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Hedegaard BS, Nordestgaard BG, Kanstrup HL, Thomsen KK, Bech J, Bang LE, Henriksen FL, Andersen LJ, Gohr T, Larsen LH, Soja AMB, Elpert FP, Jakobsen TJ, Sjøl A, Joensen AM, Klausen IC, Schmidt EB, Bork CS. High Lipoprotein(a) May Explain One-Quarter of Clinical Familial Hypercholesterolemia Diagnoses in Danish Lipid Clinics. J Clin Endocrinol Metab 2024; 109:659-667. [PMID: 37862146 DOI: 10.1210/clinem/dgad625] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023]
Abstract
CONTEXT Cholesterol carried in lipoprotein(a) adds to measured low-density lipoprotein cholesterol (LDL-C) and may therefore drive some diagnoses of clinical familial hypercholesterolemia (FH). OBJECTIVE We investigated plasma lipoprotein(a) in individuals referred to Danish lipid clinics and evaluated the effect of plasma lipoprotein(a) on a diagnosis of FH. METHODS Individuals referred to 15 Danish lipid clinics who were suspected of having FH according to nationwide referral criteria were recruited between September 1, 2020 and November 30, 2021. All individuals were classified according to the Dutch Lipid Clinical Network criteria for FH before and after LDL-C was adjusted for 30% cholesterol content in lipoprotein(a). We calculated the fraction of individuals fulfilling a clinical diagnosis of FH partly due to elevated lipoprotein(a). RESULTS We included a total of 1166 individuals for analysis, of whom 206 fulfilled a clinical diagnosis of FH. Median lipoprotein(a) was 15 mg/dL (29 nmol/L) in those referred and 28% had lipoprotein(a) greater than or equal to 50 mg/dL (105 nmol/L), while 2% had levels greater than or equal to 180 mg/dL (389 nmol/L). We found that in 27% (55/206) of those fulfilling a clinical diagnosis of FH, this was partly due to high lipoprotein(a). CONCLUSION Elevated lipoprotein(a) was common in individuals referred to Danish lipid clinics and in one-quarter of individuals who fulfilled a clinical diagnosis of FH, this was partly due to elevated lipoprotein(a). These findings support the notion that the LPA gene should be considered an important causative gene in patients with clinical FH and further support the importance of measuring lipoprotein(a) when diagnosing FH as well as for stratification of cardiovascular risk.
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Affiliation(s)
- Berit Storgaard Hedegaard
- The Danish FH Study Group, Denmark
- Department of Cardiology, Regional Hospital Central Jutland, Viborg DK-8800, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg DK-9000, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev-Gentofte DK-2730, Copenhagen, Denmark
| | - Børge Grønne Nordestgaard
- The Danish FH Study Group, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev-Gentofte DK-2730, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N DK-2200, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital, Herlev-Gentofte DK-2730, Copenhagen, Denmark
| | - Helle Lynge Kanstrup
- The Danish FH Study Group, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Kristian Korsgaard Thomsen
- The Danish FH Study Group, Denmark
- Department of Cardiology, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg DK-6700, Denmark
| | - Jan Bech
- The Danish FH Study Group, Denmark
| | - Lia Evi Bang
- The Danish FH Study Group, Denmark
- The Heart Center, Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen Ø DK-2100, Denmark
| | - Finn Lund Henriksen
- The Danish FH Study Group, Denmark
- Department of Cardiology, Odense University Hospital, Odense DK-5000, Denmark
| | - Lars Juel Andersen
- The Danish FH Study Group, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde DK-4000, Denmark
| | - Thomas Gohr
- The Danish FH Study Group, Denmark
- Department of Cardiology, Lillebælt Hospital, Kolding DK-6000, Denmark
| | - Linnea Hornbech Larsen
- The Danish FH Study Group, Denmark
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Hellerup DK-2900, Denmark
| | - Anne Merete Boas Soja
- The Danish FH Study Group, Denmark
- Department of Internal Medicine, Section of Cardiology, Holbæk Hospital, Holbæk DK-4300, Denmark
| | - Frank-Peter Elpert
- The Danish FH Study Group, Denmark
- Department of Cardiology, Hospital of Southern Jutland, Aabenraa DK-6200, Denmark
| | - Tomas Joen Jakobsen
- The Danish FH Study Group, Denmark
- Department of Cardiology, North Zealand Hospital, Frederikssund DK-3600, Denmark
| | - Anette Sjøl
- The Danish FH Study Group, Denmark
- Department of Cardiology, Amager-Hvidovre Hospital, Hvidovre DK-2650, Denmark
| | - Albert Marni Joensen
- The Danish FH Study Group, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg DK-9000, Denmark
- Department of Cardiology, North Denmark Regional Hospital, Hjørring DK-9800, Denmark
| | - Ib Christian Klausen
- The Danish FH Study Group, Denmark
- Department of Cardiology, Regional Hospital Central Jutland, Viborg DK-8800, Denmark
| | - Erik Berg Schmidt
- The Danish FH Study Group, Denmark
- Department of Cardiology, Regional Hospital Central Jutland, Viborg DK-8800, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg DK-9000, Denmark
| | - Christian Sørensen Bork
- The Danish FH Study Group, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg DK-9000, Denmark
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Cicero AFG, Fogacci F, Giovannini M, Grandi E, D’Addato S, Borghi C. Estimating the Prevalence and Characteristics of Patients Potentially Eligible for Lipoprotein(a)-Lowering Therapies in a Real-World Setting. Biomedicines 2023; 11:3289. [PMID: 38137510 PMCID: PMC10741849 DOI: 10.3390/biomedicines11123289] [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: 11/10/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
High lipoprotein(a) (Lp(a)) plasma levels are significantly associated with an increased risk of developing atherosclerotic cardiovascular diseases (ASCVD). The aim of this analysis was to estimate the prevalence and characteristics of patients potentially eligible for Lp(a)-lowering therapies in a real-world setting (i.e., patients with ASCVD and Lp(a) levels > 70 mg/dL). For this reason, we pooled data from a large cohort of Italian outpatients (N = 5961; men: 2879, women: 3982) with dyslipidemia. A binary logistic regression analysis was used to determine the significant predictors of ASCVD in the cohort, which were age (Odds Ratio (OR): 1.158, 95% Confidence Interval (CI): 1.114 to 1.203, p < 0.001), low-density lipoprotein cholesterol at entry (OR: 1.989, 95% CI: 1.080 to 1.198, p = 0.020) and Lp(a) (OR: 1.090, 95% CI: 1.074 to 1.107, p < 0.001). In our cohort, almost half of patients with ASCVD (44.7%) may be eligible to be treated with Lp(a)-lowering agents. Interestingly, patients who do not meet the treatment criteria despite high Lp(a) (50-70 mg/dL), respectively, account for 4.7% and 7.3% of those in primary and secondary ASCVD prevention. In conclusion, in our large cohort of outpatients with dyslipidemia, the prevalence of individuals with ASCVD and very high Lp(a) plasma levels is quite high, even with a conservative estimation.
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Affiliation(s)
- Arrigo F. G. Cicero
- Hypertension and Cardiovascular Risk Factors Research Centre, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (A.F.G.C.); (M.G.); (E.G.); (S.D.); (C.B.)
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Factors Research Centre, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (A.F.G.C.); (M.G.); (E.G.); (S.D.); (C.B.)
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marina Giovannini
- Hypertension and Cardiovascular Risk Factors Research Centre, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (A.F.G.C.); (M.G.); (E.G.); (S.D.); (C.B.)
| | - Elisa Grandi
- Hypertension and Cardiovascular Risk Factors Research Centre, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (A.F.G.C.); (M.G.); (E.G.); (S.D.); (C.B.)
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sergio D’Addato
- Hypertension and Cardiovascular Risk Factors Research Centre, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (A.F.G.C.); (M.G.); (E.G.); (S.D.); (C.B.)
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Factors Research Centre, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40100 Bologna, Italy; (A.F.G.C.); (M.G.); (E.G.); (S.D.); (C.B.)
- Cardiovascular Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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FAZIO SERGIO, SHAPIRO MICHAELD. PREVENTIVE CARDIOLOGY AS NEW SUBSPECIALTY OF CARDIOVASCULAR MEDICINE. Trans Am Clin Climatol Assoc 2020; 131:33-41. [PMID: 32675840 PMCID: PMC7358492] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although management of ischemic cardiovascular disease has improved by leaps and bounds and significantly reduced the risk of mortality from a heart attack relative to decades past, the life trajectory of the average person (with stress, poor diet, excess body weight, inactivity, smoking, exposure to pollutants, poor management of metabolic comorbidities, etc.) still leads straight to development of this disease. Therefore, we have an unprecedented opportunity to focus on prevention of atherosclerosis before cardiovascular events occur, an endeavor that needs expert intervention with cardiovascular risk assessment, risk factor management, lifestyle counseling, dietary interventions, use of natural supplements, and pharmacotherapy. It is time for the budding specialty of preventive cardiology to come to the fore, from the historic background of fragmented clinical services such as lipid, hypertension, diabetes, endocrine, and cardiology clinics. Many patients need this specialized service, which cannot be provided anywhere else but in a dedicated practice well integrated with all other hospital services. Here we discuss the origin of preventive cardiology, the organization and core competencies required for excellence in this medical art, and the structure for education and fellowship training for professional recognition and board certification.
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Affiliation(s)
- SERGIO FAZIO
- Correspondence and reprint requests: Sergio Fazio, MD, PhD, Center for Preventive Cardiology, Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239503-494-5690
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Selvaraj K, Olave-Pichon A, Benuck I, Ariza AJ, Binns HJ. Characteristics of Children Referred to a Lipid Clinic Before and After the Universal Screening Guidelines. Clin Pediatr (Phila) 2019; 58:656-664. [PMID: 30854883 DOI: 10.1177/0009922819834282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In 2011, universal lipid screening was recommended for children aged 9 to 11 years; the impact of this recommendation on the lipid clinic setting is unknown. We examined the rate of primary and secondary dyslipidemia diagnoses in a lipid clinic before (2010-2011) and after (2012-2015) the guideline recommendation. We conducted a retrospective study of new clinic patients aged 0 to 20 years seen between April 2010 and April 2015. Chi-square testing was applied. The 345 subjects were 58% males; 48% ≥13 years; 56% Hispanic; and 59% obese. There was no difference in the rate of dyslipidemia diagnoses between periods (before: primary 23%, secondary 73%, no dyslipidemia 4% vs after: 22%, 72%, 6%, respectively; P = .616). There was no significant difference between periods in subject demographics for the total sample, but among those with primary dyslipidemia, pre- to post-guideline percentage of subjects with public insurance decreased (71% to 39%; P = .006). Additional strategies to increase identification of children with dyslipidemia are needed.
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Affiliation(s)
- Kavitha Selvaraj
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA.,3 Stanley Manne Children's Research Institute, Chicago, IL, USA
| | | | - Irwin Benuck
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
| | - Adolfo J Ariza
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA.,3 Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Helen J Binns
- 1 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA.,3 Stanley Manne Children's Research Institute, Chicago, IL, USA
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Schmöcker C, Zhang IW, Kiesler S, Kassner U, Ostermann AI, Steinhagen-Thiessen E, Schebb NH, Weylandt KH. Effect of Omega-3 Fatty Acid Supplementation on Oxylipins in a Routine Clinical Setting. Int J Mol Sci 2018; 19:ijms19010180. [PMID: 29316682 PMCID: PMC5796129 DOI: 10.3390/ijms19010180] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 12/17/2022] Open
Abstract
Omega-6 polyunsaturated fatty acid (n-6 PUFA) is the predominant polyunsaturated fatty acid (PUFA), especially in Western diet. A high omega-6/omega-3 ratio in Western diets is implicated in the development of cardiovascular diseases and inflammatory processes. Studies in animal models and in humans have demonstrated beneficial effects of omega-3 PUFA (n-3 PUFA) in a variety of diseases, including cardiac arrhythmias and inflammatory diseases, as well as breast and colon cancer. The molecular mechanisms underlying the effects of n-3 PUFA are still not well understood. Possible mechanisms include competition between n-3 and n-6 PUFAs at the cyclooxygenase (COX) and lipoxygenase (LOX) and cytochrome P450 levels, and subsequent formation of oxylipins with specific anti-inflammatory or anti-arrhythmic effects. In this study, we report the impact of routine long-term treatment with prescription-grade n-3 PUFA (either 840 mg or 1680 mg per day) on blood cell membrane fatty acid composition, as well as plasma oxylipin patterns, in a patient population with severe hyperlipidemia and cardiovascular disease who are on standard lipid-lowering and cardioprotective medications. Lipidomics analyses were performed by LC/ESI-MS/MS. Supplementation led to a dose-dependent increase in n-3 PUFA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the blood cell fraction. We also observed a dose-dependent increase in EPA- and DHA-derived epoxy metabolites, whereas the effect of n-3 PUFA supplementation on LOX-dependent EPA- and DHA-derived hydroxy metabolites was less pronounced, with a tendency towards lower metabolites in subjects with higher n-3 PUFA levels. These data thus generally confirm effects of n-3 PUFA supplementation observed previously in healthy individuals. Additionally, they indicate a suppressive effect of high n-3 PUFA supplementation on the formation of LOX metabolites in the context of concomitant aspirin medication.
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Affiliation(s)
- Christoph Schmöcker
- Medical Department, Division of Gastroenterology, Oncology, Hematology, Rheumatology and Diabetes, Ruppiner Kliniken, Brandenburg Medical School, 16816 Neuruppin, Germany.
- Department of Gastroenterology, Sana Klinikum Lichtenberg, 10365 Berlin, Germany.
| | - Ingrid W Zhang
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
| | - Stefanie Kiesler
- Medical Department, Division of Gastroenterology, Oncology, Hematology, Rheumatology and Diabetes, Ruppiner Kliniken, Brandenburg Medical School, 16816 Neuruppin, Germany.
| | - Ursula Kassner
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
| | - Annika I Ostermann
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, 42119 Wuppertal, Germany.
- Institute for Food Toxicology, University for Veterinary Medicine Hannover, 30559 Hannover, Germany.
| | - Elisabeth Steinhagen-Thiessen
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
| | - Nils H Schebb
- Faculty of Mathematics and Natural Sciences, University of Wuppertal, 42119 Wuppertal, Germany.
- Institute for Food Toxicology, University for Veterinary Medicine Hannover, 30559 Hannover, Germany.
| | - Karsten-H Weylandt
- Medical Department, Division of Gastroenterology, Oncology, Hematology, Rheumatology and Diabetes, Ruppiner Kliniken, Brandenburg Medical School, 16816 Neuruppin, Germany.
- Medical Department, Division of Gastroenterology and Nephrology, Campus Virchow-Klinikum, Charité University Medicine, 13353 Berlin, Germany.
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Barkas F, Liberopoulos EN, Kostapanos MS, Liamis G, Tziallas D, Elisaf M. Lipid target achievement among patients with very high and high cardiovascular risk in a lipid clinic. Angiology 2014; 66:346-53. [PMID: 24830420 DOI: 10.1177/0003319714535073] [Citation(s) in RCA: 20] [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] [Indexed: 11/15/2022]
Abstract
This was a retrospective study that assessed achievement of lipid-lowering treatment targets in the setting of a University Hospital Lipid Clinic. Low-density lipoprotein cholesterol (LDL-C) goal attainment according to National Cholesterol Education Program-Adult Treatment Panel III (NCEP ATP III) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines was recorded in 1000 consecutive adult patients followed for ≥3 years (mean 8 years). The LDL-C targets according to the NCEP ATP III were attained by 66% and 86% of patients with "very high" (n = 477) and "high" (n = 408) cardiovascular risk, respectively. Fewer patients were within LDL-C goals according to the ESC/EAS guidelines: 25% and 42%. Overall, 92% of the patients were on statins: 67% were on statin monotherapy, while 33% were on combinations with ezetimibe (25%), ω-3 fatty acids (5%), fibrates (4%), or colesevelam (2%). Even in a specialist lipid clinic, a large proportion of patients are not at goal according to the recent ESC/EAS guidelines.
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Affiliation(s)
- Fotios Barkas
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | | | - Michael S Kostapanos
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - George Liamis
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Dimitrios Tziallas
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
| | - Moses Elisaf
- Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece
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