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Marais AD, Blom DJ, Raal FJ. Management of hyperlipidaemia. S Afr Med J 2024; 114:e1016. [PMID: 38525564 DOI: 10.7196/samj.2024.v114i3.1964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Indexed: 03/26/2024] Open
Affiliation(s)
- A D Marais
- Division of Chemical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - D J Blom
- Division of Lipidology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - F J Raal
- Carbohydrate and Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder R, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macias JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. METHODS For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. FINDINGS Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. INTERPRETATION Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Heidemann BE, Marais AD, Mulder MT, Visseren FLJ, Roeters van Lennep JE, Stroes ESG, Riksen NP, van Vark-van der Zee LC, Blackhurst DM, Koopal C. Composition and distribution of lipoproteins after evolocumab in familial dysbetalipoproteinemia: A randomized controlled trial. J Clin Lipidol 2023; 17:666-676. [PMID: 37517914 DOI: 10.1016/j.jacl.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Proprotein convertase subtilisin kexin type 9 (PCSK9) monoclonal antibodies (mAbs) reduce fasting and post fat load cholesterol in non-HDL and intermediate density lipoprotein (IDL) in familial dysbetalipoproteinemia (FD). However, the effect of PCSK9 mAbs on the distribution and composition of atherogenic lipoproteins in patients with FD is unknown. OBJECTIVE To evaluate the effect of the PCSK9 mAb evolocumab added to standard lipid-lowering therapy in patients with FD on fasting and post fat load lipoprotein distribution and composition. METHODS Randomized placebo-controlled double-blind crossover trial comparing evolocumab (140 mg subcutaneous every 2 weeks) with placebo during two 12-week treatment periods. Patients received an oral fat load at the start and end of each treatment period. Apolipoproteins (apo) were measured with ultracentrifugation, gradient gel electrophoresis, retinyl palmitate and SDS-PAGE. RESULTS PCSK9 mAbs significantly reduced particle number of all atherogenic lipoproteins, with a stronger effect on smaller lipoproteins than on larger lipoproteins (e.g. IDL-apoB 49%, 95%confidence interval (CI) 41-59 and very low-density lipoprotein (VLDL)-apoB 33%, 95%CI 16-50). Furthermore, PCSK9 mAbs lowered cholesterol more than triglyceride (TG) in VLDL, IDL and low-density lipoprotein (LDL) (e.g. VLDL-C 48%, 95%CI 29-63%; and VLDL-TG 20%, 95%CI 6.3-41%). PCSK9 mAbs did not affect the post fat load response of chylomicrons. CONCLUSION PCSK9 mAbs added to standard lipid-lowering therapy in FD patients significantly reduced lipoprotein particle number, in particular the smaller and more cholesterol-rich lipoproteins (i.e. IDL and LDL). PCSK9 mAbs did not affect chylomicron metabolism. It seems likely that the observed effects are achieved by increased hepatic lipoprotein clearance, but the specific working mechanism of PCSK9 mAbs in FD patients remains to be elucidated.
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Affiliation(s)
- Britt E Heidemann
- Department of Vascular Medicine (Drs Heidemann, Visseren, Koopal), University Medical Center Utrecht, Utrecht University, The Netherlands
| | - A David Marais
- Division of Chemical Pathology (Drs Marais, Blackhurst), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Monique T Mulder
- Department of Internal Medicine (Drs Mulder, van Lennep, van Vark - van der Zee), Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine (Drs Heidemann, Visseren, Koopal), University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine (Drs Mulder, van Lennep, van Vark - van der Zee), Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine (Dr van Lennep), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine (Dr Stroes), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels P Riksen
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences (Dr Riksen), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leonie C van Vark-van der Zee
- Department of Internal Medicine (Drs Mulder, van Lennep, van Vark - van der Zee), Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dee M Blackhurst
- Division of Chemical Pathology (Drs Marais, Blackhurst), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charlotte Koopal
- Department of Vascular Medicine (Drs Heidemann, Visseren, Koopal), University Medical Center Utrecht, Utrecht University, The Netherlands
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Marais AD, Blom DJ, Raal FJ. Premature cardiovascular deaths. S Afr Med J 2023; 113:6-7. [PMID: 37882038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- A D Marais
- Division of Chemical Pathology, Department of Pathology, University of Cape Town Health Science Faculty.
| | - D J Blom
- Division of Lipidology, Department of Medicine, University of Cape Town Health Science Faculty, .
| | - F J Raal
- Carbohydrate and Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Rizzo M, Colletti A, Penson PE, Katsiki N, Mikhailidis DP, Toth PP, Gouni-Berthold I, Mancini J, Marais D, Moriarty P, Ruscica M, Sahebkar A, Vinereanu D, Cicero AFG, Banach M, Al-Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Gouni-Berthold I, Bhaskar S, Bielecka-Dąbrowa A, Bjelakovic B, Bruckert E, Bytyçi I, Cafferata A, Ceska R, Cicero AF, Chlebus K, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Gouni-Berthold I, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, John Mancini G, David Marais A, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Mohammad Nabavi S, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Serban MC, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh HI, Zhisheng J, Zirlik A. Nutraceutical approaches to non-alcoholic fatty liver disease (NAFLD): A position paper from the International Lipid Expert Panel (ILEP). Pharmacol Res 2023; 189:106679. [PMID: 36764041 DOI: 10.1016/j.phrs.2023.106679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even > 50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step of irreversible alterations of the liver parenchyma causing cirrhosis, about 1/6 of those who develop NASH are at risk also developing CV disease (CVD). More recently the acronym MAFLD (Metabolic Associated Fatty Liver Disease) has been preferred by many European and US specialists, providing a clearer message on the metabolic etiology of the disease. The suggestions for the management of NAFLD are like those recommended by guidelines for CVD prevention. In this context, the general approach is to prescribe physical activity and dietary changes the effect weight loss. Lifestyle change in the NAFLD patient has been supplemented in some by the use of nutraceuticals, but the evidence based for these remains uncertain. The aim of this Position Paper was to summarize the clinical evidence relating to the effect of nutraceuticals on NAFLD-related parameters. Our reading of the data is that whilst many nutraceuticals have been studied in relation to NAFLD, none have sufficient evidence to recommend their routine use; robust trials are required to appropriately address efficacy and safety.
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Affiliation(s)
- Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, Via del Vespro 141, 90127 Palermo, Italy.
| | - Alessandro Colletti
- Department of Science and Drug Technology, University of Turin, Turin, Italy
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, Medical School, University College London (UCL), London, UK
| | - Peter P Toth
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA; Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Ioanna Gouni-Berthold
- Department of Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Germany
| | - John Mancini
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Patrick Moriarty
- Division of Clinical Pharmacology, Division of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dragos Vinereanu
- Cardiology Department, University and Emergency Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular disease risk research center, Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy; IRCCS Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
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Heidemann BE, Koopal C, Roeters van Lennep JE, Stroes ES, Riksen NP, Mulder MT, van Vark-van der Zee LC, Blackhurst DM, Visseren FLJ, Marais AD. Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol measurement in Familial Dysbetalipoproteinemia. Clin Chim Acta 2023; 539:114-121. [PMID: 36493875 DOI: 10.1016/j.cca.2022.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
AIM To compare LDL-C concentrations using the Friedewald formula, the Martin-Hopkins formula, a direct assay and polyacrylamide gradient gel electrophoresis (PGGE) to the reference standard density gradient ultracentrifugation in patients with Familial Dysbetalipoproteinemia (FD) patients. We also compared non-HDL-cholesterol concentrations by two methods. METHODS For this study data from 28 patients with genetically confirmed FD from the placebo arm of the EVOLVE-FD trial were used. Four different methods for determining LDL-C were compared with ultracentrifugation. Non-HDL-C was measured with standard assays and compared to ultracentrifugation. Correlation coefficients and Bland-Altman plots were used to compare the methods. RESULTS Mean age of the 28 FD patients was 62 ± 9 years, 43 % were female and 93 % had an ɛ2ɛ2 genotype. LDL-C determined by Friedewald (R2 = 0.62, p <0.01), Martin-Hopkins (R2 = 0.50, p = 0.01) and the direct assay (R2 = 0.41, p = 0.03) correlated with density gradient ultracentrifugation. However, Bland-Altman plots showed considerable over- or underestimation by the four methods compared to ultracentrifugation. Non-HDL-C showed good correlation and agreement. CONCLUSION In patients with FD, all four methods investigated over- or underestimated LDL-C concentrations compared with ultracentrifugation. In contrast, standard non-HDL-C assays performed well, emphasizing the use of non-HDL-C in patients with FD.
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Affiliation(s)
- Britt E Heidemann
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Erik S Stroes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Niels P Riksen
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique T Mulder
- Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leonie C van Vark-van der Zee
- Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dee M Blackhurst
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa, Cape Town, South Africa
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - A David Marais
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa, Cape Town, South Africa
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Heidemann BE, Koopal C, Roeters van Lennep JE, Stroes ESG, Riksen NP, Mulder MT, -van der Zee LCVV, Blackhurst DM, Marais AD, Visseren FLJ. Effect of evolocumab on fasting and post fat load lipids and lipoproteins in familial dysbetalipoproteinemia. J Clin Lipidol 2023; 17:112-123. [PMID: 36384662 DOI: 10.1016/j.jacl.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Familial dysbetalipoproteinemia (FD) is the second most common monogenic lipid disorder (prevalence 1 in 850-3500), characterized by postprandial remnant accumulation and associated with increased cardiovascular disease (CVD) risk. Many FD patients do not achieve non-HDL-C treatment goals, indicating the need for additional lipid-lowering treatment options. OBJECTIVES To evaluate the effect of the PCSK9 monoclonal antibody evolocumab added to standard lipid-lowering therapy on fasting and post fat load lipids and lipoproteins in patients with FD. METHODS A randomized placebo-controlled double-blind crossover trial comparing evolocumab (140 mg subcutaneous every 2 weeks) with placebo during two 12-week treatment periods. At the start and end of each treatment period patients received an oral fat load. The primary endpoint was the 8-hour post fat load non-HDL-C area under the curve (AUC). Secondary endpoints included fasting and post fat load lipids and lipoproteins. RESULTS In total, 28 patients completed the study. Mean age was 62±9 years and 93% had an Ɛ2Ɛ2 genotype. Evolocumab reduced the 8-hour post fat load non-HDL-C AUC with 49% (95%CI 42-55) and apolipoprotein B (apoB) AUC with 47% (95%CI 41-53). Other fasting and absolute post fat load lipids and lipoproteins including triglycerides and remnant-cholesterol were also significantly reduced by evolocumab. However, evolocumab did not have significant effects on the rise above fasting levels that occurred after consumption of the oral fat load. CONCLUSIONS Evolocumab added to standard lipid-lowering therapy significantly reduced fasting and absolute post fat load concentrations of non-HDL-C, apoB and other atherogenic lipids and lipoproteins in FD patients. The clinically significant decrease in lipids and lipoproteins can be expected to translate into a reduction in CVD risk in these high-risk patients.
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Affiliation(s)
- Britt E Heidemann
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jeanine E Roeters van Lennep
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Niels P Riksen
- Department of Internal Medicine and Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique T Mulder
- Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Leonie C van Vark -van der Zee
- Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dee M Blackhurst
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - A David Marais
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
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8
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Heidemann BE, Bemelmans RHH, Marais AD, Visseren FLJ, Koopal C. Clinical heterogeneity in monogenic chylomicronaemia. BMJ Case Rep 2022; 15:15/11/e251411. [PMID: 36423940 PMCID: PMC9693862 DOI: 10.1136/bcr-2022-251411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Chylomicronaemia accompanies hypertriglyceridaemia, usually due to a polygenic predisposition in combination with secondary risk factors. Monogenic chylomicronaemia represents a small subgroup of patients with hypertriglyceridaemia. This article describes three patients and illustrates the heterogeneity in the presentation of monogenic chylomicronaemia. The first case is a man with mild hypertriglyceridaemia who is a compound heterozygote for two variants in the LMF1 gene, without relevant medical history. The second case is a woman who is a double heterozygote of variants in the LPL and APOA5 genes. She experienced pancreatitis. The third case is a man, with recurrent pancreatitis attributed to severe hypertriglyceridaemia and homozygous for a variant in the APOC2 gene. This article highlights that in patients with hypertriglyceridaemia, the absence of pancreatitis or the presence of mild hypertriglyceridaemia does not exclude monogenic chylomicronaemia. Genetic screening should be considered in patients with unexplained or severe hypertriglyceridaemia, to determine appropriate treatment and follow-up.
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Affiliation(s)
- Britt E Heidemann
- Department of Vascular Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Remy H H Bemelmans
- Department of Internal Medicine, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - A David Marais
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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9
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Heidemann BE, Prinssen M, Marais AD, Visseren FLJ, Koopal C. [An abnormal lipid profile: when to perform additional research for a genetic cause?]. Ned Tijdschr Geneeskd 2022; 166. [PMID: 36633039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Abnormalities in the lipid profile are common, but it is often not easy to determine their cause. After exclusion of secondary causes, a primary (genetic) cause of dyslipidaemia should be considered. The most common monogenic dyslipidaemia is familial hypercholesterolemia (FH), but there are other clinically relevant genetic dyslipidaemias, including familial dysbetalipoproteinaemia (FD), monogenic chylomicronaemia and hypoalphalipoproteinemia. It is important to make a genetic diagnosis because it may influence the prognosis of the patient, for determining appropriate treatment goals and because it is relevant for family members. This clinical viewpoint explains the diagnostic process of genetic dyslipidaemias using two cases.
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Affiliation(s)
- Britt E Heidemann
- Universitair Medisch Centrum Utrecht, afd. Vasculaire Geneeskunde, Utrecht
| | | | - A D Marais
- University of Cape Town, Faculty of Health Sciences, Division of Chemical Pathology, Cape Town, Zuid-Afrika
| | - Frank L J Visseren
- Universitair Medisch Centrum Utrecht, afd. Vasculaire Geneeskunde, Utrecht.,Contact: Frank L.J. Visseren
| | - Charlotte Koopal
- Universitair Medisch Centrum Utrecht, afd. Vasculaire Geneeskunde, Utrecht
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10
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Heidemann BE, Koopal C, Roeters Van Lennep JE, Stroes ES, Riksen NP, Mulder MT, Van Der Zee-Van Vark LC, Blackhurst DM, Marais AD, Visseren FLJ. Effect of evolocumab versus placebo added to standard lipid-lowering therapy on fasting and post fat load lipids and lipoproteins in familial dysbetalipoproteinemia. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Familial Dysbetalipoproteinemia (FD) is the second most common genetic lipid disorder (prevalence ranging from 1 in 1000–2500), characterized by impaired postprandial lipoprotein clearance and associated with increased cardiovascular (CVD) risk. The majority of FD patients do not achieve non-HDL-cholesterol treatment goals, indicating the medical need for additional lipid-lowering treatment options.
Purpose
To evaluate the effect of the PCSK9 monoclonal antibody evolocumab added to standard lipid-lowering therapy on fasting and post fat load lipids and lipoproteins in FD patients.
Methods
A randomized placebo-controlled double-blind crossover trial comparing evolocumab (140 mg subcutaneous every 2 weeks) with placebo during two 12 week treatment periods. At the start and end of each treatment period FD patients received an oral fat load. The primary endpoint was the 8 hour post fat load non-HDL-cholesterol level expressed as area under the curve (AUC). Levels of other fasting and post fat load lipids and (apo)lipoproteins were assessed with ultracentrifugation, polyacrylamide gels, retinyl palmitate and SDS-PAGE.
Results
In total, 28 patients completed the study. Mean age was 62±9 years and 93% had an ɛ2ɛ2 genotype. Compared with placebo, evolocumab reduced fasting non-HDL-cholesterol with 51% (95% CI 43–57) and the 8 hours post fat load non-HDL-cholesterol AUC with 49% (95% CI 42–55). Fasting triglyceride levels were reduced with 24% (95% CI 14–37) and the 8 hours post fat load triglyceride AUC was reduced with 22% (95% CI 11–29). Except for HDL-cholesterol, all fasting and 8 hour post fat load lipids and (apo)lipoproteins were significantly reduced by evolocumab, including apolipoprotein B (8 hour post fat load AUC reduction 47% (95% CI 41–53) and remnant cholesterol (8 hour post fat load AUC reduction 49% (95% CI −38 to 59)), compared with placebo. After treatment with evolocumab, 89% of patients achieved their non-HDL-cholesterol treatment goal compared with 36% after placebo.
Conclusion
Evolocumab added to standard lipid-lowering therapy significantly reduced fasting and post fat load non-HDL-cholesterol and other atherogenic lipids and lipoproteins in FD patients. This is the largest clinical trial in FD to date and the first to investigate evolocumab in this very high-risk group. The large decrease in fasting and post fat load lipids and lipoproteins will likely lower CVD risk in these patients.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AmgenThis project was funded by Amgen for an investigator-initiated research project. The University Medical Center Utrecht was the sponsor of the study. The financial funder had no role in the design, collection of the data, conduct of the analyses or reporting of the study results.
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Affiliation(s)
- B E Heidemann
- University Medical Center Utrecht, Vascular Medicine , Utrecht , The Netherlands
| | - C Koopal
- University Medical Center Utrecht, Vascular Medicine , Utrecht , The Netherlands
| | | | - E S Stroes
- Amsterdam UMC - Location Academic Medical Center, Vascular Medicine , Amsterdam , The Netherlands
| | - N P Riksen
- Radboud University Medical Center, Vascular Medicine , Nijmegen , The Netherlands
| | - M T Mulder
- Erasmus University Medical Centre, Internal Medicine , Rotterdam , The Netherlands
| | | | - D M Blackhurst
- University of Cape Town, Chemical Pathology , Cape Town , South Africa
| | - A D Marais
- University of Cape Town, Chemical Pathology , Cape Town , South Africa
| | - F L J Visseren
- University Medical Center Utrecht, Vascular Medicine , Utrecht , The Netherlands
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11
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Heidemann BE, Koopal C, Baass A, Defesche JC, Zuurbier L, Mulder MT, Roeters van Lennep JE, Riksen NP, Boot C, Marais AD, Visseren FLJ. Establishing the relationship between Familial Dysbetalipoproteinemia and genetic variants in the APOE gene. Clin Genet 2022; 102:253-261. [PMID: 35781703 PMCID: PMC9543580 DOI: 10.1111/cge.14185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
Abstract
Familial Dysbetalipoproteinemia (FD) is the second most common monogenic dyslipidemia and is associated with a very high cardiovascular risk due to cholesterol‐enriched remnant lipoproteins. FD is usually caused by a recessively inherited variant in the APOE gene (ε2ε2), but variants with dominant inheritance have also been described. The typical dysbetalipoproteinemia phenotype has a delayed onset and requires a metabolic hit. Therefore, the diagnosis of FD should be made by demonstrating both the genotype and dysbetalipoproteinemia phenotype. Next Generation Sequencing is becoming more widely available and can reveal variants in the APOE gene for which the relation with FD is unknown or uncertain. In this article, two approaches are presented to ascertain the relationship of a new variant in the APOE gene with FD. The comprehensive approach consists of determining the pathogenicity of the variant and its causal relationship with FD by confirming a dysbetalipoproteinemia phenotype, and performing in vitro functional tests and, optionally, in vivo postprandial clearance studies. When this is not feasible, a second, pragmatic approach within reach of clinical practice can be followed for individual patients to make decisions on treatment, follow‐up, and family counseling.
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Affiliation(s)
- Britt E Heidemann
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Alexis Baass
- Genetic Dyslipidemias Clinic of the Montreal Clinical Research Institute, Québec, Canada; Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Québec, Canada
| | - Joep C Defesche
- Department of Human Genetics, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Linda Zuurbier
- Department of Human Genetics, Amsterdam University Medical Centers, University of Amsterdam, Netherlands
| | - Monique T Mulder
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Niels P Riksen
- Department of Internal Medicine and Research Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Christopher Boot
- Department of Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - A David Marais
- Division of Chemical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; Cape Town, South Africa
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands
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12
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Penson PE, Bruckert E, Marais D, Reiner Ž, Pirro M, Sahebkar A, Bajraktari G, Mirrakhimov E, Rizzo M, Mikhailidis DP, Sachinidis A, Gaita D, Latkovskis G, Mazidi M, Toth PP, Pella D, Alnouri F, Postadzhiyan A, Yeh HI, Mancini GBJ, von Haehling S, Banach M, Al‐Khnifsawi M, Alnouri F, Amar F, Atanasov AG, Bajraktari G, Banach M, Bhaskar S, Bytyçi I, Bjelakovic B, Bruckert E, Cafferata A, Ceska R, Cicero AF, Collet X, Daccord M, Descamps O, Djuric D, Durst R, Ezhov MV, Fras Z, Gaita D, Hernandez AV, Jones SR, Jozwiak J, Kakauridze N, Kallel A, Katsiki N, Khera A, Kostner K, Kubilius R, Latkovskis G, Mancini GJ, Marais AD, Martin SS, Martinez JA, Mazidi M, Mikhailidis DP, Mirrakhimov E, Miserez AR, Mitchenko O, Mitkovskaya NP, Moriarty PM, Nabavi SM, Nair D, Panagiotakos DB, Paragh G, Pella D, Penson PE, Petrulioniene Z, Pirro M, Postadzhiyan A, Puri R, Reda A, Reiner Ž, Radenkovic D, Rakowski M, Riadh J, Richter D, Rizzo M, Ruscica M, Sahebkar A, Sattar N, Serban M, Shehab AM, Shek AB, Sirtori CR, Stefanutti C, Tomasik T, Toth PP, Viigimaa M, Valdivielso P, Vinereanu D, Vohnout B, von Haehling S, Vrablik M, Wong ND, Yeh H, Zhisheng J, Zirlik A. Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP). J Cachexia Sarcopenia Muscle 2022; 13:1596-1622. [PMID: 35969116 PMCID: PMC9178378 DOI: 10.1002/jcsm.12960] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin-associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3-5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)-what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real-world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step-by-step patient-centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long-term compliance with lipid-lowering therapy.
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Affiliation(s)
- Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Eric Bruckert
- Pitié-Salpetrière Hospital and Sorbonne University, Cardio metabolic Institute, Paris, France
| | - David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Matteo Pirro
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinic of Cardiology, University Clinical Centre of Kosova, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Internal Disease, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
| | - Erkin Mirrakhimov
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Diseases, Bishkek, Kyrgyzstan
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,Division of Endocrinology, Diabetes and Metabolism, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London Medical School, University College London (UCL), London, UK
| | - Alexandros Sachinidis
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Timisoara, Romania.,Clinica de Cardiologie, Institutul de Boli Cardiovasculare Timisoara, Timisoara, Romania
| | - Gustavs Latkovskis
- Pauls Stradins Clinical University Hospital, Riga, Latvia.,University of Latvia, Riga, Latvia
| | - Mohsen Mazidi
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - 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
| | - Daniel Pella
- 2nd Department of Cardiology of the East Slovak Institute of Cardiovascular Disease and Faculty of Medicine, PJ Safarik University, Kosice, Slovak Republic
| | - Fahad Alnouri
- Cardiovascular Prevention Unit, Adult Cardiology Department, Prince Sultan Cardiac Centre Riyadh, Riyadh, Saudi Arabia
| | - Arman Postadzhiyan
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - G B John Mancini
- Department of General Medicine, Emergency University Hospital 'St. Anna', Medical University of Sofia, Sofia, Bulgaria
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Maciej Banach
- Polish Moother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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Korf M, Zöllner EW, Solomon GEA, Zemlin AE, Marais AD. Hypertriglyceridaemia in adolescents may have serious complications. S Afr Med J 2022; 112:307-312. [PMID: 35587241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023] Open
Abstract
Acute pancreatitis is an often-overlooked cause of acute abdominal pain in children and adolescents. Severe hypertriglyceridaemia is an important cause of recurrent acute pancreatitis. Monogenic causes of hypertriglyceridaemia, such as familial chylomicronaemia caused by lipoprotein lipase deficiency, are more frequently encountered in children and adolescents, but remain rare. Polygenic hypertriglyceridaemia is more common, but may require a precipitant before manifesting. With the global increase in obesity and type 2 diabetes, secondary causes of hypertriglyceridaemia in children and adolescents are increasing. We report two cases of severe hypertriglyceridaemia and pancreatitis in adolescent females. Hypertriglyceridaemia improved markedly with restriction of dietary fat. An inhibitor to lipoprotein lipase was found to be the cause in one patient, while in the other limited genetic investigation excluded chylomicronaemia owing to deficiency of lipoprotein lipase, its activators and processing proteins.
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Affiliation(s)
- M Korf
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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14
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Chemello K, Blom DJ, Marais AD, Lambert G, Blanchard V. Genetic and Mechanistic Insights into the Modulation of Circulating Lipoprotein (a) Concentration by Apolipoprotein E Isoforms. Curr Atheroscler Rep 2022; 24:399-405. [PMID: 35355214 DOI: 10.1007/s11883-022-01016-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Lipoprotein (a) [Lp(a)] is a highly atherogenic lipoprotein species. A unique feature of Lp(a) is the strong genetic determination of its concentration. The LPA gene is responsible for up to 90% of the variance in Lp(a), but other genes also have an impact. RECENT FINDINGS Genome-wide associations studies indicate that the APOE gene, encoding apolipoprotein E (apoE), is the second most important locus modulating Lp(a) concentrations. Population studies clearly show that carriers of the apoE2 variant (ε2) display reduced Lp(a) levels, the lowest concentrations being observed in ε2/ε2 homozygotes. This genotype can lead predisposed adults to develop dysbetalipoproteinemia, a lipid disorder characterized by sharp elevations in cholesterol and triglycerides. However, dysbetalipoproteinemia does not significantly modulate circulating Lp(a). Mechanistically, apoE appears to impair the production but not the catabolism of Lp(a). These observations underline the complexity of Lp(a) metabolism and provide key insights into the pathways governing Lp(a) synthesis and secretion.
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Affiliation(s)
- Kévin Chemello
- Laboratoire Inserm, UMR 1188 DéTROI, Université de La Réunion, 2 Rue Maxime Rivière, 97490, Sainte Clotilde, France
| | - Dirk J Blom
- Division of Lipidology and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - A David Marais
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Gilles Lambert
- Laboratoire Inserm, UMR 1188 DéTROI, Université de La Réunion, 2 Rue Maxime Rivière, 97490, Sainte Clotilde, France.
| | - Valentin Blanchard
- Laboratoire Inserm, UMR 1188 DéTROI, Université de La Réunion, 2 Rue Maxime Rivière, 97490, Sainte Clotilde, France.,Departments of Medicine, Centre for Heart Lung Innovation, Providence Healthcare Research Institute, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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15
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Vallejo-Vaz AJ, Stevens CA, Lyons AR, Dharmayat KI, Freiberger T, Hovingh GK, Mata P, Raal FJ, Santos RD, Soran H, Watts GF, Abifadel M, Aguilar-Salinas CA, Alhabib KF, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Al-Sarraf A, Al-Sayed N, Araujo F, Ashavaid TF, Banach M, Béliard S, Benn M, Binder CJ, Bogsrud MP, Bourbon M, Chlebus K, Corral P, Davletov K, Descamps OS, Durst R, Ezhov M, Gaita D, Genest J, Groselj U, Harada-Shiba M, Holven KB, Kayikcioglu M, Khovidhunkit W, Lalic K, Latkovskis G, Laufs U, Liberopoulos E, Lima-Martinez MM, Lin J, Maher V, Marais AD, März W, Mirrakhimov E, Miserez AR, Mitchenko O, Nawawi H, Nordestgaard BG, Panayiotou AG, Paragh G, Petrulioniene Z, Pojskic B, Postadzhiyan A, Raslova K, Reda A, Reiner Ž, Sadiq F, Sadoh WE, Schunkert H, Shek AB, Stoll M, Stroes E, Su TC, Subramaniam T, Susekov AV, Tilney M, Tomlinson B, Truong TH, Tselepis AD, Tybjærg-Hansen A, Vázquez Cárdenas A, Viigimaa M, Wang L, Yamashita S, Kastelein JJ, Bruckert E, Vohnout B, Schreier L, Pang J, Ebenbichler C, Dieplinger H, Innerhofer R, Winhofer-Stöckl Y, Greber-Platzer S, Krychtiuk K, Speidl W, Toplak H, Widhalm K, Stulnig T, Huber K, Höllerl F, Rega-Kaun G, Kleemann L, Mäser M, Scholl-Bürgi S, Säly C, Mayer FJ, Sablon G, Tarantino E, Nzeyimana C, Pojskic L, Sisic I, Nalbantic AD, Jannes CE, Pereira AC, Krieger JE, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Baass A, Bergeron J, Bernard S, Brisson D, Brunham LR, Cermakova L, Couture P, Francis GA, Gaudet D, Hegele RA, Khoury E, Mancini GJ, McCrindle BW, Paquette M, Ruel I, Cuevas A, Asenjo S, Wang X, Meng K, Song X, Yong Q, Jiang T, Liu Z, Duan Y, Hong J, Ye P, Chen Y, Qi J, Liu Z, Li Y, Zhang C, Peng J, Yang Y, Yu W, Wang Q, Yuan H, Cheng S, Jiang L, Chong M, Jiao J, Wu Y, Wen W, Xu L, Zhang R, Qu Y, He J, Fan X, Wang Z, Chow E, Pećin I, Perica D, Symeonides P, Vrablik M, Ceska R, Soska V, Tichy L, Adamkova V, Franekova J, Cifkova R, Kraml P, Vonaskova K, Cepova J, Dusejovska M, Pavlickova L, Blaha V, Rosolova H, Nussbaumerova B, Cibulka R, Vaverkova H, Cibickova L, Krejsova Z, Rehouskova K, Malina P, Budikova M, Palanova V, Solcova L, Lubasova A, Podzimkova H, Bujdak J, Vesely J, Jordanova M, Salek T, Urbanek R, Zemek S, Lacko J, Halamkova H, Machacova S, Mala S, Cubova E, Valoskova K, Burda L, Bendary A, Daoud I, Emil S, Elbahry A, Rafla S, Sanad O, Kazamel G, Ashraf M, Sobhy M, El-Hadidy A, Shafy MA, Kamal S, Bendary M, Talviste G, Angoulvant D, Boccara F, Cariou B, Carreau V, Carrie A, Charrieres S, Cottin Y, Di-Fillipo M, Ducluzeau PH, Dulong S, Durlach V, Farnier M, Ferrari E, Ferrieres D, Ferrieres J, Gallo A, hankard R, Inamo J, Lemale J, Moulin P, Paillard F, Peretti N, Perrin A, Pradignac A, Rabes JP, Rigalleau V, Sultan A, Schiele F, Tounian P, Valero R, Verges B, Yelnik C, Ziegler O, Haack IA, Schmidt N, Dressel A, Klein I, Christmann J, Sonntag A, Stumpp C, Boger D, Biedermann D, Usme MM, Beil FU, Klose G, König C, Gouni-Berthold I, Otte B, Böll G, Kirschbaum A, Merke J, Scholl J, Segiet T, Gebauer M, Predica F, Mayer M, Leistikow F, Füllgraf-Horst S, Müller C, Schüler M, Wiener J, Hein K, Baumgartner P, Kopf S, Busch R, Schömig M, Matthias S, Allendorf-Ostwald N, Fink B, Böhm D, Jäkel A, Koschker AC, Schweizer R, Vogt A, Parhofer K, König W, Reinhard W, Bäßler A, Stadelmann A, Schrader V, Katzmann J, Tarr A, Steinhagen-Thiessen E, Kassner U, Paulsen G, Homberger J, Zemmrich C, Seeger W, Biolik K, Deiss D, Richter C, Pantchechnikova E, Dorn E, Schatz U, Julius U, Spens A, Wiesner T, Scholl M, Rizos CV, Sakkas N, Elisaf M, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Athyros V, Skalidis E, Kolovou G, Garoufi A, Bilianou E, Koutagiar I, Agapakis D, Kiouri E, Antza C, Katsiki N, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Koutsogianni AD, Karányi Z, Harangi M, Bajnok L, Audikovszky M, Márk L, Benczúr B, Reiber I, Nagy G, Nagy A, Reddy LL, Shah SA, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Altaey M, Al-Jumaily K, Rasul D, Abdalsahib AF, Jabbar AA, Al-ageedi M, Agar R, Cohen H, Ellis A, Gavishv D, Harats D, Henkin Y, Knobler H, Leavit L, Leitersdorf E, Rubinstein A, Schurr D, Shpitzen S, Szalat A, Casula M, Zampoleri V, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Sabbà C, Bossi AC, Borghi C, Muntoni S, Cipollone F, Purrello F, Pujia A, Passaro A, Marcucci R, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Carubbi F, Iughetti L, Iannuzzi A, Iannuzzo G, Calabrò P, Averna M, Biasucci G, Zambon S, Roscini AR, Trenti C, Arca M, Federici M, Del Ben M, Bartuli A, Giaccari A, Pipolo A, Citroni N, Guardamagna O, Bonomo K, Benso A, Biolo G, Maroni L, Lupi A, Bonanni L, Zenti MG, Matsuki K, Hori M, Ogura M, Masuda D, Kobayashi T, Nagahama K, Al-Jarallah M, Radovic M, Lunegova O, Bektasheva E, Khodzhiboboev E, Erglis A, Gilis D, Nesterovics G, Saripo V, Meiere R, Upena-RozeMicena A, Terauda E, Jambart S, Khoury PE, Elbitar S, Ayoub C, Ghaleb Y, Aliosaitiene U, Kutkiene S, Kasim NA, Nor NS, Ramli AS, Razak SA, Al-Khateeb A, Kadir SH, Muid SA, Rahman TA, Kasim SS, Radzi AB, Ibrahim KS, Razali S, Ismail Z, Ghani RA, Hafidz MI, Chua AL, Rosli MM, Annamalai M, Teh LK, Razali R, Chua YA, Rosman A, Sanusi AR, Murad NA, Jamal ARA, Nazli SA, Razman AZ, Rosman N, Rahmat R, Hamzan NS, Azzopardi C, Mehta R, Martagon AJ, Ramirez GA, Villa NE, Vazquez AV, Elias-Lopez D, Retana GG, Rodriguez B, Macías JJ, Zazueta AR, Alvarado RM, Portano JD, Lopez HA, Sauque-Reyna L, Herrera LG, Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PA, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AY, Cazares HE, Gonzalez JR, Valencia CV, Padilla FG, Prado RM, De los Rios Ibarra MO, Villicaña RD, Rivera KJ, Carrera RA, Alvarez JA, Martinez JC, de los Reyes Barrera Bustillo M, Vargas GC, Chacon RC, Andrade MH, Ortega AF, Alcala HG, de Leon LE, Guzman BG, Garcia JJ, Cuellar JC, Cruz JR, Garcia AH, Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Rodriguez AB, Oyervides JC, Vazquez DI, Rodriguez EA, Osorio ML, Saucedo JR, Tamayo MT, Talavera LA, Arroyo LE, Carrillo EA, Isara A, Obaseki DE, Al-Waili K, Al-Zadjali F, Al-Zakwani I, Al-Kindi M, Al-Mukhaini S, Al-Barwani H, Rana A, Shah LS, Starostecka E, Konopka A, Lewek J, Bartłomiejczyk M, Gąsior M, Dyrbuś K, Jóźwiak J, Gruchała M, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Woś M, Michalska-Grzonkowska A, Medeiros AM, Alves AC, Silva F, Lobarinhas G, Palma I, de Moura JP, Rico MT, Rato Q, Pais P, Correia S, Moldovan O, Virtuoso MJ, Salgado JM, Colaço I, Dumitrescu A, Lengher C, Mosteoru S, Meshkov A, Ershova A, Rozkova T, Korneva V, Yu KT, Zafiraki V, Voevoda M, Gurevich V, Duplyakov D, Ragino Y, Safarova M, Shaposhnik I, Alkaf F, Khudari A, Rwaili N, Al-Allaf F, Alghamdi M, Batais MA, Almigbal TH, Kinsara A, AlQudaimi AH, Awan Z, Elamin OA, Altaradi H, Rajkovic N, Popovic L, Singh S, Stosic L, Rasulic I, Lalic NM, Lam C, Le TJ, Siang EL, Dissanayake S, I-Shing JT, Shyong TE, Jin TC, Balinth K, Buganova I, Fabryova L, Kadurova M, Klabnik A, Kozárová M, Sirotiakova J, Battelino T, Kovac J, Mlinaric M, Sustar U, Podkrajsek KT, Fras Z, Jug B, Cevc M, Pilcher GJ, Blom D, Wolmarans K, Brice B, Muñiz-Grijalvo O, Díaz-Díaz JL, de Isla LP, Fuentes F, Badimon L, Martin F, Lux A, Chang NT, Ganokroj P, Akbulut M, Alici G, Bayram F, Can LH, Celik A, Ceyhan C, Coskun FY, Demir M, Demircan S, Dogan V, Durakoglugil E, Dural IE, Gedikli O, Hacioglu A, Ildizli M, Kilic S, Kirilmaz B, Kutlu M, Oguz A, Ozdogan O, Onrat E, Ozer S, Sabuncu T, Sahin T, Sivri F, Sonmez A, Temizhan A, Topcu S, Tuncez A, Vural M, Yenercag M, Yesilbursa D, Yigit Z, Yildirim AB, Yildirir A, Yilmaz MB, Atallah B, Traina M, Sabbour H, Hay DA, Luqman N, Elfatih A, Abdulrasheed A, Kwok S, Oca ND, Reyes X, Alieva RB, Kurbanov RD, Hoshimov SU, Nizamov UI, Ziyaeva AV, Abdullaeva GJ, Do DL, Nguyen MN, Kim NT, Le TT, Le HA, Tokgozoglu L, Catapano AL, Ray KK. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Lancet 2021; 398:1713-1725. [PMID: 34506743 DOI: 10.1016/s0140-6736(21)01122-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. METHODS Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. FINDINGS Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3-58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5-56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32-6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20-5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). INTERPRETATION Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Stelten BML, Raal FJ, Marais AD, Riksen NP, Roeters van Lennep JE, Duell PB, van der Graaf M, Kluijtmans LAJ, Wevers RA, Verrips A. Cerebrotendinous xanthomatosis without neurological involvement. J Intern Med 2021; 290:1039-1047. [PMID: 33830582 DOI: 10.1111/joim.13277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cerebrotendinous xanthomatosis (CTX) is an autosomal recessively inherited inborn error of metabolism. Neurological symptoms are considered to be a clinical hallmark of untreated adult patients. We describe a 'milder CTX phenotype', without neurological involvement. METHODS We performed a retrospective patient file study in 79 genetically confirmed Dutch patients with CTX (55 patients aged ≥ 21 years) to study the clinical heterogeneity of CTX. We studied the frequency of adult patients with CTX without neurological involvement at diagnosis, in our Dutch cohort, and included a family from South Africa and patients from Italy, USA, Chile and Asia from the literature. RESULTS In total, we describe 19 adult patients with CTX from 16 independent families, without neurological symptoms at diagnosis. A relatively small percentage (21%, n = 4) had a history of cataract. The majority, 84% (n = 16), presented with tendon xanthomas as the sole or predominant feature. The majority of patients showed increased plasma cholesterol levels. No correlation was found between this 'milder phenotype', the cholestanol levels and the CYP27A1 genotype. In addition, we describe three novel mutations in the CYP27A1 gene. CONCLUSIONS This study shows the clinical heterogeneity of CTX, highlighting the existence of a 'milder phenotype', that is without neurological involvement at diagnosis. Adult patients with CTX may present with tendon xanthomas as the sole or predominant feature, mimicking familial hypercholesterolemia. It is important to realize that the absence of neurological symptoms does not rule out the development of future neurological symptoms. As CTX is a treatable disorder, early diagnosis and initiation of treatment when additional clinical signs occur is therefore essential.
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Affiliation(s)
- B M L Stelten
- From the, Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - F J Raal
- The Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A D Marais
- Chemical pathology, University of Cape Town, Cape Town, South Africa
| | - N P Riksen
- Department of Internal Medicine, Division of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J E Roeters van Lennep
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P B Duell
- Division of Endocrinology, Diabetes, and Clinical Nutrition, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - M van der Graaf
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L A J Kluijtmans
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R A Wevers
- Department of Laboratory Medicine, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Verrips
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Seedat F, Patel M, Phillip V, Mohamed F, Marais AD, Blackhurst DM, Solomon G, Currin S, Raal FJ. Hyperlipidemic myeloma, a rare form of acquired dysbetalipoproteinemia, in an HIV seropositive African female. Clin Chim Acta 2021; 520:71-75. [PMID: 34052205 DOI: 10.1016/j.cca.2021.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
Dysbetalipoproteinemia (DBL) is an uncommon condition characterized by a mixed hyperlipidemia due to accumulation of remnant lipoproteins and is highly atherogenic. Typically, DBL is an autosomal recessive condition requiring an additional metabolic stress with reduced apolipoprotein E (apoE) function. However, DBL is also described in patients with multiple myeloma without the characteristic apoE2/E2 mutation seen in familial DBL. Although the underlying pathogenesis in these cases is not fully characterized, it is thought to occur due to interference with apoE function by antibodies produced from clonal plasma cells. Such cases are referred to as hyperlipidemic myeloma (HLM) and have rarely been described in the literature. To our knowledge there is no prior description of HLM in HIV positive patients in Africa. We describe a case of HLM in an African woman with underlying HIV infection who presented with phenotypic and biochemical features of DBL that responded poorly to lipid lowering therapy.
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Affiliation(s)
- Faheem Seedat
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Moosa Patel
- Division of Clinical Hematology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vinitha Phillip
- Division of Clinical Hematology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Farzahna Mohamed
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A David Marais
- Division of Chemical Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Dee M Blackhurst
- Division of Chemical Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Gabriele Solomon
- Division of Chemical Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Sean Currin
- Department of Chemical Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Frederick J Raal
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Heidemann BE, Wolters FJ, Kavousi M, Gruppen EG, Dullaart RP, Marais AD, Visseren FL, Koopal C. Adiposity and the development of dyslipidemia in APOE ε2 homozygous subjects: A longitudinal analysis in two population-based cohorts. Atherosclerosis 2021; 325:57-62. [PMID: 33892328 DOI: 10.1016/j.atherosclerosis.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Familial dysbetalipoproteinemia (FD), characterized by remnant lipoprotein accumulation and premature cardiovascular disease, occurs in homozygous carriers of the APOE ε2 allele, but genetic predisposition alone does not suffice for the clinical phenotype. Cross-sectional studies suggest that a second metabolic hit - notably adiposity or insulin resistance - is required, but the association between these risk factors and development of FD has not been studied prospectively. METHODS For this study, we evaluated 18,987 subjects from two large prospective Dutch population-based cohorts (PREVEND and Rotterdam Study) of whom 118 were homozygous APOE ε2 carriers. Of these, 69 subjects were available for prospective analyses. Dyslipidemia - likely to be FD - was defined as fasting triglyceride (TG) levels >3 mmol/L in untreated subjects or use of lipid lowering medication. The effect of weight, body mass index (BMI), waist circumference, type 2 diabetes mellitus and non-TG metabolic syndrome on development of dyslipidemia was investigated. RESULTS Eleven of the 69 ε2ε2 subjects (16%) developed dyslipidemia - likely FD - during follow-up. Age-, sex- and cohort-adjusted risk factors for the development of FD were BMI (OR 1.19; 95%CI 1.04-1.39), waist circumference (OR 1.26 95%CI 1.01-1.61) and presence of non-TG metabolic syndrome (OR 4.39; 95%CI 1.04-18.4) at baseline. Change in adiposity during follow-up was not associated with development of dyslipidemia. CONCLUSIONS Adiposity increases the risk of developing an FD-like lipid phenotype in homozygous APOE ε2 subjects. These results stress the importance of healthy body weight in subjects at risk of developing FD.
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Affiliation(s)
- Britt E Heidemann
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eke G Gruppen
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, University of Groningen, the Netherlands
| | - Robin Pf Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, University of Groningen, the Netherlands
| | - A David Marais
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa, Cape Town, South Africa
| | - Frank Lj Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands
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Huijgen R, Blom DJ, Hartgers ML, Chemello K, Benito-Vicente A, Uribe KB, Behardien Z, Blackhurst DM, Brice BC, Defesche JC, de Jong AG, Jooste RJ, Solomon GAE, Wolmarans KH, Hovingh GK, Martin C, Lambert G, Marais AD. Novel PCSK9 (Proprotein Convertase Subtilisin Kexin Type 9) Variants in Patients With Familial Hypercholesterolemia From Cape Town. Arterioscler Thromb Vasc Biol 2020; 41:934-943. [PMID: 33147992 DOI: 10.1161/atvbaha.120.314482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Familial hypercholesterolemia (FH) is characterized by elevated low-density lipoprotein-cholesterol and markedly increased cardiovascular risk. In patients with a genetic diagnosis, low-density lipoprotein receptor (LDLR) mutations account for >90% of cases, apolipoprotein B (APOB) mutations for ≈5% of cases, while proprotein convertase subtilisin kexin type 9 (PCSK9) gain of function mutations are rare (<1% of cases). We aimed to evaluate the functional impact of several novel PCSK9 variants in a cohort of patients with FH by genetic cascade screening and in vitro functionality assays. Approach and Results: Patients with clinically diagnosed FH underwent genetic analysis of LDLR, and if negative, sequential testing of APOB and PCSK9. We analyzed cosegregation of hypercholesterolemia with novel PCSK9 variants. Gain of function status was determined by in silico analyses and validated by in vitro functionality assays. Among 1055 persons with clinical FH, we identified nonsynonymous PCSK9 variants in 27 (2.6%) patients and 7 of these carried one of the 4 previously reported gain of function variants. In the remaining 20 patients with FH, we identified 7 novel PCSK9 variants. The G516V variant (c.1547G>T) was found in 5 index patients and cascade screening identified 15 additional carriers. Low-density lipoprotein-cholesterol levels were higher in these 15 carriers compared with the 27 noncarriers (236±73 versus 124±35 mg/dL; P<0.001). In vitro studies demonstrated the pathogenicity of the G516V variant. CONCLUSIONS In our study, 1.14% of cases with clinical FH were clearly attributable to pathogenic variants in PCSK9. Pathogenicity is established beyond doubt for the G516V variant.
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Affiliation(s)
- Roeland Huijgen
- Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (R.H., M.L.H., A.G.d.J., G.K.H.).,Spaarne Gasthuis, Haarlem, The Netherlands (R.H.)
| | - Dirk J Blom
- Division of Lipidology, Department of Medicine, Hatter Institute for Cardiovascular Research in Africa (D.J.B., Z.B., D.M.B., D.M.B., B.C.B., R.J.J., K.H.W.), University of Cape Town, South Africa
| | - Merel L Hartgers
- Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (R.H., M.L.H., A.G.d.J., G.K.H.)
| | - Kévin Chemello
- Laboratoire Inserm UMR1188 DéTROI, Université de La Réunion, Sainte Clotilde, France (K.C., G.L.)
| | - Asier Benito-Vicente
- Biofisika Institute (UPV/EHU, CSIC) and Departamento de Bioquímica, Universidad del País Vasco, Bilbao, Spain (A.B.-V., K.B.U., C.M.)
| | - Kepa B Uribe
- Biofisika Institute (UPV/EHU, CSIC) and Departamento de Bioquímica, Universidad del País Vasco, Bilbao, Spain (A.B.-V., K.B.U., C.M.)
| | - Zorena Behardien
- Division of Lipidology, Department of Medicine, Hatter Institute for Cardiovascular Research in Africa (D.J.B., Z.B., D.M.B., D.M.B., B.C.B., R.J.J., K.H.W.), University of Cape Town, South Africa
| | - Dee M Blackhurst
- Division of Lipidology, Department of Medicine, Hatter Institute for Cardiovascular Research in Africa (D.J.B., Z.B., D.M.B., D.M.B., B.C.B., R.J.J., K.H.W.), University of Cape Town, South Africa
| | - Brigitte C Brice
- Division of Lipidology, Department of Medicine, Hatter Institute for Cardiovascular Research in Africa (D.J.B., Z.B., D.M.B., D.M.B., B.C.B., R.J.J., K.H.W.), University of Cape Town, South Africa
| | - Joep C Defesche
- Department of Clinical Genetics, Laboratory of Genome Diagnostics, Amsterdam University Medical Center, The Netherlands (J.C.D.)
| | - Annemiek G de Jong
- Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (R.H., M.L.H., A.G.d.J., G.K.H.)
| | - Rosemary J Jooste
- Division of Lipidology, Department of Medicine, Hatter Institute for Cardiovascular Research in Africa (D.J.B., Z.B., D.M.B., D.M.B., B.C.B., R.J.J., K.H.W.), University of Cape Town, South Africa
| | - Gabriele A E Solomon
- Division of Chemical Pathology, Department of Pathology (G.A.E.S., A.D.M.), University of Cape Town, South Africa.,Division of Chemical Pathology, Department of Pathology, University of Cape Town, South Africa (G.A.E.S., A.D.M.)
| | - Karen H Wolmarans
- Division of Lipidology, Department of Medicine, Hatter Institute for Cardiovascular Research in Africa (D.J.B., Z.B., D.M.B., D.M.B., B.C.B., R.J.J., K.H.W.), University of Cape Town, South Africa
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (R.H., M.L.H., A.G.d.J., G.K.H.)
| | - Cesar Martin
- Biofisika Institute (UPV/EHU, CSIC) and Departamento de Bioquímica, Universidad del País Vasco, Bilbao, Spain (A.B.-V., K.B.U., C.M.)
| | - Gilles Lambert
- Laboratoire Inserm UMR1188 DéTROI, Université de La Réunion, Sainte Clotilde, France (K.C., G.L.)
| | - A David Marais
- Division of Chemical Pathology, Department of Pathology (G.A.E.S., A.D.M.), University of Cape Town, South Africa.,Division of Chemical Pathology, Department of Pathology, University of Cape Town, South Africa (G.A.E.S., A.D.M.)
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Marais AD, Blom DJ, Raal FJ. Homozygous familial hypercholesterolemia and its treatment by inclisiran. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1784721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A David Marais
- Chemical Pathology Division of the Department of Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Dirk J Blom
- Lipidology Division of the Department of Medicine and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Frederick J Raal
- Endocrinology, Department of Medicine, University of Witwatersrand Health Science Faculty, Johannesburg, South Africa
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21
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Marais AD. Familial hypercholesterolaemia and its management in South Africa. Cardiovasc J Afr 2019; 30:247-248. [PMID: 31746939 DOI: 10.5830/cvja-2019-054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- A D Marais
- Chemical Pathology, Health Sciences, University of Cape Town, Observatory, South Africa.
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22
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Marais AD, Kotze MJ, Raal FJ, Khine AA, Talmud PJ, Humphries SE. Familial hypercholesterolaemia workshop for leveraging point-of-care testing and personalised medicine in association with the Lipid and Atherosclerosis Society of Southern Africa. Cardiovasc J Afr 2019; 30:297-304. [PMID: 31746944 DOI: 10.5830/cvja-2019-055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/12/2019] [Indexed: 11/06/2022] Open
Abstract
Familial hypercholesterolaemia (FH) is a common autosomal dominantly inherited disorder in which impaired clearance of plasma low-density lipoprotein cholesterol causes premature atherosclerotic vascular disease and tendon xanthomata. This workshop aimed to consolidate information on the diagnosis and management of FH in South Africa. The genetic causes include mutations in the LDL receptor, apolipoprotein B100 and proprotein convertase subtilisin/kexin type 9 (PCSK9). Additionally, the concatenation of multiple gene variants can result in polygenic FH. Therapeutic measures include a healthy lifestyle, statins and cholesterol-absorption inhibitors that will achieve control of the dyslipidaemia in the majority of cases. The recently introduced monoclonal antibodies to PCSK9 can improve achievement of target concentration in severe cases. FH is present in all sectors of the South African population but there is sparse documentation in the indigenous African populations. FH should be actively sought, diagnosed and treated with judicious pharmacotherapy and screening of relatives.
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Affiliation(s)
- A D Marais
- Chemical Pathology, Health Sciences Faculty, University of Cape Town, Observatory, South Africa.
| | - M J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University; National Health Laboratory Service, Tygerberg Hospital, Tygerberg, South Africa
| | - F J Raal
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A A Khine
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University; National Health Laboratory Service, Tygerberg Hospital, Tygerberg, South Africa
| | - P J Talmud
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - S E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
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Blom DJ, Raal FJ, Santos RD, Marais AD. Lomitapide and Mipomersen-Inhibiting Microsomal Triglyceride Transfer Protein (MTP) and apoB100 Synthesis. Curr Atheroscler Rep 2019; 21:48. [PMID: 31741187 DOI: 10.1007/s11883-019-0809-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to evaluate the role of inhibiting the synthesis of lipoproteins when there is no or little residual LDL-receptor function as in patients with homozygous familial hypercholesterolaemia. Lomitapide is administered orally once a day while mipomersen is given by subcutaneous injection once a week. Lomitapide inhibits microsomal triglyceride transfer protein while mipomersen is an antisense oligonucleotide directed against apoB100. RECENT FINDINGS The pivotal registration trials for lomitapide and mipomersen were published in 2013 and 2010, respectively. More recently published data from extension trials and cohort studies provides additional information on long-term safety and efficacy. The mean LDL cholesterol reduction was 50% with lomitapide in its single-arm open-label registration trial. Mipomersen reduced LDL cholesterol by approximately 25% in its double-blind, placebo-controlled registration study. Both lomitapide and mipomersen therapy are associated with variable increases in hepatic fat content. The long-term safety of increased hepatic fat content in patients receiving these therapies is uncertain and requires further study. Both drugs may cause elevated transaminase in some patients, but no cases of severe liver injury have been reported. Lomitapide may also cause gastrointestinal discomfort and diarrhoea, especially if patients consume high-fat meals and patients are advised to follow a low-fat diet supplemented with essential fatty acids and fat-soluble vitamins. Mipomersen may cause injection-site and influenza-like reactions. The effect of lomitapide and mipomersen on cardiovascular outcomes has not been studied, but circumstantial evidence suggests that the LDL cholesterol lowering achieved with these two agents may reduce cardiovascular event rates.
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Affiliation(s)
- Dirk J Blom
- Department of Medicine, Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, 4th Floor Chris Barnard Building, Anzio Road, 7925 Observatory, Cape Town, South Africa.
| | - Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.,Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - A David Marais
- Division of Chemical Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
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Blanchard V, Croyal M, Khantalin I, Ramin-Mangata S, Chemello K, Nativel B, Blom DJ, Marais AD, Lambert G. Reduced Lipoprotein(a) Associated With the Apolipoprotein E2 Genotype Confers Cardiovascular Protection in Familial Hypercholesterolemia. JACC Basic Transl Sci 2019; 4:425-427. [PMID: 31312765 PMCID: PMC6610154 DOI: 10.1016/j.jacbts.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Koopal C, Bemelmans R, Marais AD, Visseren FL. Severe hypertriglyceridaemia and pancreatitis in a patient with lipoprotein lipase deficiency based on mutations in lipoprotein lipase (LPL) and apolipoprotein A5 (APOA5) genes. BMJ Case Rep 2019; 12:12/4/e228199. [PMID: 30948399 DOI: 10.1136/bcr-2018-228199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 44-year-old woman was admitted with pancreatitis caused by hypertriglyceridaemia (fasting triglycerides 28 mmol/L). She used oral contraceptives and ezetimibe 10 mg. She was overweight (body mass index 29.7 kg/m2). Diabetes mellitus was ruled out, as were nephrotic syndrome, alcohol abuse, hypothyroidism and dysbetalipoproteinaemia. Genetic analysis revealed mutations in two genes involved in triglyceride metabolism (apolipoprotein A5 and lipoprotein lipase [LPL]). The LPL activity was 45% compared with pooled healthy controls. The post-heparin triglyceride reduction was 6%, compared with a normal reduction of >20%. The patient was initially treated with gemfibrozil, but this was discontinued due to side effects. Dietary triglyceride restriction and discontinuation of the oral contraceptives lowered the plasma triglycerides within 2 weeks to 3.4 mmol/L. Hypertriglyceridaemia is a risk factor for pancreatitis and cardiovascular disease, and has a broad differential diagnosis including genetic causes. Patients can achieve near-normal triglyceride values with a low-fat diet only.
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Affiliation(s)
| | | | - A David Marais
- Division of Chemical Pathology, University of Cape Town Health Science Faculty, Cape Town, South Africa
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26
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Pang J, Chan DC, Hu M, Muir LA, Kwok S, Charng MJ, Florkowski CM, George PM, Lin J, Loi DD, Marais AD, Nawawi HM, Gonzalez-Santos LE, Su TC, Truong TH, Santos RD, Soran H, Tomlinson B, Yamashita S, Ademi Z, Watts GF. Comparative aspects of the care of familial hypercholesterolemia in the "Ten Countries Study". J Clin Lipidol 2019; 13:287-300. [PMID: 30797720 DOI: 10.1016/j.jacl.2019.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/18/2018] [Accepted: 01/21/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is a lack of information on the health care of familial hypercholesterolemia (FH). OBJECTIVE The objective of this study was to compare the health care of FH in countries of the Asia-Pacific region and Southern Hemisphere. METHODS A series of questionnaires were completed by key opinion leaders from selected specialist centers in 12 countries concerning aspects of the care of FH, including screening, diagnosis, risk assessment, treatment, teaching/training, and research; the United Kingdom (UK) was used as the international benchmark. RESULTS The estimated percentage of patients diagnosed with the condition was low (overall <3%) in all countries, compared with ∼15% in the UK. Underdetection of FH was associated with government expenditure on health care (ϰ = 0.667, P < .05). Opportunistic and systematic screening methods, and the Dutch Lipid Clinic Network criteria were most commonly used to detect FH; genetic testing was infrequently used. Noninvasive imaging of coronary calcium and/or carotid plaques was underutilized in risk assessment. Patients with FH were generally not adequately treated, with <30% of patients achieving guideline recommended low-density lipoprotein cholesterol targets on conventional therapies. Treatment gaps included suboptimal availability and use of lipoprotein apheresis and proprotein convertase subtilsin-kexin type 9 inhibitors. A deficit of FH registries, training programs, and publications were identified in less economically developed countries. The demonstration of cost-effectiveness for cascade screening, genetic testing, and specialized treatments were significantly associated with the availability of subsidies from the health care system (ϰ = 0.571-0.800, P < .05). CONCLUSION We identified important gaps across the continuum of care for FH, particularly in less economically developed countries. Wider implementation of primary and pediatric care, telehealth services, patient support groups, education/training programs, research activities, and health technology assessments are needed to improve the care of patients with FH in these countries.
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Affiliation(s)
- Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Dick C Chan
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Miao Hu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR
| | - Lauretta A Muir
- Biochemistry and Pathology, Canterbury Health Laboratories, Lipid Clinic, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - See Kwok
- University of Manchester, Faculty of Biology, Medicine and Health, Manchester, United Kingdom; Cardiovascular Trials Unit, Clinical Trial Management Office, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Min-Ji Charng
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Christopher M Florkowski
- Biochemistry and Pathology, Canterbury Health Laboratories, Lipid Clinic, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - Peter M George
- Biochemistry and Pathology, Canterbury Health Laboratories, Lipid Clinic, Christchurch Hospital, University of Otago, Christchurch, New Zealand
| | - Jie Lin
- Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Do Doan Loi
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam; Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - A David Marais
- Division of Chemical Pathology, University of Cape Town Health Science Faculty, South Africa
| | - Hapizah M Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Lourdes E Gonzalez-Santos
- Department of Cardiology, Section of Preventive Cardiology, UP-Philippine General Hospital, Manila, Philippines
| | - Ta-Chen Su
- Departments of Environmental and Occupational Medicine, Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Thanh Huong Truong
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam; Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Handrean Soran
- University of Manchester, Faculty of Biology, Medicine and Health, Manchester, United Kingdom; Cardiovascular Trials Unit, Clinical Trial Management Office, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR
| | - Shizuya Yamashita
- Departments of Cardiovascular Medicine and Community Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Rinku General Medical Center, Osaka, Japan
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia; Department of Cardiology, Lipid Disorders Clinic, Cardiometabolic Services, Royal Perth Hospital, Perth, Western Australia, Australia.
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Marais AD. Apolipoprotein E in lipoprotein metabolism, health and cardiovascular disease. Pathology 2018; 51:165-176. [PMID: 30598326 DOI: 10.1016/j.pathol.2018.11.002] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 12/16/2022]
Abstract
Apolipoprotein E (apoE), a 34 kDa circulating glycoprotein of 299 amino acids, predominantly synthesised in the liver, associates with triglyceride-rich lipoproteins to mediate the clearance of their remnants after enzymatic lipolysis in the circulation. Its synthesis in macrophages initiates the formation of high density-like lipoproteins to effect reverse cholesterol transport to the liver. In the nervous system apoE forms similar lipoproteins which perform the function of distributing lipids amongst cells. ApoE accounts for much of the variation in plasma lipoproteins by three common variants (isoforms) that influence low-density lipoprotein concentration and the risk of atherosclerosis. ApoE2 generally is most favourable and apoE4 least favourable for cardiovascular and neurological health. The apoE variants relate to different amino acids at positions 112 and 158: cysteine in both for apoE2, arginine at both sites for apoE4, and respectively cysteine and arginine for apoE3 that is viewed as the wild type. Paradoxically, under metabolic stress, homozygosity for apoE2 may result in dysbetalipoproteinaemia in adults owing to impaired binding of remnant lipoproteins to the LDL receptor and related proteins as well as heparan sulphate proteoglycans. This highly atherogenic condition is also seen with other mutations in apoE, but with autosomal dominant inheritance. Mutations in apoE may also cause lipoprotein glomerulopathy. In the central nervous system apoE binds amyloid β-protein and tau protein and fragments may incur cellular damage. ApoE4 is a strong risk factor for the development of Alzheimer's disease. ApoE has several other physiological effects that may influence health and disease, including supply of docosahexaenoic acid for the brain and modulating immune and inflammatory responses. Genotyping of apoE may have application in disorders of lipoprotein metabolism as well as glomerulopathy and may be relevant to personalised medicine in understanding cardiovascular risk, and the outcome of nutritional and therapeutic interventions. Quantitation of apoE will probably not be clinically useful. ApoE is also of interest as it may generate peptides with biological function and could be employed in nanoparticles that may allow crossing of the blood-brain barrier. Therapeutic options may emerge from these newer insights.
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Affiliation(s)
- A David Marais
- Chemical Pathology Division, Pathology Department, University of Cape Town Health Science Faculty and National Health Laboratory Service, Cape Town, South Africa.
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Klug E, Raal FJ, Marais AD, Smuts CM, Schamroth C, Jankelow D, Blom DJ, Webb DA. South African dyslipidaemia guideline consensus statement: 2018 update A joint statement from the South African Heart Association (SA Heart) and the Lipid and Atherosclerosis Society of Southern Africa (LASSA). S Afr Med J 2018; 108:973-1000. [PMID: 30421699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 06/09/2023] Open
Abstract
South Africa (SA) is home to a heterogeneous population with a wide range of cardiovascular risk factors. Cholesterol reduction in combination with aggressive management of modifiable risk factors, including nutrition, physical activity, blood pressure and smoking, can help to reduce and prevent morbidity and mortality in individuals who are at increased risk of cardiovascular events. This updated consensus guide to management of dyslipidaemia in SA is based on the updated European Society of Cardiology and European Atherosclerosis Society dyslipidaemia guidelines published in 2016. For individuals who are not considered to be at high or very high cardiovascular risk, the decision whether to treat and which interventional strategy to use is based on a cardiovascular risk score calculated using total cholesterol, high-density lipoprotein cholesterol (HDL-C), gender, age and smoking status. The cardiovascular risk score refers to the 10-year risk of any cardiovascular event and includes 4 categories of risk (low, moderate, high and very high). People with established cardiovascular disease, diabetes mellitus, chronic kidney disease and genetic or severe dyslipidaemias are considered to already be at high or very high risk and do not require risk scoring. Therapeutic lifestyle change is the mainstay of management for all patients. The need for and intensity of drug therapy is determined according to baseline low-density lipoprotein (LDL-C) levels and the target LDL-C concentration appropriate to the individual. LDL-C treatment targets are based on pre-treatment risk and are as follows: <3 mmol/L in low- and moderate risk cases; <2.5 mmol/L and a reduction of at least 50% if the baseline concentration is 2.5 - 5.2 mmol/L in high-risk cases; and <1.8 mmol/L and a reduction of at least 50% if the baseline concentration is 1.8 - 3.5 mmol/L in very high-risk cases. A statin is usually recommended first-line; the specific agent is based on the required degree of cholesterol reduction, comorbidities and co-prescribed medication. Special attention should be paid to children with a family history of genetic or severe dyslipidaemia, who should be screened for dyslipidaemia from 8 years of age. In SA, HIV infection is not considered to be a significant cardiovascular risk factor and treatment recommendations for HIV-positive individuals are the same as for the general population, with careful choice of pharmacotherapy to avoid potential adverse drug-drug interactions. The benefit of statins in individuals older than 70 years is uncertain and clinical judgement should be used to guide treatment decisions and to avoid side-effects and overmedication in this group.
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Affiliation(s)
- E Klug
- Netcare Sunninghill and Sunward Park Hospitals, Division of Cardiology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
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Pang J, David Marais A, Blom DJ, Brice BC, Silva PRS, Jannes CE, Pereira AC, Hooper AJ, Ray KK, Santos RD, Watts GF. Heterozygous familial hypercholesterolaemia in specialist centres in South Africa, Australia and Brazil: Importance of early detection and lifestyle advice. Atherosclerosis 2018; 277:470-476. [DOI: 10.1016/j.atherosclerosis.2018.06.822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
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van Delden XM, Huijgen R, Wolmarans KH, Brice BC, Barron JK, Blom DJ, Marais AD. LDL-cholesterol target achievement in patients with heterozygous familial hypercholesterolemia at Groote Schuur Hospital: Minority at target despite large reductions in LDL-C. Atherosclerosis 2018; 277:327-333. [DOI: 10.1016/j.atherosclerosis.2018.06.820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/07/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
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Agostini M, Schoenmakers E, Beig J, Fairall L, Szatmari I, Rajanayagam O, Muskett FW, Adams C, Marais AD, O'Rahilly S, Semple RK, Nagy L, Majithia AR, Schwabe JWR, Blom DJ, Murphy R, Chatterjee K, Savage DB. A Pharmacogenetic Approach to the Treatment of Patients With PPARG Mutations. Diabetes 2018; 67:1086-1092. [PMID: 29622583 PMCID: PMC5967605 DOI: 10.2337/db17-1236] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/27/2018] [Indexed: 01/09/2023]
Abstract
Loss-of-function mutations in PPARG cause familial partial lipodystrophy type 3 (FPLD3) and severe metabolic disease in many patients. Missense mutations in PPARG are present in ∼1 in 500 people. Although mutations are often binarily classified as benign or deleterious, prospective functional classification of all missense PPARG variants suggests that their impact is graded. Furthermore, in testing novel mutations with both prototypic endogenous (e.g., prostaglandin J2 [PGJ2]) and synthetic ligands (thiazolidinediones, tyrosine agonists), we observed that synthetic agonists selectively rescue function of some peroxisome proliferator-activated receptor-γ (PPARγ) mutants. We report on patients with FPLD3 who harbor two such PPARγ mutations (R308P and A261E). Both PPARγ mutants exhibit negligible constitutive or PGJ2-induced transcriptional activity but respond readily to synthetic agonists in vitro, with structural modeling providing a basis for such differential ligand-dependent responsiveness. Concordant with this finding, dramatic clinical improvement was seen after pioglitazone treatment of a patient with R308P mutant PPARγ. A patient with A261E mutant PPARγ also responded beneficially to rosiglitazone, although cardiomyopathy precluded prolonged thiazolidinedione use. These observations indicate that detailed structural and functional classification can be used to inform therapeutic decisions in patients with PPARG mutations.
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Affiliation(s)
- Maura Agostini
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K
- The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, U.K
| | - Erik Schoenmakers
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K
| | - Junaid Beig
- Greenlane Diabetes Centre, Auckland Hospital, Auckland, New Zealand
| | - Louise Fairall
- Leicester Institute of Structural and Chemical Biology, Department of Molecular and Cell Biology, University of Leicester, Leicester, U.K
| | - Istvan Szatmari
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Odelia Rajanayagam
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K
- The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, U.K
| | - Frederick W Muskett
- Leicester Institute of Structural and Chemical Biology, Department of Molecular and Cell Biology, University of Leicester, Leicester, U.K
| | - Claire Adams
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K
- The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, U.K
| | - A David Marais
- Division of Chemical Pathology, Department of Pathology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | - Stephen O'Rahilly
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K
- The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, U.K
| | - Robert K Semple
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K
- The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, U.K
| | - Laszlo Nagy
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Amit R Majithia
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - John W R Schwabe
- Leicester Institute of Structural and Chemical Biology, Department of Molecular and Cell Biology, University of Leicester, Leicester, U.K.
| | - Dirk J Blom
- Department of Medicine, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Rinki Murphy
- Greenlane Diabetes Centre, Auckland Hospital, Auckland, New Zealand
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Krishna Chatterjee
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K.
- The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, U.K
| | - David B Savage
- The University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Cambridge, U.K.
- The National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge, U.K
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Koopal C, Marais AD, Westerink J, van der Graaf Y, Visseren FLJ. Effect of adding bezafibrate to standard lipid-lowering therapy on post-fat load lipid levels in patients with familial dysbetalipoproteinemia. A randomized placebo-controlled crossover trial. J Lipid Res 2017; 58:2180-2187. [PMID: 28928170 DOI: 10.1194/jlr.m076901] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/13/2017] [Indexed: 12/12/2022] Open
Abstract
Familial dysbetalipoproteinemia (FD) is a genetic disorder associated with impaired postprandial lipid clearance. The effect of adding bezafibrate to standard lipid-lowering therapy on postprandial and fasting lipid levels in patients with FD is unknown. In this randomized placebo-controlled double-blind crossover trial, 15 patients with FD received bezafibrate and placebo for 6 weeks in randomized order in addition to standard lipid-lowering therapy (statin, ezetimibe, and/or lifestyle). We assessed post-fat load lipids, expressed as incremental area under the curve (iAUC) and area under the curve (AUC), as well as fasting levels and safety, and found that adding bezafibrate did not reduce post-fat load non-HDL-cholesterol (non-HDL-C) iAUC (1.78 ± 4.49 mmol·h/l vs. 1.03 ± 2.13 mmol·h/l, P = 0.57), but did reduce post-fat load triglyceride (TG) iAUC (8.05 ± 3.32 mmol·h/l vs. 10.61 ± 5.92 mmol·h/l, P = 0.03) and apoB (0.64 ± 0.62 g·h/l vs. 0.93 ± 0.71 g·h/l, P = 0.01). Furthermore, bezafibrate significantly improved AUC and fasting levels of non-HDL-C, TG, total cholesterol, HDL-C, and apoB. Bezafibrate was associated with lower estimated glomerular filtration rate (78.4 ± 11.4 ml/min/1.73 m2 vs. 86.1 ± 5.85 ml/min/1.73 m2, P = 0.002). In conclusion, in patients with FD, the addition of bezafibrate to standard lipid-lowering therapy resulted in improved post-fat load and fasting plasma lipids. Combination therapy of statin/fibrate could be considered as standard lipid-lowering treatment in FD.
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Affiliation(s)
- Charlotte Koopal
- Department of Vascular Medicine University Medical Center Utrecht, Utrecht, The Netherlands
| | - A David Marais
- Division of Chemical Pathology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa
| | - Jan Westerink
- Department of Vascular Medicine University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine University Medical Center Utrecht, Utrecht, The Netherlands
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Thompson GR, Blom DJ, Marais AD, Seed M, Pilcher GJ, Raal FJ. Survival in homozygous familial hypercholesterolaemia is determined by the on-treatment level of serum cholesterol. Eur Heart J 2017; 39:1162-1168. [DOI: 10.1093/eurheartj/ehx317] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/25/2017] [Indexed: 12/15/2022] Open
Affiliation(s)
- Gilbert R Thompson
- Department of Metabolic Medicine, Faculty of Medicine, Imperial College London, Hammersmith Campus, Ducane Road, London W12 0NN, UK
| | - Dirk J Blom
- Division of Lipidology, Department of Medicine, UCT Faculty Health Sciences, University of Cape Town, Anzio Road, 7925 Observatory, Cape Town, South Africa
| | - A David Marais
- Division of Chemical Pathology, Department of Pathology, UCT Faculty Health Sciences, University of Cape Town, Anzio Road, 7925 Observatory, Cape Town, South Africa
| | - Mary Seed
- Department of Cardiology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Gillian J Pilcher
- Carbohydrate and Lipid Metabolism Research Unit, Department of Medicine, University of the Witwatersrand, 7 York Rd, Parktown 2193, Johannesburg, South Africa
| | - Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Department of Medicine, University of the Witwatersrand, 7 York Rd, Parktown 2193, Johannesburg, South Africa
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Abstract
PURPOSE OF REVIEW To review pathophysiological, epidemiological and clinical aspects of familial dysbetalipoproteinemia; a model disease for remnant metabolism and remnant-associated cardiovascular risk. RECENT FINDINGS Familial dysbetalipoproteinemia is characterized by remnant accumulation caused by impaired remnant clearance, and premature cardiovascular disease. Most familial dysbetalipoproteinemia patients are homozygous for apolipoprotein ε2, which is associated with decreased binding of apolipoprotein E to the LDL receptor. Although familial dysbetalipoproteinemia is an autosomal recessive disease in most cases, 10% is caused by autosomal dominant mutations. Of people with an ε2ε2 genotype 15% develops familial dysbetalipoproteinemia, which is associated with secondary risk factors, such as obesity and insulin resistance, that inhibit remnant clearance by degradation of the heparan sulfate proteoglycan receptor. The prevalence of familial dysbetalipoproteinemia ranges from 0.12 to 0.40% depending on the definition used. Clinical characteristics of familial dysbetalipoproteinemia are xanthomas and mixed hyperlipidemia (high total cholesterol and triglycerides); the primary lipid treatment goal in familial dysbetalipoproteinemia is non-HDL-cholesterol; and treatment consists of dietary therapy and treatment with statin and fibrate combination. SUMMARY Familial dysbetalipoproteinemia is a relatively common, though often not diagnosed, lipid disorder characterized by mixed hyperlipidemia, remnant accumulation and premature cardiovascular disease, which should be treated with dietary therapy and statin and fibrate combination.
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Affiliation(s)
- Charlotte Koopal
- aVascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands bDivision of Chemical Pathology, University of Cape Town Health Science Faculty and National Health Laboratory Service, Cape Town, South Africa
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Vallejo-Vaz AJ, Akram A, Kondapally Seshasai SR, Cole D, Watts GF, Hovingh GK, Kastelein JJP, Mata P, Raal FJ, Santos RD, Soran H, Freiberger T, Abifadel M, Aguilar-Salinas CA, Alnouri F, Alonso R, Al-Rasadi K, Banach M, Bogsrud MP, Bourbon M, Bruckert E, Car J, Ceska R, Corral P, Descamps O, Dieplinger H, Do CT, Durst R, Ezhov MV, Fras Z, Gaita D, Gaspar IM, Genest J, Harada-Shiba M, Jiang L, Kayikcioglu M, Lam CSP, Latkovskis G, Laufs U, Liberopoulos E, Lin J, Lin N, Maher V, Majano N, Marais AD, März W, Mirrakhimov E, Miserez AR, Mitchenko O, Nawawi H, Nilsson L, Nordestgaard BG, Paragh G, Petrulioniene Z, Pojskic B, Reiner Ž, Sahebkar A, Santos LE, Schunkert H, Shehab A, Slimane MN, Stoll M, Su TC, Susekov A, Tilney M, Tomlinson B, Tselepis AD, Vohnout B, Widén E, Yamashita S, Catapano AL, Ray KK. Pooling and expanding registries of familial hypercholesterolaemia to assess gaps in care and improve disease management and outcomes: Rationale and design of the global EAS Familial Hypercholesterolaemia Studies Collaboration. ATHEROSCLEROSIS SUPP 2016; 22:1-32. [PMID: 27939304 DOI: 10.1016/j.atherosclerosissup.2016.10.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The potential for global collaborations to better inform public health policy regarding major non-communicable diseases has been successfully demonstrated by several large-scale international consortia. However, the true public health impact of familial hypercholesterolaemia (FH), a common genetic disorder associated with premature cardiovascular disease, is yet to be reliably ascertained using similar approaches. The European Atherosclerosis Society FH Studies Collaboration (EAS FHSC) is a new initiative of international stakeholders which will help establish a global FH registry to generate large-scale, robust data on the burden of FH worldwide. METHODS The EAS FHSC will maximise the potential exploitation of currently available and future FH data (retrospective and prospective) by bringing together regional/national/international data sources with access to individuals with a clinical and/or genetic diagnosis of heterozygous or homozygous FH. A novel bespoke electronic platform and FH Data Warehouse will be developed to allow secure data sharing, validation, cleaning, pooling, harmonisation and analysis irrespective of the source or format. Standard statistical procedures will allow us to investigate cross-sectional associations, patterns of real-world practice, trends over time, and analyse risk and outcomes (e.g. cardiovascular outcomes, all-cause death), accounting for potential confounders and subgroup effects. CONCLUSIONS The EAS FHSC represents an excellent opportunity to integrate individual efforts across the world to tackle the global burden of FH. The information garnered from the registry will help reduce gaps in knowledge, inform best practices, assist in clinical trials design, support clinical guidelines and policies development, and ultimately improve the care of FH patients.
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Affiliation(s)
| | - Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), School of Public Health, Imperial College London, London, UK.
| | - Asif Akram
- Global eHealth Unit, School of Public Health, Imperial College London, London, UK; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Della Cole
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, UK
| | - Gerald F Watts
- Cardiovascular Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Frederick J Raal
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Raul D Santos
- Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
| | - Handrean Soran
- University Department of Medicine, Central Manchester University Hospitals, Manchester, UK
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Ceitec, Masaryk University, Brno, Czech Republic
| | - Marianne Abifadel
- Laboratory of Biochemistry and Molecular Therapeutics, Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
| | | | - Fahad Alnouri
- Cardiovascular Prevention and Rehabilitation Unit, Prince Sultan Cardiac Centre Riyadh, Riyadh, Saudi Arabia
| | - Rodrigo Alonso
- Lipid Clinic, Department of Nutrition, Clínica Las Condes, Santiago de Chile, Chile
| | | | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Martin P Bogsrud
- National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Norway
| | - Mafalda Bourbon
- Instituto Nacional de Saúde Doutor Ricardo Jorge and Biosystems & Integrative Sciences Institute (BioISI), Universidade de Lisboa, Portugal
| | - Eric Bruckert
- Endocrinologie, métabolisme et prévention cardiovasculaire, Institut E3M et IHU cardiométabolique (ICAN), Hôpital Pitié-Salpêtrière, Paris, France
| | - Josip Car
- Global eHealth Unit, School of Public Health, Imperial College London, London, UK; Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Richard Ceska
- Charles University in Prague, Prague, Czech Republic
| | - Pablo Corral
- FASTA University, School of Medicine, Mar del Plata, Argentina
| | | | - Hans Dieplinger
- Austrian Atherosclerosis Society, c/o Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Can T Do
- Vietnam Heart Institute, Bach Mai Hospital, Hanoi, Viet Nam
| | - Ronen Durst
- Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Marat V Ezhov
- Russian Cardiology Research and Production Centre, Moscow, Russia
| | - Zlatko Fras
- University Medical Centre Ljubljana, Division of Medicine, Preventive Cardiology Unit, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes din Timisoara, Romania
| | - Isabel M Gaspar
- Medical Genetics Department, Centro Hospitalar de Lisboa Ocidental and Genetics Laboratory, Lisbon Medical School, University of Lisbon, Portugal
| | | | - Mariko Harada-Shiba
- National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan
| | - Lixin Jiang
- National Clinical Research Centre of Cardiovascular Diseases, Fuwai Hospital, National Centre for Cardiovascular Diseases, Beijing, China
| | - Meral Kayikcioglu
- Ege University Medical School, Department of Cardiology, Izmir, Turkey
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Gustavs Latkovskis
- Research Institute of Cardiology and Regenerative Therapy, Faculty of Medicine, University of Latvia, Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | | | - Jie Lin
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Lin
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), School of Public Health, Imperial College London, London, UK
| | | | | | - A David Marais
- University of Cape Town and National Health Laboratory Service, South Africa
| | - Winfried März
- Medical Clinic V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Medical Faculty Mannheim, University of Heidelberg, Germany
| | | | - André R Miserez
- Diagene GmbH, Research Institute, Reinach, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Olena Mitchenko
- Dyslipidaemia Department, Institute of Cardiology AMS of Ukraine, Ukraine
| | - Hapizah Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM) and Faculty of Medicine, Universiti Teknologi MARA, Malaysia
| | - Lennart Nilsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Børge G Nordestgaard
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - György Paragh
- Institute of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Zaneta Petrulioniene
- Vilnius University Santariskiu Hospital, Centre of Cardiology and Angiology, Vilnius, Lithuania
| | | | - Željko Reiner
- Department for Metabolic Diseases, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Croatia
| | - Amirhossein Sahebkar
- Biotechnology Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lourdes E Santos
- Cardinal Santos Medical Centre, University of the Philippines - Philippine General Hospital (UP-PGH), Philippines
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), Munich Heart Alliance, Germany
| | | | - M Naceur Slimane
- Research Unit on Dyslipidaemia and Atherosclerosis, Faculty of Medicine of Monastir, Tunisia
| | - Mario Stoll
- Cardiovascular Genetic Laboratory, Cardiovascular Health Commission, Montevideo, Uruguay
| | - Ta-Chen Su
- Department of Internal Medicine and Cardiovascular Centre, National Taiwan University Hospital, Taipei, Taiwan
| | - Andrey Susekov
- Department of Clinical Pharmacology and Therapeutics, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russian Federation, Russia
| | - Myra Tilney
- Faculty of Medicine & Surgery, Medical School, Mater Dei Hospital, University of Malta, Malta
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | | | - Branislav Vohnout
- Coordination Centre for Familial Hyperlipoproteinemias, Institute of Nutrition, FOZOS, Slovak Medical University, Department of Epidemiology, School of Medicine, Comenius University, Bratislava, Slovakia
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Shizuya Yamashita
- Rinku General Medical Centre and Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), School of Public Health, Imperial College London, London, UK
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Villard EF, Thedrez A, Blankenstein J, Croyal M, Tran TTT, Poirier B, Le Bail JC, Illiano S, Nobécourt E, Krempf M, Blom DJ, Marais AD, Janiak P, Muslin AJ, Guillot E, Lambert G. PCSK9 Modulates the Secretion But Not the Cellular Uptake of Lipoprotein(a) Ex Vivo: An Effect Blunted by Alirocumab. ACTA ACUST UNITED AC 2016; 1:419-427. [PMID: 29308438 PMCID: PMC5753417 DOI: 10.1016/j.jacbts.2016.06.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unlike LDL uptake, Lp(a) uptake is not altered by PCSK9 or PCSK9 inhibition in primary human hepatocytes and in primary dermal fibroblasts isolated from familial hypercholesterolemic and non–familial hypercholesterolemic patients. Lp(a) uptake is occurring in the absence of a functional LDL receptor and is not affected by LDL receptor blockade with monoclonal antibodies. Lp(a) cellular binding and whole particle uptake are not altered by PCSK9. The secretion of Lp(a) from primary human hepatocytes is enhanced by PCSK9, an effect that is blunted by PCSK9 inhibition with alirocumab.
To elucidate how the proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor alirocumab modulates lipoprotein(a) [Lp(a)] plasma levels, the authors performed a series of Lp(a) uptake studies in primary human hepatocytes and dermal fibroblasts and measured Lp(a) secretion from human hepatocytes. They found that Lp(a) cellular uptake occurred in a low-density lipoprotein receptor–independent manner. Neither PCSK9 nor alirocumab altered Lp(a) internalization. By contrast, the secretion of apolipoprotein (a) from human hepatocytes was sharply increased by PCSK9, an effect that was reversed by alirocumab. They propose that PCSK9 does not significantly modulate Lp(a) catabolism, but rather enhances the secretion of Lp(a) from liver cells.
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Affiliation(s)
| | - Aurélie Thedrez
- Inra UMR 1280, Nantes, France.,Université de Nantes UMR1280, Faculté de Médecine, Nantes, France
| | | | | | | | - Bruno Poirier
- Sanofi Recherche Développement, Chilly-Mazarin, France
| | | | | | - Estelle Nobécourt
- Inra UMR 1280, Nantes, France.,Université de Nantes UMR1280, Faculté de Médecine, Nantes, France
| | - Michel Krempf
- Inra UMR 1280, Nantes, France.,Université de Nantes UMR1280, Faculté de Médecine, Nantes, France
| | - Dirk J Blom
- Division of Lipidology, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - A David Marais
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Philip Janiak
- Sanofi Recherche Développement, Chilly-Mazarin, France
| | | | | | - Gilles Lambert
- Inra UMR 1280, Nantes, France.,Inserm UMR 1188, Sainte-Clotilde, France.,Université de la Réunion UMR1188, Faculté de Médecine, Saint-Denis, France.,CHU de la Réunion, Saint Denis, France
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Koopal C, Visseren FL, Marais AD, Westerink J, Spiering W. Tendon xanthomas: Not always familial hypercholesterolemia. J Clin Lipidol 2016; 10:1262-5. [DOI: 10.1016/j.jacl.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/31/2016] [Accepted: 05/06/2016] [Indexed: 02/07/2023]
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Watts GF, Ding PY, George P, Hagger MS, Hu M, Lin J, Khoo KL, Marais AD, Miida T, Nawawi HM, Pang J, Park JE, Gonzalez-Santos LB, Su TC, Truong TH, Santos RD, Soran H, Yamashita S, Tomlinson B. Translational Research for Improving the Care of Familial Hypercholesterolemia: The "Ten Countries Study" and Beyond. J Atheroscler Thromb 2016; 23:891-900. [PMID: 27384016 DOI: 10.5551/jat.35949] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Familial hypercholesterolemia (FH) is the most common and serious form of inherited hyperlipidaemia. Dominantly inherited with high penetrance, untreated FH leads to premature death from coronary artery disease due to accelerated atherosclerosis from birth. Despite its importance, there is still a major shortfall in awareness, detection and treatment of FH worldwide. International models of care for FH have recently been published, but their effective implementation requires the garnering of more knowledge about the condition. The "Ten Countries Study" aims to investigate diagnostic, epidemiological and service aspects, as well as physician practices and patient experiences of FH in several countries in the Asia-Pacific Region and the Southern Hemisphere. Five observational studies are being undertaken that will systematically investigate the following aspects of FH: the phenotypic predictors of low-density lipoprotein receptor mutations, the point prevalence in available community populations, current knowledge and clinical practices among primary care physicians, availability and utilisation of services and facilities, and patient perceptions and personal experiences of the condition. The information gathered will inform better clinical practice and will enable the development of country-specific models of care for FH.
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Affiliation(s)
- Gerald F Watts
- School of Medicine and Pharmacology, University of Western Australia
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Affiliation(s)
- Dirk Jacobus Blom
- Division of Lipidology, Department of Medicine, University of Cape Town, MRC Cape Heart Group, Cape Town, South Africa
| | - A. David Marais
- Division of Chemical Pathology, Department of Clinical Laboratory Sciences, University of Cape Town, MRC Cape Heart Group, Cape Town, South Africa
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Hopkins PN, Defesche J, Fouchier SW, Bruckert E, Luc G, Cariou B, Sjouke B, Leren TP, Harada-Shiba M, Mabuchi H, Rabès JP, Carrié A, van Heyningen C, Carreau V, Farnier M, Teoh YP, Bourbon M, Kawashiri MA, Nohara A, Soran H, Marais AD, Tada H, Abifadel M, Boileau C, Chanu B, Katsuda S, Kishimoto I, Lambert G, Makino H, Miyamoto Y, Pichelin M, Yagi K, Yamagishi M, Zair Y, Mellis S, Yancopoulos GD, Stahl N, Mendoza J, Du Y, Hamon S, Krempf M, Swergold GD. Characterization of Autosomal Dominant Hypercholesterolemia Caused by PCSK9 Gain of Function Mutations and Its Specific Treatment With Alirocumab, a PCSK9 Monoclonal Antibody. ACTA ACUST UNITED AC 2015; 8:823-31. [PMID: 26374825 PMCID: PMC5098466 DOI: 10.1161/circgenetics.115.001129] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 08/25/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with PCSK9 gene gain of function (GOF) mutations have a rare form of autosomal dominant hypercholesterolemia. However, data examining their clinical characteristics and geographic distribution are lacking. Furthermore, no randomized treatment study in this population has been reported. METHODS AND RESULTS We compiled clinical characteristics of PCSK9 GOF mutation carriers in a multinational retrospective, cross-sectional, observational study. We then performed a randomized placebo-phase, double-blind study of alirocumab 150 mg administered subcutaneously every 2 weeks to 13 patients representing 4 different PCSK9 GOF mutations with low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL on their current lipid-lowering therapies at baseline. Observational study: among 164 patients, 16 different PCSK9 GOF mutations distributed throughout the gene were associated with varying severity of untreated LDL-C levels. Coronary artery disease was common (33%; average age of onset, 49.4 years), and untreated LDL-C concentrations were higher compared with matched carriers of mutations in the LDLR (n=2126) or apolipoprotein B (n=470) genes. Intervention study: in PCSK9 GOF mutation patients randomly assigned to receive alirocumab, mean percent reduction in LDL-C at 2 weeks was 62.5% (P<0.0001) from baseline, 53.7% compared with placebo-treated PCSK9 GOF mutation patients (P=0.0009; primary end point). After all subjects received 8 weeks of alirocumab treatment, LDL-C was reduced by 73% from baseline (P<0.0001). CONCLUSIONS PCSK9 GOF mutation carriers have elevated LDL-C levels and are at high risk of premature cardiovascular disease. Alirocumab, a PCSK9 antibody, markedly lowers LDL-C levels and seems to be well tolerated in these patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01604824.
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Lambert G, Chatelais M, Petrides F, Passard M, Thedrez A, Rye KA, Schwahn U, Gusarova V, Blom DJ, Sasiela W, Marais AD. Normalization of low-density lipoprotein receptor expression in receptor defective homozygous familial hypercholesterolemia by inhibition of PCSK9 with alirocumab. J Am Coll Cardiol 2014; 64:2299-300. [PMID: 25456764 DOI: 10.1016/j.jacc.2014.07.995] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
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Klug EQ, Raal FJ, Marais AD, Taskinen MR, Dalby AJ, Schamroth C, Rapeport N, Jankelow D, Blom DJ, Catsicas R, Webb DA. South African Dyslipidaemia Guideline Consensus Statement. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Marais AD, Blackhurst DM. Do heavy metals counter the potential health benefits of wine? Journal of Endocrinology, Metabolism and Diabetes of South Africa 2014. [DOI: 10.1080/22201009.2009.10872197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lambert G, Petrides F, Chatelais M, Blom DJ, Choque B, Tabet F, Wong G, Rye KA, Hooper AJ, Burnett JR, Barter PJ, Marais AD. Elevated plasma PCSK9 level is equally detrimental for patients with nonfamilial hypercholesterolemia and heterozygous familial hypercholesterolemia, irrespective of low-density lipoprotein receptor defects. J Am Coll Cardiol 2014; 63:2365-73. [PMID: 24632287 DOI: 10.1016/j.jacc.2014.02.538] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/09/2014] [Accepted: 02/11/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Do elevated proprotein convertase subtilisin/kexin type 9 (PCSK9) levels constitute an even greater risk for patients who already have reduced low-density lipoprotein receptor (LDLR) levels, such as those with heterozygous familial hypercholesterolemia (HeFH)? BACKGROUND As a circulating inhibitor of LDLR, PCSK9 is an attractive target for lowering LDL-cholesterol (LDL-C) levels. METHODS Circulating PCSK9 levels were measured by enzyme-linked immunosorbent assay in nontreated patients with HeFH carrying a D206E (n = 237), V408M (n = 117), or D154N (n = 38) LDLR missense mutation and in normolipidemic controls (n = 152). Skin fibroblasts and lymphocytes were isolated from a subset of patients and grown in 0.5% serum and mevastatin with increasing amounts of recombinant PCSK9. LDLR abundance at the cell surface was determined by flow cytometry. RESULTS PCSK9 reduced LDLR expression in a dose-dependent manner in control and FH fibroblasts to similar extents, by up to 77 ± 8% and 82 ± 7%, respectively. Likewise, PCSK9 reduced LDLR abundance by 39 ± 8% in nonfamilial hypercholesterolemia (non-FH) and by 45 ± 10% in HeFH lymphocytes, irrespective of their LDLR mutation status. We found positive correlations of the same magnitude between PCSK9 and LDL-C levels in controls (beta = 0.22; p = 0.0003), D206E (beta = 0.20; p = 0.0002), V408M (beta = 0.24; p = 0.0002), and D154N (beta = 0.25; p = 0.048) patients with HeFH. The strengths of these associations were all similar. CONCLUSIONS Elevated PCSK9 levels are equally detrimental for patients with HeFH or non-FH: a 100-ng/ml increase in PCSK9 will lead to an increase in LDL-C of 0.20 to 0.25 mmol/l in controls and HeFH alike, irrespective of their LDLR mutation. This explains why patients with non-FH or HeFH respond equally well to monoclonal antibodies targeting PCSK9.
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Affiliation(s)
- Gilles Lambert
- Faculté de Médecine, Université de Nantes, UMR PhAN 1280, Nantes, France; Lipid Research Group, Heart Research Institute, Sydney, Australia.
| | - Francine Petrides
- Lipid Research Group, Heart Research Institute, Sydney, Australia; Centre for Vascular Research, University of New South Wales, Sydney, Australia
| | - Mathias Chatelais
- Faculté de Médecine, Université de Nantes, UMR PhAN 1280, Nantes, France
| | - Dirk J Blom
- Lipidology Division of Internal Medicine, MRC Cape Heart Group, University of Cape Town Health Science Faculty, Cape Town, South Africa
| | - Benjamin Choque
- Lipid Research Group, Heart Research Institute, Sydney, Australia
| | - Fatiha Tabet
- Lipid Research Group, Heart Research Institute, Sydney, Australia; Centre for Vascular Research, University of New South Wales, Sydney, Australia
| | - Gida Wong
- Lipid Research Group, Heart Research Institute, Sydney, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, Heart Research Institute, Sydney, Australia; Centre for Vascular Research, University of New South Wales, Sydney, Australia
| | - Amanda J Hooper
- Royal Perth Hospital, Department of Clinical Biochemistry, PathWest Laboratory of Medicine WA, Perth, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - John R Burnett
- Royal Perth Hospital, Department of Clinical Biochemistry, PathWest Laboratory of Medicine WA, Perth, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Philip J Barter
- Lipid Research Group, Heart Research Institute, Sydney, Australia; Centre for Vascular Research, University of New South Wales, Sydney, Australia
| | - A David Marais
- Chemical Pathology Division of Clinical Laboratory Sciences, MRC Cape Heart Group, University of Cape Town Health Science Faculty, Cape Town, South Africa
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Marais AD, Solomon GAE, Blom DJ. Dysbetalipoproteinaemia: a mixed hyperlipidaemia of remnant lipoproteins due to mutations in apolipoprotein E. Crit Rev Clin Lab Sci 2014; 51:46-62. [PMID: 24405372 DOI: 10.3109/10408363.2013.870526] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Atherosclerosis is strongly associated with dyslipoproteinaemia, and especially with increasing concentrations of low-density lipoprotein and decreasing concentrations of high-density lipoproteins. Its association with increasing concentrations of plasma triglyceride is less clear but, within the mixed hyperlipidaemias, dysbetalipoproteinaemia (Fredrickson type III hyperlipidaemia) has been identified as a very atherogenic entity associated with both premature ischaemic heart disease and peripheral arterial disease. Dysbetalipoproteinaemia is characterized by the accumulation of remnants of chylomicrons and of very low-density lipoproteins. The onset occurs after childhood and usually requires an additional metabolic stressor. In women, onset is typically delayed until menopause. Clinical manifestations may vary from no physical signs to severe cutaneous and tendinous xanthomata, atherosclerosis of coronary and peripheral arteries, and pancreatitis when severe hypertriglyceridaemia is present. Rarely, mutations in apolipoprotein E are associated with lipoprotein glomerulopathy, a condition characterized by progressive proteinuria and renal failure with varying degrees of plasma remnant accumulation. Interestingly, predisposing genetic causes paradoxically result in lower than average cholesterol concentration for most affected persons, but severe dyslipidaemia develops in a minority of patients. The disorder stems from dysfunctional apolipoprotein E in which mutations result in impaired binding to low-density lipoprotein (LDL) receptors and/or heparin sulphate proteoglycans. Apolipoprotein E deficiency may cause a similar phenotype. Making a diagnosis of dysbetalipoproteinaemia aids in assessing cardiovascular risk correctly and allows for genetic counseling. However, the diagnostic work-up may present some challenges. Diagnosis of dysbetalipoproteinaemia should be considered in mixed hyperlipidaemias for which the apolipoprotein B concentration is relatively low in relation to the total cholesterol concentration or when there is significant disparity between the calculated LDL and directly measured LDL cholesterol concentrations. Genetic tests are informative in predicting the risk of developing the disease phenotype and are diagnostic only in the context of hyperlipidaemia. Specialised lipoprotein studies in reference laboratory centres can also assist in diagnosis. Fibrates and statins, or even combination treatment, may be required to control the dyslipidaemia.
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Affiliation(s)
- A D Marais
- Department of Chemical Pathology, Health Science Faculty, University of Cape Town , Cape Town , South Africa
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Abstract
Patients with Addison's disease (AD) are believed to be at risk for cardiovascular disease (CVD). South Africa, like the rest of the developing world is experiencing an increase in CVD and patients with AD may be at double the risk of their peers. We wished to explore AD patients' CVD risk factors. A cross-sectional nationwide study in South Africa of patients with AD was conducted. A cohort of 147 patients with AD and 147 healthy control subjects were matched by age, gender, ethnicity, and BMI as far as was possible. Lipoproteins and highly-sensitive C-reactive-protein (hs-CRP) were the main outcome measures. AD patients had significantly higher triglycerides; (p=0.001), lower HDLC (p<0.001), higher hs-CRP (p<0.001), and more small dense LDL; (p=0.002) than controls. Nonesterified fatty acids were lower in patients (p<0.001). Approximately 65% [95% confidence interval (CI 55.6-72.4%)] had hypercholesterolaemia, 75% (CI 64.8-81.2%) had low HDLC, and 75% (CI 68.0-84.1%) had a higher LDLC. Thirteen percent of AD patients had diabetes mellitus, but none of the risk factors differed from the nondiabetics. Only HDLC correlated positively with daily hydrocortisone dose (r=0.32; p=0.005). In conclusion dyslipidaemia is common in South African AD patients; CVD risk assessment and intervention are probably warranted in the management of these patients.
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Affiliation(s)
- I L Ross
- Division of Endocrinology Department of Medicine University of Cape Town, Cape Town, South Africa
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Parihar SP, Guler R, Khutlang R, Lang DM, Hurdayal R, Mhlanga MM, Suzuki H, Marais AD, Brombacher F. Statin Therapy Reduces the Mycobacterium tuberculosis Burden in Human Macrophages and in Mice by Enhancing Autophagy and Phagosome Maturation. J Infect Dis 2013; 209:754-63. [DOI: 10.1093/infdis/jit550] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parihar SP, Guler R, Lang DM, Suzuki H, Marais AD, Brombacher F. Simvastatin enhances protection against Listeria monocytogenes infection in mice by counteracting Listeria-induced phagosomal escape. PLoS One 2013; 8:e75490. [PMID: 24086542 PMCID: PMC3782446 DOI: 10.1371/journal.pone.0075490] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/15/2013] [Indexed: 12/16/2022] Open
Abstract
Statins are well-known cholesterol lowering drugs targeting HMG-CoA-reductase, reducing the risk of coronary disorders and hypercholesterolemia. Statins are also involved in immunomodulation, which might influence the outcome of bacterial infection. Hence, a possible effect of statin treatment on Listeriosis was explored in mice. Statin treatment prior to subsequent L. monocytogenes infection strikingly reduced bacterial burden in liver and spleen (up to 100-fold) and reduced histopathological lesions. Statin-treatment in infected macrophages resulted in increased IL-12p40 and TNF-α and up to 4-fold reduced bacterial burden within 6 hours post infection, demonstrating a direct effect of statins on limiting bacterial growth in macrophages. Bacterial uptake was normal investigated in microbeads and GFP-expressing Listeria experiments by confocal microscopy. However, intracellular membrane-bound cholesterol level was decreased, as analyzed by cholesterol-dependent filipin staining and cellular lipid extraction. Mevalonate supplementation restored statin-inhibited cholesterol biosynthesis and reverted bacterial growth in Listeria monocytogenes but not in listeriolysin O (LLO)-deficient Listeria. Together, these results suggest that statin pretreatment increases protection against L. monocytogenes infection by reducing membrane cholesterol in macrophages and thereby preventing effectivity of the cholesterol-dependent LLO-mediated phagosomal escape of bacteria.
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Affiliation(s)
- Suraj P. Parihar
- International Centre for Genetic Engineering & Biotechnology (ICGEB), Cape Town Component and Institute of Infectious Diseases and Molecular Medicine (IIDMM), Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Reto Guler
- International Centre for Genetic Engineering & Biotechnology (ICGEB), Cape Town Component and Institute of Infectious Diseases and Molecular Medicine (IIDMM), Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dirk M. Lang
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Harukazu Suzuki
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Japan
| | - A. David Marais
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Frank Brombacher
- International Centre for Genetic Engineering & Biotechnology (ICGEB), Cape Town Component and Institute of Infectious Diseases and Molecular Medicine (IIDMM), Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Sliwa K, Lyons JG, Carrington MJ, Lecour S, Marais AD, Raal FJ, Stewart S. Different lipid profiles according to ethnicity in the Heart of Soweto study cohort of de novo presentations of heart disease. Cardiovasc J Afr 2013; 23:389-95. [PMID: 22914997 PMCID: PMC3721871 DOI: 10.5830/cvja-2012-036] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/02/2012] [Indexed: 11/28/2022] Open
Abstract
Background Historically, sub-Saharan Africa has reported low levels of atherosclerotic cardiovascular disease (CVD). However as these populations undergo epidemiological transition, this may change. Methods This was an observational cohort study performed at Chris Hani Baragwanath Hospital in Soweto, South Africa. As part of the Heart of Soweto study, a clinical registry captured detailed clinical data on all de novo cases of structural and functional heart disease presenting to the Cardiology unit during the period 2006 to 2008. We examined fasting lipid profiles in 2 182 patients (of 5 328 total cases) according to self-reported ethnicity. The study cohort comprised 1 823 patients of African descent (61% female, aged 56 ± 16 years), 142 white Europeans (36% female, aged 57 ± 13 years), 133 Indians (51% female, aged 59 ± 12 years) and 87 of mixed ancestry (40% female, aged 56 ± 12 years). Results Consistent with different patterns in heart disease aetiology, there were clear differences in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides across ethnicities (p < 0.001): patients of African descent had the lowest TC and LDL-C levels and Indians the highest. However, there were no significant differences in high-density lipoprotein cholesterol (HDL-C) levels between ethnicities (p = 0.20). Adjusting for age, gender and body mass index, patients of African descent were significantly less likely to record a TC of > 4.5 mmol/l (OR 0.33, 95% CI: 0.25–0.41) compared to all ethnic groups (all p < 0.001). Conclusions These data confirm important blood lipid differentials according to ethnicity in patients diagnosed with heart disease in Soweto, South Africa. Such disparities in CVD risk factors may justify the use of specialised prevention and management protocols.
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Faculty of Health Sciences, University of Cape Town, South Africa
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Cuchel M, Meagher EA, du Toit Theron H, Blom DJ, Marais AD, Hegele RA, Averna MR, Sirtori CR, Shah PK, Gaudet D, Stefanutti C, Vigna GB, Du Plessis AME, Propert KJ, Sasiela WJ, Bloedon LT, Rader DJ. Efficacy and safety of a microsomal triglyceride transfer protein inhibitor in patients with homozygous familial hypercholesterolaemia: a single-arm, open-label, phase 3 study. Lancet 2013; 381:40-6. [PMID: 23122768 PMCID: PMC4587657 DOI: 10.1016/s0140-6736(12)61731-0] [Citation(s) in RCA: 517] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients with homozygous familial hypercholesterolaemia respond inadequately to existing drugs. We aimed to assess the efficacy and safety of the microsomal triglyceride transfer protein inhibitor lomitapide in adults with this disease. METHODS We did a single-arm, open-label, phase 3 study of lomitapide for treatment of patients with homozygous familial hypercholesterolemia. Current lipid lowering therapy was maintained from 6 weeks before baseline through to at least week 26. Lomitapide dose was escalated on the basis of safety and tolerability from 5 mg to a maximum of 60 mg a day. The primary endpoint was mean percent change in levels of LDL cholesterol from baseline to week 26, after which patients remained on lomitapide through to week 78 for safety assessment. Percent change from baseline to week 26 was assessed with a mixed linear model. FINDINGS 29 men and women with homozygous familial hypercholesterolaemia, aged 18 years or older, were recruited from 11 centres in four countries (USA, Canada, South Africa, and Italy). 23 of 29 enrolled patients completed both the efficacy phase (26 weeks) and the full study (78 weeks). The median dose of lomitapide was 40 mg a day. LDL cholesterol was reduced by 50% (95% CI -62 to -39) from baseline (mean 8·7 mmol/L [SD 2·9]) to week 26 (4·3 mmol/L [2·5]; p<0·0001). Levels of LDL cholesterol were lower than 2·6 mmol/L in eight patients at 26 weeks. Concentrations of LDL cholesterol remained reduced by 44% (95% CI -57 to -31; p<0·0001) at week 56 and 38% (-52 to -24; p<0·0001) at week 78. Gastrointestinal symptoms were the most common adverse event. Four patients had aminotransaminase levels of more than five times the upper limit of normal, which resolved after dose reduction or temporary interruption of lomitapide. No patient permanently discontinued treatment because of liver abnormalities. INTERPRETATION Our study suggests that treatment with lomitapide could be a valuable drug in the management of homozygous familial hypercholesterolaemia. FUNDING FDA Office of the Orphan Product Development, Aegerion Pharmaceuticals.
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Affiliation(s)
- Marina Cuchel
- Institute for Translational Medicine and Therapeutics, Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
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