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Agouridis AP, Filippatos TD, Kostapanos M, Kostara C, Tsimihodimos V. The effect of rosuvastatin alone or in combination with fenofibrate or omega-3 fatty acids on lipoprotein(a) levels in patients with mixed hyperlipidemia. Arch Med Sci Atheroscler Dis 2024; 9:e26-e32. [PMID: 38434941 PMCID: PMC10905261 DOI: 10.5114/amsad/178441] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Lipoprotein(a) [Lp(a)] is a strong, genetically determined, pathogenetic factor of atherosclerotic cardiovascular disease (ASCVD). The aim of this post-hoc analysis was to compare the effect of hypolipidemic treatment on Lp(a) levels of patients with mixed hyperlipidemia. Material and methods We previously randomized patients with mixed hyperlipidemia (low-density lipoprotein [LDL-C] > 160 mg/dl and triglycerides > 200 mg/dl) to rosuvastatin monotherapy 40 mg/day (R group, n = 30) or rosuvastatin 10 mg/day combined with fenofibrate 200 mg/day (RF group, n = 30) or omega-3 fatty acids 2 g/day (RΩ group, n = 30). In the present post-hoc analysis, we included only the patients whose Lp(a) levels were assessed (16, 16 and 15 in the R, RF and RΩ groups, respectively). Lipid profile and Lp(a) were measured at baseline and after 3 months of treatment. Results Significant reductions in total cholesterol, LDL-C, non-high-density lipoprotein-cholesterol (non-HDL-C) and triglyceride levels were observed in all groups. A significant increase in Lp(a) levels was noted in the R (p = 0.017) and RF (p = 0.029) groups, while no significant difference was seen in the RΩ group (p = NS). Regarding Lp(a) elevations, no differences were found between groups. In the R group, a strong negative correlation between the changes in Lp(a) and LDL-C (r = -0.500, p = 0.049) was observed, while a significant negative correlation between the changes in Lp(a) and triglycerides (r = -0.531, p = 0.034) was noted in the RF group. Conclusions Rosuvastatin and/or fenofibrate treatment increases Lp(a) levels in patients with mixed hyperlipidemia. Novel therapies should target Lp(a) level reduction to decrease the residual ASCVD risk in patients with mixed hyperlipidemia.
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Affiliation(s)
- Aris P Agouridis
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Department of Internal Medicine, German Oncology Center, Limassol, Cyprus
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Theodosios D Filippatos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Michael Kostapanos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
- Lipid Clinic, Department of General Medicine, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom
| | - Christina Kostara
- Laboratory of Clinical Chemistry, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasilis Tsimihodimos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Zhao T, Sriranjan R, Lu Y, Hubsch A, Kaloyirou F, Vamvaka E, Helmy J, Kostapanos M, Klatzmann D, Tedgui A, Rudd J, Hoole S, Bond S, Mallat Z, Cheriyan J. Low dose interleukin-2 in patients with stable ischaemic heart disease and acute coronary syndrome (LILACS). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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
Regulatory T lymphocytes (Tregs) are critical for immune homeostasis. Pre-clinical models have demonstrated that Tregs can modulate post-ischaemic immune responses and promote myocardial healing. Patients with ischaemic heart disease (IHD) display reduced anti-inflammatory Tregs and increased pro-inflammatory effector T cells (Teffs). Low-dose interleukin-2 (ld-IL2) has been shown to increase Tregs in patients with autoimmune diseases but is currently contraindicated in patients with IHD.
Purpose
To assess the safety and pharmacodynamic effect of ld-IL-2 in patients with IHD.
Methods
LILACS was a prospective, randomised, double-blind, placebo-controlled, dose-escalation, Phase I/II clinical trial, which tested ld-IL-2 (aldesleukin) given once daily subcutaneously, for five consecutive days. In Part A, 25 patients with stable IHD were randomised (drug:placebo ratio of 3:2) in 5 dose groups (0.3, 0.6, 1.2, 2.4 and 3x106 IU/day); whilst in Part B, 16 patients with non-ST elevation myocardial infarction (NSTEMI) were randomised (drug:placebo ratio of 6:2) in two dose groups (1.5 and 2.5x106 IU/day). Follow up was performed the day after dosing and again 7 days later. Doses were determined after blinded review. An independent committee reviewed unblinded data prior to commencing Part B. The primary endpoint was safety in parts A and B. Additionally in Part B, a co-primary endpoint was to calculate the dose required to increase Tregs by 75%. [NCT03113773]
Results
Ld-IL2 was well tolerated for all dose groups with the commonest adverse events being mild injection site reactions. Two serious adverse events, not considered to be drug related, occurred in Part B – one prior to dosing and resulting in withdrawal. The other was a recurrent NSTEMI after dosing ended in a patient with severe triple vessel coronary artery disease awaiting urgent bypass surgery. In Part A, Tregs increased with dose escalation whilst no Teff increases were noted (Figure 1A). In Part B, patients treated with 1.5 and 2.5x106 IU/day doses had a median increase in Tregs of 80.5% (CI 36.2–124.7%, p=0.003) and 108.3% (CI 55.3–161.3%, p=0.002) respectively (Figure 1B). A linear regression model estimated an increase of 43.3% (CI 23.6–63.0%, p=0.0003) per unit dose. The estimated dose to achieve a 75% increase in Tregs was 1.46x106 IU/day (CI 1.06–1.87). No increase in Teffs cells were seen however, a dose-dependent decrease was measured in B cells, whilst NK cells and eosinophils increased at the top 2.5 and 3x106 IU/day dose. A panel of 29 cytokines and chemokines showed a dose-dependent type 1 and 2 cytokine response. Single-cell RNA sequencing was performed on immune cells before and after dosing.
Conclusions
Ld-IL2 was safe and well-tolerated. An induction dose of 1.5x106 IU per day for 5 days provided an effective expansion of Tregs without increasing Teffs. This work provides important data for the future therapeutic use of ld-IL-2 which is ongoing.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Medical Research Council, British Heart Foundation Cambridge Centre of Excellence
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Affiliation(s)
- T.X Zhao
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - R.S Sriranjan
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - Y Lu
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - A Hubsch
- University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Cambridge, United Kingdom
| | - F Kaloyirou
- University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Cambridge, United Kingdom
| | - E Vamvaka
- University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Cambridge, United Kingdom
| | - J Helmy
- University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Cambridge, United Kingdom
| | - M Kostapanos
- University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Cambridge, United Kingdom
| | - D Klatzmann
- Hospital Pitie-Salpetriere, Biotherapy and Inflammation-Biotherapy Department, Paris, France
| | - A Tedgui
- Paris Cardiovascular Research Center (PARCC), Paris, France
| | - J.H.F Rudd
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - S.P Hoole
- Royal Papworth Hospital NHS Foundation Trust, Department of Cardiology, Cambridge, United Kingdom
| | - S.P Bond
- University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Cambridge, United Kingdom
| | - Z Mallat
- University of Cambridge, Department of Cardiovascular Medicine, Cambridge, United Kingdom
| | - J Cheriyan
- University of Cambridge, Division of Experimental Medicine and Immunotherapeutics, Cambridge, United Kingdom
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Abstract
Vital organs are exposed to the central rather than the brachial blood pressure. To date, central blood pressure can be assessed noninvasively through the use of several devices. In this review, we critically discuss the clinical relevance of central blood pressure assessment. Considerable evidence suggests that central blood pressure is a better predictor of end-organ damage than brachial blood pressure. However, there is still uncertainty concerning the value of central pressure for predicting cardiovascular outcomes, as the existing studies are underpowered to address this issue. A full synthesis of the available data is needed in this regard. Among the different antihypertensive drug classes, beta-blockers appear to lower central blood pressure less than brachial blood pressure. This difference may, at least in part, explain the reduced efficacy of beta-blockers in the prevention of cardiovascular outcomes compared with the other antihypertensive drug classes, which may lower central and brachial blood pressure to a similar extent. Nevertheless, this differential effect might not be relevant to the newer beta-blockers with vasodilating properties, including nebivolol, celliprolol and carvedilol. However, whether a preferential reduction of central blood pressure results in better outcomes should be further assessed by appropriately powered clinical trials. Other emerging challenges include the assessment of the potential predictive value of central blood pressure variability and the development of new antihypertensive medications based on central blood pressure rather than brachial blood pressure.
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Affiliation(s)
- Michael Kostapanos
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Carmel M McEniery
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
| | - Ian B Wilkinson
- 1 Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom
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Christogiannis L, Kostapanos M, Kostara C, Barkas F, Liontos A, Panagiotopoulou T, Bairaktari E, Elisaf M. Effects of combinations of valsartan with amlodipine or hydrochlorothiazide on renal function and proteinuria in hypertensive patients with metabolic syndrome. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Milionis H, Barkas F, Liberopoulos E, Kostapanos M, Klouras E, Elisaf M. Lipid target achievement among patients according to ESC/EAS and ACC/AHA guidelines in a lipid clinic. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Barkas F, Liberopoulos E, Kostapanos M, Liamis G, Tzialas D, Elisaf M. Lipid target achievement among very high and high cardiovascular risk patients in a lipid clinic. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Christogiannis L, Kostapanos M, Agouridis A, Barkas F, Klouras E, Tellis C, Tselepis A, Elisaf M. Effect of valsartan/hydrochlorothiazide combination on low-density-lipoprotein particle size and plasma lipoprotein-associated phospholipase A2 activity in hypertensive patients with metabolic syndrome. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kostapanos M, Florentin M, Elisaf M, Mikhailidis D. Hemostatic Factors and the Metabolic Syndrome. Curr Vasc Pharmacol 2014; 11:880-905. [PMID: 24168445 DOI: 10.2174/15701611113116660171] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/28/2012] [Accepted: 07/12/2012] [Indexed: 11/22/2022]
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Moutzouri E, Liberopoulos E, Kostapanos M, Milionis H, Elisaf M. 79 COMPARISON OF THE EFFECTS OF SIMVASTATIN VERSUS ROSUVASTATIN VERSUS SIMVASTATIN/EZETIMIBE ON PARAMETERS OF CARBOHYDRATE METABOLISM. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70080-0] [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: 11/28/2022]
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Rizos C, Milionis H, Kostapanos M, Florentin M, Kostara C, Elisaf M, Liberopoulos E. MS448 DIFFERENTIAL EFFECT OF SARTANS WITH VARIOUS PPARγ ACTIVATING CAPACITY COMBINED WITH ROSUVASTATIN ON GLUCOSE METABOLISM INDICES. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Korantzopoulos P, Tzimas P, Kalantzi K, Kostapanos M, Vemmos K, Goudevenos J, Elisaf M, Milionis H. Association between serum gamma-glutamyltransferase and acute ischemic nonembolic stroke in elderly subjects. Arch Med Res 2010; 40:582-9. [PMID: 20082873 DOI: 10.1016/j.arcmed.2009.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 07/23/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Elevated serum gamma-glutamyltransferase (GGT) levels have been proposed as an independent predictor for cardiovascular morbidity and mortality. The aim of this study was to determine whether GGT levels are associated with acute ischemic/nonembolic stroke in a case-control study of elderly subjects. METHODS A total of 163 patients >70 years of age (88 men) admitted due to a first-ever acute ischemic/nonembolic stroke and 166 volunteers (87 men) without a history of cardiovascular disease were included. The association between GGT and stroke was determined by multivariate logistic regression modelling after adjusting for potential confounding factors. RESULTS GGT levels were higher in subjects with metabolic syndrome (MetS) and correlated with MetS individual components including insulin resistance. Stroke patients showed higher concentrations of GGT compared with controls. In univariate analysis, crude odds ratio (OR) for GGT was 1.06/1 IU/L increase (95% CI, 1.03-1.09; p<0.001). Compared to subjects with GGT levels in the lowest quartile, those within the highest quartile had a 4.7-times increase in the odds of experiencing an ischemic stroke (95% CI 2.39-9.11, p<0.001). This association remained significant after controlling for all potential confounders (adjusted OR, 2.90, 95% CI, 1.35-6.27; p=0.007). Analysis of interaction between MetS and GGT showed that subjects with MetS had a 1.08 higher odds/1 IU/L increase in GGT to experience an ischemic stroke [adjusted OR, 1.08 (95% CI, 1.04-1.12; p<0.001). CONCLUSIONS There are positive associations between serum GGT and first ischemic/nonembolic stroke in individuals >70 years of age independent of established risk factors for cardiovascular disease and concurrent metabolic abnormalities.
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Tsimihodimos V, Gazi I, Filippatos T, Kostapanos M, Lagos K, Kostara C, Tellis CC, Elisaf M, Tselepis AD. Plasma triglyceride levels and body mass index values are the most important determinants of prebeta-1 HDL concentrations in patients with various types of primary dyslipidemia. Atherosclerosis 2009; 208:506-11. [PMID: 19682687 DOI: 10.1016/j.atherosclerosis.2009.07.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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] [Received: 04/08/2009] [Revised: 07/16/2009] [Accepted: 07/17/2009] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Experimental studies have shown that the prebeta-1 subclass of high-density lipoprotein particles (prebeta-1 HDL) may play an important role in the reverse cholesterol transport pathway as the initial acceptors of cellular cholesterol. The aim of the present study was the direct comparison of prebeta-1 HDL values in individuals with various types of primary dyslipidemias. METHODS Four hundred and eighty-six unrelated individuals were included in the study. According to their lipid values study participants were subdivided into four groups: control group (n=206), type IIA dyslipidemia group (n=148), type IIB dyslipidemia group (n=49) and type IV dyslipidemia group (n=83). RESULTS All dyslipidemic patients displayed higher concentrations of prebeta-1 HDL compared to control individuals. However, patients with dyslipidemias characterized by an abnormal catabolism of triglyceride-rich lipoproteins (such as dyslipidemias of type IIB and IV) tend to have higher prebeta-1 HDL values compared to patients with hypercholesterolemia, and this increase is proportional to the degree of hypertriglyceridemia. In addition, patients with metabolic syndrome exhibited significantly higher levels of prebeta-1 HDL compared to individuals that do not fulfill the criteria for the diagnosis of this syndrome. Multiple regression analysis revealed that serum triglyceride concentrations and body mass index (BMI) values were the most important determinants of prebeta-1 HDL levels in our population. CONCLUSION All dyslipidemic patients exhibit increased prebeta-1 HDL concentrations as compared to normolipidemic individuals. Whether this increase represents a defensive mechanism against atherosclerosis or it is indicative of impaired maturation of HDL particles and thus of a defective reverse cholesterol transport mechanism remains to be established.
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Affiliation(s)
- Vasilis Tsimihodimos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Florentin M, Liberopoulos E, Kostapanos M, Nakou E, Elisaf M. Abstract: P1243 TREATMENT WITH EZETIMIBE AND ORLISTAT OR RIMONABANT IN OVERWEIGHT/OBESE PATIENTS WITH DYSLIPIDEMIA AND A HISTORY OF STATIN-INTOLERANCE. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71260-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Filippatos T, Tsimihodimos V, Kostapanos M, Kostara C, Tzallas C, Bairaktari E, Tselepis A, Elisaf M. Abstract: P933 APOLIPOPROTEINS C-II AND C-III AND SMALL DENSE LDL CHOLESTEROL LEVELS IN NON-DIABETIC OBESE SUBJECTS WITH METABOLIC SYNDROME. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Filippatos TD, Tsimihodimos V, Kostapanos M, Kostara C, Bairaktari ET, Kiortsis DN, Elisaf MS. Analysis of 6-month effect of orlistat administration, alone or in combination with fenofibrate, on triglyceride-rich lipoprotein metabolism in overweight and obese patients with metabolic syndrome. J Clin Lipidol 2008; 2:279-84. [PMID: 21291744 DOI: 10.1016/j.jacl.2008.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 03/23/2008] [Accepted: 06/08/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Orlistat significantly reduced serum triglycerides (TG) in most clinical trials. Orlistat-induced TG reduction has not been studied to determine the factors contributing to TG alterations in clinical settings. OBJECTIVE We examined the factors influencing TG reduction during orlistat administration, alone or in combination with fenofibrate, and we investigated the effects of these treatments on apolipoprotein C-II (ApoC-II) and C-III (ApoC-III) levels. METHODS Patients with the metabolic syndrome were randomly allocated to receive orlistat 120 mg three times daily (n = 28, O group), micronized fenofibrate 200 mg/day (n = 28, F group), or both (n = 27, OF group) for 6 months. Plasma ApoC-II and ApoC-III were determined by an immunoturbidimetric assay. RESULTS In the O group, we observed reductions of plasma ApoC-III (P < 0.05) and ApoC-II (P = NS) levels. Fenofibrate administration significantly reduced concentrations of ApoC-II and ApoC-III, whereas the combination of orlistat and fenofibrate had an additive effect on these apolipoproteins. There were significant in-group reductions in serum TG levels in all treatment groups. Multivariate analysis showed that in O group's baseline TG levels were independently positively correlated, whereas the baseline ApoC-II levels were negatively correlated with TG-lowering. In the F group, baseline TG levels and ApoC-III reduction were significantly and independently correlated with TG reduction. OF group's baseline TG levels and ApoC-III reduction were independently positively correlated and baseline ApoC-II levels were negatively correlated with TG-lowering. CONCLUSIONS Orlistat-mediated TG-lowering is independently associated with baseline TG and ApoC-II levels. When orlistat is combined with fenofibrate, ApoC-III reduction is another independent contributor to TG alterations.
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Affiliation(s)
- Theodosios D Filippatos
- Department of Internal Medicine, School of Medicine, University of Ioannina, 45 110 Ioannina, Greece
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Filippatos TD, Liberopoulos EN, Kostapanos M, Gazi IF, Papavasiliou EC, Kiortsis DN, Tselepis AD, Elisaf MS. The effects of orlistat and fenofibrate, alone or in combination, on high-density lipoprotein subfractions and pre-beta1-HDL levels in obese patients with metabolic syndrome. Diabetes Obes Metab 2008; 10:476-83. [PMID: 17459096 DOI: 10.1111/j.1463-1326.2007.00733.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We assessed the effect of orlistat and fenofibrate, alone or in combination, on plasma high-density lipoprotein (HDL) subfractions and plasma pre-beta1-HDL levels in overweight and obese subjects with metabolic syndrome (MetS). METHODS Patients (n = 89) were prescribed a low-fat low-calorie diet and were randomly allocated to receive orlistat 120 mg three times daily (O group), micronized fenofibrate 200 mg/day (F group) or both (OF group) for 6 months. HDL subfractions were determined using a polyacrylamide gel tube electrophoresis method and pre-beta1-HDL levels using enzyme-linked immunoabsorbent assay. RESULTS We observed a significant change of high-density lipoprotein cholesterol (HDL-C) levels only in the F group (+3%, p < 0.05). Large HDL-C levels were significantly increased and small HDL-C levels were significantly reduced with O administration. In F group we observed a significant increase of small HDL-C levels. No significant change of large or small HDL-C levels was observed with combination treatment. We observed a significant increase of pre-beta1-HDL levels in all groups, which was significantly greater in OF group compared with O or F monotherapy. CONCLUSION OF combination increased the antiatherogenic pre-beta1-HDL levels in overweight and obese patients with MetS. Furthermore, OF combination counterbalanced the reduction of small HDL-C levels observed with orlistat monotherapy.
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Affiliation(s)
- T D Filippatos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Saougos VG, Tambaki AP, Kalogirou M, Kostapanos M, Gazi IF, Wolfert RL, Elisaf M, Tselepis AD. Differential effect of hypolipidemic drugs on lipoprotein-associated phospholipase A2. Arterioscler Thromb Vasc Biol 2007; 27:2236-43. [PMID: 17656665 DOI: 10.1161/atvbaha.107.147280] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a predictor for incident atherosclerotic disease. We investigated the effect of 3 hypolipidemic drugs that exert their action through different mechanisms on plasma and lipoprotein-associated Lp-PLA2 activity and mass. METHODS AND RESULTS In 50 patients with Type IIA dyslipidemia were administered rosuvastatin (10 mg daily), whereas in 50 Type IIA dyslipidemic patients exhibiting intolerance to previous statin therapy were administered ezetimibe as monotherapy (10 mg daily). Fifty patients with Type IV dyslipidemia were given micronised fenofibrate (200 mg daily). Low- and high-density lipoprotein (LDL and HDL, respectively) subclass analysis was performed electrophoretically, whereas lipoprotein subfractions were isolated by ultracentrifugation. Ezetimibe reduced plasma Lp-PLA2 activity and mass attributable to the reduction in plasma levels of all LDL subfractions. Rosuvastatin reduced enzyme activity and mass because of the decrease in plasma levels of all LDL subfractions and especially the Lp-PLA2 on dense LDL subfraction (LDL-5). Fenofibrate preferentially reduced the Lp-PLA2 activity and mass associated with the VLDL+IDL and LDL-5 subfractions. Among studied drugs only fenofibrate increased HDL-associated Lp-PLA2 (HDL-Lp-PLA2) activity and mass attributable to a preferential increase in Lp-PLA2 associated with the HDL-3c subfraction. CONCLUSIONS Ezetimibe, rosuvastatin, and fenofibrate reduce Lp-PLA2 activity and mass associated with the atherogenic apoB-lipoproteins. Furthermore, fenofibrate improves the enzyme specific activity on apoB-lipoproteins and induces the HDL-Lp-PLA2. The clinical implications of these effects remain to be established.
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Affiliation(s)
- Vasilios G Saougos
- Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
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Milionis HJ, Rizos E, Kostapanos M, Filippatos TD, Gazi IF, Ganotakis ES, Goudevenos J, Mikhailidis DP, Elisaf MS. Treating to target patients with primary hyperlipidaemia: comparison of the effects of ATOrvastatin and ROSuvastatin (the ATOROS study). Curr Med Res Opin 2006; 22:1123-31. [PMID: 16846545 DOI: 10.1185/030079906x112462] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In a 24-week, open-label, randomized, parallel-group study, we compared the efficacy and metabolic effects, beyond low density lipoprotein cholesterol (LDL-C)-lowering, of atorvastatin (ATV) and rosuvastatin (RSV) in cardiovascular disease-free subjects with primary hyperlipidaemia, treated to an LDL-C target (130 mg/dL). METHODS After a 6-week dietary lead-in period, patients were randomized to RSV 10 mg/day (n = 60) or ATV 20 mg/day (n = 60). After 6 weeks on treatment the dose of the statin was increased (to RSV 20 mg/day or ATV 40 mg/day) if the treatment goal was not achieved. A control group of healthy volunteers (n = 60) was also included for the validation of baseline serum and urinary laboratory parameters. The primary outcome was the percentage of patients reaching the LDL-C goal; secondary outcomes were changes in lipid and non-lipid metabolic parameters. RESULTS A total of 45 patients (75.0%) in the RSV-treated group and 43 (71.7%) in the ATV-treated group achieved the treatment target at the initial dose. Both regimens were generally well tolerated and there were no withdrawals due to treatment-related serious adverse events. Similar significant reductions in total cholesterol, LDL-C, apolipoprotein (apo) B, triglycerides, apoB/apoA1 ratio, fibrinogen and high-sensitivity C-reactive protein levels were seen. RSV had a significant high density lipoprotein cholesterol (HDL-C)-raising effect and showed a trend towards increasing apoA1 levels. Glycaemic control and renal function parameters were not influenced by statin therapy. ATV, but not RSV, showed a significant hypouricaemic effect. CONCLUSIONS RSV and ATV were equally efficacious in achieving LDL-C treatment goals in patients with primary hyperlipidaemia at the initial dose and following dose titration. RSV seems to have a significantly higher HDL-C-raising effect, while ATV lowers serum uric acid levels.
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Kostapanos M, Filippatos T, Milionis H, Kostara C, Bairaktari E, Elisaf M. Th-P16:404 Effect of rosuvastatin on apolipoprotein CII and CIII serum levels in patients with primary dyslipidemia. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)82362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Milionis H, Rizos E, Kostapanos M, Filippatos T, Goudevenos J, Mikhailidis D, Elisaf M. Th-P16:381 Treating to target patients with primary hyperlipidemia: Comparison of the effects of atorvastatin and rosuvastatin (The atoros study). ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)82339-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gazi I, Tsimihodimos V, Liamis G, Kostapanos M, Tselepis A, Elisaf M. We-P11:105 The hypertrigly ceridaemic waist phenotype as a marker of the atherogenic lipoprotein profile in metabolic syndrome. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81459-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kostapanos M, Filippatos T, Gazi I, Milionis H, Tselepis A, Elisaf M. Th-P15:33 Effect of rosuvastatin on low density lipoprotein (LDL) concentration and relative distribution in patients with primary dyslipidaemia. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81993-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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