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Jiao J, Hu B, Mou T, Li Q, Tian Y, Zhang N, Zhang Y, Yun M, Nan N, Tian J, Yu W, Mi H, Dong W, Song X. Translocator Protein 18 kDa Tracer 18F-FDPA PET/CTA Imaging for the Evaluation of Inflammation in Vulnerable Plaques. Mol Pharm 2024; 21:3623-3633. [PMID: 38819959 DOI: 10.1021/acs.molpharmaceut.4c00344] [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: 06/02/2024]
Abstract
Inflammation induced by activated macrophages within vulnerable atherosclerotic plaques (VAPs) constitutes a significant risk factor for plaque rupture. Translocator protein (TSPO) is highly expressed in activated macrophages. This study investigated the effectiveness of TSPO radiotracers, 18F-FDPA, in detecting VAPs and quantifying plaque inflammation in rabbits. 18 New Zealand rabbits were divided into 3 groups: sham group A, VAP model group B, and evolocumab treatment group C. 18F-FDPA PET/CTA imaging was performed at 12, 16, and 24 weeks in all groups. Optical coherence tomography (OCT) was performed on the abdominal aorta at 24 weeks. The VAP was defined through OCT images, and ex vivo aorta PET imaging was also performed at 24 weeks. The SUVmax and SUVmean of 18F-FDPA were measured on the target organ, and the target-to-background ratio (TBRmax) was calculated as SUVmax/SUVblood pool. The arterial sections of the isolated abdominal aorta were analyzed by HE staining, CD68 and TSPO immunofluorescence staining, and TSPO Western blot. The results showed that at 24 weeks, the plaque TBRmax of 18F-FDPA in group B was significantly higher than in groups A and C. Immunofluorescence staining of CD68 and TSPO, as well as Western blot, confirmed the increased expression of macrophages and TSPO in the corresponding regions of group B. HE staining revealed an increased presence of the lipid core, multiple foam cells, and inflammatory cell infiltration in the area with high 18F-FDPA uptake. This indicates a correlation between 18F-FDPA uptake, inflammation severity, and VAPs. The TSPO-targeted tracer 18F-FDPA shows specific uptake in macrophage-rich regions of atherosclerotic plaques, making it a valuable tool for assessing inflammation in VAPs.
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Affiliation(s)
- Jian Jiao
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Biao Hu
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Tiantian Mou
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Quan Li
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yi Tian
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Ying Zhang
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Mingkai Yun
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jing Tian
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wei Yu
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Hongzhi Mi
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Wei Dong
- Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Sarraju A, Nissen SE. Atherosclerotic plaque stabilization and regression: a review of clinical evidence. Nat Rev Cardiol 2024; 21:487-497. [PMID: 38177454 DOI: 10.1038/s41569-023-00979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/06/2024]
Abstract
Atherosclerotic plaque results from a complex interplay between lipid deposition, inflammatory changes, cell migration and arterial wall injury. Over the past two decades, clinical trials utilizing invasive arterial imaging modalities, such as intravascular ultrasonography, have shown that reducing levels of atherogenic lipoproteins, mainly serum LDL-cholesterol (LDL-C), to very low levels can safely reduce overall atherosclerotic plaque burden and favourably modify plaque composition. Classically, this outcome has been achieved with intensive statin therapy. Since 2016, newer and potent lipid-lowering strategies, such as proprotein convertase subtilisin-kexin type 9 inhibition, have shown incremental effects on plaque regression and risk of clinical events. Despite maximal reduction in plasma LDL-C levels, considerable residual cardiovascular risk remains in some patients. Therefore, there is a need to study therapeutic approaches that address residual risk beyond LDL-C reduction to promote plaque stabilization or regression. Contemporary imaging modalities, such as coronary computed tomography angiography, enable non-invasive assessment of the overall atherosclerotic plaque burden as well as of certain local plaque characteristics. This technology could allow further study of plaque stabilization and regression using novel therapeutic approaches. Non-invasive plaque assessment might also offer the potential to guide personalized management strategies if validated for this purpose.
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Affiliation(s)
- Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Minami Y, Ako J, Tsujita K, Yokoi H, Ikari Y, Morino Y, Kobayashi Y, Kozuma K. Drug intervention as an emerging concept for secondary prevention in patients with coronary disease. Cardiovasc Interv Ther 2024; 39:223-233. [PMID: 38587750 DOI: 10.1007/s12928-024-00994-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
Non-culprit lesion-related coronary events are a significant concern in patients with coronary artery disease (CAD) undergoing coronary intervention. Since several studies using intra-coronary imaging modalities have reported a high prevalence of vulnerable plaques in non-culprit lesions at the initial coronary event, the immediate stabilization of these plaques by intensive pharmacological regimens may contribute to the reduction in the adverse events. Although current treatment guidelines recommend the titration of statin and other drugs to attain the treatment goal of low-density lipoprotein cholesterol (LDL-C) level in patients with CAD, the early prescription of strong LDL-C lowering drugs with more intensive regimen may further reduce the incidence of recurrent cardiovascular events. In fact, several studies with intensive regimen have demonstrated a higher percentage of patients with the attainment of LDL-C treatment goal in the early phase following discharge. In addition to many imaging studies showing plaque stabilization by LDL-C lowering drugs, several recent reports have shown the efficacy of early statin and proprotein convertase subtilisin/kexin type 9 inhibitors on the immediate stabilization of non-culprit coronary plaques. To raise awareness regarding this important concept of immediate plaque stabilization and subsequent reduction in the incidence of recurrent coronary events, the term 'Drug Intervention' has been introduced and gradually applied in the clinical field, although a clear definition is lacking. The main target of this concept is patients with acute coronary syndrome as a higher prevalence of vulnerable plaques in non-culprit lesions in addition to the worse clinical outcomes has been reported in recent imaging studies. In this article, we discuss the backgrounds and the concept of drug intervention.
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Affiliation(s)
- Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, 252-0375, Japan.
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, 252-0375, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Yahaba-Cho, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University, Chiba, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Lin J, Wang J, Fang J, Li M, Xu S, Little PJ, Zhang D, Liu Z. The cytoplasmic sensor, the AIM2 inflammasome: A precise therapeutic target in vascular and metabolic diseases. Br J Pharmacol 2024; 181:1695-1719. [PMID: 38528718 DOI: 10.1111/bph.16355] [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: 06/14/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 03/27/2024] Open
Abstract
Cardio-cerebrovascular diseases encompass pathological changes in the heart, brain and vascular system, which pose a great threat to health and well-being worldwide. Moreover, metabolic diseases contribute to and exacerbate the impact of vascular diseases. Inflammation is a complex process that protects against noxious stimuli but is also dysregulated in numerous so-called inflammatory diseases, one of which is atherosclerosis. Inflammation involves multiple organ systems and a complex cascade of molecular and cellular events. Numerous studies have shown that inflammation plays a vital role in cardio-cerebrovascular diseases and metabolic diseases. The absent in melanoma 2 (AIM2) inflammasome detects and is subsequently activated by double-stranded DNA in damaged cells and pathogens. With the assistance of the mature effector molecule caspase-1, the AIM2 inflammasome performs crucial biological functions that underpin its involvement in cardio-cerebrovascular diseases and related metabolic diseases: The production of interleukin-1 beta (IL-1β), interleukin-18 (IL-18) and N-terminal pore-forming Gasdermin D fragment (GSDMD-N) mediates a series of inflammatory responses and programmed cell death (pyroptosis and PANoptosis). Currently, several agents have been reported to inhibit the activity of the AIM2 inflammasome and have the potential to be evaluated for use in clinical settings. In this review, we systemically elucidate the assembly, biological functions, regulation and mechanisms of the AIM2 inflammasome in cardio-cerebrovascular diseases and related metabolic diseases and outline the inhibitory agents of the AIM2 inflammasome as potential therapeutic drugs.
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Affiliation(s)
- Jiuguo Lin
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou, China
| | - Jiaojiao Wang
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou, China
| | - Jian Fang
- Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Meihang Li
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou, China
| | - Suowen Xu
- Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Peter J Little
- Pharmacy Australia Centre of Excellence, School of Pharmacy, University of Queensland, Woolloongabba, Queensland, Australia
| | - Dongmei Zhang
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
| | - Zhiping Liu
- State Key Laboratory of Bioactive Molecules and Druggability Assessment, Jinan University, Guangzhou, China
- Guangdong Province Key Laboratory of Pharmacodynamic Constituents of Traditional Chinese Medicine and New Drugs Research, College of Pharmacy, Jinan University, Guangzhou, China
- International Cooperative Laboratory of Traditional Chinese Medicine Modernization and Innovative Drug Development of Ministry of Education (MOE) of China, Jinan University, Guangzhou, China
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5
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Tada H, Kojima N, Takeji Y, Nohara A, Kawashiri MA, Takamura M. Impact of changes in Achilles tendon thickening on cardiovascular events in patients with familial hypercholesterolemia. Am J Prev Cardiol 2024; 18:100660. [PMID: 38590629 PMCID: PMC10999807 DOI: 10.1016/j.ajpc.2024.100660] [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: 01/12/2024] [Revised: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background Achilles tendon thickening (ATT) can be ameliorated by lowering low-density lipoprotein (LDL) levels in patients with familial hypercholesterolemia (FH). The Japan Atherosclerosis Society (JAS) defines ATT as ≥8.0 mm in males and ≥7.5 mm in females. We aimed to determine the clinical impact of changes in ATT on the development of major adverse cardiovascular events (MACE). Methods Patients with clinically diagnosed heterozygous FH (HeFH) (N = 1273; 614 males, 659 females) with ATT data from X-ray were assessed. Patients were divided into four groups: patients without ATT from baseline until follow-up (group 1), patients without ATT at baseline but developed ATT at follow-up (group 2), patients with ATT at baseline but regressed at follow-up (group 3), and patients with ATT from baseline until follow-up (group 4). Cox proportional hazard models were used to assess the factors associated with MACE, including cardiovascular death and any coronary events. Results On follow-up (median: 10.9 years), 142 MACEs were observed, and the median ATT regressed from 7.8 to 7.6 mm. Changes in ATT were significantly associated with the occurrence of MACE in all groups, when compared to group 1 (hazard ratio [HR]: 2.73; 95 % confidence interval [CI]: 1.33-4.13 [p < 0.001], HR: 2.18, 95 % CI: 1.08-3.28, [p < 0.001], HR: 6.34, 95 % CI: 3.10-9.58, [p < 0.001], in groups 2, 3, and 4, respectively). Conclusions Assessing ATT has diagnostic value and allows for risk stratification among patients with HeFH.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Nobuko Kojima
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Atsushi Nohara
- Department of Genetics, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | | | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Gargiulo P, Basile C, Galasso G, Bellino M, D'Elia D, Patti G, Bosco M, Prinetti M, Andò G, Campanella F, Taverna G, Calabrò P, Cesaro A, Fimiani F, Catalano A, Varbella F, Corleto A, Barillà F, Muscoli S, Musumeci G, Delnevo F, Giallauria F, Napoli R, Porto I, Polimeni A, Quarta R, Maloberti A, Merlini PA, De Luca L, Casu G, Brunetti ND, Crisci M, Paloscia L, Bilato C, Indolfi C, Marzano F, Fontanarosa S, Buonocore D, Parlati ALM, Nardi E, Prastaro M, Soricelli A, Salvatore M, Paolillo S, Perrone-Filardi P. Strike early-strike strong lipid-lowering strategy with PCSK9i in ACS patients. Real-world evidence from AT-TARGET-IT registry. Eur J Prev Cardiol 2024:zwae170. [PMID: 38788773 DOI: 10.1093/eurjpc/zwae170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
AIMS No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in real-world. This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major CV events in real-world. METHODS The lipid control outcome was the percentage of patients reaching the LDL-C target of < 55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all cause death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization) during follow-up in relation to quartiles of LDL-C at first lipid control. RESULTS We included 771 patients with ACS from AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C <55 mg/dL. CONCLUSIONS Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.
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Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Christian Basile
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Debora D'Elia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Patti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Manuel Bosco
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Matteo Prinetti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Francesca Campanella
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Giovanni Taverna
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Paolo Calabrò
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Arturo Cesaro
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Fabio Fimiani
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Angelo Catalano
- Cardiology Division Emergency Department, Eboli-Battipaglia-Roccadaspide, Maria SS Addolorata General Hospital, Eboli, Italy
| | - Ferdinando Varbella
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Antonella Corleto
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | | | - Francesco Giallauria
- Department of Traslational Medical Sciences, Precision Medicine Unit, Federico II University, Naples, Italy
| | - Raffaele Napoli
- Department of Traslational Medical Sciences, Precision Medicine Unit, Federico II University, Naples, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy and Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy
| | - Alberto Polimeni
- Division of Cardiology AOCS, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy
| | - Rossella Quarta
- Division of Cardiology AOCS, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy
| | - Alessandro Maloberti
- Cardiology 4, ASST GOM Niguarda, Milan, Italy and School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Piera Angelica Merlini
- Cardiology 4, ASST GOM Niguarda, Milan, Italy and School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini, Rome, Italy
| | - Gavino Casu
- Department of Cardiology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy and Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Mario Crisci
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, Naples, Italy
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Vicenza, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Sara Fontanarosa
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Davide Buonocore
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Ermanno Nardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Andrea Soricelli
- IRCCS Synlab SDN, Naples, Italy; Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Ji J, Wei X, Wan D, Wu L, Chen G, Liu H. Predictive Value of Plasma PCSK9 Levels for Degree of Atherosclerosis and Major Adverse Cardiovascular and Cerebrovascular Events in Older Adult Patients with Non-Alcoholic Fatty Liver Disease. Int J Gen Med 2024; 17:2177-2186. [PMID: 38770364 PMCID: PMC11104394 DOI: 10.2147/ijgm.s454633] [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: 01/10/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose This study investigated the influence of plasma proprotein convertase subtilisin/kexin 9 (PCSK9) levels on the degree of atherosclerosis and major adverse cardiovascular and cerebrovascular events (MACCE) in older adults with non-alcoholic fatty liver disease. Methods The degree of atherosclerosis severity was assessed by the standard Gensini score quartile method. According to the degree of atherosclerosis, patients were divided into mild (0-24 points; n=84), moderate (25-53 points; n=86), and severe groups (≥54 points; n=84) and then categorized as MACCE (n=30) or non-MACCE (n=224) according to 6-month follow-up data. The patients' age, sex, smoking history, medical history, and early morning fasting venous blood, for measuring biochemical indexes, were collected. Clinical data were compared between groups and the relationship between Gensini scores and PCSK9 was evaluated. Results Compared with the mild group, the moderate and severe groups had higher high-sensitivity C-reactive protein(hs-CRP), PCSK9, triglycerides(TG), low-density lipoprotein cholesterol (LDL-C), and lipoprotein(a)[Lp(a)] levels and lower high-density lipoprotein cholesterol(HDL-C) levels (all P<0.05). Moreover, PCSK9 positively correlated with Gensini scores (r=0.657, P<0.01). The MACCE and non-MACCE groups had significantly different ages, statin use, Gensini scores, PCSK9, and LDL-C (all P<0.05). Multi-factorial Cox risk regression analysis showed the Gensini score (HR=1.018, 95% CI: 1.006~1.029) and PCSK9 (HR=1.147, 95% CI: 1.038~1.287) were independent risk factors for MACCE. Conclusion The Gensini score and PCSK9 levels can be used as predictive indicators for the degree of illness and occurrence of MACCE in older NAFLD patients.
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Affiliation(s)
- Jinrui Ji
- Clinical Medical Department, Faculty of Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
- Department of Cardiology, People’s Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
| | - Xiaoyun Wei
- Clinical Medical Department, Faculty of Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
- Department of Cardiology, People’s Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
| | - Dongyun Wan
- Clinical Medical Department, Faculty of Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
- Department of Cardiology, People’s Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
| | - Lei Wu
- Clinical Medical Department, Faculty of Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
- Department of Cardiology, People’s Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
| | - Guangyao Chen
- Clinical Medical Department, Faculty of Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
- Zhengzhou Institute of Gastroenterology, People’s Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
| | - Hengliang Liu
- Clinical Medical Department, Faculty of Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
- Department of Cardiology, People’s Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, People’s Republic of China
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8
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Biccirè FG, Gatto L, Prati F. Intracoronary imaging to guide percutaneous coronary intervention: from evidence to guidelines. Eur Heart J Suppl 2024; 26:i11-i14. [PMID: 38784149 PMCID: PMC11110448 DOI: 10.1093/eurheartjsupp/suae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Despite notable advances in devices and techniques, percutaneous coronary intervention (PCI) is still affected by a substantial number of complications and failure rates. Over the years, the use of intracoronary imaging (ICI) has dramatically improved the understanding of mechanical and technical factors related to successful and failed PCI, becoming a mainstay in complex trans-catheter interventions. However, ICI modalities are invasive, time-consuming, and costly, and a net clinical benefit needs to be shown in order to recommend their routine use in clinical practice. In the past, the lack of evidence from randomized trials has been reflected in the scepticism shown by international guidelines. The recent publication of large randomized clinical trials conducted worldwide has provided new evidence regarding the clinical usefulness of ICI guidance in PCI. The consistent reduction of adverse events achieved in these trials, also demonstrated in an updated meta-analysis, suggested that the use of ICI in PCI is compelling to achieve optimal technical results and better outcomes, especially in complex high-risk interventions. Also considering the burden of information provided by ICI on coronary artery disease, looking from the inside seems today an opportunity that modern cardiology cannot ignore anymore.
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Affiliation(s)
- Flavio Giuseppe Biccirè
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome
- Centro per la Lotta contro l’Infarto, CLI Foundation, Rome
- Dept. of General and Specialized Surgery “Paride Stefanini”, Sapienza University of Rome, Rome
| | - Laura Gatto
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome
- Centro per la Lotta contro l’Infarto, CLI Foundation, Rome
| | - Francesco Prati
- Cardiovascular Sciences Department, San Giovanni Addolorata Hospital, Rome
- Centro per la Lotta contro l’Infarto, CLI Foundation, Rome
- Cardiology, UniCamillus, Saint Camillus International University of Health Sciences, Rome
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9
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Fuster V. Editor-in-Chief's Top Picks From 2023. J Am Coll Cardiol 2024; 83:961-1026. [PMID: 38448128 DOI: 10.1016/j.jacc.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Each week, I record audio summaries for every paper in JACC, as well as an issue summary. This process has become a true labor of love due to the time they require, but I am motivated by the sheer number of listeners (16M+), and it has allowed me to familiarize myself with every paper that we publish. Thus, I have selected the top 100 papers (Original Investigations, Review Articles, Society Documents, and the Global Burden of Diseases) from distinct specialties each year. In addition to my personal choices, I have included papers that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these abstracts in this issue of JACC, as well as their Central Illustrations∗ and podcasts. The highlights comprise the following sections: Aorta; Basic and Translational Science; Cardiac Failure, Myocarditis, and Pericarditis; Cardiomyopathies and Genetics; Congenital Heart Disease; Coronary, Peripheral, and Structural Interventions; Coronavirus; Health Promotion and Preventive Cardiology; Imaging; Metabolic and Lipid Disorders; Neurovascular Disease and Dementia; Rhythm Disorders and Thromboembolism; and Valvular Heart Disease.1-104 ∗ To view the full manuscript, including the full-sized Central Illustration, please refer to the original publication in JACC.
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10
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Shah PK. Aggressive Low-Density Lipoprotein Cholesterol Lowering Soon After Acute Coronary Syndrome: Should We Hit Early and Hit Hard? Am J Cardiol 2024; 214:180-181. [PMID: 38160926 DOI: 10.1016/j.amjcard.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/02/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Prediman K Shah
- The Smidt Heart Institute and Oppenheimer Atherosclerosis Research Center, Department of Cardiology, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, California.
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11
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Dimitriadis K, Pyrpyris N, Tsioufis K. The potential future role of extensive lipid lowering in ACS patients with the use of PCSK9 inhibitors: early bird catches the worm. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:85-86. [PMID: 37977850 DOI: 10.1093/ehjcvp/pvad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27, Athens, Greece
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27, Athens, Greece
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12
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Wu NQ, Li ZF, Lu MY, Li JJ. Monoclonal antibodies for dyslipidemia in adults: a focus on vulnerable patients groups. Expert Opin Biol Ther 2024:1-13. [PMID: 38375817 DOI: 10.1080/14712598.2024.2321374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Dyslipidemia significantly contributes to atherosclerotic cardiovascular disease (ASCVD). Patients with lipid-rich vulnerable plaques are particularly susceptible to cardiovascular complications. Despite available lipid-lowering therapies (LLTs), challenges in effective lipid management remain. AREAS COVERED This article reviews monoclonal antibody (mAb) therapy in dyslipidemia, particularly focusing on vulnerable plaques and patients. We have reviewed the definitions of vulnerable plaques and patients, outlined the efficacy of traditional LLTs, and discussed in-depth the mAbs targeting PCSK9. We extensively discuss the potential mechanisms, intracoronary imaging, and clinical evidence of PCSK9mAbs in vulnerable plaques and patients. A brief overview of promising mAbs targeting other targets such as ANGPTL3 is also provided. EXPERT OPINION Research consistently supports the potential of mAb therapies in treating adult dyslipidemia, particularly in vulnerable patients. PCSK9mAbs are effective in regulating lipid parameters, such as LDL-C and Lp(a), and exhibit anti-inflammatory and anti-thrombotic properties. These antibodies also maintain endothelial and smooth muscle health, contributing to the stabilization of vulnerable plaques and reduction in adverse cardiovascular events. Future research aims to further understand PCSK9 and other targets like ANGPTL3, focusing on vulnerable groups. Overall, mAbs are emerging as a promising and superior approach in dyslipidemia management and cardiovascular disease prevention.
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Affiliation(s)
- Na-Qiong Wu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Zhi-Fan Li
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Meng-Ying Lu
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Cardiometabolic Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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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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14
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Montalescot G, Granger C, Procopi N. Lipid Lowering After Myocardial Infarction: Too Little, Too Late. J Am Coll Cardiol 2023; 82:1748-1750. [PMID: 37879778 DOI: 10.1016/j.jacc.2023.08.038] [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: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Gilles Montalescot
- ACTION Group, Sorbonne University, Institute of Cardiology (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.
| | - Camille Granger
- ACTION Group, Sorbonne University, Institute of Cardiology (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
| | - Niki Procopi
- ACTION Group, Sorbonne University, Institute of Cardiology (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
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