta
- Universidad FASTA, Facultad de Medicina, Cátedra de Farmacología Especial y Toxicología, Mar del Plata, Argentina
| | - Valeria Zago
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Lab. de Lípidos y Aterosclerosis, Hospital de Clínicas. INFIBIOC-UBA, Buenos Aires, Argentina
| | - Laura Schreier
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Lab. de Lípidos y Aterosclerosis, Hospital de Clínicas. INFIBIOC-UBA, Buenos Aires, Argentina
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9
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Watts GF, Gidding SS, Hegele RA, Raal FJ, Sturm AC, Jones LK, Sarkies MN, Al-Rasadi K, Blom DJ, Daccord M, de Ferranti SD, Folco E, Libby P, Mata P, Nawawi HM, Ramaswami U, Ray KK, Stefanutti C, Yamashita S, Pang J, Thompson GR, Santos RD. International Atherosclerosis Society guidance for implementing best practice in the care of familial hypercholesterolaemia. Nat Rev Cardiol 2023; 20:845-869. [PMID: 37322181 DOI: 10.1038/s41569-023-00892-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
This contemporary, international, evidence-informed guidance aims to achieve the greatest good for the greatest number of people with familial hypercholesterolaemia (FH) across different countries. FH, a family of monogenic defects in the hepatic LDL clearance pathway, is a preventable cause of premature coronary artery disease and death. Worldwide, 35 million people have FH, but most remain undiagnosed or undertreated. Current FH care is guided by a useful and diverse group of evidence-based guidelines, with some primarily directed at cholesterol management and some that are country-specific. However, none of these guidelines provides a comprehensive overview of FH care that includes both the lifelong components of clinical practice and strategies for implementation. Therefore, a group of international experts systematically developed this guidance to compile clinical strategies from existing evidence-based guidelines for the detection (screening, diagnosis, genetic testing and counselling) and management (risk stratification, treatment of adults or children with heterozygous or homozygous FH, therapy during pregnancy and use of apheresis) of patients with FH, update evidence-informed clinical recommendations, and develop and integrate consensus-based implementation strategies at the patient, provider and health-care system levels, with the aim of maximizing the potential benefit for at-risk patients and their families worldwide.
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Affiliation(s)
- Gerald F Watts
- School of Medicine, University of Western Australia, Perth, WA, Australia.
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, WA, Australia.
| | | | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine, Western University, London, ON, Canada
| | - Frederick J Raal
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy C Sturm
- Department of Genomic Health, Geisinger, Danville, PA, USA
- 23andMe, Sunnyvale, CA, USA
| | - Laney K Jones
- Department of Genomic Health, Geisinger, Danville, PA, USA
| | - Mitchell N Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Khalid Al-Rasadi
- Medical Research Centre, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Dirk J Blom
- Division of Lipidology and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Hapizah M Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Specialist Lipid and Coronary Risk Prevention Clinics, Hospital Al-Sultan Abdullah (HASA) and Clinical Training Centre, Puncak Alam and Sungai Buloh Campuses, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Uma Ramaswami
- Royal Free London NHS Foundation Trust, University College London, London, UK
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK
| | - Claudia Stefanutti
- Department of Molecular Medicine, Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Regional Centre for Rare Diseases, Immunohematology and Transfusion Medicine, Umberto I Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - Shizuya Yamashita
- Department of Cardiology, Rinku General Medical Center, Osaka, Japan
| | - Jing Pang
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | | | - Raul D Santos
- Lipid Clinic, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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10
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Gidding SS. Childhood Screening for Familial Hypercholesterolemia: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:1558-1563. [PMID: 37793753 DOI: 10.1016/j.jacc.2023.07.028] [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: 05/22/2023] [Revised: 06/21/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023]
Abstract
Screening for familial hypercholesterolemia (FH) in childhood remains controversial. Existing guidelines offer practitioners conflicting advice despite generally agreeing on the evidence and areas in which evidence is lacking, including a lack of long-term clinical trials demonstrating coronary event reduction as a result of screening and long-term data on statin side effects. A limitation of existing evidence-based frameworks is reliance on 1 evidence grading system to determine recommendations. However, rigorous evidence evaluation alternatives relevant to FH exist. FH is considered a tier 1 genetic condition, meaning that identification and treatment will improve health outcomes among those affected. Elevated low-density lipoprotein cholesterol, the primary consequence of FH, can be considered causal for atherosclerosis and coronary heart disease. Incorporating these concepts into existing evidence pathways allows the inclusion of surrogate clinical trial outcomes (low-density lipoprotein cholesterol reduction and atherosclerosis regression) and observational data on medication safety, strengthening the evidence for pediatric screening for FH.
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Affiliation(s)
- Samuel S Gidding
- Department of Genomic Health, Geisinger, Danville, Pennsylvania, USA.
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11
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Lan NSR, Bajaj A, Watts GF, Cuchel M. Recent advances in the management and implementation of care for familial hypercholesterolaemia. Pharmacol Res 2023; 194:106857. [PMID: 37460004 DOI: 10.1016/j.phrs.2023.106857] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
Familial hypercholesterolaemia (FH) is a common autosomal semi-dominant and highly penetrant disorder of the low-density lipoprotein (LDL) receptor pathway, characterised by lifelong elevated levels of low-density lipoprotein cholesterol (LDL-C) and increased risk of atherosclerotic cardiovascular disease (ASCVD). However, many patients with FH are not diagnosed and do not attain recommended LDL-C goals despite maximally tolerated doses of potent statin and ezetimibe. Over the past decade, several cholesterol-lowering therapies such as those targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) or angiopoietin-like 3 (ANGPTL3) with monoclonal antibody or ribonucleic acid (RNA) approaches have been developed that promise to close the treatment gap. The availability of new therapies with complementary modes of action of lipid metabolism has enabled many patients with FH to attain guideline-recommended LDL-C goals. Emerging therapies for FH include liver-directed gene transfer of the LDLR, vaccines targeting key proteins involved in cholesterol metabolism, and CRISPR-based gene editing of PCSK9 and ANGPTL3, but further clinical trials are required. In this review, current and emerging treatment strategies for lowering LDL-C, and ASCVD risk-stratification, as well as implementation strategies for the care of patients with FH are reviewed.
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Affiliation(s)
- Nick S R Lan
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia; School of Medicine, The University of Western Australia, Perth, Australia.
| | - Archna Bajaj
- Division of Translational Medicine & Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gerald F Watts
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia; School of Medicine, The University of Western Australia, Perth, Australia
| | - Marina Cuchel
- Division of Translational Medicine & Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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12
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Lee H, Kang BG, Jo J, Park HE, Yoon S, Choi SY, Kim MJ. Deep learning-based prediction for significant coronary artery stenosis on coronary computed tomography angiography in asymptomatic populations. Front Cardiovasc Med 2023; 10:1167468. [PMID: 37416918 PMCID: PMC10320158 DOI: 10.3389/fcvm.2023.1167468] [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: 03/06/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
Background Although coronary computed tomography angiography (CCTA) is currently utilized as the frontline test to accurately diagnose coronary artery disease (CAD) in clinical practice, there are still debates regarding its use as a screening tool for the asymptomatic population. Using deep learning (DL), we sought to develop a prediction model for significant coronary artery stenosis on CCTA and identify the individuals who would benefit from undergoing CCTA among apparently healthy asymptomatic adults. Methods We retrospectively reviewed 11,180 individuals who underwent CCTA as part of routine health check-ups between 2012 and 2019. The main outcome was the presence of coronary artery stenosis of ≥70% on CCTA. We developed a prediction model using machine learning (ML), including DL. Its performance was compared with pretest probabilities, including the pooled cohort equation (PCE), CAD consortium, and updated Diamond-Forrester (UDF) scores. Results In the cohort of 11,180 apparently healthy asymptomatic individuals (mean age 56.1 years; men 69.8%), 516 (4.6%) presented with significant coronary artery stenosis on CCTA. Among the ML methods employed, a neural network with multi-task learning (19 selected features), one of the DL methods, was selected due to its superior performance, with an area under the curve (AUC) of 0.782 and a high diagnostic accuracy of 71.6%. Our DL-based model demonstrated a better prediction than the PCE (AUC, 0.719), CAD consortium score (AUC, 0.696), and UDF score (AUC, 0.705). Age, sex, HbA1c, and HDL cholesterol were highly ranked features. Personal education and monthly income levels were also included as important features of the model. Conclusion We successfully developed the neural network with multi-task learning for the detection of CCTA-derived stenosis of ≥70% in asymptomatic populations. Our findings suggest that this model may provide more precise indications for the use of CCTA as a screening tool to identify individuals at a higher risk, even in asymptomatic populations, in clinical practice.
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Affiliation(s)
- Heesun Lee
- Department of Internal Medicine, School of Medicine, Seoul National University, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Bong Gyun Kang
- Interdisciplinary Program in Artificial Intelligence, Seoul National University, Seoul, Republic of Korea
| | - Jeonghee Jo
- Institute of New Media and Communications, Seoul National University, Seoul, Republic of Korea
| | - Hyo Eun Park
- Department of Internal Medicine, School of Medicine, Seoul National University, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Sungroh Yoon
- Interdisciplinary Program in Artificial Intelligence, Seoul National University, Seoul, Republic of Korea
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, School of Medicine, Seoul National University, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Min Joo Kim
- Department of Internal Medicine, School of Medicine, Seoul National University, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
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13
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Pérez de Isla L, Díaz-Díaz JL, Romero MJ, Muñiz-Grijalvo O, Mediavilla JD, Argüeso R, Sánchez Muñoz-Torrero JF, Rubio P, Álvarez-Baños P, Ponte P, Mañas D, Suárez Gutierrez L, Cepeda JM, Casañas M, Fuentes F, Guijarro C, Ángel Barba M, Saltijeral Cerezo A, Padró T, Mata P. Alirocumab and Coronary Atherosclerosis in Asymptomatic Patients with Familial Hypercholesterolemia: The ARCHITECT Study. Circulation 2023; 147:1436-1443. [PMID: 37009731 PMCID: PMC10158600 DOI: 10.1161/circulationaha.122.062557] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/01/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The effect of alirocumab, a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor, on coronary plaque burden in patients with familial hypercholesterolemia has not been addressed. Our aim was to assess changes in coronary plaque burden and its characteristics after treatment with alirocumab by quantification and characterization of atherosclerotic plaque throughout the coronary tree on the basis of a noninvasive analysis of coronary computed tomographic angiography in asymptomatic subjects with familial hypercholesterolemia receiving optimized and stable treatment with maximum tolerated statin dose with or without ezetimibe. METHODS This study is a phase IV, open-label, multicenter, single-arm clinical trial to assess changes in coronary plaque burden and its characteristics after 78 weeks of treatment with alirocumab in patients with familial hypercholesterolemia without clinical atherosclerotic cardiovascular disease. Participants underwent an initial coronary computed tomographic angiography at baseline and another at 78 weeks. Every patient received 150 mg of alirocumab subcutaneiously every 14 days in addition to high-intensity statin therapy. The main outcome was the change on coronary plaque burden and its characteristics by quantification and characterization of atherosclerotic plaque throughout the coronary tree on the basis of analysis of coronary computed tomographic angiography. RESULTS The study was completed by 104 patients. The median age was 53.3 (46.2-59.4) years. Of these patients, 54 were women (51.9%). Median low-density lipoprotein cholesterol was 138.9 (117.5-175.3) mg/dL at entry and 45.0 (36.0-65.0) mg/dL at follow-up (P<0.001). Coronary plaque burden changed from 34.6% (32.5%-36.8%) at entry to 30.4% (27.4%-33.4%) at follow-up (P<0.001). A significant change in the characteristics of the coronary atherosclerosis was also found: an increase in the proportion of calcified (+0.3%; P<0.001) and mainly fibrous (+6.2%; P<0.001) plaque, accompanied by a decrease in the percentage of fibro-fatty (-3.9%; P<0.001) and necrotic plaque (-0.6%; P<0.001). CONCLUSIONS Treatment with alirocumab in addition to high-intensity statin therapy resulted in significant regression of coronary plaque burden and plaque stabilization on coronary computed tomographic angiography over 78 weeks in these groups of patients with familial hypercholesterolemia without clinical atherosclerotic cardiovascular disease. ARCHITECT (Effect of Alirocumab on Atherosclerotic Plaque Volume, Architecture and Composition) could link and explain ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) results. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT05465278.
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Affiliation(s)
| | - Jose L. Díaz-Díaz
- Internal Medicine Department, Hospital Abente y Lago, A Coruña, Spain (J.L.E.-D.)
| | - Manuel J. Romero
- Internal Medicine Department, Hospital Infanta Elena, Huelva, Spain M.J.R.)
| | | | - Juan D. Mediavilla
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.D.M.)
| | - Rosa Argüeso
- Endocrinology Department, Hospital Universitario Lucus Augusti, Lugo, Spain (R.A.)
| | | | - Patricia Rubio
- Internal Medicine Department, Hospital Universitario Jerez de la Frontera, Spain (P.R.)
| | | | - Paola Ponte
- Internal Medicine Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain (P.P.)
| | - Dolores Mañas
- Internal Medicine Department, Hospital General Universitario de Ciudad Real, Spain (D.M.)
| | | | - José María Cepeda
- Internal Medicine Department, Hospital Comarcal Vega Baja, Orihuela, Alicante, Spain (J.M.C.)
| | - Marta Casañas
- Internal Medicine Department, Hospital San Pedro, Logroño, Spain (M.C.)
| | - Francisco Fuentes
- Lipid and Atherosclerosis Unit, CIBERObn, IMBIC. Hospital Universitario Reina Sofia, Córdoba, Spain (F.F.)
| | - Carlos Guijarro
- Internal Medicine Department, Hospital Universitario Fundación Alcorcón-Universidad Rey Juan Carlos, Madrid, Spain (C.G.)
| | - Miguel Ángel Barba
- Internal Medicine Department, Complejo Hospitalario Universitario, Albacete, Spain (M.A.B.)
| | | | - Teresa Padró
- Programa-ICCC Cardiovascular, Institut de Recerca Hospital Santa Creu i Sant Pau, IIB-Sant Pau, CIBERCV, Barcelona, Spain (T.P.)
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain (P.M.)
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14
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Tada H, Takamura M, Kawashiri MA. Individualized Treatment for Patients With Familial Hypercholesterolemia. J Lipid Atheroscler 2022; 11:39-54. [PMID: 35118021 PMCID: PMC8792816 DOI: 10.12997/jla.2022.11.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/18/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Familial hypercholesterolemia (FH) is one of the most common and, therefore, important inherited disorders in preventive cardiology. This disease is mainly caused by a single pathogenic mutation in the low-density lipoprotein receptor or its associated genes. Moreover, it is correlated with a high risk of cardiovascular disease. However, the phenotype severity even in this monogenic disease significantly varies. Thus, the current study aimed to describe FH and its importance and the factors (inherited and acquired) contributing to differences in phenotype severity. Different lipid-modification therapies according to these factors can lead to individualized treatments, which are also essential in the general populations.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masa-aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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15
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Shibayama J, Tada H, Sakata K, Usui S, Takamura M, Kawashiri MA. The Assessment of Carotid Atherosclerotic Plaque among Young Patients with Familial Hypercholesterolemia. Intern Med 2022; 61:3165-3169. [PMID: 36328583 PMCID: PMC9683824 DOI: 10.2169/internalmedicine.9249-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective Few data exist regarding when atherosclerotic changes occur among patients with familial hypercholesterolemia (FH). Carotid ultrasonography is a non-invasive method of evaluating this issue. The present study (1) compared the clinical utilities of carotid intima-media thickness (cIMT) and carotid plaque score (cPS) and (2) estimated the onset and progression of carotid atherosclerosis among patients with heterozygous FH (HeFH). Methods We retrospectively analyzed 511 patients under 30 years old who underwent carotid ultrasonography at our hospital from 2006 to 2019. We classified them into the HeFH group (n=78, 21.4±5.9 years old) and non-FH group (n=433, 23.4±6.0 years old) based on the clinical diagnosis and compared their cIMT and cPS values. In addition, we estimated the onset and progression of carotid atherosclerosis among young HeFH patients. Results There was no significant difference in the cIMT between the HeFH and non-FH groups (0.44 mm vs. 0.42 mm, p=0.25). In contrast, the cPS was significantly higher in the HeFH group than in the non-FH group (1.11 vs. 0.26, p=0.002). The regression equation for cPS of HeFH group was Y=-2.05+0.15X (r=0.37, p<0.001). Conclusion An assessment based on the cPS rather than the cIMT appears to be better to capture the progress of carotid atherosclerosis among young HeFH patients. Carotid atherosclerosis may start to develop at 14 years old in patients with HeFH.
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Affiliation(s)
- Junichi Shibayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Japan
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16
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Coronary Computer Tomography Angiography in 2021-Acquisition Protocols, Tips and Tricks and Heading beyond the Possible. Diagnostics (Basel) 2021; 11:diagnostics11061072. [PMID: 34200866 PMCID: PMC8230532 DOI: 10.3390/diagnostics11061072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.
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17
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Garcia-Arguinzonis M, Diaz-Riera E, Peña E, Escate R, Juan-Babot O, Mata P, Badimon L, Padro T. Alternative C3 Complement System: Lipids and Atherosclerosis. Int J Mol Sci 2021; 22:ijms22105122. [PMID: 34066088 PMCID: PMC8151937 DOI: 10.3390/ijms22105122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 12/14/2022] Open
Abstract
Familial hypercholesterolemia (FH) is increasingly associated with inflammation, a phenotype that persists despite treatment with lipid lowering therapies. The alternative C3 complement system (C3), as a key inflammatory mediator, seems to be involved in the atherosclerotic process; however, the relationship between C3 and lipids during plaque progression remains unknown. The aim of the study was to investigate by a systems biology approach the role of C3 in relation to lipoprotein levels during atherosclerosis (AT) progression and to gain a better understanding on the effects of C3 products on the phenotype and function of human lipid-loaded vascular smooth muscle cells (VSMCs). By mass spectrometry and differential proteomics, we found the extracellular matrix (ECM) of human aortas to be enriched in active components of the C3 complement system, with a significantly different proteomic signature in AT segments. Thus, C3 products were more abundant in AT-ECM than in macroscopically normal segments. Furthermore, circulating C3 levels were significantly elevated in FH patients with subclinical coronary AT, evidenced by computed tomographic angiography. However, no correlation was identified between circulating C3 levels and the increase in plaque burden, indicating a local regulation of the C3 in AT arteries. In cell culture studies of human VSMCs, we evidenced the expression of C3, C3aR (anaphylatoxin receptor) and the integrin αMβ2 receptor for C3b/iC3b (RT-PCR and Western blot). C3mRNA was up-regulated in lipid-loaded human VSMCs, and C3 protein significantly increased in cell culture supernatants, indicating that the C3 products in the AT-ECM have a local vessel-wall niche. Interestingly, C3a and iC3b (C3 active fragments) have functional effects on VSMCs, significantly reversing the inhibition of VSMC migration induced by aggregated LDL and stimulating cell spreading, organization of F-actin stress fibers and attachment during the adhesion of lipid-loaded human VSMCs. This study, by using a systems biology approach, identified molecular processes involving the C3 complement system in vascular remodeling and in the progression of advanced human atherosclerotic lesions.
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MESH Headings
- Adult
- Atherosclerosis/immunology
- Atherosclerosis/metabolism
- Atherosclerosis/pathology
- Case-Control Studies
- Cell Adhesion
- Cells, Cultured
- Complement C3/metabolism
- Female
- Humans
- Hyperlipoproteinemia Type II/immunology
- Hyperlipoproteinemia Type II/metabolism
- Hyperlipoproteinemia Type II/pathology
- Male
- Middle Aged
- Muscle, Smooth, Vascular/immunology
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/immunology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Proteome/analysis
- Proteome/metabolism
- Vascular Remodeling
- Wound Healing
- Young Adult
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Affiliation(s)
- Maisa Garcia-Arguinzonis
- Cardiovascular Program-ICCC, Research Institute-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (M.G.-A.); (E.D.-R.); (E.P.); (R.E.); (O.J.-B.); (L.B.)
| | - Elisa Diaz-Riera
- Cardiovascular Program-ICCC, Research Institute-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (M.G.-A.); (E.D.-R.); (E.P.); (R.E.); (O.J.-B.); (L.B.)
| | - Esther Peña
- Cardiovascular Program-ICCC, Research Institute-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (M.G.-A.); (E.D.-R.); (E.P.); (R.E.); (O.J.-B.); (L.B.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Rafael Escate
- Cardiovascular Program-ICCC, Research Institute-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (M.G.-A.); (E.D.-R.); (E.P.); (R.E.); (O.J.-B.); (L.B.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Oriol Juan-Babot
- Cardiovascular Program-ICCC, Research Institute-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (M.G.-A.); (E.D.-R.); (E.P.); (R.E.); (O.J.-B.); (L.B.)
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, 28010 Madrid, Spain;
| | - Lina Badimon
- Cardiovascular Program-ICCC, Research Institute-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (M.G.-A.); (E.D.-R.); (E.P.); (R.E.); (O.J.-B.); (L.B.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Cardiovascular Research Chair, UAB, 08025 Barcelona, Spain
| | - Teresa Padro
- Cardiovascular Program-ICCC, Research Institute-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (M.G.-A.); (E.D.-R.); (E.P.); (R.E.); (O.J.-B.); (L.B.)
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-935-565-886; Fax: +34-935-565-559
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