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Lyons ARM, Stevens CAT, Dharmayat KI, Vallejo-Vaz DAJ, Ray KK. Overview of a collaborative global effort to address the burden of familial hypercholesterolaemia. Indian Heart J 2024; 76 Suppl 1:S113-S116. [PMID: 37981086 PMCID: PMC11019322 DOI: 10.1016/j.ihj.2023.11.005] [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: 10/12/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
This is an overview of the EAS Familial Hypercholesterolaemia (FH) Studies Collaboration (FHSC) global consortium and registry (established 2015), which broadly addresses the global burden of FH. Eighty-seven National Lead Investigators from 74 countries form this expanding global consortium, and this global registry currently includes pooled data on 70,000 participants from participating countries to facilitate FH surveillance. Published first results from this global registry concluded that FH is diagnosed late, and management of LDL-cholesterol falls below guideline recommendations, and therefore earlier detection of FH and wider use of combination therapy is required. Further FHSC studies will follow on updated data including new countries, participants and variables, and non-DNA genetic information, and on the remaining cohorts in the registry. FHSC cross-sectional collaborative global studies are expected to promote FH detection earlier in life to subsequently initiate early lipid lowering therapy to reduce lifelong exposure to cumulative LDL-cholesterol thus reducing cardiovascular disease risk.
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Affiliation(s)
- Alexander R M Lyons
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Christophe A T Stevens
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Kanika I Dharmayat
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Dr Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom; Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain; Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen Del Rocío, Universidad de Sevilla, CSIC, Seville, Spain
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Valenzuela PL, Santos-Lozano A, Saco-Ledo G, Castillo-García A, Lucia A. Obesity, cardiovascular risk, and lifestyle: cross-sectional and prospective analyses in a nationwide Spanish cohort. Eur J Prev Cardiol 2023; 30:1493-1501. [PMID: 37317985 DOI: 10.1093/eurjpc/zwad204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/13/2022] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 06/16/2023]
Abstract
AIMS To assess whether overweight and obesity are independently associated with cardiometabolic health [as categorized based on the presence/absence of cardiovascular disease (CVD) risk factors (diabetes, hypercholesterolaemia, or hypertension)], and the role of lifestyle on this association. METHODS AND RESULTS A nationwide cohort of Spanish adults (18-64 years) was studied using a cross-sectional design and prospective observational design. Lifestyle-related factors (physical activity, sleeping characteristics, alcohol drinking, and smoking) were registered, and participants were classified as having an 'unhealthy' or 'healthy' cardiometabolic status attending to the presence or absence, respectively, of ≥1 CVD risk factor. A number of 596 111 participants (44 ± 9 years, 67% male) were studied at baseline, with prospective analyses in a subcohort [n = 302 061; median follow-up, 2 years (range, 2 to 5)]. Compared to normal weight, overweight and obesity were associated with a higher prevalence [odds ratio, 1.67 (95% confidence interval, 1.61-1.67) and 2.70 (2.69-2.78), respectively] and incidence [1.62 (1.59-1.67) and 2.70 (2.63-2.78)] of an unhealthy cardiometabolic status. Meeting physical activity guidelines reduced the odds of an unhealthy cardiometabolic status at baseline [0.87 (0.85-0.88)] among individuals with overweight/obesity, as well as of transitioning from a healthy status to an unhealthy status during the follow-up [0.87 (0.84-0.94)]. No significant associations were found for the remainder of lifestyle factors. CONCLUSION Overweight and obesity are independently associated with an unhealthy cardiometabolic status. Regular physical activity attenuates not only the prevalence but also the incidence of CVD risk factors.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), 7ª Planta, Bloque D., Av. de Córdoba s/n, 28041 Madrid, Spain
- Department of Systems Biology, University of Alcalá, C/ 19, Av. de Madrid, Km 33,600, Alcalá de Henares, 28871 Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, European University Miguel de Cervantes, C/ del Padre Julio Chevalier, 2, 47012 Valladolid, Spain
| | - Gonzalo Saco-Ledo
- Faculty of Sport Sciences, Universidad Europea de Madrid, C. Tajo, s/n, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Adrián Castillo-García
- Department of Systems Biology, University of Alcalá, C/ 19, Av. de Madrid, Km 33,600, Alcalá de Henares, 28871 Madrid, Spain
| | - Alejandro Lucia
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), 7ª Planta, Bloque D., Av. de Córdoba s/n, 28041 Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, C. Tajo, s/n, Villaviciosa de Odón, 28670 Madrid, Spain
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Li X, Han T, Sun X, Chen Y, Xu J, Ma Y, Hou W, Sun C. Association of meal timing of energy, macronutrients and foods with hypercholesterolaemia in the US adults. Br J Nutr 2023; 130:304-311. [PMID: 36597806 DOI: 10.1017/s0007114522003257] [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] [Indexed: 01/05/2023]
Abstract
Few studies examined the association of energy, macronutrients and food consumption at dinner v. breakfast with hypercholesterolaemia. A total of 27 911 participants from the National Health and Nutrition Examination Survey (2003-2016) were included in the cross-sectional study. Energy, macronutrients and food consumption at breakfast, dinner and the difference at dinner v. breakfast (Δratio) were calculated. Multiple logistic regression models and substitution effects of foods at dinner with breakfast were also performed. After adjustment for potential covariates, compared with the lowest quintile, participants in the highest quintile of Δratio in terms of energy had a higher risk of prevalent hypercholesterolaemia (ORΔratio of energy 1·16, 95 % CI (1·01, 1·33)) mainly due to Δratio of low-quality carbohydrates and plant protein (ORΔratio of low-quality carbohydrates 1·19; 95 % CI (1·05, 1·35)); ORΔratio of plant protein 1·13; 95 % CI (1·01, 1·28)). ΔAdded sugars and Δnuts were associated with hypercholesterolaemia (ORΔadded sugars 1·01; 95 % CI (1·00, 1·02)); ORΔnuts 1·08; 95 % CI (1·01, 1·16)). Furthermore, the substitution of added sugars, nuts and processed meat at dinner with breakfast could reduce the OR of hypercholesterolaemia. This study indicated that among US adults, overconsumption of energy, macronutrients including low-quality carbohydrates and plant protein at dinner than breakfast was significantly associated with a higher risk of prevalent hypercholesterolaemia. The replacing of added sugar, nuts and processed meat at dinner with breakfast reduced the risk of prevalent hypercholesterolaemia. This study emphasised the importance of meal timing in the prevention of hypercholesterolaemia.
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Affiliation(s)
- Xiangning Li
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Tianshu Han
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Xinyi Sun
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Yunyan Chen
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Jiaxu Xu
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Yifan Ma
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Wanying Hou
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Changhao Sun
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, 150081, People's Republic of China
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De Luca L, Riccio C, Navazio A, Valente S, Cipriani M, Corda M, De Nardo A, Francese GM, Napoletano C, Tizzani E, Roncon L, Caldarola P, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. ANMCO position paper on the management of hypercholesterolaemia in patients with acute coronary syndrome. Eur Heart J Suppl 2023; 25:D312-D322. [PMID: 37213800 PMCID: PMC10194822 DOI: 10.1093/eurheartjsupp/suad100] [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] [Indexed: 05/23/2023]
Abstract
Patients suffering from acute coronary syndrome (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that LDL-C levels decrease linearly correlates with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS. In this position paper, Italian Association of Hospital Cardiologists proposes a decision algorithm on early adoption of lipid-lowering strategies at hospital discharge and short-term follow-up of patients with ACS, in the light of the multiple evidence generated in recent years on the treatment of hypercholesterolaemia and the available therapeutic options, considering current reimbursement criteria.
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Affiliation(s)
- Leonardo De Luca
- Corresponding author. Tel: 00390658704419, Fax: 00390658704423, ;
| | - Carmine Riccio
- UOSD Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta 81100, Italy
| | - Alessandro Navazio
- SOC Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia—IRCCS, Reggio Emilia 42121, Italy
| | - Serafina Valente
- Dipartimento Cardio-Toracico, AOU Senese, Ospedale Santa Maria alle Scotte, Siena 53100, Italy
| | - Manlio Cipriani
- UOC Cardiologia, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo 90121, Italy
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera G. Brotzu, Cagliari 09121, Italy
| | - Alfredo De Nardo
- UO Cardiologia-UTIC, Ospedale Civile ‘G. Jazzolino’, Vibo Valentia 89900, Italy
| | - Giuseppina Maura Francese
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania 95100, Italy
| | - Cosimo Napoletano
- UOC Cardiologia-UTIC-Emodinamica, Presidio Ospedaliero ‘G. Mazzini’, Teramo 64100, Italy
| | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO), Torino 10098, Italy
| | - Loris Roncon
- UOC Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo 45100, Italy
| | | | - Michele Massimo Gulizia
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania 95100, Italy
| | - Domenico Gabrielli
- Dipartimento di Scienze Cardio-Toraco-Vascolari, UOC Cardiologia, AO San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Fabrizio Oliva
- Unità di Cure Intensive Cardiologiche, Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milano 20162, Italy
| | - Furio Colivicchi
- UOC Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, Roma 00176, Italia
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Henry P, Cariou B, Farnier M, Lakhdari SL, Detournay B. Lipid-lowering efficacy and safety of alirocumab in a real-life setting in France: Insights from the ODYSSEY APPRISE study. Arch Cardiovasc Dis 2023; 116:3-8. [PMID: 36535853 DOI: 10.1016/j.acvd.2022.10.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Recently, a multicentre, prospective, single-arm, phase 3b, open-label trial was conducted to determine the safety and efficacy of alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in a real-life setting. This study enrolled patients at high cardiovascular risk, with heterozygous familial hypercholesterolaemia (HeFH) or non-familial hypercholesterolaemia (non-FH). Results showed that alirocumab was well tolerated and resulted in a clinically significant reduction in low-density lipoprotein cholesterol (LDL-C). AIM This ancillary analysis aimed to describe the characteristics of the French patients enrolled in the study, the main results observed in this population according to their familial hypercholesterolaemia status, and adherence to treatment. METHODS French data were analysed separately from the original dataset of the study. RESULTS Among 215 French patients in the ODYSSEY APPRISE trial, 63.7% had non-FH, with a mean LDL-C concentration of 5.0±1.8mmol/L at baseline. The mean duration of alirocumab exposure was 72.4±42.5 weeks, with only 48.4% of patients receiving statins concomitantly. At week 12, a mean reduction in LDL-C of 56.5±17.8% was observed: 51.2±22.8% in HeFH; 59.5±13.2% in non-FH. This improvement in LDL-C started from week 4 and remained stable and sustained until week 120 in both populations. The overall incidence of severe treatment-emergent adverse events (TEAEs) was 33.5%. The most frequent TEAEs were myalgia (15.8%) and asthenia (15.3%). No tolerance or efficacy differences were observed between patients with or without established coronary artery disease or other cardiovascular disease, whatever the age of these events or considering the concomitant use of other lipid-lowering therapies. CONCLUSIONS In the French setting, alirocumab was well tolerated, safe and highly effective at reducing LDL-C. These findings support the use of alirocumab to manage hypercholesterolaemia in patients at high cardiovascular risk.
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Affiliation(s)
- Patrick Henry
- Cardiologie et maladies vasculaires, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - Bertrand Cariou
- Inserm, CNRS, Nantes université, CHU de Nantes, institut du thorax, 44000 Nantes, France
| | - Michel Farnier
- Équipe PEC2, EA 7460, UFR sciences de santé, université de Bourgogne Franche Comté, BP 87900, 21079 Dijon, France
| | - Sarah L Lakhdari
- Medical Head, Cardiology & Transplant, General Medicines, Sanofi, 94250 Gentilly, France
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Castilla Guerra L, Fernández Moreno MC, Jiménez Hernández MD, Ramírez Gurruchaga P, Colmenero Camacho MA. Trends in the use of statins after ischaemic stroke: Have clinical practices changed? Neurologia 2023; 38:15-20. [PMID: 36162698 DOI: 10.1016/j.nrleng.2020.03.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/20/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population. METHODS We conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016. RESULTS The study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P = .0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P = .0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P = .0001). In both periods, atorvastatin was the most commonly prescribed statin (80 mg: 6% vs 42.7%; 40 mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age. CONCLUSION There has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised.
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Affiliation(s)
- L Castilla Guerra
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | | | | | - P Ramírez Gurruchaga
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M A Colmenero Camacho
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Heintjes EM, Anastassopoulou A, Kuiper J, Bilitou A, Beest FJAPV, Herings RMC, Postma MJ, Jukema JW. Treatment and low-density lipoprotein cholesterol levels in patients with hypercholesterolaemia or mixed dyslipidaemia at high or very high cardiovascular risk: a population-based cross-sectional study in the Netherlands. Curr Med Res Opin 2023; 39:1-11. [PMID: 36168818 DOI: 10.1080/03007995.2022.2129228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To describe treatment patterns, low-density lipoprotein cholesterol (LDL-C) levels and healthcare resource utilization (HCRU) in the Netherlands in 2018 of patients with hypercholesterolaemia or mixed dyslipidaemia at high or very high cardiovascular (CV) risk. METHODS From the PHARMO Database Network adult patients with a diagnosis or receiving lipid lowering therapy (LLT) between 2009 and 2018 were selected. Patients at high or very high CV risk according to 2016 ESC/EAS guidelines with recorded LDL-C levels who were treated with LLT or were characterized as statin intolerant in 2018 were included. LLT treatment patterns, LDL-C levels and HCRU (General Practitioner [GP] consultations and hospitalizations) were assessed. RESULTS The study population included 54,346 patients, of which 70% were at very high CV risk and 30% at high CV risk. The majority (93%) received statin monotherapy, mostly of moderate (73%) or high (15%) intensity. Only 3% received a combination of statin and ezetimibe. Statin intolerance, based on a treatment algorithm, was estimated at 3%. Average LDL-C decreased with LLT intensity. Overall, 74% reached LDL-C < 2.5 mmol/l and 34% <1.8 mmol/l with their current treatment, and 46% reached their LDL-C goal according to 2016 ESC/EAS guidelines. The highest rates of hospitalizations and GP consultations, including home visits, were recorded in patients with peripheral artery disease or polyvascular disease. CONCLUSION The treatment of hypercholesterolaemia and mixed dyslipidaemia in patients at high or very high CV risk in the Netherlands was suboptimal in 2018. To further lower CV risk alternative treatment strategies using add-on therapies are needed.
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Affiliation(s)
- Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | - Josephina Kuiper
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
- Pharmacoepidemiology & Health Care Optimization, Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, the Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
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Assmann AK, Winnicki V, Sugimura Y, Chekhoeva A, Barth M, Assmann A, Lichtenberg A, Akhyari P. Impact of PPAR-gamma activation on the durability of biological heart valve prostheses in hypercholesterolaemic rats. Eur J Cardiothorac Surg 2022; 63:6984719. [PMID: 36629469 DOI: 10.1093/ejcts/ezad005] [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] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/02/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Hypercholesterolaemia and obesity are risk factors for the development of calcified aortic valve disease and common comorbidities in respective patients. Peroxisome proliferator-activated receptor gamma activation has been shown to reduce the progression of native aortic valve sclerosis, while its effect on bioprosthetic valve degeneration is yet unknown. This project aims to analyse the impact of pioglitazone, a peroxisome proliferator-activated receptor gamma agonist, on the degeneration of biological aortic valve conduits in an implantation model in obese and hypercholesterolaemic rats. METHODS Cryopreserved allogenic rat aortic valve conduits (n = 40) were infrarenally implanted into Wistar rats on high-fat (34.6%) diet. One cohort was treated with pioglitazone (75 mg/kg chow; n = 20, group PIO) and compared to untreated rats (n = 20, group control). After 4 or 12 weeks, conduits were explanted and analysed by (immuno-)histology and real-time polymerase chain reaction. RESULTS A significantly decreased intima hyperplasia occurred in group PIO compared to control after 4 (P = 0.014) and 12 weeks (P = 0.045). Calcification of the intima was significantly decreased in PIO versus control at 12 weeks (P = 0.0001). No significant inter-group differences were shown for media calcification after 4 and 12 weeks. Echocardiographically, significantly lower regurgitation through the implanted aortic valve conduit was observed in PIO compared to control after 4 (P = 0.018) and 12 weeks (P = 0.0004). Inflammatory activity was comparable between both groups. CONCLUSIONS Systemic peroxisome proliferator-activated receptor gamma activation decreases intima hyperplasia and subsequent intima calcification of cryopreserved allografts in obese, hypercholesterolaemic recipients. Additionally, it seems to inhibit functional impairment of the implanted aortic valve. Further preclinical studies are required to determine the long-term impact of peroxisome proliferator-activated receptor gamma agonists on graft durability.
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Affiliation(s)
- Anna Kathrin Assmann
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Vanessa Winnicki
- Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Yukiharu Sugimura
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Agunda Chekhoeva
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Mareike Barth
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Alexander Assmann
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Ray KK, Kallend D, Leiter LA, Raal FJ, Koenig W, Jaros MJ, Schwartz GG, Landmesser U, Garcia Conde L, Wright RS. Effect of inclisiran on lipids in primary prevention: the ORION-11 trial. Eur Heart J 2022; 43:5047-5057. [PMID: 36331315 PMCID: PMC9769955 DOI: 10.1093/eurheartj/ehac615] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/26/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Patients often require combination therapies to achieve LDL cholesterol (LDL-C) targets for the primary prevention of atherosclerotic cardiovascular disease. This study investigates the effect of inclisiran, a small interfering ribonucleic acid targeting hepatic proprotein convertase subtilisin/kexin type 9 production, in primary prevention patients with elevated LDL-C despite statins. METHODS AND RESULTS This pre-specified analysis of the placebo-controlled, randomized ORION-11 trial included 203 individuals at risk of, but without prior, cardiovascular events and LDL-C ≥2.6 mmol/L, despite maximally tolerated statins. Inclisiran 284 mg or placebo was administered on Days 1, 90, and thereafter every 6 months up to 540 days. Co-primary endpoints were percentage LDL-C change from baseline to Day 510 and time-adjusted change from baseline after Day 90 and up to Day 540. Key secondary endpoints included percentage and absolute changes in atherogenic lipoproteins. Safety was assessed over 540 days. The mean baseline (SD) LDL-C was 3.6 (1.5) mmol/L. At Day 510, the placebo-corrected LDL-C change with inclisiran was -43.7% [95% confidence interval (CI): -52.8 to -34.6] with a corresponding time-adjusted change of -41.0% (95% CI: -47.8 to -34.2); (P < 0.0001). The placebo-corrected absolute change in LDL-C at Day 510 with inclisiran was -1.5 mmol/L (95% CI: -1.8 to -1.2), with a respective time-adjusted change of -1.3 mmol/L (95% CI: -1.6 to -1.1). Inclisiran significantly lowered non-HDL cholesterol and apolipoprotein B (apoB) at Day 510 vs. placebo (P < 0.0001 for both), with a greater likelihood of attaining lipoprotein and apoB goals, and was well-tolerated except for mainly mild, treatment-emergent adverse events at the injection site. CONCLUSION Inclisiran was generally well-tolerated in primary prevention patients with elevated LDL-C, who derived significant reductions in atherogenic lipoprotein levels with twice-yearly maintenance dosing.
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Affiliation(s)
| | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Frederick J Raal
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wolfgang Koenig
- German Heart Centre, Technical University Munich, DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany,Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - Gregory G Schwartz
- Cardiology Division, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ulf Landmesser
- Department of Cardiology, Charité-University Medicine Berlin, Berlin Institute of Health (BIH), DZHK, Partner Site Berlin, Germany
| | | | - R Scott Wright
- Mayo Clinic Department of Cardiology, Rochester, MN, USA
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10
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Jadhav SB, Crass RL, Chapel S, Kerschnitzki M, Sasiela WJ, Emery MG, Amore BM, Barrett PHR, Watts GF, Catapano AL. Pharmacodynamic effect of bempedoic acid and statin combinations: predictions from a dose-response model. European Heart Journal - Cardiovascular Pharmacotherapy 2022; 8:578-586. [PMID: 34448822 PMCID: PMC9440868 DOI: 10.1093/ehjcvp/pvab064] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/03/2021] [Indexed: 02/04/2023]
Abstract
AIMS Many patients are unable to achieve guideline-recommended LDL cholesterol (LDL-C) targets, despite taking maximally tolerated lipid-lowering therapy. Bempedoic acid, a competitive inhibitor of ATP citrate lyase, significantly lowers LDL-C with or without background statin therapy in diverse populations. Because pharmacodynamic interaction between statins and bempedoic acid is complex, a dose-response model was developed to predict LDL-C pharmacodynamics following administration of statins combined with bempedoic acid. METHODS AND RESULTS Bempedoic acid and statin dosing and LDL-C data were pooled from 14 phase 1-3 clinical studies. Dose-response models were developed for bempedoic acid monotherapy and bempedoic acid-statin combinations using previously published statin parameters. Simulations were performed using these models to predict change in LDL-C levels following treatment with bempedoic acid combined with clinically relevant doses of atorvastatin, rosuvastatin, simvastatin, and pravastatin. Dose-response models predicted that combining bempedoic acid with the lowest statin dose of commonly used statins would achieve a similar degree of LDL-C lowering as quadrupling that statin dose; for example, the predicted LDL-C lowering was 54% with atorvastatin 80 mg compared with 54% with atorvastatin 20 mg + bempedoic acid 180 mg, and 42% with simvastatin 40 mg compared with 46% with simvastatin 10 mg + bempedoic acid 180 mg. CONCLUSION These findings suggest bempedoic acid combined with lower statin doses offers similar LDL-C lowering compared with statin monotherapy at higher doses, potentially sparing patients requiring additional lipid-lowering therapies from the adverse events associated with higher statin doses.
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Affiliation(s)
- Satyawan B Jadhav
- Ann Arbor Pharmacometrics Group, 900 Victors Way #328, Ann Arbor, MI 48108, USA
| | - Ryan L Crass
- Ann Arbor Pharmacometrics Group, 900 Victors Way #328, Ann Arbor, MI 48108, USA
| | - Sunny Chapel
- Ann Arbor Pharmacometrics Group, 900 Victors Way #328, Ann Arbor, MI 48108, USA
| | | | - William J Sasiela
- Esperion Therapeutics, Inc., 3891 Ranchero Dr, Ann Arbor, MI 48108, USA
| | - Maurice G Emery
- Esperion Therapeutics, Inc., 3891 Ranchero Dr, Ann Arbor, MI 48108, USA
| | - Benny M Amore
- Esperion Therapeutics, Inc., 3891 Ranchero Dr, Ann Arbor, MI 48108, USA
| | - P Hugh R Barrett
- Faculty of Medicine and Health, University of New England, Armidale, NSW 2351, Australia
| | - Gerald F Watts
- School of Medicine, University of Western Australia, Medical Research Foundation Building, Rear 50 Murray Street, Perth, WA 6001, Australia
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and IRCCS Multimedica, Via Balzaretti 9, 20133 Milan, Italy
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11
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Burvill AJ, Murray K, Knuiman MW, Hung J. Comparing self-reported and measured hypertension and hypercholesterolaemia at standard and more stringent diagnostic thresholds: the cross-sectional 2010-2015 Busselton Healthy Ageing study. Clin Hypertens 2022; 28:16. [PMID: 35642010 DOI: 10.1186/s40885-022-00199-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Population health behaviour and risk factor surveys most often rely on self-report but there is a lack of studies assessing the validity of self-report using Australian data. This study investigates the sensitivity, specificity and agreement of self-reported hypertension and hypercholesterolaemia with objective measures at standard and more stringent diagnostic thresholds; and factors associated with sensitivity and specificity of self-report at different thresholds. Methods This study was a secondary analysis of a representative community-based cross-sectional sample of 5,092 adults, aged 45–69 years, residing in Busselton, Western Australia, surveyed in 2010–2015. Participants completed a self-administered questionnaire. Blood pressure and serum cholesterol levels were measured. Results At currently accepted diagnostic thresholds, sensitivities of self-reported hypertension and hypercholesterolaemia were 58.5% and 39.6%, respectively and specificities were >90% for both. Agreement using Cohen’s kappa coefficient was 0.562 and 0.223, respectively. At two higher diagnostic thresholds, sensitivities of self-reported hypertension and hypercholesterolaemia improved by an absolute 14–23% and 15–25%, respectively and specificities remained >85%. Agreement was substantial for hypertension (kappa = 0.682–0.717) and moderate for hypercholesterolaemia (kappa = 0.458–0.533). Variables that were independently associated with higher sensitivity and lower specificity of self-report were largely consistent across thresholds and included increasing age, body mass index, worse self-rated health, diabetes and family history of hypertension. Conclusions Self-reported hypertension and hypercholesterolaemia often misclassify individuals’ objective status and underestimate objective prevalences, at standard diagnostic thresholds, which has implications for surveillance studies that rely on self-reported data. Self-reports of hypertension, however, may be reasonable indicators of those with blood pressures ≥160/100 mmHg or those taking anti-hypertensive medications. Self-reported hypercholesterolaemia data should be used with caution at all thresholds.
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12
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Keeter WC, Carter NM, Nadler JL, Galkina EV. The AAV-PCSK9 murine model of atherosclerosis and metabolic dysfunction. Eur Heart J Open 2022; 2:oeac028. [PMID: 35919346 PMCID: PMC9242032 DOI: 10.1093/ehjopen/oeac028] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/06/2022] [Indexed: 01/27/2023]
Abstract
Aims Mouse models with genetic modifications are required to investigate atherogenesis and associated metabolic syndrome. Adeno-associated virus-8 (AAV8)-mediated overexpression of PCSK9 (AAV8-PCSK9) induces hyperlipidaemia and promotes atherosclerosis in C57BL/6 mice. We aimed to assess whether AAV8-PCSK9-injected C57BL/6 mice fed high-fat diet with added cholesterol (HFD-C) would serve as a model of combined metabolic syndrome and atherosclerosis. Methods and results C57BL/6 mice received i.v. injection of AAV-PCSK9 and sex- and age-matched Ldlr-/- and C57BL/6 control mice were placed on HFD-C or chow diet for 20 weeks (B6-PCSK9-HFD-C, Ldlr-/- HFD-C, B6-HFD-C, and B6-Chow, respectively). High-fat diet with added cholesterol feeding led to insulin resistance and impaired glucose clearance in B6-PCSK9-HFD-C mice compared with B6-Chow controls. This decrease in metabolic health in B6-PCSK9-HFD-C mice as well as the development of atherosclerosis was similar to Ldlr-/- HFD-C mice. Importantly, HFD-C feeding induced pancreatic islet hyperplasia in B6-PCSK9-HFD-C and B6-HFD-C compared with B6-Chow controls. In line with alterations in the metabolic phenotype, there was an increase in the number of pro-inflammatory Ly6Chigh/med monocytes within the adipose tissues of B6-PCSK9-HFD-C and B6-HFD-C compared with B6-Chow controls. Conclusion High-fat diet with added cholesterol-fed AAV-PCSK9-injected C57BL/6 mice can serve as a useful model of integrated metabolic syndrome and atherosclerosis that does not require genetic manipulations.
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Affiliation(s)
- William Coles Keeter
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, 700 West Olney Rd, LH3180, Norfolk 23507, VA, USA
| | - Nigeste M Carter
- Present address: Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond 23284, VA, USA
| | - Jerry L Nadler
- Department of Medicine and Pharmacology, New York Medical College, Valhalla 10595, NY, USA
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13
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Affiliation(s)
- Arjen J Cupido
- Department of Vascular Medicine, Amsterdam University Medical Centres - location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - John J P Kastelein
- Department of Vascular Medicine, Amsterdam University Medical Centres - location AMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Stiekema LCA, Willemsen L, Kaiser Y, Prange KHM, Wareham NJ, Boekholdt SM, Kuijk C, de Winther MPJ, Voermans C, Nahrendorf M, Stroes ESG, Kroon J. Impact of cholesterol on proinflammatory monocyte production by the bone marrow. Eur Heart J 2021; 42:4309-4320. [PMID: 34343254 PMCID: PMC8572558 DOI: 10.1093/eurheartj/ehab465] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 10/25/2020] [Revised: 02/22/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022] Open
Abstract
AIM Preclinical work indicates that low-density lipoprotein cholesterol (LDL-C) not only drives atherosclerosis by directing the innate immune response at plaque level but also augments proinflammatory monocyte production in the bone marrow (BM) compartment. In this study, we aim to unravel the impact of LDL-C on monocyte production in the BM compartment in human subjects. METHODS AND RESULTS A multivariable linear regression analysis in 12 304 individuals of the EPIC-Norfolk prospective population study showed that LDL-C is associated with monocyte percentage (β = 0.131 [95% CI: 0.036-0.225]; P = 0.007), at the expense of granulocytes (β = -0.876 [95% CI: -1.046 to -0.705]; P < 0.001). Next, we investigated whether altered haematopoiesis could explain this monocytic skewing by characterizing CD34+ BM haematopoietic stem and progenitor cells (HSPCs) of patients with familial hypercholesterolaemia (FH) and healthy normocholesterolaemic controls. The HSPC transcriptomic profile of untreated FH patients showed increased gene expression in pathways involved in HSPC migration and, in agreement with our epidemiological findings, myelomonocytic skewing. Twelve weeks of cholesterol-lowering treatment reverted the myelomonocytic skewing, but transcriptomic enrichment of monocyte-associated inflammatory and migratory pathways persisted in HSPCs post-treatment. Lastly, we link hypercholesterolaemia to perturbed lipid homeostasis in HSPCs, characterized by lipid droplet formation and transcriptomic changes compatible with increased intracellular cholesterol availability. CONCLUSIONS Collectively, these data highlight that LDL-C impacts haematopoiesis, promoting both the number and the proinflammatory activation of circulating monocytes. Furthermore, this study reveals a potential contributory role of HSPC transcriptomic reprogramming to residual inflammatory risk in FH patients despite cholesterol-lowering therapy.
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Affiliation(s)
- Lotte C A Stiekema
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Lisa Willemsen
- Department of Medical Biochemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Yannick Kaiser
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Koen H M Prange
- Department of Medical Biochemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Nicholas J Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - S Matthijs Boekholdt
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Carlijn Kuijk
- Sanquin Research and Landsteiner Laboratory, Department of Hematopoiesis, University of Amsterdam, Plesmanlaan 125, Amsterdam 1066 CX, The Netherlands
| | - Menno P J de Winther
- Department of Medical Biochemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.,Department of Medical Biochemistry, Amsterdam UMC, University of Amsterdam, Amsterdam Infection and Immunity, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Carlijn Voermans
- Sanquin Research and Landsteiner Laboratory, Department of Hematopoiesis, University of Amsterdam, Plesmanlaan 125, Amsterdam 1066 CX, The Netherlands
| | - Matthias Nahrendorf
- Center for Systems Biology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA 02114, USA
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Jeffrey Kroon
- Department of Experimental Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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15
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Sjuls S, Jensen U, Littmann K, Bruchfeld A, Brinck J. Effective cholesterol lowering after myocardial infarction in patients with nephrotic syndrome may require a multi-pharmacological approach: a case report. Eur Heart J Case Rep 2021; 5:ytab151. [PMID: 34124564 PMCID: PMC8189300 DOI: 10.1093/ehjcr/ytab151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/10/2020] [Accepted: 04/09/2021] [Indexed: 01/10/2023]
Abstract
Background Nephrotic syndrome causes severe hypercholesterolaemia due to increased production and altered clearance of lipoproteins from the liver. It is challenging for patients with nephrotic syndrome and coronary heart disease to meet LDL-cholesterol (LDL-C) goals for secondary prevention with conventional lipid-lowering therapy. Case summary We present a man with nephrotic syndrome caused by focal segmental glomerular sclerosis (FSGS) and hypercholesterolaemia. He presented at the emergency room (ER) with an ST-elevation myocardial infarction at the age of 26. On follow-up, the patient had persistent hypercholesterolaemia [LDL-C 3.9 mmol/L and lipoprotein(a) 308 nmol/L] despite a combination of lipid-lowering therapy with atorvastatin 80 mg/day and ezetimibe 10 mg/day. Addition of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitory antibody evolocumab 140 mg bi-monthly did not improve cholesterol levels. However, after addition of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin 10 mg/day on top of other anti-proteinuric treatments, the patient’s proteinuria was reduced and a dramatic drop in LDL-C level by 3.2–0.6 mmol/L (−81%) was observed when evolocumab was re-introduced. Discussion We show that target LDL-C levels were obtained in this patient with therapy-resistant FSGS and hypercholesterolaemia following multi-pharmacological treatment with SGLT2 and PCSK9 inhibitors on top of conventional lipid-lowering therapy. The SGLT2-inhibitor reduced proteinuria and, speculatively, also reduced urinary loss of PCSK9-antibody. Therefore, in patients with nephrotic syndrome and cardiovascular disease novel therapeutic options to manage proteinuria could be considered to improve the efficacy of the lipid-lowering therapy, especially when the protein-based PCSK9 inhibitors are used.
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Affiliation(s)
- Simon Sjuls
- Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm 141 86, Sweden
| | - Ulf Jensen
- Department of Cardiology, Södersjukhuset, Stockholm 118 83, Sweden
| | - Karin Littmann
- Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm 141 86, Sweden.,Department of Medicine H7, Karolinska Institutet, Stockholm 141 86, Sweden
| | - Annette Bruchfeld
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 581 83, Sweden.,Department of Renal Medicine, Karolinska University Hospital and CLINTEC Karolinska Institute, Stockholm 141 86, Sweden
| | - Jonas Brinck
- Department of Endocrinology, Karolinska University Hospital Huddinge, Stockholm 141 86, Sweden.,Department of Medicine H7, Karolinska Institutet, Stockholm 141 86, Sweden
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16
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Pedro-Botet J, Climent E, Gabarró N, Millán J. Familial combined hyperlipidaemia/polygenic mixed hyperlipidaemia. Clin Investig Arterioscler 2021; 33 Suppl 2:43-49. [PMID: 34006353 DOI: 10.1016/j.arteri.2020.12.013] [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] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022]
Abstract
Familial combined hyperlipidaemia (FCH) is the most prevalent form of familial hyperlipidaemia with a multigenic origin and a complex pattern of inheritance. In this respect, FCH is an oligogenic primary lipid disorder due to interaction of genetic variants and mutations with environmental factors. Patients with FCH are at increased risk of cardiovascular disease and often have other associated metabolic conditions. Despite its relevance in cardiovascular prevention, FCH is frequently underdiagnosed and very often undertreated. In this review, emphasis is placed on the most recent advances in FCH, in order to increase its awareness and ultimately contribute to improving its clinical control.
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Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Elisenda Climent
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
| | - Nuria Gabarró
- Unidad de Lípidos, Servicio de Medicina Interna, H. U. Gregorio Marañón, Universidad Complutense, Madrid, España
| | - Jesús Millán
- Unidad de Lípidos, Servicio de Medicina Interna, H. U. Gregorio Marañón, Universidad Complutense, Madrid, España
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17
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Frederiksen TC, Mortensen MB, Kanstrup HL. Seventeen years of misdiagnosis in rare dyslipidaemia: a case report of sitosterolaemia in a young female. Eur Heart J Case Rep 2021; 5:ytab188. [PMID: 34268478 PMCID: PMC8276620 DOI: 10.1093/ehjcr/ytab188] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 04/16/2021] [Indexed: 01/21/2023]
Abstract
Background Sitosterolaemia is a rare, autosomal recessive dyslipidaemia with increased absorption
of dietary plant sterol and often presents with hypercholesterolaemia, xanthomas, and
haematologic manifestations. If left untreated, sitosterolaemia can lead to high
symptomatic burden and coronary artery disease (CAD). Case summary We describe a case of a young female who initially presented at 4 years of age with
classic manifestations of sitosterolaemia. She was misdiagnosed and treated for both
juvenile arthritis and later familial hypercholesterolaemia until adulthood, when venous
blood samples showed significantly elevated concentrations of plant sterols. DNA
analyses showed that the patient was homozygous for a mutation in the ABCG5 gene,
[c.1336C>T, p.(Arg446*)], which is known to be associated with sitosterolaemia. Discussion Sitosterolaemia presents with multiple manifestations, which can initially be
misinterpreted leading to prolonged misdiagnosis. Early diagnosis is key in order to
relieve symptoms and prevent CAD.
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Affiliation(s)
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Helle Lynge Kanstrup
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
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18
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Ingoe L, Potter A, Musson S, Neely D, Pilkington G, Allen AJ, Reay D, Luvai A, McAnulty C, Camm N, Berry I, Nichols J, Forbes G, Newton J, Carey PE. Improving the identification of patients with a genetic diagnosis of familial hypercholesterolaemia in primary care: A strategy to achieve the NHS long term plan. Atherosclerosis 2021; 325:38-45. [PMID: 33892327 DOI: 10.1016/j.atherosclerosis.2021.03.035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS We aimed to validate a nurse-led process using electronic health records to identify those at risk of familial hypercholesterolaemia (FH) for genetic diagnosis in primary care. METHODS Those at risk of FH were identified using searches developed and refined locally and implemented in primary care by a trained nurse; they were invited for further assessment and genetic testing if indicated. Family members at risk of FH were identified and invited for cascade testing. RESULTS In total 94,444 patient records were screened (expected prevalence of FH (1 in 250); 377). Of 176 records which already had a diagnostic for FH, 15 had been genetically confirmed and one was undergoing DNA testing. A further 572 (0.61%) were identified as high risk of FH. After desktop screening, 113 (15%) were invited for further assessment. Of these, 73 individuals attended the primary care clinic (64%) of whom 61 (54%) underwent proband genetic testing. Pathogenic variants were detected in 22 cases (36%) and variants of unknown significance in a further 4 cases; a total of 26 probands (43%) were therefore referred for family cascade testing. CONCLUSIONS An optimised FH identification pathway, based on the NICE CG71 recommendations for systematic searching of primary care electronic health records, can be deployed successfully in primary care settings.
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Affiliation(s)
- Lorna Ingoe
- Genetic Medicine, Centre for Life, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE1 3BZ, UK; Academic Health Science Network North East and North Cumbria (AHSN), Room 2.13, Biomedical Research Building, The Campus for Ageing and Vitality, Nun's Moor Road, Newcastle, NE4 5PL, UK
| | - Aimee Potter
- Genetic Medicine, Centre for Life, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE1 3BZ, UK
| | - Susan Musson
- Genetic Medicine, Centre for Life, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, NE1 3BZ, UK
| | - Dermot Neely
- Academic Health Science Network North East and North Cumbria (AHSN), Room 2.13, Biomedical Research Building, The Campus for Ageing and Vitality, Nun's Moor Road, Newcastle, NE4 5PL, UK
| | - Guy Pilkington
- Newcastle Gateshead CCG, Riverside House, Goldcrest Way, Newburn Riverside Business Park, Newcastle, NE15 8NY, UK
| | - A Joy Allen
- Population Health Sciences Institute, The Medical School, Newcastle University, Newcastle, NE2 4HH, UK; NIHR in Vitro Diagnostics Co-operative Newcastle, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Danielle Reay
- Northern Genetics Service, The Newcastle Upon Tyne Hospitals NHS Trust, Centre for Life, Central Parkway, Newcastle, NE1 3BZ, UK
| | - Ahai Luvai
- Laboratory Medicine, The Newcastle Upon Tyne Hospitals NHS Trust, Newcastle, NE1 3BZ, UK
| | - Ciaron McAnulty
- Northern Genetics Service, The Newcastle Upon Tyne Hospitals NHS Trust, Centre for Life, Central Parkway, Newcastle, NE1 3BZ, UK
| | - Nick Camm
- Yorkshire and North East Genomic Laboratory Hub, Central Lab. Bexley Wing (Level 5), St. James's University Hospital, Beckett Street, Leed, LS9 7TF, UK
| | - Ian Berry
- Yorkshire and North East Genomic Laboratory Hub, Central Lab. Bexley Wing (Level 5), St. James's University Hospital, Beckett Street, Leed, LS9 7TF, UK
| | - Jody Nichols
- Academic Health Science Network North East and North Cumbria (AHSN), Room 2.13, Biomedical Research Building, The Campus for Ageing and Vitality, Nun's Moor Road, Newcastle, NE4 5PL, UK
| | - Gareth Forbes
- Leadgate Surgery, George Ewen House, Watling St, Leadgate, Consett, DH8 6DP, UK
| | - Julia Newton
- Academic Health Science Network North East and North Cumbria (AHSN), Room 2.13, Biomedical Research Building, The Campus for Ageing and Vitality, Nun's Moor Road, Newcastle, NE4 5PL, UK; Population Health Sciences Institute, The Medical School, Newcastle University, Newcastle, NE2 4HH, UK.
| | - Peter E Carey
- South Tyneside and Sunderland NHS Foundation Trust, Kayll Road, Sunderland, Tyne and Wear, SR4 7TP, UK
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19
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Mohamed-Yassin MS, Baharudin N, Daher AM, Abu Bakar N, Ramli AS, Abdul-Razak S, Mohamed Noor Khan NA, Mohamad M, Yusoff K. High prevalence of dyslipidaemia subtypes and their associated personal and clinical attributes in Malaysian adults: the REDISCOVER study. BMC Cardiovasc Disord 2021; 21:149. [PMID: 33757445 PMCID: PMC7988996 DOI: 10.1186/s12872-021-01956-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/09/2020] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dyslipidaemia refers to lipid abnormalities consisting of either one or any combination of the following: elevated total cholesterol (TC), elevated low-density lipoprotein cholesterol (LDL-c), elevated triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-c). The prevalence of hypercholesterolaemia is steadily increasing in Malaysia. However, data on the prevalence of dyslipidaemia subtypes among Malaysians are lacking. This is important as it may have implications for preventive and management strategies for this increasing public health challenge. This study is aimed at determining the prevalence of dyslipidaemia subtypes and their associated personal and clinical attributes in Malaysians. METHODS REDISCOVER, a prospective study, enrolled 11,288 adults where sociodemographic data, anthropometric and blood pressure measurements, fasting lipid profile and glucose, and history of diabetes, hypertension, and smoking were obtained. The cross-sectional analytic sample presented in this article comprised 10,482 participants from baseline recruitment. The data was analysed by descriptive statistics and multivariable logistic regression. RESULTS The overall prevalence of elevated TC, elevated LDL-c, elevated TG, low HDL-c, and elevated non-HDL-c were 64.0% (95% CI 63.0-65.0), 56.7% (CI 55.7-57.7), 37.4% (CI 36.5-38.4), 36.2% (CI 35.2-37.1), and 56.2% (CI 55.3-57.2), respectively. Overweight, obesity, and central obesity were highly prevalent and significantly associated with elevated TC and all dyslipidaemia subtypes. Older age was associated with elevated TC, elevated LDL-c and elevated non-HDL-c. Hypertension was associated with elevated TC, elevated TG, and elevated non-HDL-c, while diabetes was associated with elevated TG and low HDL-c. CONCLUSIONS Elevated TC and all dyslipidaemia subtypes are highly prevalent in Malaysia where increased body mass seems the main driver. Differences in the prevalence and associated personal and clinical attributes may facilitate specific preventive and management strategies.
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Affiliation(s)
- Mohamed-Syarif Mohamed-Yassin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Jalan Prima Selayang 7, 68100, Batu Caves, Selangor, Malaysia
| | - Noorhida Baharudin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Jalan Prima Selayang 7, 68100, Batu Caves, Selangor, Malaysia
| | - Aqil Mohammad Daher
- Department of Community Medicine, School of Medicine, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Najmin Abu Bakar
- Centre for Translational Research and Epidemiology (CenTRE), Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Anis Safura Ramli
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Jalan Prima Selayang 7, 68100, Batu Caves, Selangor, Malaysia.,Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Suraya Abdul-Razak
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, Jalan Prima Selayang 7, 68100, Batu Caves, Selangor, Malaysia.,Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Nor-Ashikin Mohamed Noor Khan
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Mariam Mohamad
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
| | - Khalid Yusoff
- Faculty of Medicine and Health Sciences, UCSI University, No.1, Jalan Menara Gading, UCSI Heights, Taman Connaught, 56000, Cheras, Kuala Lumpur, Malaysia. .,Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
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20
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Mauri M, Calmarza P, Ibarretxe D. Dyslipemias and pregnancy, an update. Clin Investig Arterioscler 2020; 33:41-52. [PMID: 33309071 DOI: 10.1016/j.arteri.2020.10.002] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
During pregnancy there is a physiological increase in total cholesterol (TC) and triglycerides (TG) plasma concentrations, due to increased insulin resistance, oestrogens, progesterone, and placental lactogen, although their reference values are not exactly known, TG levels can increase up to 300mg/dL, and TC can go as high as 350mg/dL. When the cholesterol concentration exceeds the 95th percentile (familial hypercholesterolaemia (FH) and transient maternal hypercholesterolaemia), there is a predisposition to oxidative stress in foetal vessels, exposing the newborn to a greater fatty streaks formation and a higher risk of atherosclerosis. However, the current treatment of pregnant women with hyperlipidaemia consists of a diet and suspension of lipid-lowering drugs. The most prevalent maternal hypertriglyceridaemia (HTG) is due to secondary causes, like diabetes, obesity, drugs, etc. The case of severe HTG due to genetic causes is less prevalent, and can be a higher risk of maternal-foetal complications, such as, acute pancreatitis (AP), pre-eclampsia, preterm labour, and gestational diabetes. Severe HTG-AP is a rare but potentially lethal pregnancy complication, for the mother and the foetus, usually occurs during the third trimester or in the immediate postpartum period, and there are no specific protocols for its diagnosis and treatment. In conclusion, it is crucial that dyslipidaemia during pregnancy must be carefully evaluated, not just because of the acute complications, but also because of the future cardiovascular morbidity and mortality of the newborn child. That is why the establishment of consensus protocols or guidelines is essential for its management.
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Affiliation(s)
- Marta Mauri
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España
| | - Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Zaragoza, España.
| | - Daiana Ibarretxe
- Unidad de Medicina Vascular y Metabolismo (UVASMET), Hospital Universitario de Reus, Universidad Rovira y Virgili, IISPV, CIBERDEM, Reus, Tarragona, España
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21
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Donato F, Raffetti E, Toninelli G, Festa A, Scarcella C, Castellano M. Guggulu and Triphala for the Treatment of Hypercholesterolaemia: A Placebo-Controlled, Double-Blind, Randomised Trial. Complement Med Res 2020; 28:216-225. [PMID: 33242870 DOI: 10.1159/000510985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/04/2019] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several herbs are used for lowering high blood cholesterol levels in traditional medicines including Indian Medicine (Ayurveda). We aimed to assess the short-term effects of the combination of Guggulu (Commiphora mukul) and Triphala (Terminalia chebula, Terminalia belerica, and Phyllanthus emblica) on serum cholesterol in healthy subjects with hypercholesterolaemia. PATIENTS AND METHODS This was a parallel randomised double-blind controlled trial that included 90 individuals at low-moderate cardiovascular risk. The main outcome measures were serum levels of total and low- and high-density lipoprotein cholesterol (LDL-C, HDL-C). Secondary outcome measures included BMI, waist circumference, and adverse events. Subjects were administered either Guggulu and Triphala or placebo three times daily for 3 months, with 3 months of follow-up after the end of treatment. RESULTS At intention-to-treat analysis, from baseline to 3 months, total serum cholesterol decreased by 1.9% in the placebo (n = 44) and 3.3% (p = 0.01) in the intervention (n = 46) group. Serum LDL-C decreased by 4.9% (p = 0.03) and 4.8% (p = 0.02) in the placebo and intervention group, respectively, without differences between them. Two participants in the intervention group developed hypersensitivity rash (4.3%) as compared with none in the placebo group. CONCLUSIONS Three months of treatment with Guggulu and Triphala did not show better effects than placebo on serum levels of total and LDL cholesterol, BMI, and waist circumference.
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Affiliation(s)
- Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Elena Raffetti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden,
| | | | - Andrea Festa
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | | | - Maurizio Castellano
- Department of Internal Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
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22
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Castilla Guerra L, Fernández Moreno MC, Jiménez Hernández MD, Ramírez Gurruchaga P, Colmenero Camacho MA. Trends in the use of statins after ischaemic stroke: Have clinical practices changed? Neurologia 2020; 38:S0213-4853(20)30126-2. [PMID: 32591153 DOI: 10.1016/j.nrl.2020.03.002] [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: 11/16/2019] [Revised: 02/24/2020] [Accepted: 03/20/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The role of statins after ischaemic stroke changed with the publication of the SPARCL study in 2006. We analyse how this has influenced the prescription of statins in this patient population. METHODS We conducted a retrospective study of patients discharged with ischaemic stroke at the Virgen Macarena, Virgen del Rocío, and Valme hospitals in Seville (Spain) over two periods: 1999-2001 and 2014-2016. RESULTS The study included 1575 patients: 661 (42%) were women and mean age (standard deviation) was 69 (10) years. Patients from the later period are older (68 [10] vs 71 [11]; P=.0001); include a higher proportion of women; and present higher rates of dyslipidaemia, hypertension, and diabetes. At discharge, statins were used in 18.7% of patients (vs 86.9% in the first period; P=.0001), with high-intensity statins prescribed in 11.1% of cases (vs 54.4%; P=.0001). In both periods, atorvastatin was the most commonly prescribed statin (80mg: 6% vs 42.7%; 40mg: 5.1% vs 11.1%). In the first period, the use of statins and high-intensity statins was correlated with hypercholesterolaemia, and inversely correlated with age. In the second period, statin use was correlated with hypertension and hypercholesterolaemia, and high-intensity statin use was correlated with ischaemic heart disease and inversely correlated with age. CONCLUSION There has been a clear change in the prescription of statins to patients with ischaemic stroke at discharge. However, many patients remain undertreated and the use of these drugs needs to be optimised.
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Affiliation(s)
- L Castilla Guerra
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España.
| | | | | | - P Ramírez Gurruchaga
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M A Colmenero Camacho
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, España
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23
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Sivamaruthi BS, Fern LA, Rashidah Pg Hj Ismail DSN, Chaiyasut C. The influence of probiotics on bile acids in diseases and aging. Biomed Pharmacother 2020; 128:110310. [PMID: 32504921 DOI: 10.1016/j.biopha.2020.110310] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 01/16/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 02/07/2023] Open
Abstract
Recent evidence indicates the use of probiotics in the prevention and treatment of diseases. Probiotics are capable of changing the gut microbiota composition and bile acid synthesis to elicit health benefits such as cholesterol-lowering, weight reduction, and improving insulin sensitivity. The aging population is prone to develop diseases because of their decreased physiological and biological systems. Probiotics are one of the promising supplements that may potentially counteract these detrimental effects. This review will discuss the influence of probiotics on bile acids in different populations-the elderly, obese individuals, and those with hypercholesterolemia, type 2 diabetes, hypertension, and non-alcoholic fatty liver disease.
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Affiliation(s)
- Bhagavathi Sundaram Sivamaruthi
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Lim Ai Fern
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link BE1410, Brunei
| | | | - Chaiyavat Chaiyasut
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand.
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24
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Liu S, Wang C, Chen Y, Peng S, Chen X, Tan Z. Association of SLC15A1 polymorphisms with susceptibility to dyslipidaemia in a Chinese Han population. J Clin Pharm Ther 2019; 44:868-874. [PMID: 31454435 DOI: 10.1111/jcpt.13016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/18/2018] [Revised: 04/03/2019] [Accepted: 07/14/2019] [Indexed: 12/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Dyslipidaemia is an increasingly serious clinical and public health issue. In this study, we aim to explore the association of genetic polymorphisms in solute carrier transporter (SLC) 15A1 with the risk of dyslipidaemia in a Chinese Han population. METHODS Three single nucleotide polymorphisms (SNPs) in SLC15A1 (rs2297322, rs4646234 and rs1289389) were selected using bioinformatics in a Chinese Han population with 530 participants. Genotyping was conducted with Sequenom MassARRAY. A logistic regression model was used for the analysis of the association between genotypes and dyslipidaemia. SHEsis software was applied to the haplotype analysis. RESULTS AND DISCUSSION The SLC15A1 rs2297322 TT genotype was associated with a lower risk of hypertriglyceridaemia compared with the CC genotype (OR = 0.44, 95% CI = 0.21-0.93, P = .032). The carriers of the SLC15A1 rs1289389 T allele were found to be significantly associated with a lower risk of hypertriglyceridaemia compared with the C allele (OR = 0.54, 95% CI = 0.33-0.88, P = .013). In the recessive model, the carriers of the SLC15A1 rs4646234 CC genotype showed a significantly reduced risk of hypercholesterolaemia (OR = 2.29, 95% CI = 1.23-4.28, P = .009). Haplotype analysis showed that the CTC haplotype composed of SLC15A1 rs2297322, rs4646234 and rs1289389 was associated with a lower risk of hypertriglyceridaemia (OR = 1.58, 95% CI = 1.12-2.24, P = .009), whereas the TTC haplotype was associated with a significantly reduced risk of hypertriglyceridaemia (OR = 0.63, 95% CI = 0.40-0.99, P = .045). WHAT IS NEW AND CONCLUSION SLC15A1 rs2297322 and rs1289389 polymorphisms were associated with alterations in the risk of dyslipidaemia in a Chinese Han population.
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Affiliation(s)
- Shu Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
| | - Chunyang Wang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
| | - Yao Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
| | - Shifang Peng
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
| | - Zhirong Tan
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha, China
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25
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Yao J, Zeng H, Zhang M, Wei Q, Wang Y, Yang H, Lu Y, Li R, Xiong Q, Zhang L, Chen Z, Xing G, Cao X, Dai Y. OSBPL2-disrupted pigs recapitulate dual features of human hearing loss and hypercholesterolaemia. J Genet Genomics 2019; 46:379-87. [PMID: 31451425 DOI: 10.1016/j.jgg.2019.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 02/06/2023]
Abstract
Oxysterol binding protein like 2 (OSBPL2), an important regulator in cellular lipid metabolism and transport, was identified as a novel deafness-causal gene in our previous work. To resemble the phenotypic features of OSBPL2 mutation in animal models and elucidate the potential genotype-phenotype associations, the OSBPL2-disrupted Bama miniature (BM) pig model was constructed using CRISPR/Cas9-mediated gene editing, somatic cell nuclear transfer (SCNT) and embryo transplantation approaches, and then subjected to phenotypic characterization of auditory function and serum lipid profiles. The OSBPL2-disrupted pigs displayed progressive hearing loss (HL) with degeneration/apoptosis of cochlea hair cells (HCs) and morphological abnormalities in HC stereocilia, as well as hypercholesterolaemia. High-fat diet (HFD) feeding aggravated the development of HL and led to more severe hypercholesterolaemia. The dual phenotypes of progressive HL and hypercholesterolaemia resembled in OSBPL2-disrupted pigs confirmed the implication of OSBPL2 mutation in nonsydromic hearing loss (NSHL) and contributed to the potential linkage between auditory dysfunction and dyslipidaemia/hypercholesterolaemia.
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26
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Simon A, Dézsi CA. Treatment of Hypertensive and Hypercholesterolaemic Patients with the Triple Fixed Combination of Atorvastatin, Perindopril and Amlodipine: The Results of the CORAL Study. Adv Ther 2019; 36:2010-2020. [PMID: 31183780 DOI: 10.1007/s12325-019-01002-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/22/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hypertension and hypercholesterolaemia are important contributors to the development and progression of atherosclerosis. The coexistence of these two conditions is rather common: hypercholesterolaemia is present in 40-60% of hypertensive patients. Remarkably, patient compliance with antihypertensive regimens is better than with statin therapy. Thus, the inclusion of statins and blood pressure-lowering agents into a fixed combination might even double the effectiveness of statin therapy, and thereby achieve significantly greater reduction of cardiovascular risk. The CORAL study was a 3-month, prospective, multicentre, observational, non-interventional survey, which evaluated the blood pressure- and lipid-lowering efficacy of the triple fixed combination of atorvastatin/perindopril/amlodipine, administered in various dose combinations. METHODS The efficacy of the triple fixed combination was reflected by the changes of the blood pressure readings taken in the office and during 24-h blood pressure monitoring (3 months elapsed between visits 1 and 3). The laboratory parameters obtained during data acquisition were also recorded. RESULTS After 3 months of therapy, mean office blood pressure decreased from 158.5 ± 16.7/91.7 ± 9.4 to 132.2 ± 8.3/80.1 ± 6.8 mmHg (p < 0.0001), whereas mean 24-h blood pressure decreased from 146.0 ± 14.5/82.5 ± 12.1 to 132.1 ± 13.2/75.6 ± 9.9 mmHg. With regard to metabolic parameters, the inclusion of pre-existing statin therapy in the fixed combination led to further, significant reduction of lipid parameters as follows: total cholesterol level from 6.18 ± 1.15 to 5.16 ± 0.88 mmol/L, LDL-cholesterol from 3.41 ± 1.01 to 2.80 ± 0.82 mmol/L and triglyceride level from 2.26 ± 1.17 to 1.82 ± 0.83 mmol/L (all p < 0.0001). CONCLUSION Treatment with the fixed triple combination of atorvastatin, perindopril and amlodipine might take us closer to the optimal therapy for hypertensive patients with hypercholesterolaemia. The expected improvement of patient adherence to treatment may result in an increase of the percentage patients who achieve both blood pressure control and the LDL-cholesterol targets recommended in guidelines. Moreover, this may translate into the further decline of the risk of prospective cardiovascular events. FUNDING Egis Pharmaceuticals.
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Affiliation(s)
| | - Csaba András Dézsi
- Department of Cardiology, Petz Aladár County Teaching Hospital, Gyor, Hungary.
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27
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Rosenson RS, Daviglus ML, Handelsman Y, Pozzilli P, Bays H, Monsalvo ML, Elliott-Davey M, Somaratne R, Reaven P. Efficacy and safety of evolocumab in individuals with type 2 diabetes mellitus: primary results of the randomised controlled BANTING study. Diabetologia 2019; 62:948-958. [PMID: 30953107 PMCID: PMC6509076 DOI: 10.1007/s00125-019-4856-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/18/2019] [Indexed: 01/24/2023]
Abstract
AIMS/HYPOTHESIS The study aimed to examine the efficacy of 12 weeks of monthly evolocumab or placebo in lowering LDL-cholesterol (LDL-C) in individuals with type 2 diabetes and hypercholesterolaemia or mixed dyslipidaemia and on a maximum-tolerated statin of at least moderate intensity. METHODS For this randomised, placebo-controlled outpatient study, eligible individuals were ≥18 years old with type 2 diabetes, HbA1c <10% (86 mmol/mol), had been on stable pharmacological therapy for diabetes for ≥6 months and were taking a maximum-tolerated statin dose of at least moderate intensity. Lipid eligibility criteria varied by history of clinical cardiovascular disease. Participants were randomised 2:1 to evolocumab 420 mg s.c. or placebo. Randomisation was performed centrally via an interactive web-based or voice recognition system. Allocation was concealed using the centralised randomisation process. Treatment assignment was blinded to the sponsor study team, investigators, site staff and patients throughout the study. Co-primary endpoints were mean percentage change in LDL-C from baseline to week 12 and to the mean of weeks 10 and 12. Additional endpoints included LDL-C <1.81 mmol/l, LDL-C reduction ≥50% and other lipids. Exploratory analyses included percentage changes in fasting and post mixed-meal tolerance test (MMTT) lipoproteins and lipids, glucose metabolism variables and inflammatory biomarkers. RESULTS In total, 421 individuals were randomised and analysed, having received evolocumab (280 participants) or placebo (141 participants) (mean [SD] age 62 [8] years; 44% women; 77% white). Evolocumab decreased LDL-C by 54.3% (1.4%) at week 12 (vs 1.1% [1.9%] decrease with placebo; p < 0.0001) and by 65.0% (1.3%) at the mean of weeks 10 and 12 (vs 0.8% [1.8%] decrease with placebo; p < 0.0001); it also decreased non-HDL-cholesterol (HDL-C) by 46.9% (1.3%) at week 12 (vs 0.6% [1.8%] decrease with placebo) and by 56.6% (1.2%) at the mean of weeks 10 and 12 (vs 0.1% [1.6%] decrease with placebo). Evolocumab significantly improved levels of other lipids and allowed more participants to reach LDL-C <1.81 mmol/l or a reduction in LDL-C levels ≥50%. After an MMTT (120 min), there were favourable changes (p < 0.05; nominal, post hoc, no multiplicity adjustment) in chylomicron triacylglycerol (triglycerides), chylomicron cholesterol, VLDL-C and LDL-C. Evolocumab had no effect on glycaemic variables and was well tolerated. CONCLUSIONS/INTERPRETATION In statin-treated individuals with type 2 diabetes and hypercholesterolaemia or mixed dyslipidaemia, evolocumab significantly reduced LDL-C and non-HDL-C. Favourable changes (p < 0.05) were observed in postprandial levels of chylomicrons, VLDL-C and LDL-C. TRIAL REGISTRATION ClinicalTrials.gov NCT02739984 FUNDING: This study was funded by Amgen Inc. DATA AVAILABILITY Qualified researchers may request data from Amgen clinical studies. Complete details are available at www.amgen.com/datasharing .
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Affiliation(s)
- Robert S Rosenson
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, MC Level, New York, NY, 10029, USA.
| | - Martha L Daviglus
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | | | | | - Harold Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | | | | | | | - Peter Reaven
- University of Arizona College of Medicine, Phoenix VA Health Care System, Phoenix, AZ, USA
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28
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Asenjo Mota Á, Caamaño Selma O, Sánchez-Aquino González R. [Are there different responses to different PCSK9 inhibitors?]. Hipertens Riesgo Vasc 2019; 37:42-44. [PMID: 31064717 DOI: 10.1016/j.hipert.2019.04.001] [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: 03/20/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
Abstract
The case is presented of a 62-year-old patient who required lipid-lowering therapy with proprotein convertase subtilisin/kexin type9 (PCSK9). It was empirically decided to change one drug to another of the two currently available, obtaining a different response. Our objective is to present our experience and to consider a possible therapeutic option in patients in whom, exceptionally, this could happen.
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Affiliation(s)
- Á Asenjo Mota
- Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España.
| | - O Caamaño Selma
- Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
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29
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Abstract
Objective To investigate trends in total fat and fatty acid intakes and chronic health conditions among Korean adults over nine years between 2007 and 2015. Design Cross-sectional, observational study using a stratified, multistage probability sampling design at a national level. Intakes of total fat and fatty acids were estimated from 24 h dietary recalls by sex and age groups. Trends of total fat and fatty acid intakes were determined by multiple linear regression after adjusting for covariates. Trends in age-standardized prevalence of obesity, hypercholesterolaemia and hypertriacylglycerolaemia were examined by sex. Setting Korea. Participants Population data of 47749 healthy adults (aged ≥19 years) derived from the Korea National Health and Nutrition Examination Survey between 2007 and 2015. Results Over the survey period, daily intakes of energy and total, saturated, monounsaturated, polyunsaturated, n-3 and n-6 fats (grams and percentage of energy (%E)) increased steadily. In all sex and age groups, significant increases were seen in SFA intake from 9·9 g (4·7 %E) to 12·0 g (5·3 %E) and in MUFA intake from 9·9 g (4·6 %E) to 13·3 g (5·8 %E). The prevalence of hypercholesterolaemia increased from 10·7 to 17·9 % over the same period. Conclusions In Korean adults, total fat, SFA and other fatty acids have been increasing along with the prevalence of hypercholesterolaemia. This information can help set adequate macronutrient and fatty acid distribution ranges in developing population-specific preventive strategies against diet-related illness.
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30
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Ryan PM, Stolte EH, London LEE, Wells JM, Long SL, Joyce SA, Gahan CGM, Fitzgerald GF, Ross RP, Caplice NM, Stanton C. Lactobacillus mucosae DPC 6426 as a bile-modifying and immunomodulatory microbe. BMC Microbiol 2019; 19:33. [PMID: 30736731 PMCID: PMC6368806 DOI: 10.1186/s12866-019-1403-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 05/20/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
Background Lactobacillus mucosae DPC 6426 has previously demonstrated potentially cardio-protective properties, in the form of dyslipidaemia and hypercholesterolemia correction in an apolipoprotein-E deficient mouse model. This study aims to characterise the manner in which this microbe may modulate host bile pool composition and immune response, in the context of cardiovascular disease. Lactobacillus mucosae DPC 6426 was assessed for bile salt hydrolase activity and specificity. The microbe was compared against several other enteric strains of the same species, as well as a confirmed bile salt hydrolase-active strain, Lactobacillus reuteri APC 2587. Results Quantitative bile salt hydrolase assays revealed that enzymatic extracts from Lactobacillus reuteri APC 2587 and Lactobacillus mucosae DPC 6426 demonstrate the greatest activity in vitro. Bile acid profiling of porcine and murine bile following incubation with Lactobacillus mucosae DPC 6426 confirmed a preference for hydrolysis of glyco-conjugated bile acids. In addition, the purified exopolysaccharide and secretome of Lactobacillus mucosae DPC 6426 were investigated for immunomodulatory capabilities using RAW264.7 macrophages. Gene expression data revealed that both fractions stimulated increases in interleukin-6 and interleukin-10 gene transcription in the murine macrophages, while the entire secretome was necessary to increase CD206 transcription. Moreover, the exopolysaccharide elicited a dose-dependent increase in nitric oxide and interleukin-10 production from RAW264.7 macrophages, concurrent with increased tumour necrosis factor-α secretion at all doses. Conclusions This study indicates that Lactobacillus mucosae DPC 6426 modulates both bile pool composition and immune system tone in a manner which may contribute significantly to the previously identified cardio-protective phenotype. Electronic supplementary material The online version of this article (10.1186/s12866-019-1403-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul M Ryan
- Teagasc Food Research Centre, Food Biosciences Department, Moorepark, Fermoy, Co, Cork, Ireland.,School of Microbiology, University College Cork, Cork, Ireland
| | - Ellen H Stolte
- Host-Microbe Interactomics, University of Wageningen, Animal Sciences Department, Wageningen, The Netherlands
| | - Lis E E London
- Teagasc Food Research Centre, Food Biosciences Department, Moorepark, Fermoy, Co, Cork, Ireland
| | - Jerry M Wells
- Host-Microbe Interactomics, University of Wageningen, Animal Sciences Department, Wageningen, The Netherlands
| | - Sarah L Long
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Susan A Joyce
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,School of Biochemistry and Cell Biology, University College Cork, Cork, Ireland
| | - Cormac G M Gahan
- School of Microbiology, University College Cork, Cork, Ireland.,APC Microbiome Ireland, University College Cork, Cork, Ireland.,School of Pharmacy, University College Cork, Cork, Ireland
| | - Gerald F Fitzgerald
- School of Microbiology, University College Cork, Cork, Ireland.,APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - R Paul Ross
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Noel M Caplice
- Centre for Research in Vascular Biology, University College Cork, Cork, Ireland
| | - Catherine Stanton
- Teagasc Food Research Centre, Food Biosciences Department, Moorepark, Fermoy, Co, Cork, Ireland. .,APC Microbiome Ireland, University College Cork, Cork, Ireland.
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Dominko K, Dikic D, Hecimovic S. Enhanced activity of superoxide dismutase is a common response to dietary and genetically induced increased cholesterol levels. Nutr Neurosci 2018; 23:398-410. [PMID: 30118401 DOI: 10.1080/1028415x.2018.1511027] [Citation(s) in RCA: 3] [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] [Indexed: 01/27/2023]
Abstract
Objectives: Hypercholesterolaemia has been implicated in the pathogenesis of neurodegenerative diseases. In this work, we tested whether cholesterol-mediated neurodegeneration induced either by cholesterol-rich diet or genetic mutation may share a common mechanism involving increased oxidative stress and mitochondria oxidant status. Additionally, we analysed whether upon cholesterol-rich diet, different brain regions (prefrontal cortex, cortex, hippocampus, and cerebellum) show distinct vulnerability to an oxidative stress response.Methods: Oxidative stress parameters were measured both in vivo (in the liver and in different brain regions) in cholesterol-fed mice and in vitro in genetically induced cholesterol accumulation in NPC1-null cells.Results: Increased superoxide dismutase (SOD) activity was a common feature of cholesterol-mediated antioxidant response in both models. Moreover, upon high-cholesterol diet, all four brain regions analysed responded via somewhat different capacity of antioxidant defence, hippocampus showing the highest basal activity of SOD. Increased activity of SOD upon cholesterol accumulation in vitro involves mitochondrial SOD2. We found that SOD/SOD2 activities are modulated by cholesterol levels.Discussion: Hypercholesterolaemia could potentiate brain dysfunction and neurodegenerative processes via oxidative stress, and activity of mitochondrial SOD2 may play a key role in this process. Our findings suggest that preventing/reducing mitochondrial oxidative stress may represent a common approach against neurodegenerative diseases.
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Affiliation(s)
- Kristina Dominko
- Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia
| | - Domagoj Dikic
- Department of Animal Physiology, Biology Division, Faculty of Science, University of Zagreb, Rooseveltov trg 6, 10000 Zagreb, Croatia
| | - Silva Hecimovic
- Division of Molecular Medicine, Ruder Boskovic Institute, Bijenicka 54, 10000 Zagreb, Croatia
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Yang Y, Lu H, Qu J. Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management. J Orthop Translat 2018; 16:14-22. [PMID: 30723677 PMCID: PMC6350019 DOI: 10.1016/j.jot.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 05/13/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 01/18/2023] Open
Abstract
Tendon pathology is a general term used to describe a group of musculoskeletal conditions related to tendons and surrounding structures. There is only limited evidence available regarding the exact aetiology and natural history of tendon pathology. In hypercholesterolaemia environments, lipids could accumulate within the extracellular matrix of the tendon and thus affect the mechanical properties of the tendon. Current evidence suggested that hypercholesterolaemia was an important risk factor in the development and progression of tendon pathology. The severity of hypercholesterolaemia was correlated with the severity of tendon pathology. The translational potential of this article: Hypercholesterolaemia lead to the structural, inflammatory and mechanical changes in tendons, which predispose hypercholesterolaemia patients to a greater risk of tendon pathology. Measurements of serum cholesterol are suggested to be performed in patients presenting with tendon pathology. The strict control of hypercholesterolaemia would mitigate the development and progression of tendon pathology.
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Affiliation(s)
- Yang Yang
- Department of Cardiovascular Disease, The Second Xiangya Hospital, Central South University, Changsha 410011, PR China
| | - Hongbin Lu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Jin Qu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
- Corresponding author. Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China.
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Stefanutti C, Mazza F, Mesce D, Morozzi C, Di Giacomo S, Vitale M, Pergolini M. Monascus purpureus for statin and ezetimibe intolerant heterozygous familial hypercholesterolaemia patients: A clinical study. ATHEROSCLEROSIS SUPP 2018; 30:86-91. [PMID: 29096866 DOI: 10.1016/j.atherosclerosissup.2017.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hypercholesterolaemia is a major risk factor for cardiovascular disease and requires effective therapy in affected patients. Statins, the mainstay of lipid-lowering therapy, can cause side effects, including myalgia, in some patients. Ezetimibe, is frequently used as an add-on therapy for statins, and is also used as a monotherapy in statin-intolerant patients, however elevations in liver transaminases can occur. We examined the lipid-lowering efficacy of the natural fungal product Monascus purpureus (MP), which contains the natural statin monacolin K. METHODS Fifty-five patients with familial hypercholesterolaemia who had discontinued statins due to muscle symptoms. Patients were placed on a lipid-lowering diet cholesterol-lowering diet (1500-1800 kcal daily, 30% lipids, 19% proteins and 52% carbohydrates). MP was added to the diet at a dose of 300 mg (providing monacolin K 10 mg). Patients were followed for 12 months. Lipid profiles and adverse event data were collected in the normal course of patient care. RESULTS After 6 months of treatment with MP and diet therapy, statistically significant changes in low-density lipoprotein cholesterol were evident (-17% for males, -16% for females; p < 0.005) Levels fell to -24% and -27% respectively at 12 months. No patients experienced elevated serum aminotransferases or C-reactive protein levels. CONCLUSIONS MP is a viable option for lipid-lowering therapy in statin-intolerant patients with hypercholesterolaemia, with good efficacy and safety profiles.
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Affiliation(s)
- Claudia Stefanutti
- Extracorporeal Therapeutic Techniques, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, University of Rome 'Sapienza', Umberto I Hospital, Rome, Italy.
| | - Fabio Mazza
- Extracorporeal Therapeutic Techniques, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, University of Rome 'Sapienza', Umberto I Hospital, Rome, Italy
| | - Dario Mesce
- Extracorporeal Therapeutic Techniques, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, University of Rome 'Sapienza', Umberto I Hospital, Rome, Italy
| | - Claudia Morozzi
- Extracorporeal Therapeutic Techniques, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, University of Rome 'Sapienza', Umberto I Hospital, Rome, Italy
| | - Serafina Di Giacomo
- Extracorporeal Therapeutic Techniques, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, University of Rome 'Sapienza', Umberto I Hospital, Rome, Italy
| | - Marco Vitale
- Extracorporeal Therapeutic Techniques, Lipid Clinic and Atherosclerosis Prevention Centre, Department of Molecular Medicine, University of Rome 'Sapienza', Umberto I Hospital, Rome, Italy
| | - Mario Pergolini
- Department of Internal Medicine and Medical Specialties, University of Rome 'Sapienza', Umberto I Hospital, Rome, Italy
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34
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King K, Macken A, Blake O, O'Gorman CS. Cholesterol screening and statin use in children: a literature review. Ir J Med Sci 2018; 188:179-188. [PMID: 29858795 DOI: 10.1007/s11845-018-1835-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/12/2016] [Accepted: 05/18/2018] [Indexed: 01/24/2023]
Abstract
Atherosclerosis begins in childhood. Fatty streaks, the earliest precursor of atherosclerotic lesions, have been found in the coronary arteries of children of 2 years of age. Hypercholesterolaemia is a risk factor for coronary artery disease. Hypercholesterolaemia can be either primary, when it is characteristic of the main disease, or secondary when it occurs as a result of either a disease process or drug treatment. Given the risk of vascular disease, including myocardial infarction (MI), cerebrovascular accidents (CVA, also known as strokes), peripheral vascular disease (PVD) and ruptured aortic aneurysm, which may follow atherosclerosis, it is important to prevent or slow the early development of atherosclerotic lesions. This prevention necessitates the control of key risk factors such hypercholesterolaemia, dyslipidaemia, hypertension etc. However, at what point this prevention ought to occur, and in what form, is uncertain. Using pharmacological primary prevention for hypercholesterolaemia in the paediatric population is controversial. In an adult patient, hypercholesterolaemia warrants the initiation of a statin. Statins, also known as hydroxymethylglutaryl co-enzyme A inhibitors (or HMG-CoA inhibitors) act by altering cholesterol metabolism. In the paediatric population, the clinical course of vascular disease and the effect of altering this clinical course are less certain. This article reviews the published literature on hypercholesterolaemia in children and the use of statins as a treatment for dyslipidaemia in children. The US National Cholesterol Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents 2012 guidelines (NCEP guidelines) regarding the recognition and treatment of childhood dyslipidaemia are reviewed.
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Affiliation(s)
- Karen King
- The Children's Ark, Department of Paediatrics, University Hospital, Limerick, Ireland.
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Alan Macken
- The Children's Ark, Department of Paediatrics, University Hospital, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
| | - Ophelia Blake
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Department of Biochemistry, University Hospital, Limerick, Ireland
| | - Clodagh S O'Gorman
- The Children's Ark, Department of Paediatrics, University Hospital, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- National Children's Research Centre, Crumlin, Dublin 12, Ireland
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35
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Anyasodor AE, Nwose EU, Richards RS, Bwititi PT, Mudiaga LI, Aganbi E. Prediabetes and cardiovascular complications screening in Nigeria: A family case presentation. Diabetes Metab Syndr 2017; 11:273-275. [PMID: 28043816 DOI: 10.1016/j.dsx.2016.12.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022]
Abstract
Metabolic disorders are on the increase globally, and the need for screening remains imperative. This case report is of a 48-year-old man who was screened as dyslipidaemic and on metabolic syndrome prevention, precipitating screening of family relatives. The extended family members (N=11) were invited for screening, of which 4 were hyperglycaemic, 3 had hypercholesterolaemia; and the HDL levels of 6 participants were abnormal. All family members had normal plasma triglyceride levels, and 4 people had high blood pressure. There was an indication that 55% members of a family had up to two metabolic disorders or risk factors including dyslipidaemia that may predispose them to CVD; as well as family history of periodontitis in the family. This pilot study plans to follow-up its association with dyslipidaemia as well as with prediabetes. The feasibility of using simple and affordable screening test for diabetes in oral health clinics and vice versa, including review of observations of technical importance relevant to pathology logistics will be investigated.
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Affiliation(s)
| | - Ezekiel Uba Nwose
- School of Community Health, Charles Sturt University, NSW, Australia; School of Biomedical Sciences, Charles Sturt University, NSW, Australia; Department of Public & Community Health, Novena University, Delta State, Nigeria.
| | | | | | | | - Eferhire Aganbi
- Department of Biochemistry, Delta State University, Abraka, Nigeria
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36
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Colivicchi F, Gulizia MM, Arca M, Abrignani MG, Perna GP, Mureddu GF, Nardi F, Riccio C. ANMCO Scientific Statement: clinical management of hypercholesterolaemia in patients with acute coronary syndromes. Eur Heart J Suppl 2017; 19:D64-D69. [PMID: 28751835 PMCID: PMC5526473 DOI: 10.1093/eurheartj/sux018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/05/2023]
Abstract
LDL cholesterol (LDL-C) reduction after Acute Coronary Syndromes (ACS) is associated with a significant decrease in subsequent atherosclerotic cardiovascular events. Accordingly, international guidelines recommend a reduction of LDL-C below 70 mg/dL in ACS patients. Such a result can be effectively accomplished in most cases by using high intensity statins. In selected cases, the association with ezetimibe may be necessary in order to achieve recommended LDL-C targets. This document outlines management strategies that can be consistently implemented in clinical practice in order to achieve and maintain guidelines recommended therapeutic goals.
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Affiliation(s)
- Furio Colivicchi
- Cardiology Department, Ospedale S. Filippo Neri, ASL Roma 1, Via Giovanni Martinotti, 20 - 00135, Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | - Marcello Arca
- Atherosclerosis Center, Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | | | | | | | - Federico Nardi
- Cardiology Department, Ospedale Castelli, Verbania, Italy
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Loch A, Bewersdorf JP, Kofink D, Ismail D, Abidin IZ, Veriah RS. Generic atorvastatin is as effective as the brand-name drug (LIPITOR ®) in lowering cholesterol levels: a cross-sectional retrospective cohort study. BMC Res Notes 2017; 10:291. [PMID: 28716156 PMCID: PMC5514478 DOI: 10.1186/s13104-017-2617-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 09/22/2016] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background In a world of ever increasing health care costs, generic drugs represent a major opportunity to ensure access to essential medicines for people who otherwise would be unable to afford them. However, some clinicians and patients are still questioning the safety and effectiveness of generic formulations compared to the proprietary drugs necessitating further systematic research analyzing the generic drugs’ efficacy. Our objective was to compare the lipid lowering effects of generic and branded atorvastatin. Methods This cross-sectional, retrospective cohort study was conducted at the University of Malaya Medical Centre from 1 May 2013 until 30 May 2013. We analyzed the lipid profiles (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides) of 629 patients before and at least 3 months after switching them from proprietary atorvastatin (Lipitor®) to generic atorvastatin (atorvastatin calcium from Ranbaxy Laboratories, Inc.). We also investigated if there was any difference in the effectiveness of both atorvastatin formulations in various ethnic groups. Results 266 patients were included in this study. When comparing the median values we found no statistically significant differences (Wilcoxon signed-rank test; p < 0.05) between proprietary and generic atorvastatin in lowering total cholesterol (4.60 mmol/l pre-transition vs. 4.50 mmol/l post-transition; p = 0.583), LDL-cholesterol (2.42 mmol/l vs. 2.41 mmol/l; p = 0.923) and triglycerides (1.50 mmol/l vs. 1.50 mmol/l; p = 0.513). While there was a statistically significant (p = 0.009) difference in HDL-cholesterol levels favouring proprietary atorvastatin, the extent of this change (1.26 mmol/l vs. 1.25 mmol/l) was deemed not to be clinically relevant. There was no statistically significant difference when analyzing the effects on various ethnic groups. Conclusions Substituting proprietary atorvastatin for its generic formulation atorvastatin calcium does not result in a less effective management of hyperlipidemia. Our findings lend support to the approach of lowering health care costs by switching patients from branded drugs to their less expensive generic analogues.
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Affiliation(s)
- Alexander Loch
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | | | - Daniel Kofink
- Laboratory of Experimental Cardiology, Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dzafir Ismail
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Imran Zainal Abidin
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ramesh Singh Veriah
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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38
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Nanyan P. Modifiable Co-Morbidities Trends During Hospital Admissions for Obesity in France (2009-2014). Acta Med Iran 2017; 55:447-452. [PMID: 28918614] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 06/07/2023] Open
Abstract
Obesity is a growing public health problem in France, but modifiable co-morbidities in obese patients during their hospital admissions excluding bariatric surgery are lacking. Data were extracted from the French national hospital discharge database. Data on patient admissions, age, gender, and length of stay were extracted by selecting any stay coded primary as obesity. Obesity was defined as body mass index (BMI) between 30-39 kg/m², and morbid obesity as BMI≥40 kg/m². Only modifiable co-morbidities frequently diagnosed during the 6-year period with a rate≥3% were chosen. The admission rate for obesity decreased by 27.2% (P<0.001) with more females than males (71.9% vs. 28.1 %; P<0.001). The main modifiable co-morbidities were hypertension (22.72%), sleep apnea (13.64%), diabetes (12.34%), vitamin D deficiency (7.09%), hyperlipidemia (6.9%), hypercholesterolemia (4.98%), and nonalcoholic steatohepatitis (4.94%). Significant decreases were observed for hypertension (14.5%), diabetes (20%), hypercholesterolemia (30%) with steeper increase for vitamin D deficiency (830.7%) and nonalcoholic steatohepatitis (165.2%). Considering obesity class, admission for obesity (BMI: 30-40 kg/m²) and morbid obesity (BMI≥40 kg/m²) increased (P<0.001) by 6% and 7% respectively. Taking into account severity in proportion, stay>3 days significantly increased by 29.2% (P<0.001). The increase in the proportion of morbid obesity, vitamin D deficiency, and nonalcoholic steatohepatitis adds further evidence on the likely adverse health consequences of modifiable obesity-related comorbidities. There is a need for Health Authorities to promoting healthy lifestyle.
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Zhang Y, Wang N, Zhu L, Liu Y, Pei Z, Wang G, Luo L, Liu H. The Dipeptidyl Peptidase-4 Inhibitor Teneligliptin Reduces Aortic Damage from Hypercholesterolaemia in Apolipoprotein E-Deficient Mice. Biomed Hub 2017; 2:1-9. [PMID: 31988912 PMCID: PMC6945959 DOI: 10.1159/000473869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 01/10/2023] Open
Abstract
Objective Hypercholesterolaemia is a well-established risk factor for blood vessel damage, which can lead to cardiovascular diseases. An abundance of clinical data show that dipeptidyl peptidase-4 inhibitors protect against aortic damage in patients with diabetes. The goal of this study was to investigate the possible protective effects of teneligliptin against aortic damage in apolipoprotein E knockout (ApoE-/-) mice. Methods Eight-week-old male ApoE-/- mice were randomly divided into 3 groups: a control group fed a normal diet, a high-cholesterol diet (HD group), and an HD diet mixed with teneligliptin (HD + Tene group), and all the groups were fed with the different treatments for 6 weeks. Results and Conclusion The metabolic characteristics of total cholesterol, low-density lipoprotein-cholesterol, and high-sensitivity C-reactive protein were lower in ApoE-/- HD + Tene mice than in ApoE-/- HD mice. Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) gene and protein expression were lower in the aortic tissue of ApoE-/- HD + Tene mice than in ApoE-/- HD mice. IL-6 and TNF-α gene expression were lower in ApoE-/- HD + Tene mice than in ApoE-/- HD mice. These results indicate that teneligliptin may provide a potential therapeutic target for the aortic damage from hypercholesterolaemia.
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Affiliation(s)
- Ying Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Nan Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liyue Zhu
- Rehabilitation Center, Zhejiang Hospital, Hangzhou, China
| | - Yingshu Liu
- Department of Endocrinology, Dalian Municipal Central Hospital, Dalian, China
| | - Zuowei Pei
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Guan Wang
- International Medical Department, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Lin Luo
- Department of Central Intensive Care Unit (ICU), The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongyang Liu
- Department of Heart Intensive Care Unit, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Gulizia MM, Colivicchi F, Ricciardi G, Giampaoli S, Maggioni AP, Averna M, Graziani MS, Ceriotti F, Mugelli A, Rossi F, Medea G, Parretti D, Abrignani MG, Arca M, Perrone Filardi P, Perticone F, Catapano A, Griffo R, Nardi F, Riccio C, Di Lenarda A, Scherillo M, Musacchio N, Panno AV, Zito GB, Campanini M, Bolognese L, Faggiano PM, Musumeci G, Pusineri E, Ciaccio M, Bonora E, Cantelli Forti G, Ruggieri MP, Cricelli C, Romeo F, Ferrari R, Maseri A. ANMCO/ISS/AMD/ANCE/ARCA/FADOI/GICR-IACPR/SICI-GISE/SIBioC/SIC/SICOA/SID/SIF/SIMEU/SIMG/SIMI/SISA Joint Consensus Document on cholesterol and cardiovascular risk: diagnostic-therapeutic pathway in Italy. Eur Heart J Suppl 2017; 19:D3-D54. [PMID: 28751833 PMCID: PMC5526476 DOI: 10.1093/eurheartj/sux029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 02/05/2023]
Abstract
Atherosclerotic cardiovascular disease still represents the leading cause of death in Western countries. A wealth of scientific evidence demonstrates that increased blood cholesterol levels have a major impact on the outbreak and progression of atherosclerotic plaques. Moreover, several cholesterol-lowering pharmacological agents, including statins and ezetimibe, have proved effective in improving clinical outcomes. This document focuses on the clinical management of hypercholesterolaemia and has been conceived by 16 Italian medical associations with the support of the Italian National Institute of Health. The authors discuss in detail the role of hypercholesterolaemia in the genesis of atherosclerotic cardiovascular disease. In addition, the implications for high cholesterol levels in the definition of the individual cardiovascular risk profile have been carefully analysed, while all available therapeutic options for blood cholesterol reduction and cardiovascular risk mitigation have been explored. Finally, this document outlines the diagnostic and therapeutic pathways for the clinical management of patients with hypercholesterolaemia.
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Affiliation(s)
- Michele Massimo Gulizia
- Italian Association of Hospital Cardiologists (ANMCO)
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Via Palermo 636, 95122 Catania, Italy
| | | | | | | | | | | | | | - Ferruccio Ceriotti
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC)
| | | | | | | | | | | | - Marcello Arca
- Italian Society for the Study of Arteriosclerosis (SISA)
| | | | | | | | - Raffaele Griffo
- Italian Group of Rehabilitation and Preventative Cardiology (GICR-IACPR)
| | | | | | | | | | | | | | | | | | | | | | | | - Enrico Pusineri
- Italian Society of Accredited Cardiology Hospital Care (SICOA)
| | - Marcello Ciaccio
- Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC)
| | | | | | | | | | | | | | - Attilio Maseri
- Fondazione ‘per il Tuo cuore’ Heart Care Foundation Onlus
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Murphy C, Shelley E, O'Halloran AM, Fahey T, Kenny RA. Failure to control hypercholesterolaemia in the Irish adult population: cross-sectional analysis of the baseline wave of The Irish Longitudinal Study on Ageing (TILDA). Ir J Med Sci 2017; 186:1009-1017. [PMID: 28283862 PMCID: PMC5660837 DOI: 10.1007/s11845-017-1590-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 12/20/2016] [Accepted: 02/22/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hypercholesterolaemia is an important modifiable risk factor for cardiovascular disease (CVD) which requires monitoring and management at a population level. AIMS This study aims to describe the distribution of serum cholesterol in a community living population of older adults in Ireland and to examine the awareness, treatment and control of hypercholesterolaemia according to CVD risk status. METHOD This is a cross-sectional study in a nationally representative sample of adults aged 50-79 years (n = 5287). Hypercholesterolaemia was defined as low-density lipoprotein cholesterol (LDL-C) in excess of the recommended CVD risk category target and/or on lipid-lowering medication. RESULTS This study reports a mean total cholesterol (TC) of 5.1 mmol/L (95% CI 5.0-5.1 mmol/L) and a mean LDL-C of 2.9 mmol/L (95% CI 2.8-2.9 mmol/L) in those aged 50-79 years. In a subgroup aged 50-64 years, 73% (95% CI 71.5-74.5%) were hypercholesterolaemic. LDL-C was controlled to the guideline target in 57% of those with CVD and 49% of those with diabetes. Lack of awareness of hypercholesterolaemia was high across the remainder of the population. CONCLUSION Despite a substantial reduction in population mean TC from a high of 6.0 mmol/L in the 1980s to 5.1 mmol/L, this study reports a failure to control hypercholesterolaemia to recommended risk-stratified targets in the Irish adult population. Recommendations for policy include continued monitoring of those at highest risk and CVD risk assessment in those perceived to be at low risk in order to inform shared decision making in relation to lifestyle modification and medication management.
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Affiliation(s)
- C Murphy
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland. .,The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland.
| | - E Shelley
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - A M O'Halloran
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - T Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Dublin, Ireland
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Jang H, Bae WJ, Kim SJ, Cho HJ, Yuk SM, Han DS, Youn CS, Kwon EB, Hwang SY, Kim SW. The herbal formula KH-204 is protective against erectile dysfunction by minimizing oxidative stress and improving lipid profiles in a rat model of erectile dysfunction induced by hypercholesterolaemia. BMC Complement Altern Med 2017; 17:129. [PMID: 28235412 PMCID: PMC5324223 DOI: 10.1186/s12906-017-1588-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/17/2017] [Indexed: 02/06/2023]
Abstract
Background Hypercholesterolaemia (HC) is a major risk factor for ischemic heart disease and is also known to be a risk factor for erectile dysfunction (ED). ED caused by HC is thought to be related to HC-induced oxidative stress damage in the vascular endothelium and erectile tissue. KH-204 is an herbal formula with a strong antioxidant effect. We evaluated the effects of KH-204 on erectile function in a rat model of HC-induced ED. Methods Male Sprague-Dawley rats (6 weeks old) were divided into normal control, high-fat and cholesterol diet (HFC), and HFC with KH-204 treatment (HFC + KH) groups (n = 12 each). Normal control group rats were fed normal chow diet. HFC and HFC + KH group rats were fed high-fat and cholesterol diets and treated with or without daily oral doses of KH-204 for 12 weeks. Subsequently, intracavernous pressure (ICP) and mean arterial pressure (MAP) were measured, and lipid profiles, expression of endothelial (eNOS) and neuronal (nNOS) nitric oxide synthase, oxidative stress (8-hydroxy-2-deoxyguanosine), and ratio of smooth muscle cells and collagen fibres were evaluated in the serum and corpora tissue. Results Compared to the HFC group, the HFC + KH group showed statistically significant increases in peak ICP and ICP/MAP ratio, expression of eNOS and nNOS, and ratio of smooth muscle cells and collagen fibres (p < 0.05). The HFC + KH group also showed statistically significant decreases in oxidative stress (p < 0.05). Further the lipid profiles of this group were ameliorated compared to those of the HFC group (p < 0.05). Conclusions The current study shows that the antioxidant and hypolipidemic effects of KH-204 are effective in ameliorating ED by restoring endothelial dysfunction and suggests that KH-204 may be a potential therapeutic agent for ED by correcting the fundamental cause of ED.
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Bergheanu SC, Bodde MC, Jukema JW. Pathophysiology and treatment of atherosclerosis : Current view and future perspective on lipoprotein modification treatment. Neth Heart J 2017; 25:231-242. [PMID: 28194698 PMCID: PMC5355390 DOI: 10.1007/s12471-017-0959-2] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [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: 01/14/2023] Open
Abstract
Recent years have brought a significant amount of new results in the field of atherosclerosis. A better understanding of the role of different lipoprotein particles in the formation of atherosclerotic plaques is now possible. Recent cardiovascular clinical trials have also shed more light upon the efficacy and safety of novel compounds targeting the main pathways of atherosclerosis and its cardiovascular complications. In this review, we first provide a background consisting of the current understanding of the pathophysiology and treatment of atherosclerotic disease, followed by our future perspectives on several novel classes of drugs that target atherosclerosis. The focus of this update is on the pathophysiology and medical interventions of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and lipoprotein(a) (Lp(a)).
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Affiliation(s)
- S C Bergheanu
- Centre for Human Drug Research, Leiden, The Netherlands.,InterEuropa Clinical Research, Rotterdam, The Netherlands
| | - M C Bodde
- Department of Cardiology C5-P, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Jukema
- Department of Cardiology C5-P, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Since the publication of the JUPITER trial, attention has been focused on the adverse glycemic effects of statin therapy. Although the modest increase in the risk of new diabetes mellitus is outweighed by the reduction in cardiovascular events for statins, emerging biochemical and genetic links between lipid metabolism and glycemic control raise the prospect of a broader diabetogenic effect of lipid-lowering therapies. For the novel and powerful PCSK9-inhibitor class available evidence does not support a major glycaemic effect with the results of large scale trials awaited although preliminary genetic data does suggest a link. In contrast, there is clear evidence of a diabetogenic effect for the now outdated but well-studied niacin. For ezetimibe and fibrates, evidence is scarce but currently broadly unconcerning. For now, the glycemic effects of lipid-lowering therapies should have a limited influence on clinical decision-making. Further study in this topical area is needed.
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Affiliation(s)
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University Of Glasgow, 126 University Place, Glasgow, G12 8TA UK
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Chan DC, Pang J, Barrett PHR, Sullivan DR, Mori TA, Burnett JR, van Bockxmeer FM, Watts GF. Effect of omega-3 fatty acid supplementation on arterial elasticity in patients with familial hypercholesterolaemia on statin therapy. Nutr Metab Cardiovasc Dis 2016; 26:1140-1145. [PMID: 27614801 DOI: 10.1016/j.numecd.2016.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 02/09/2016] [Revised: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Increased arterial stiffness is closely linked with raised blood pressure that contributes substantially to enhanced risk of coronary heart disease in high risk individuals with familial hypercholesterolaemia (FH). Omega-3 fatty acid (ω3-FA) supplementation has been demonstrated to lower blood pressure in subjects with a high cardiovascular disease risk. Whether ω3-FA supplementation improves arterial stiffness in FH subjects, on background statin therapy, has yet to be investigated. METHOD AND RESULTS We carried out an 8-week randomized, crossover intervention trial to test the effect of 4 g/d ω3-FA supplementation (46% eicosapentaenoic acid and 38% docosahexaenoic acid) on arterial elasticity in 20 adults with FH on optimal cholesterol-lowering therapy. Large and small artery elasticity were measured by pulse contour analysis of the radial artery. ω3-FA supplementation significantly (P < 0.05 in all) increased large artery elasticity (+9%) and reduced systolic blood pressure (-6%) and diastolic blood pressure (-6%), plasma triglycerides (-20%), apoB concentration (-8%). In contrast, ω3-FAs had no significant effect on small artery elasticity. The change in large artery elasticity was not significantly associated with changes in systolic blood pressure or plasma triglyceride concentration. CONCLUSIONS ω3-FA supplementation improves large arterial elasticity and arterial blood pressure independent of statin therapy in adults with FH. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.com/NCT01577056.
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Affiliation(s)
- D C Chan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - J Pang
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - P H R Barrett
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Faculty of Engineering, Computing and Mathematics, University of Western Australia, Perth, Western Australia, Australia
| | - D R Sullivan
- Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, Australia
| | - T A Mori
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - J R Burnett
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Australia
| | - F M van Bockxmeer
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Australia; School of Surgery, University of Western Australia, Perth, Australia
| | - G F Watts
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
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Abstract
Familial hypercholesterolaemia (FH) is an autosomal dominant lipid disorder. Homozygous FH (HFH), though rare, presents in early childhood. Two different presentations of HFH are reported. The first child presented at 5 years of age with xanthomas on the knees, elbows and buttocks and failure to thrive since the second year of life. He was found to be hypertensive with moderate aortic regurgitation. He is now stable on statins and antihypertensives. The second child presented at 10 years of age with multiple xanthomas and severe aortic stenosis. He died of refractory cardiac failure despite emergency aortic balloon valvoplasty due to diffuse coronary artery disease. Strong clinical suspicion can aid early diagnosis and delay cardiovascular complications.
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Affiliation(s)
- Shivani Deswal
- a Department of Pediatrics , Postgraduate Institute of Medical Education and Research and Dr RML Hospital , New Delhi
| | | | | | - Vikas Kohli
- c Pediatric Cardiology and Cardiothoracic surgery, Apollo Centre for Advanced Pediatrics , Indraprastha Apollo Hospital , New Delhi , India
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Ríos-Rodríguez MDLÁ, García-Cerdán MR, Calonge-Vallejo AR, Tobella-Andreu L, Baena-Díez JM, Schröder H. [Feasibility and results of the short Diet Quality Screener in Primary Care: EMAP study]. Enferm Clin 2016; 26:351-357. [PMID: 27650698 DOI: 10.1016/j.enfcli.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/12/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study the feasibility and results of the self-reported short diet quality screener (sDQS) in Primary Care. The variables associated with difficulty and inadequate diet are also determined. METHOD Cross-sectional descriptive study conducted with 196 participants aged >18 years with diabetes mellitus, hypertension, or hypercholesterolaemia, consecutively included from 4 Primary Health Care Centres in Barcelona. The main variables collected were, age, sex, educational level, cardiovascular risk factors, body mass index, time to complete the sDQS, degree of difficulty, and diet score: inadequate diet ≤18, adequate in some aspects 19-27, adequate >27. RESULTS The mean age was 48.8 years (52% males). The analysis of the variables showed that the prevalence of having higher than a primary education level, hypertension, diabetes, hypercholesterolemia, and obesity was 50%, 54.6%, 23.5%, 56.6%, and 27.5%, respectively. The mean time to complete the questionnaire was 2.3min. More than 80% considered it easy or very easy. An inadequate diet was reported by 21.4%, adequate in some aspects by 76.5%, and an adequate diet only by 2%. To be older than 49 years and a low diet quality increased the risk of needing ≥2min to complete the sDQS (OR 2.0, 95% CI; 1.0-4.3, and OR 2.3, 95% CI; 1.1-5.1, respectively). Not following a low cholesterol diet and age less than 49 years increased the risk of a low diet quality (OR 2.2; 95% CI: 1.1-4.5, and OR 2.9; 95% CI: 1.2-6.8, respectively). CONCLUSIONS The completion of the sDQS is easy and was not a significant time-burden in Primary Care. A significant proportion of participants with cardiovascular risk reported a low diet quality.
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Affiliation(s)
| | - María Rosa García-Cerdán
- Servicio de Atención Primaria Baix Llobregat Centro, Centro de Atención Primaria Camps Blancs, Sant Boi de Llobregat, Barcelona, España
| | - Ana Rosa Calonge-Vallejo
- Servicio de Atención Primaria Vallès Oriental, Centro de Atención Primaria Les Franqueses del Vallès, Les Franqueses del Vallès, Barcelona, España
| | - Laia Tobella-Andreu
- Servicio de Atención Primaria Esquerra de Barcelona, Centro de Atención Primaria La Marina, Barcelona, España
| | - José Miguel Baena-Díez
- Servicio de Atención Primaria Esquerra de Barcelona, Centro de Atención Primaria La Marina, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Grupo de Investigación en Riesgo Cardiovascular y Nutrición (CARIN-ULEC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - Helmut Schröder
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Grupo de Investigación en Riesgo Cardiovascular y Nutrición (CARIN-ULEC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
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Huang H, Xie Z, Yokoyama W, Yu L, Wang TT. Identification of liver CYP51 as a gene responsive to circulating cholesterol in a hamster model. J Nutr Sci 2016; 5:e16. [PMID: 27110359 DOI: 10.1017/jns.2016.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/05/2016] [Indexed: 12/17/2022] Open
Abstract
Hypercholesterolaemia is a risk factor for CVD, which is a leading cause of death in industrialised societies. The biosynthetic pathways for cholesterol metabolism are well understood; however, the regulation of circulating cholesterol by diet is still not fully elucidated. The present study aimed to gain more comprehensive understanding of the relationship between circulating cholesterol levels and molecular effects in target tissues using the hamster model. Male golden Syrian hamsters were fed with chow or diets containing 36 % energy from fat with or without 1 % cholesteyramine (CA) as a modulator of circulating cholesterol levels for 35 d. It was revealed that the expression of lanosterol 14α-demethylase (CYP51) instead of 3-hydroxy-3-methyl-glutaryl (HMG)-CoA reductase mRNA expression was responsive to circulating cholesterol in hamsters fed hypercholesterolaemic diets. The high-fat diet increased circulating cholesterol and down-regulated CYP51, but not HMG-CoA reductase. The CA diet decreased cholesterol and increased CYP51 expression, but HMG-CoA reductase expression was not affected. The high-fat diet and CA diet altered the expression level of cholesterol, bile acids and lipid metabolism-associated genes (LDL receptor, cholesterol 7α-hydroxylase (CYP7A1), liver X receptor (LXR) α, and ATP-binding cassette subfamily G member 5/8 (ABCG5/8)) in the liver, which were significantly correlated with circulating cholesterol levels. Correlation analysis also showed that circulating cholesterol levels were regulated by LXR/retinoid X receptor and PPAR pathways in the liver. Using the hamster model, the present study provided additional molecular insights into the influence of circulating cholesterol on hepatic cholesterol metabolism pathways during hypercholesterolaemia.
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Key Words
- ABCG5/, ATP-binding cassette subfamily G member 5/8
- CA, cholestyramine
- CYP51
- CYP51, lanosterol 14α-demethylase
- CYP7A1, cholesterol 7α-hydroxylase
- Circulating cholesterol
- HF + CA, high-fat + cholestyramine
- HF, high-fat
- HMG, 3-hydroxy-3-methyl-glutaryl
- Hamsters
- Hypercholesterolaemia
- IPA, Ingenuity Pathway Analysis
- LXRα, liver X receptor α
- RXR, retinoid X receptor
- SREBP, sterol regulatory element-binding protein
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49
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Martin WP, Sharif F, Flaherty G. Lifestyle risk factors for cardiovascular disease and diabetic risk in a sedentary occupational group: the Galway taxi driver study. Ir J Med Sci 2016; 185:403-12. [PMID: 26984791 DOI: 10.1007/s11845-016-1442-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 12/11/2015] [Accepted: 03/07/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Taxi drivers are at increased risk of cardiovascular disease (CVD), something which persists after correcting for the overrepresentation of traditional risk factors for CVD in this cohort. The contribution of lifestyle risk factors to this residually elevated CVD risk remains under-evaluated. AIMS We aimed to determine the prevalence of lifestyle risk factors for CVD, self-reported medical risk factors for CVD, and future risk of type 2 diabetes amongst Irish taxi drivers. METHODS Male taxi drivers with no history of CVD and type 2 diabetes and working in Galway city in the west of Ireland were invited to participate. Physical activity levels, dietary patterns, anthropometry, smoking, hypertension, hypercholesterolaemia, and Finnish Diabetes Risk Score (FINDRISC) values were recorded in a cross-sectional manner. RESULTS 41 taxi drivers (mean age 56.7 ± 9.8 years) participated. 37 % were insufficiently active based on self-report, although only 8 % objectively achieved 10, 000 steps per day. Mean modified Mediterranean diet score (mMDS) was 4.6 ± 2.2, and only 13 % of participants had a normal body mass index (BMI) or waist circumference (WC). Those who worked for taxi companies tended to have a higher BMI (p = .07) and WC (p = .04) by multivariable regression. 22 % were current smokers, although a quit rate of 72 % was observed amongst the 78 % of taxi drivers who had ever smoked. 25 % were at high or very high risk of future type 2 diabetes. CONCLUSION Lifestyle risk factors for CVD and dysglycaemia are prevalent amongst Irish taxi drivers.
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Affiliation(s)
- W P Martin
- School of Medicine, National University of Ireland, Galway, Ireland. .,National Institute for Preventive Cardiology, Galway, Ireland.
| | - F Sharif
- School of Medicine, National University of Ireland, Galway, Ireland
| | - G Flaherty
- School of Medicine, National University of Ireland, Galway, Ireland.,National Institute for Preventive Cardiology, Galway, Ireland
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50
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Kim HS, Kim H, Lee H, Park B, Park S, Lee SH, Cho JH, Song H, Kim JH, Yoon KH, Choi IY. Analysis and comparison of statin prescription patterns and outcomes according to clinical department. J Clin Pharm Ther 2016; 41:70-7. [PMID: 26791968 DOI: 10.1111/jcpt.12350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 05/21/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE There is a disparity between the Korean treatment guidelines and actual clinical prescription habits. This study was designed to evaluate the department-specific disparities and achievement rates for low-density lipoprotein cholesterol (LDL-C) targets, based on each department's specific statin prescription patterns. METHODS We retrospectively evaluated data from 31 718 patients who had been prescribed a statin at least once between January 2008 and June 2013 at our institution. Patients were classified into the high-risk (target LDL-C < 100 mg/dL) or moderate-risk (target LDL-C < 130 mg/dL) groups, according to the National Cholesterol Education Programme-Adult Treatment Panel III guidelines. RESULTS AND DISCUSSION Statins were most commonly prescribed in the cardiology (32·0%) and endocrinology (26·6%) departments. For the high-risk group, 70% of patients in the cardiology, endocrinology and cardiac surgery departments achieved their target LDL-C levels (<100 mg/dL). However, the target achievement rates in most other departments were <70%. For the moderate-risk group, 79·2% of patients achieved their target levels. Departments that prescribed a greater number of high- or intermediate-potency statins were more likely to achieve their target LDL-C levels. The group that achieved their target LDL-C levels (<100 mg/dL) exhibited a significant positive relationship (Spearman's correlation coefficient = 0·8571, P = 0·0065), from low to high potency. WHAT IS NEW AND CONCLUSION Some departments tend to undertreat when prescribing statins. However, to reach to the target LDL-C levels, physicians must overcome their tendency to undertreat with statins. We believe that the target achievement rate will increase if doctors are more actively aware of a patient's individual status and related risk factors before prescribing statins.
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Affiliation(s)
- H-S Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - H Lee
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - B Park
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Information System, Hanyang University, Seoul, Korea
| | - S Park
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Information System, Hanyang University, Seoul, Korea
| | - S-H Lee
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J H Cho
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Song
- Department of Thoracic and Cardiovascular surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J H Kim
- Division of Biomedical Informatics, Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - K-H Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - I Y Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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