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Miller M. Pemafibrate and other triglyceride-lowering therapies to reduce risk of cardiovascular and metabolic disease. Curr Opin Cardiol 2024; 39:286-291. [PMID: 38482842 PMCID: PMC11150088 DOI: 10.1097/hco.0000000000001136] [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] [Indexed: 06/05/2024]
Abstract
PURPOSE OF REVIEW Although high triglycerides are consistently associated with elevated risk of cardiovascular disease (CVD), therapies that reduce triglyceride levels have inconsistently translated into reduced CVD risk. RECENT FINDINGS To date, three clinical trials have tested triglyceride-lowering therapies in patients with hypertriglyceridemia (HTG) and elevated risk of incident/recurrent CVD. In REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial), assignment to IPE, a highly purified eicosapentanoic acid (EPA), resulted in a 25% reduction in nonfatal myocardial infarction), nonfatal stroke, cardiovascular death, coronary revascularization and hospitalization for unstable angina. By contrast, the combination of EPA and docosahexanoic acid (DHA) carboxylic fatty acids used in the STRENGTH trial (Statin Residual Risk With Epanova in High Cardiovascular Risk Patients With Hypertriglyceridemia) failed to reduce CVD risk. Most recently, PROMINENT (Pemafibrate to Reduce Cardiovascular Outcomes by Reducing Triglycerides in Patients with Diabetes) also failed to demonstrate reduction in CVD events despite use of a potent triglyceride-lowering, fibric-acid derivative. However, improvement in HTG-associated metabolic complications (e.g. nonalcoholic fatty liver disease) was observed with pemafibrate as well as with another potent triglyceride-lowering therapy (i.e. pegozafermin). Moreover, trials are underway evaluating whether the most fatal metabolic complication of HTG, pancreatitis, may be reduced with highly potent triglyceride-lowering therapies (e.g. apolipoprotein C3 inhibitors). SUMMARY Taken together, HTG is associated with increased risk of CVD and attendant adverse metabolic sequalae. To this end, a potentially promising and evidence-based landscape is emerging for treating a clinical phenotype that in the past has been insufficiently addressed.
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Affiliation(s)
- Michael Miller
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania and Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Bäck M, Banach M, Braunschweig F, De Rosa S, Flachskampf FA, Kahan T, Ketelhuth DFJ, Lancellotti P, Larsson SC, Mellbin L, Nagy E, Savarese G, Szummer K, Wahl D. Editors' highlight picks from 2023 in EHJ Open. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae008. [PMID: 38390349 PMCID: PMC10882979 DOI: 10.1093/ehjopen/oeae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Magnus Bäck
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
- Nancy University Hospital, University of Lorraine and INSERM U1116, 54505 Vandoeuvre les Nancy Cedex, France
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz and Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Frank A Flachskampf
- Divisions of Clinical Physiology and Cardiology, Uppsala University Clinic, and the Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Thomas Kahan
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Daniel F J Ketelhuth
- Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Linda Mellbin
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Edit Nagy
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Gianluigi Savarese
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Karolina Szummer
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17176 Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Denis Wahl
- Nancy University Hospital, University of Lorraine and INSERM U1116, 54505 Vandoeuvre les Nancy Cedex, France
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Bäck M, Latini R. Metabolic syndrome cardiovascular risk prevention by omega-3 polyunsaturated fatty acids. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead115. [PMID: 38035039 PMCID: PMC10684293 DOI: 10.1093/ehjopen/oead115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Magnus Bäck
- CArdiovascularREsolution of INflammation to promote HEALTH (CARE-IN-HEALTH) Consortium
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Nancy University Hospital, University of Lorraine and INSERM U1116, 9 avenue de la Foret de Haye, BP 20199, 54505 Vandoeuvre les Nancy Cedex, France
| | - Roberto Latini
- CArdiovascularREsolution of INflammation to promote HEALTH (CARE-IN-HEALTH) Consortium
- Department of Acute Brain and Cardiovascular Injury, Istituto di Ricerche Farmacologiche Mario Negri—IRCCS, Via Mario Negri, 2, 20156 Milano, Italy
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