1
|
Long-term efficacy and safety of proprotein convertase subtilisin/kexin 9 monoclonal antibodies: A meta-analysis of 11 randomized controlled trials. J Clin Lipidol 2018; 12:277-291.e3. [PMID: 29428832 DOI: 10.1016/j.jacl.2018.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/12/2017] [Accepted: 01/04/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Monoclonal antibodies targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) have been shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) levels. OBJECTIVE The purpose of this study was to assess the long-term efficacy and safety of PCSK9 antibodies. METHODS PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov were searched for relevant studies. RESULTS A total of 11 studies including 38,235 participants who were treated for at least 48 weeks were included in this meta-analysis. The results suggested that PCSK9 antibody treatment significantly decreased LDL-C levels (mean difference, -50.23% [95% confidence interval {CI}, -56.65% to -43.82%]) compared with no PCSK9 antibody treatment and also decreased other atherogenic lipid fractions. PCSK9 antibody treatment also elicited a significant reduction in cardiovascular event rates compared with no antibody treatment (relative risk [RR], 0.86 [95% CI, 0.81-0.92]). This reduction consisted of separate significant reductions in the rates of myocardial infarction (RR, 0.73 [95% CI, 0.65-0.82]), coronary revascularization (RR, 0.79 [95% CI, 0.73-0.87]), and stroke (RR, 0.81 [95% CI, 0.68-0.96]). There were no clear differences in the incidences of treatment-emergent adverse events (TEAEs), serious TEAEs, or TEAEs of interest between the 2 groups; moreover, no differences between the 2 groups were found for other laboratory parameters. CONCLUSION PCSK9 antibodies have significant effects on reducing LDL-C levels and improve cardiovascular outcomes. These antibodies have a satisfactory safety profile, which suggests that they are suitable for use as a long-term treatment.
Collapse
|
2
|
Li J, Liang X, Wang Y, Xu Z, Li G. Investigation of highly expressed PCSK9 in atherosclerotic plaques and ox-LDL-induced endothelial cell apoptosis. Mol Med Rep 2017; 16:1817-1825. [PMID: 28656218 PMCID: PMC5561783 DOI: 10.3892/mmr.2017.6803] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 02/02/2017] [Indexed: 11/13/2022] Open
Abstract
The present study aimed to explore the direct toxicity of proprotein convertase subtilisin/kexin type 9 (PCSK9) to atherosclerosis (AS) and its association with apoptotic endothelial cells. Apolipoprotein E−/− mice were randomly divided into two groups, control and experimental. The control group was administered a normal diet and the experimental group was administered a high-fat diet. After 20 weeks, the aorta was isolated and dissected. Hematoxylin and eosin staining, and immunohistochemical analysis were performed. Human umbilical vein endothelial cells were incubated with varied concentrations of oxidized low-density lipoprotein (ox-LDL) for different times. The apoptotic rate was detected by flow cytometry. Western blotting and reverse transcription-quantitative polymerase chain reaction analysis were conducted to detect the expression of PCSK9, B-cell lymphoma 2 (Bcl-2), bcl-2-like protein 4 (Bax) and caspase-3. Short hairpin (sh) RNA-PCSK9 was transfected into endothelial cells using lentiviral transfection. The expression levels of PCSK9, Bax, Bcl-2, caspase-3 and the mitogen-activated protein kinase (MAPK) pathway proteins were detected. The high-fat group was successfully established as an AS model and PCSK9 was highly expressed in the AS plaque. Treatment with ox-LDL induced apoptosis and increased mRNA and protein levels of PCSK9. PCSK9 mRNA and proteins levels were downregulated by shRNA-PCSK9. The deficiency of PCSK9 markedly inhibited the expression of pro-apoptotic proteins and promoted anti-apoptotic proteins. In addition, phosphorylation of p38 and c-Jun N-terminal kinases was altered by shRNA-PCSK9. Targeting of PCSK9 by shRNA-PCSK9 may repress endothelial cell apoptosis through MAPK signaling in AS, providing a novel direction for understanding the mechanism and treatment of AS.
Collapse
Affiliation(s)
- Jiao Li
- Tianjin Key Laboratory of Ionic‑Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Xue Liang
- Tianjin Key Laboratory of Ionic‑Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Yuanyuan Wang
- Tianjin Key Laboratory of Ionic‑Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Zhao Xu
- Tianjin Key Laboratory of Ionic‑Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic‑Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| |
Collapse
|
3
|
Wang LR, Hegele RA. Genetics for the Identification of Lipid Targets Beyond PCSK9. Can J Cardiol 2017; 33:334-342. [DOI: 10.1016/j.cjca.2016.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/06/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022] Open
|
4
|
Toplak H, Ludvik B, Lechleitner M, Dieplinger H, Föger B, Paulweber B, Weber T, Watschinger B, Horn S, Wascher TC, Drexel H, Brodmann M, Pilger E, Rosenkranz A, Pohanka E, Oberbauer R, Traindl O, Roithinger FX, Metzler B, Haring HP, Kiechl S. Austrian Lipid Consensus on the management of metabolic lipid disorders to prevent vascular complications: A joint position statement issued by eight medical societies. 2016 update. Wien Klin Wochenschr 2017; 128 Suppl 2:S216-28. [PMID: 27052248 PMCID: PMC4839054 DOI: 10.1007/s00508-016-0993-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In 2010, eight Austrian medical societies proposed a joint position statement on the management of metabolic lipid disorders for the prevention of vascular complications. An updated and extended version of these recommendations according to the current literature is presented, referring to the primary and secondary prevention of vascular complications in adults, taking into consideration the guidelines of other societies. The "Austrian Lipid Consensus - 2016 update" provides guidance for individualized risk stratification and respective therapeutic targets, and discusses the evidence for reducing vascular endpoints with available lipid-lowering therapies. Furthermore, specific management in key patient groups is outlined, including subjects presenting with coronary, cerebrovascular, and/or peripheral atherosclerosis; diabetes mellitus and/or metabolic syndrome; nephropathy; and familial hypercholesterolemia.
Collapse
Affiliation(s)
- Hermann Toplak
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Bernhard Ludvik
- First Medical Department, Rudolfstiftung Hospital, Vienna, Austria
| | | | - Hans Dieplinger
- Department of Medical Genetics, Clinical and Molecular Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Föger
- Department of Internal Medicine, Bregenz Hospital, Bregenz, Austria
| | - Bernhard Paulweber
- First Medical Department, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Weber
- Department of Cardiology, Wels Hospital, Wels, Austria
| | - Bruno Watschinger
- Third Medical Department, Medical University of Vienna, Vienna, Austria
| | - Sabine Horn
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | | | - Heinz Drexel
- Department of Internal Medicine and Cardiology, Feldkirch Hospital, Feldkirch, Austria
| | - Marianne Brodmann
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Ernst Pilger
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Alexander Rosenkranz
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Erich Pohanka
- Medical Department, Linz General Hospital, Linz, Austria
| | | | - Otto Traindl
- First Medical Department, Mistelbach Hospital, Mistelbach, Austria
| | | | - Bernhard Metzler
- Third Medical Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Hans-Peter Haring
- First Department of Neurology, Kepler University Clinic, Linz, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
5
|
Hoe E, Hegele RA. Lipid Management in Diabetes with a Focus on Emerging Therapies. Can J Diabetes 2016; 39 Suppl 5:S183-90. [PMID: 26653256 DOI: 10.1016/j.jcjd.2015.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/07/2015] [Accepted: 09/17/2015] [Indexed: 11/18/2022]
Abstract
We reviewed the current and potential future management of dyslipidemia in patients with diabetes, with a focus on reduction of risk for macrovascular disease. We considered novel dyslipidemia therapies, in particular, inhibitors of proprotein convertase subtilisin kexin 9 (PCSK9), which have been approved in Canada for reducing low-density lipoprotein (LDL) cholesterol in certain patient groups. We searched for English-language randomized clinical trials (RCTs) of lipid-lowering modalities, mainly since 2012, that included patients with diabetes. The results from some RCTs may have future impacts on the approach to patients with diabetes. In particular, ezetimibe added to statins in the context of acute coronary syndromes seems to have particular benefits in patients with diabetes. Also, patients with diabetes show no differences, so far, from patients without diabetes with respect to efficacy of PCSK9 inhibitors in LDL cholesterol reduction and also in the frequency of adverse effects. RCTs of clinical outcomes with PCSK9 inhibitors performed exclusively in patients with diabetes are desirable, but approval of these agents for use in Canada has occurred before the availability of such results. Clinicians will have to gauge whether certain subjects with diabetes might benefit from this therapy, such as those with superimposed familial dyslipidemia, those with recurrent cardiovascular events and recalcitrant LDL cholesterol levels despite maximally tolerated statin therapy and those with high cardiovascular risk who cannot tolerate any dose of statins.
Collapse
MESH Headings
- Combined Modality Therapy/adverse effects
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/therapy
- Drug Therapy, Combination/adverse effects
- Drug Therapy, Combination/trends
- Drugs, Investigational/adverse effects
- Drugs, Investigational/therapeutic use
- Dyslipidemias/complications
- Dyslipidemias/prevention & control
- Humans
- Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects
- Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
- Hypolipidemic Agents/adverse effects
- Hypolipidemic Agents/therapeutic use
- Practice Guidelines as Topic
- Precision Medicine
- Proprotein Convertase 9
- Proprotein Convertases/antagonists & inhibitors
- Proprotein Convertases/metabolism
- Randomized Controlled Trials as Topic
- Serine Endopeptidases/metabolism
- Serine Proteinase Inhibitors/adverse effects
- Serine Proteinase Inhibitors/therapeutic use
Collapse
|
6
|
Affiliation(s)
- J. David Spence
- Stroke Prevention & Atherosclerosis Research CentreRobarts Research InstituteWestern UniversityLondonOntarioCanada
- Division of Clinical PharmacologyDepartment of MedicineWestern UniversityLondonOntarioCanada
| | - George K. Dresser
- Division of Clinical PharmacologyDepartment of MedicineWestern UniversityLondonOntarioCanada
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW We provide an overview of recent advances in the therapy of hypertriglyceridemia, focusing on several new therapies with potential for treating of familial chylomicronemia, other forms of hypertriglyceridemia, and for triglyceride-lowering in patients with other lipid disorders. RECENT FINDINGS Newer triglyceride-lowering modalities under evaluation include gene therapy for lipoprotein lipase deficiency (alipogene tiparvovec), and antisense oligonucleotides against mRNA for apolipoproteins B (mipomersen) and C3 (volanesorsen, ISIS 304801). Other potential therapies include small molecule inhibitors of microsomal triglyceride transfer protein (lomitapide) and diacylglycerol acyltransferase-1 (pradigastat), and a monoclonal antibody against angiopoietin-like protein 3 (REGN1500). There is also renewed interest in omega-3 fatty acids, and in developing potent and selective agonists of peroxisome proliferator-activated receptors. SUMMARY Several promising triglyceride-lowering therapies are at various stages of development; a few are even available in some markets. Although existing data suggest good biochemical efficacy, data on long-term clinical outcomes are still limited. For some therapies, cost will be an important consideration, and use will likely be restricted to orphan indications, for example very severe cases of hypertriglyceridemia as seen in familial chylomicronemia syndrome, although some therapies could theoretically be more broadly used one day for cardiovascular disease prevention.
Collapse
Affiliation(s)
- Steven E Gryn
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | |
Collapse
|
8
|
Gryn SE, Hegele RA. Ezetimibe plus simvastatin for the treatment of hypercholesterolemia. Expert Opin Pharmacother 2015; 16:1255-62. [DOI: 10.1517/14656566.2015.1041504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
9
|
Affiliation(s)
- Ruth McPherson
- From the Atherogenomics Laboratory, Ruddy Canadian Cardiovascular Genetics Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); and Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (R.A.H.)
| | - Robert A. Hegele
- From the Atherogenomics Laboratory, Ruddy Canadian Cardiovascular Genetics Centre, Department of Medicine, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.); and Department of Medicine, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (R.A.H.)
| |
Collapse
|
10
|
Relation of circulating PCSK9 concentration to fibrinogen in patients with stable coronary artery disease. J Clin Lipidol 2014; 8:494-500. [PMID: 25234562 DOI: 10.1016/j.jacl.2014.07.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/22/2022]
|
11
|
Abstract
PURPOSE OF REVIEW To review recent advances in the field of remnant cholesterol as a contributor to the development of ischemic heart disease (IHD). RECENT FINDINGS Epidemiologic, mechanistic, and genetic studies all support a role for elevated remnant cholesterol (=cholesterol in triglyceride-rich lipoproteins) as a contributor to the development of atherosclerosis and IHD. Observational studies show association between elevated remnant cholesterol and IHD, and mechanistic studies show remnant cholesterol accumulation in the arterial wall like LDL-cholesterol (LDL-C) accumulation. Furthermore, large genetic studies show evidence of remnant cholesterol as a causal risk factor for IHD independent of HDL-cholesterol levels. Genetic studies also show that elevated remnant cholesterol is associated with low-grade inflammation, whereas elevated LDL-C is not. There are several pharmacologic ways of lowering remnant cholesterol levels; however, it remains to be seen in large randomized clinical intervention trials if lowering of remnant cholesterol, in individuals with elevated levels, will reduce the risk of IHD. SUMMARY Evidence is emerging for elevated remnant cholesterol being a causal risk factor for IHD. Elevated remnant cholesterol levels likely are part of the explanation of the residual risk of IHD observed after LDL-C has been lowered to recommended levels.
Collapse
Affiliation(s)
- Anette Varbo
- aDepartment of Clinical Biochemistry bThe Copenhagen General Population Study, Herlev Hospital, Copenhagen University Hospital cFaculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | |
Collapse
|
12
|
Ghosh S, Bie J, Wang J, Yuan Q, Ghosh SS. Cholesterol removal from plaques and elimination from the body: change in paradigm to reduce risk for heart disease. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.14.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
13
|
Pharmacogenomics, lipid disorders, and treatment options. Clin Pharmacol Ther 2014; 96:36-47. [PMID: 24722394 DOI: 10.1038/clpt.2014.82] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 04/07/2014] [Indexed: 01/14/2023]
Abstract
Statins form the backbone of lipid-lowering therapy in the prevention of cardiovascular disease. Numerous studies have evaluated the effect of genomics on the clinical efficacy and adverse effects of statins. Several gene variants that can be linked to either the pharmacokinetics or pharmacodynamics of statins have been identified as potentially important, although there are some discrepant findings among studies. Effect sizes are modest for lipid-lowering efficacy and perhaps somewhat larger for risk of myopathy, although results are inconsistent. Pharmacogenomics of nonstatin lipid-lowering agents have not been evaluated to the same extent, given their relatively limited use, although there are some promising candidate genes for further study. Finally, with several new classes of lipid-lowering therapies soon becoming available, there may be a potential application for pharmacogenomics to identify patients ideally suited to receive-or those who should avoid-specific medications.
Collapse
|
14
|
Varbo A, Benn M, Nordestgaard BG. Remnant cholesterol as a cause of ischemic heart disease: Evidence, definition, measurement, atherogenicity, high risk patients, and present and future treatment. Pharmacol Ther 2014; 141:358-67. [DOI: 10.1016/j.pharmthera.2013.11.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 10/31/2013] [Indexed: 11/30/2022]
|
15
|
Nguyen MA, Kosenko T, Lagace TA. Internalized PCSK9 dissociates from recycling LDL receptors in PCSK9-resistant SV-589 fibroblasts. J Lipid Res 2013; 55:266-75. [PMID: 24296664 PMCID: PMC3886665 DOI: 10.1194/jlr.m044156] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Secreted PCSK9 binds to cell surface LDL receptor (LDLR) and directs the receptor for lysosomal degradation. PCSK9 is potent at inducing LDLR degradation in cultured liver-derived cells, but it is considerably less active in immortalized fibroblasts. We examined PCSK9 trafficking in SV-589 human skin fibroblasts incubated with purified recombinant wild-type PCSK9 or gain-of-function mutant PCSK9-D374Y with increased LDLR binding affinity. Despite LDLR-dependent PCSK9 uptake, cell surface LDLR levels in SV-589 fibroblasts were only modestly reduced by wild-type PCSK9, even at high nonphysiological concentrations (20 µg/ml). Internalized 125I-labeled wild-type PCSK9 underwent lysosomal degradation at high levels, indicating its dissociation from recycling LDLRs. PCSK9-D374Y (2 µg/ml) reduced cell surface LDLRs by approximately 50%, but this effect was still blunted compared with HepG2 hepatoma cells. Radioiodinated PCSK9-D374Y was degraded less efficiently in SV-589 fibroblasts, and Alexa488-labeled PCSK9-D374Y trafficked to both lysosomes and endocytic recycling compartments. Endocytic recycling assays showed that more than 50% of internalized PCSK9-D374Y recycled to the cell surface compared with less than 10% for wild-type PCSK9. These data support that wild-type PCSK9 readily dissociates from the LDLR within early endosomes of SV-589 fibroblasts, contributing to PCSK9-resistance. Although a large proportion of gain-of-function PCSK9-D374Y remains bound to LDLR in these cells, degradative activity is still diminished.
Collapse
Affiliation(s)
- My-Anh Nguyen
- Department of Pathology and Laboratory Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada K1Y 4W7
| | | | | |
Collapse
|
16
|
Kassner U, Wühle-Demuth M, Missala I, Humphries SE, Steinhagen-Thiessen E, Demuth I. Clinical utility gene card for: hyperlipoproteinemia, TYPE II. Eur J Hum Genet 2013; 22:ejhg2013271. [PMID: 24253857 DOI: 10.1038/ejhg.2013.271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ursula Kassner
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Marion Wühle-Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Isabelle Missala
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Institute Cardiovascular Sciences, University College London, London, UK
| | - Elisabeth Steinhagen-Thiessen
- 1] Lipid Clinic at the Interdisciplinary Metabolism Center, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany [2] The Berlin Aging Study II, Research Group on Geriatrics, Charité-Universitätsmedizin Berlin, Reinickendorfer Str. 61, Berlin, Germany
| | - Ilja Demuth
- 1] The Berlin Aging Study II, Research Group on Geriatrics, Charité-Universitätsmedizin Berlin, Reinickendorfer Str. 61, Berlin, Germany [2] Institute of Medical and Human Genetics, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| |
Collapse
|