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Cicero AFG, Fogacci F, Giovannini M, Rizzoli E, Grandi E, D’Addato S, Borghi C. The Effect of Dietary Supplementation with Plant Sterols on Total and LDL-Cholesterol in Plasma Is Affected by Adherence to Mediterranean Diet: Insights from the DESCO Randomized Clinical Study. Nutrients 2023; 15:4555. [PMID: 37960208 PMCID: PMC10649106 DOI: 10.3390/nu15214555] [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: 10/02/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Plant sterols are well-known natural lipid-lowering agents. The DESCO (Diet and plant sterols in the control of cholesterolemia) study was a single-center, randomized, double-blind, placebo-controlled, two-way crossover clinical trial designed to investigate the effect of a once-a-day ready-to-drink dietary supplement containing 2.5 g of phytosterols on the lipid profile, also in relation to the quality of the diet, in a cohort of 50 Italian individuals with polygenic hypercholesterolemia and low global cardiovascular risk. Eligible individuals were enrolled in a run-in period of 2 weeks. Then, participants who qualified for continuation in the study were randomly allocated (1:1) to a 3-week treatment with either phytosterols or placebo. After a 2-week washout period, enrolled individuals were crossed over to receive the alternative treatment. Dietary supplementation with phytosterols was associated with significant improvement in plasma levels of total cholesterol (TC; -11.8 ± 4.0 mg/dL, p = 0.016), low-density lipoprotein cholesterol (LDL-C; -7.8 ± 7.7 mg/dL, p = 0.021), and apolipoprotein B-100 (Apo B-100, -3.7 ± 4.1 mg/dL, p = 0.048) compared to baseline. The changes in TC and LDL-C were also significant compared to placebo, and greater adherence to the Mediterranean diet was significantly associated with greater reductions in LDL-C. Dietary supplementation with phytosterols was well tolerated and adherence to treatment was high. According to the findings of DESCO, the once-a-day ready-to-drink dietary supplement we tested is able to quickly and significantly decrease plasma levels of TC, LDL-C, and Apo B-100, with a greater effect in individuals more adhering to the Mediterranean dietary pattern.
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Affiliation(s)
- Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy; (A.F.G.C.); (M.G.); (E.R.); (E.G.); (S.D.); (C.B.)
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy; (A.F.G.C.); (M.G.); (E.R.); (E.G.); (S.D.); (C.B.)
- Italian Nutraceutical Society (SINut), 40100 Bologna, Italy
| | - Marina Giovannini
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy; (A.F.G.C.); (M.G.); (E.R.); (E.G.); (S.D.); (C.B.)
| | - Elisabetta Rizzoli
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy; (A.F.G.C.); (M.G.); (E.R.); (E.G.); (S.D.); (C.B.)
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | - Elisa Grandi
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy; (A.F.G.C.); (M.G.); (E.R.); (E.G.); (S.D.); (C.B.)
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | - Sergio D’Addato
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy; (A.F.G.C.); (M.G.); (E.R.); (E.G.); (S.D.); (C.B.)
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy; (A.F.G.C.); (M.G.); (E.R.); (E.G.); (S.D.); (C.B.)
- IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, Italy
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Insani WN, Whittlesea C, Ju C, Man KKC, Alwafi H, Alsharif A, Chapman S, Wei L. Statin-related adverse drug reactions in UK primary care consultations: A retrospective cohort study to evaluate the risk of cardiovascular events and all-cause mortality. Br J Clin Pharmacol 2022; 88:4902-4914. [PMID: 35695656 PMCID: PMC9796911 DOI: 10.1111/bcp.15438] [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: 01/06/2022] [Revised: 04/28/2022] [Accepted: 06/05/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS To investigate the risk of cardiovascular disease (CVD) events and all-cause mortality in patients with statin-related adverse drug reaction (ADR) consultation in primary care and examine whether different treatments following the ADR affect subsequent outcomes. METHODS This was a retrospective cohort study of statin users between 2004 and 2019 using IQVIA Medical Research Data (formally known as the THIN database). Patients with statin-related ADR consultation were matched by propensity score (1:1) to statin users without ADR consultation based on demographics, comorbidities and concomitant medication. Cox proportional hazard regression was used to compare the risk of subsequent CVD event and all-cause mortality, stratified by history of CVD. In the secondary analysis among patients with statin-related ADR, treatment changes within a 1-year period following the ADR were examined and the outcomes were compared between different treatment groups. RESULTS Among 1 564 687 statin users, 19 035 (1.22%) had a statin-related ADR consultation in primary care. The mean (standard deviation) follow-up time was 6.32 (3.74) years and 5.31 (3.83) years for CVD primary and secondary prevention cohorts, respectively. Statin-related ADR consultation was associated with subsequent CVD events in both cohorts (adjusted hazard ratio [HR] of 1.39 [95% CI 1.23, 1.57] and 1.34 [95% CI 1.25,1.42], respectively). In the secondary analysis among patients with statin-related ADR consultation, we found that (i) continued statin prescription or combination of any statin with additional lipid-lowering treatment (LLT) and (ii) other LLT only were associated with lower risks of CVD event (adjusted HR 0.71 [95% CI 0.64, 0.78] and 0.75 [95% CI 0.62, 0.92], respectively) and all-cause mortality (adjusted HR 0.46 [95% CI 0.42, 0.50] and 0.52 [95% CI, 0.43, 0.64], respectively), compared to discontinuation of all LLT. CONCLUSION Statin-related ADR was associated with an increased risk of subsequent CVD event, indicating that these patients should be monitored more closely. Continued lipid-lowering medication is of importance to protect against CVD events and mortality.
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Affiliation(s)
- Widya N. Insani
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacology and Clinical Pharmacy, Centre of Excellence for Pharmaceutical Care InnovationPadjadjaran UniversityBandungIndonesia
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK
| | - Chengsheng Ju
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and ResearchUniversity of Hong KongHong Kong Special Administrative RegionChina,Laboratory of Data Discovery for HealthHong Kong Science ParkHong Kong Special Administrative RegionChina
| | - Hassan Alwafi
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Faculty of MedicineUmm Al Qura UniversityMeccaSaudi Arabia
| | - Alaa Alsharif
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacy Practice, Faculty of PharmacyPrincess Nourah bint Abdulrahman UniversityRiyadhSaudi Arabia
| | - Sarah Chapman
- Department of Pharmacy and PharmacologyUniversity of BathBathUK
| | - Li Wei
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Laboratory of Data Discovery for HealthHong Kong Science ParkHong Kong Special Administrative RegionChina
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Fogacci F, Giovannini M, Grandi E, Imbalzano E, Degli Esposti D, Borghi C, Cicero AFG. Management of High-Risk Hypercholesterolemic Patients and PCSK9 Inhibitors Reimbursement Policies: Data from a Cohort of Italian Hypercholesterolemic Outpatients. J Clin Med 2022; 11:jcm11164701. [PMID: 36012937 PMCID: PMC9410302 DOI: 10.3390/jcm11164701] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective and safe lipid-lowering treatments (LLT). The primary endpoint of the study was to assess the prevalence of patients eligible for treatment with PCSK9 inhibitors in a real-life clinical setting in Italy before and after the recent enlargement of reimbursement criteria. For this study, we consecutively considered the clinical record forms of 6231 outpatients consecutively admitted at the Lipid Clinic of the University Hospital of Bologna (Italy). Patients were stratified according to whether they were allowed or not allowed to access to treatment with PCSK9 inhibitors based on national prescription criteria and reimbursement rules issued by the Italian Medicines Agency (AIFA). According to the indications of the European Medicines Agency (EMA), 986 patients were candidates to treatment with PCSK9 inhibitors. However, following the prescription criteria issued by AIFA, only 180 patients were allowed to access to PCSK9 inhibitors before reimbursement criteria enlargement while 322 (+14.4%) with the current ones. Based on our observations, low-cost tailored therapeutic interventions for individual patients can significantly reduce the number of patients potentially needing treatment with PCSK9 inhibitors among those who are not allowed to access to the treatment. The application of enlarged reimbursement criteria for PCSK9 inhibitors could mildly improve possibility to adequately manage high-risk hypercholesterolemic subjects in the setting of an outpatient lipid clinic.
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Affiliation(s)
- Federica Fogacci
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marina Giovannini
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elisa Grandi
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Daniela Degli Esposti
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Borghi
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Arrigo F. G. Cicero
- Hypertension and Atherosclerosis Research Group, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-512-142-224
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Cicero AFG, Fogacci F, Stoian AP, Vrablik M, Al Rasadi K, Banach M, Toth PP, Rizzo M. Nutraceuticals in the Management of Dyslipidemia: Which, When, and for Whom? Could Nutraceuticals Help Low-Risk Individuals with Non-optimal Lipid Levels? Curr Atheroscler Rep 2021; 23:57. [PMID: 34345932 PMCID: PMC8332568 DOI: 10.1007/s11883-021-00955-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review The aim of this review is to summarize the available clinical efficacy and safety data related to the most studied and used lipid-lowering nutraceuticals. Recent Findings A growing number of meta-analyses of randomized clinical trials supports the effectiveness and tolerability of some lipid-lowering nutraceuticals such as red yeast rice, plant sterols and stanols, soluble fibers, berberine, artichoke extracts, bergamot polyphenol fraction, garlic, green tea, and spiruline. No significant safety concern has been raised for the use of such products. Association of more lipid-lowering nutraceuticals and of some nutraceuticals with lipid-lowering drugs has been tested as well. Summary Current evidence suggests that some clinically tested lipid-lowering nutraceuticals could be safely used to improve plasma lipid levels in subjects affected by mild-to-moderate dyslipidaemia with low cardiovascular risk.
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Affiliation(s)
- Arrigo F G Cicero
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy. .,Italian Society of Nutraceuticals (SINut), Bologna, Italy. .,IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy. .,Atherosclerosis Research Center, University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy.
| | - Federica Fogacci
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.,Italian Society of Nutraceuticals (SINut), Bologna, Italy.,IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Anca Pantea Stoian
- Faculty of Medicine, Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Michal Vrablik
- Third Department of Internal Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Łódź, Poland
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA.,Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manfredi Rizzo
- Italian Society of Nutraceuticals (SINut), Bologna, Italy.,Faculty of Medicine, Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Palermo, Italy
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Derosa G, Colletti A, Maffioli P, D'Angelo A, Lupi A, Zito GB, Mureddu GF, Raddino R, Fedele F, Cicero AFG. Lipid-lowering nutraceuticals update on scientific evidence. J Cardiovasc Med (Hagerstown) 2021; 21:845-859. [PMID: 32639326 DOI: 10.2459/jcm.0000000000000970] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
: Cardiovascular diseases (CVDs) are the main cause of mortality worldwide. Risk factors of CVD can be classified into modifiable (smoking, hypertension, diabetes, hypercholesterolemia) through lifestyle changes or taking drug therapy and not modifiable (age, ethnicity, sex and family history). Elevated total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C) levels have a lead role in the development of coronary heart disease (CHD), while high levels of high-density lipoprotein-cholesterol (HDL-C) seem to have a protective role.The current treatment for dyslipidemia consists of lifestyle modification or drug therapy even if not pharmacological treatment should be always considered in addition to lipid-lowering medications.The use of lipid-lowering nutraceuticals alone or in association with drug therapy may be considered when the atherogenic cholesterol goal was not achieved.These substances can be classified according to their mechanisms of action into natural inhibitors of intestinal cholesterol absorption, inhibitors of hepatic cholesterol synthesis and enhancers of the excretion of LDL-C. Nevertheless, many of them are characterized by mixed or unclear mechanisms of action.The use of these nutraceuticals is suggested in individuals with borderline lipid profile levels or with drug intolerance, but cannot replace standard lipid-lowering treatment in patients at high, or very high CVD risk.Nutraceuticals can also have vascular effects, including improvement in endothelial dysfunction and arterial stiffness, as well as antioxidative properties. Moreover, epidemiological and clinical studies reported that in patients intolerant of statins, many nutraceuticals with demonstrated hypolipidemic effect are well tolerated.
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Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, PAVIA; SINut (Italian Society of Nutraceuticals)
| | - Alessandro Colletti
- Department of Medical and Surgical Sciences, University of Bologna, BOLOGNA; SINut (Italian Society of Nutraceuticals)
| | - Pamela Maffioli
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, PAVIA; SINut (Italian Society of Nutraceuticals)
| | - Angela D'Angelo
- Department of Internal Medicine and Therapeutics, University of Pavia, Fondazione IRCCS Policlinico San Matteo, PAVIA; SINut (Italian Society of Nutraceuticals)
| | - Alessandro Lupi
- Cardiology Unit, Ospedali Riuniti di Domodossola e Verbania, OMEGNA; CFC (Federative College of Cardiology)
| | - Giovanni B Zito
- ASL Naples 3 SOUTH, NAPLES; ARCA (Regional Association of Ambulatorial Cardiologists)
| | - Gian Francesco Mureddu
- Cardiology Unit - San Giovanni Addolorata Hospital, ROME; AICPR (Italian Association of Clinical, Preventive and Rehabilitative Cardiology)
| | - Riccardo Raddino
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, BRESCIA; SIRC (Italian Society of Cardiovascular Research)
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Anesthesiology, Nephrology and Geriatric Sciences, Sapienza University of Rome, ROME; INCRC (Cardiovascular Research Consortium)
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, University of Bologna, BOLOGNA; SINut (Italian Society of Nutraceuticals)
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Abstract
PURPOSE OF REVIEW Statins are highly effective therapies for reducing low-density lipoprotein cholesterol and preventing cardiovascular events. However, many patients taking statins experience statin-associated muscle symptoms. In the current manuscript, we review algorithms to define statin intolerance and approaches to optimize cardiovascular risk reduction and reduce the nocebo effect among individuals reporting statin-associated muscle pain. RECENT FINDINGS Patients with statin intolerance have a higher cardiovascular event risk. These data underscore the need to apply clinical strategies that improve treatment utilization and adherence of patients experiencing statin-related side effects. Recent data have shown that the nocebo effect is frequent with statin therapy. This may be explained by the high frequency of muscle symptoms in the general population and media misinformation. When statins even at a low dosage are not tolerated other therapies can be used such as fibrate, ezetimibe nutraceuticals and antiPCSK9 antibodies. Recent data have identified other alternative therapeutic strategies such as bempedoic acid. SUMMARY There are multiple strategies for the management of statin-intolerance, both pharmacological and nonpharmacological. Patient involvement in the justification of statin treatment indication and therapeutic choice is the first step to overcome misbelief and reduce nocebo effect.
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Affiliation(s)
- Antonio Gallo
- Department of Endocrinology and Cardiovascular Disease Prevention, Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
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Cicero AFG, Fogacci F, Zambon A. Red Yeast Rice for Hypercholesterolemia: JACC Focus Seminar. J Am Coll Cardiol 2021; 77:620-628. [PMID: 33538260 DOI: 10.1016/j.jacc.2020.11.056] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023]
Abstract
The extracts of red yeast rice (RYR) are currently the most effective cholesterol-lowering nutraceuticals. This activity is mainly due to monacolin K, a weak reversible inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, whose daily consumption causes a reduction in low-density lipoprotein (LDL)-cholesterol plasma levels up to 15% to 25% within 6 to 8 weeks. The decrease in LDL-cholesterol is accompanied by a proportional decrease in total and non-high-density lipoprotein cholesterol, plasma apolipoprotein B, and high-sensitivity C-reactive protein. Some trials suggest that RYR use is associated with improvement in endothelial function and arterial stiffness, whereas a long-term study supports its role in the prevention of cardiovascular events. Despite the statin-like mechanism of action, the risk related to 3 to 10 mg monacolin K taken per day is minimal (mild myalgia in previously severely statin-intolerant subjects). RYR could represent a therapeutic tool to support lifestyle improvement in managing mild to moderate hypercholesterolemia in low-risk patients, including those who cannot be treated with statins or other LDL-cholesterol-lowering therapies.
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Affiliation(s)
- Arrigo F G Cicero
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy.
| | - Federica Fogacci
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy
| | - Alberto Zambon
- Department of Medicine-DIMED, University of Padua, Padua, Italy
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8
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Latest Updates on Lipid Management. High Blood Press Cardiovasc Prev 2019; 26:85-100. [PMID: 30877603 DOI: 10.1007/s40292-019-00306-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/14/2019] [Indexed: 12/15/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide. Despite the clinical long-term and near-term benefits of lowering cholesterol in, respectively, primary and secondary prevention of ASCVD, cholesterol levels remain under-treated, with many patients not achieving their recommended targets. The present article will review the latest updates on lipid management with emphases on the different classes of cholesterol-lowering agents and their clinical uses.
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Scicali R, Di Pino A, Ferrara V, Urbano F, Piro S, Rabuazzo AM, Purrello F. New treatment options for lipid-lowering therapy in subjects with type 2 diabetes. Acta Diabetol 2018; 55:209-218. [PMID: 29260404 DOI: 10.1007/s00592-017-1089-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/11/2017] [Indexed: 12/15/2022]
Abstract
Dyslipidemias represent a variety of quantitative and/or qualitative lipoprotein abnormalities. According to etiology, we distinguish primary dyslipidemias with strictly genetic background and secondary ones with their origin in other disease or pathological states. Diabetic dyslipidemia is a type of secondary dyslipidemia and plays an important role in determining the cardiovascular risk of subjects with type 2 diabetes. In these patients, insulin resistance is responsible for overproduction and secretion of atherogenic very low density lipoprotein. In addition, insulin resistance promotes the production of small dense low-density lipoprotein (LDL) and reduces high-density lipoprotein (HDL) production. Cardiovascular disease remains a leading cause of morbidity and mortality in diabetic patients. Previous results support the role for small, dense LDL particles in the etiology of atherosclerosis and their association with coronary artery disease. Moreover, lowering LDL cholesterol reduces the risk of cardiovascular death. Therefore, the European guidelines for the management of dyslipidemias recommend an LDL cholesterol goal < 100 mg/dL in diabetic subjects without cardiovascular events. Moreover, if triglycerides (TG) are elevated (> 400 mg/dL), they recommend a non-HDL cholesterol goal < 130 mg/dL in diabetic individuals without cardiovascular events. Statins are the first line of LDL-lowering therapy in diabetic patients and combined therapy with ezetimibe and statins could be useful in very high cardiovascular risk diabetic subjects. Furthermore, the effect of a fibrate as an add-on treatment to a statin could improve the lipid profile in diabetic individuals with high TG and low HDL cholesterol. Regarding new therapies, recent data from phase III trials show that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors considerably decrease LDL cholesterol. Thus, they may be useful in diabetic patients with concomitant diseases such as familial dyslipidemia, recurrent cardiovascular events, and elevated LDL cholesterol after second drug administration in addition to maximal statin dose or statin intolerance.
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Affiliation(s)
- Roberto Scicali
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonino Di Pino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Viviana Ferrara
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesca Urbano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Agata Maria Rabuazzo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi Hospital, University of Catania, Via Palermo, 636, 95122, Catania, Italy.
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Ward NC, Pang J, Ryan JDM, Watts GF. Nutraceuticals in the management of patients with statin-associated muscle symptoms, with a note on real-world experience. Clin Cardiol 2018; 41:159-165. [PMID: 29363784 DOI: 10.1002/clc.22862] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/16/2017] [Accepted: 11/21/2017] [Indexed: 12/21/2022] Open
Abstract
There is considerable evidence for the role of low-density lipoprotein cholesterol (LDL-C) in the development of atherosclerotic cardiovascular disease. Although statin therapy remains the most frequency prescribed medication to reduce LDL-C and lower risk of cardiovascular disease, a considerable number of patients develop muscle-related side affects. This review summarizes recent literature supporting the role of nutraceuticals as LDL-C-lowering therapy in statin-intolerant patients, with evidence from our own clinical practices.
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Affiliation(s)
- Natalie C Ward
- School of Medicine, Faculty of Health & Medical Sciences, University of Western Australia, Perth.,School of Biomedical Sciences and Curtin Health Innovation Research Institute, Perth, Australia
| | - Jing Pang
- School of Medicine, Faculty of Health & Medical Sciences, University of Western Australia, Perth.,Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Jacqueline D M Ryan
- School of Medicine, Faculty of Health & Medical Sciences, University of Western Australia, Perth.,Perth Lipid Clinic, Primary Care, Perth, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health & Medical Sciences, University of Western Australia, Perth.,Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, Australia
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Cicero AFG, Fogacci F, Colletti A. Commentary to: "The Effects of Coenzyme Q10 Supplementation on Blood Pressures Among Patients with Metabolic Diseases: A Systematic Review and Meta-analysis of Randomized Controlled Trials". High Blood Press Cardiovasc Prev 2018; 25:51-52. [PMID: 29352426 DOI: 10.1007/s40292-018-0248-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 01/06/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Arrigo F G Cicero
- Atherosclerosis Research Unit, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi Hospital-University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy.
| | - Federica Fogacci
- Atherosclerosis Research Unit, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi Hospital-University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
| | - Alessandro Colletti
- Atherosclerosis Research Unit, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi Hospital-University of Bologna, Via Albertoni, 15, 40138, Bologna, Italy
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Cicero AF, Colletti A, Bajraktari G, Descamps O, Djuric DM, Ezhov M, Fras Z, Katsiki N, Langlois M, Latkovskis G, Panagiotakos DB, Paragh G, Mikhailidis DP, Mitchenko O, Paulweber B, Pella D, Pitsavos C, Reiner Ž, Ray KK, Rizzo M, Sahebkar A, Serban MC, Sperling LS, Toth PP, Vinereanu D, Vrablík M, Wong ND, Banach M. Lipid lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Arch Med Sci 2017; 13:965-1005. [PMID: 28883839 PMCID: PMC5575230 DOI: 10.5114/aoms.2017.69326] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/28/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Arrigo F.G. Cicero
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Italian Society of Nutraceuticals (SINut)
| | - Alessandro Colletti
- Department of Medicine and Surgery Sciences, University of Bologna, Bologna, Italy; Italian Society of Nutraceuticals (SINut)
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo; Medical Faculty, University of Prishtina, Prishtina, Kosovo; Kosovo Society of Caridology
| | - Olivier Descamps
- Institute of Medical Physiology “Richard Burian“, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Serbian Association for Arteriosclerosis, Thrombosis and Vascular Biology Research
| | - Dragan M. Djuric
- Institute of Medical Physiology “Richard Burian“, Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Serbian Association for Arteriosclerosis, Thrombosis and Vascular Biology Research
| | - Marat Ezhov
- Russian Cardiology Research and Production Centre, Moscow, Russia; Russian National Atherosclerosis Society
| | - Zlatko Fras
- Preventive Cardiology Unit, Department of Vascular Medicine, Division of Internal Medicine, University Medical Centre Ljubljana, Slovenia; Chair for Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia; Slovenian Society of Cardiology
| | - Niki Katsiki
- Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Michel Langlois
- Department of Laboratory Medicine, AZ Sint-Jan Hospital, Bruges, Belgium; Belgian Atheroclerosis Society
| | - Gustavs Latkovskis
- Faculty of Medicine and Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia; Baltic Atherosclerosis Society
| | - Demosthenes B. Panagiotakos
- School of Health Science and Education, Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Gyorgy Paragh
- Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary; Hungarian Atherosclerosis Society
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, Medical School, University College London (UCL), London, UK
| | - Olena Mitchenko
- 13Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Ukraine; Ukrainian Atherosclerosis Society
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Private Medical University, Salzburg, Austria; Austrian Atheroclerosis Society (AAS)
| | - Daniel Pella
- 1 Department of Internal Medicine, Faculty of Medicine, Pavol Jozef Safarik University, Košice, Slovakia; Slovak Association of Atherosclerosis
| | - Christos Pitsavos
- Cardiology Clinic, School of Medicine, University of Athens, Greece; Hellenic Atherosclerosis Society
| | - Željko Reiner
- University Hospital Centre Zagreb, School of Medicine University of Zagreb, Department of Internal Medicine, Zagreb, Croatia; Croatian Atherosclerosis Society
| | - Kausik K. Ray
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy; Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maria-Corina Serban
- Center for Interdisciplinary Research, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; Department of Functional Sciences, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania
| | - Laurence S. Sperling
- Division of Cardiology, Emory University, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Peter P. Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, Illinois, USA
| | - Dragos Vinereanu
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania; Department of Cardiology, University and Emergency Hospital, Bucharest, Romania; Romanian Society of Cardiology
| | - Michal Vrablík
- Third Department of Internal Medicine, First Medical Faculty, Charles University, Prague, Czech Republic; Czech Atherosclerosis Society
| | - Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, USA
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland; Lipid and Blood Pressure Meta-Analysis Collaboration (LBPMC) Group; Polish Lipid Association (PoLA)
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Mark L, Paragh G, Ray KK. The need for a new classification of cholesterol lowering therapies. Curr Med Res Opin 2017; 33:67-69. [PMID: 27599680 DOI: 10.1080/03007995.2016.1233102] [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] [Indexed: 10/21/2022]
Affiliation(s)
- Laszlo Mark
- a Bekes County Central Hospital Pandy Kalman Section , Department of Cardiology , Gyula , Hungary
| | - György Paragh
- b Medical and Health Science Centre , University of Debrecen, 1st Department of Medicine , Debrecen , Hungary
| | - Kausik K Ray
- c Department of Primary Care and Public Health , School of Public Health, Imperial College London , London , UK
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Mikhailidis DP, Katsiki N, Athyros VG. Adherence to statin treatment: an important issue in clinical practice. Curr Med Res Opin 2016; 32:1639-1640. [PMID: 27357858 DOI: 10.1080/03007995.2016.1207621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Dimitri P Mikhailidis
- a Department of Clinical Biochemistry (Vascular Disease Prevention Clinics) , Royal Free Hospital Campus, University College London Medical School, University College London (UCL) , London , UK
| | - Niki Katsiki
- b Second Propedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, Hippocration Hospital , Thessaloniki , Greece
| | - Vasilios G Athyros
- b Second Propedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, Hippocration Hospital , Thessaloniki , Greece
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