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Han Y, Ren L, Fei X, Wang J, Chen T, Guo J, Wang Q. Effect of moderate-intensity statin on carotid intraplaque neovascularization of coronary artery disease: a retrospective cohort study. Quant Imaging Med Surg 2024; 14:1660-1672. [PMID: 38415148 PMCID: PMC10895147 DOI: 10.21037/qims-23-1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/04/2023] [Indexed: 02/29/2024]
Abstract
Background Statin treatment can reduce atherosclerotic plaque as detected via invasive intracoronary methods. However, few studies have evaluated the effect of moderate-intensity statin therapy on carotid intraplaque neovascularization (IPN) using semiquantitative indices. This study thus aimed to assess the effect of statin on the carotid IPN of coronary artery disease with contrast-enhanced ultrasound (CEUS). Methods In this noncontrol, retrospective, cohort study, 35 inpatients who underwent coronary angiography, serial CEUS, and laboratory evaluations were consecutively enrolled from June 2020 to December 2022 at the Department of Cardiology, Chinese PLA General Hospital. All patients were administered moderate-intensity statin during serial CEUS, and continuous and categorical assessment of IPN and maximum plaque height (MPH) of carotid plaque was performed. Patients with a target low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L at 12-month follow-up were compared with those who did not reach the LDL-C 1.8 mmol/L target. Results From baseline to 12-month follow-up, there were significant differences in the LDL-C levels between patients (2.71±1.29 vs. 1.35±0.83 mmol/L), those with 12-month follow-up LDL-C <1.8 mmol/L (2.58±1.24 vs. 1.08±0.52 mmol/L), and those with 12-month follow-up LDL-C ≥1.8 mmol/L (3.24±1.44 vs. 2.56±0.85 mmol/L) all P values <0.05, with decreases of 41%, 49%, and 11% from baseline, respectively. The mean MPH (12 months to baseline) decreased from 2.47±0.63 to 2.22±0.60 mm (P<0.05), and the IPN also decreased from 1.15±0.62 to 0.58±0.56, representing a reduction of 0.57±0.59 from baseline (P<0.001). In the LDL-C <1.8 mmol/L patients, there were significant differences between baseline and 12 months in MPH (2.37±0.56 vs. 2.03±0.52 mm; P<0.05) and IPN (1.32±0.77 vs. 0.54±0.63; P<0.05) compared with those with a follow-up LDL-C ≥1.8 mmol/L. Patients with a follow-up LDL-C <1.8 mmol/L, compared with those with a follow-up LDL-C ≥1.8 mmol/L, showed a significantly greater reduction in MPH (-0.34±0.46 vs. -0.13±0.39; P<0.05) and IPN (-0.79±0.63 vs. -0.57±0.79; P<0.05). Additionally, patients with carotid IPN regression showed a higher percent change in LDL-C compared with those without carotid IPN regression (-53.31±23.20 vs. -29.55±19.47; P<0.05). Conclusions Controlling the LDL-C to <1.8 mmol/L under moderate-intensity statin can stabilize and reduce carotid IPN as detected by the semiquantitative noninvasive CEUS.
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Affiliation(s)
- Yanyan Han
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ling Ren
- Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing, China
- The Second Medical College of Lanzhou University, Lanzhou, China
| | - Xiang Fei
- Department of Ultrasound, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jingjing Wang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tao Chen
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jun Guo
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qi Wang
- Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
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Coppinger C, Pomales B, Movahed MR, Marefat M, Hashemzadeh M. Berberine: A Multi-Target Natural PCSK9 Inhibitor with the Potential to Treat Diabetes, Alzheimer's, Cancer and Cardiovascular Disease. Curr Rev Clin Exp Pharmacol 2024; 19:CRCEP-EPUB-137875. [PMID: 38361373 DOI: 10.2174/0127724328250471231222094648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 02/17/2024]
Abstract
Berberine is a natural product with a wide range of pharmacological effects. It has antimicrobial, anti-cancer, anti-inflammatory, anti-hyperlipidemic, neuroprotective, and cholesterollowering properties, among others. It has been used in traditional Chinese and Ayurvedic medicine for 3000 years and is generally well-tolerated with few side effects. Its main drawback is low oral bioavailability, which has hindered widespread clinical use. However, recent interest has surged with the emergence of evidence that berberine is effective in treating cancer, diabetes, Alzheimer's disease, and cardiovascular disease via multiple mechanisms. It enhances insulin sensitivity and secretion by pancreatic β-cells in Type 2 Diabetes Mellitus in addition to reducing pro-inflammatory cytokines such as IL-6, IL-1β, TLR4 and TNF-α. These cytokines are elevated in Alzheimer's disease, cardiovascular disease, and diabetes. Reductions in pro-inflammatory cytokine levels are associated with positive outcomes such as improved cognition, reduced cardiovascular events, and improved glucose metabolism and insulin sensitivity. Berberine is a natural PCSK9 inhibitor, which contributes to its hypolipidemic effects. It also increases low-density lipoprotein receptor expression, reduces intestinal cholesterol absorption, and promotes cholesterol excretion from the liver to the bile. This translates into a notable decrease in LDL cholesterol levels. High LDL cholesterol levels are associated with increased cardiovascular disease risk. Novel synthetic berberine derivatives are currently being developed that optimize LDL reduction, bioavailability, and other pharmacokinetic properties.
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Affiliation(s)
| | | | - Mohammad Reza Movahed
- University of Arizona College of Medicine, Phoenix, USA
- University of Arizona, Tucson, AZ, USA
| | | | - Mehrnoosh Hashemzadeh
- University of Arizona College of Medicine Phoenix medicine tucson United States
- Pima College, Tucson, AZ, USA
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Yamada M, Gam H, Ikegami N, Nishikawa Y, Ishikawa A, Funaki A, Matsuda T, Kamemoto K, Hashimoto Y, Okamoto T, Yamazaki H, Tanaka H, Sakamaki-Sunaga M. Effects of acute aerobic exercise on arterial stiffness in transgender men. Front Physiol 2023; 14:1294284. [PMID: 38028805 PMCID: PMC10644819 DOI: 10.3389/fphys.2023.1294284] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Testosterone replacement therapy (TRT) in transgender men (TM) results in side effects such as elevated triglycerides and increased arterial stiffness. Exercise may be useful to ameliorate such effects, but no studies have examined the effects of acute aerobic exercise in TM. This study aimed to investigate the effects of acute aerobic exercise on arterial stiffness in TM. Thirty-six participants were included, comprising 12 TM (duration of TRT: 57.4 ± 30.3 months), 12 males and 12 females. All participants performed acute aerobic exercise on a treadmill at 50% heart rate reserve for 30 min. Arterial stiffness as measured by brachial-ankle pulse wave velocity (baPWV) was measured before exercise (Pre), 30 min after exercise (Post30), and 60 min after exercise (Post60). Serum sex hormone levels, and serum lipid profile were determined only before exercise. Serum low-density lipoprotein cholesterol (LDL-C) levels before exercise were significantly higher in TM than in males or females (males: p < 0.01; females: p < 0.05). At all points, baPWV in TM was significantly higher than in females (p < 0.05) and significantly lower than in males (p < 0.05). However, when comparing changes in baPWV over time in each group, significant decreases in Post30 and Post60 were seen in males compared to Pre (both p < 0.05), but no significant change after aerobic exercise was seen in TM or females. These results suggest that acute aerobic exercise yield different effects in TM than in males, but is unlikely to reduce arterial stiffness in TM receiving TRT.
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Affiliation(s)
- Mizuki Yamada
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
- Research Fellow, Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
| | - Hyunjun Gam
- Department of Physical Education, Yongin University, Gyeonggi, Repulic of Korea
| | - Nodoka Ikegami
- Research Fellow, Japan Society for the Promotion of Science (JSPS), Tokyo, Japan
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Yuriko Nishikawa
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Akira Ishikawa
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Akiko Funaki
- Department of Judo Therapy, Teikyo University of Science, Yamanashi, Japan
| | - Tomoka Matsuda
- Department of Sport Sciences and Research, Japan Institute of Sports Sciences (JISS), Tokyo, Japan
| | - Kayoko Kamemoto
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
| | - Yuto Hashimoto
- Research Institute for Sports Science, Nippon Sport Science University, Tokyo, Japan
| | - Takanobu Okamoto
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
| | - Hiroki Yamazaki
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotoshi Tanaka
- Department of Rheumatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Poudel A, Gachumi G, Paterson PG, El-Aneed A, Badea I. Liposomal Phytosterols as LDL-Cholesterol-Lowering Agents in Diet-Induced Hyperlipidemia. Mol Pharm 2023; 20:4443-4452. [PMID: 37492942 DOI: 10.1021/acs.molpharmaceut.2c01072] [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: 07/27/2023]
Abstract
The high blood level of low-density lipoprotein cholesterol (LDL-C) is a primary risk factor for cardiovascular disease. Plant sterols, known as phytosterols (PSs), can reduce LDL-C in a range of 8-14%. The extent of LDL-C reduction depends on its formulation. Encapsulation into liposomes is one formulation strategy to enhance the efficiency of PSs. PSs (campesterol, stigmasterol, and β-sitosterol) have frequently been assessed alone or in combination for their LDL-C-lowering ability. However, one naturally abundant PS, brassicasterol, has not yet been tested for its efficacy. We have previously developed a novel liposomal formulation containing the PS mixture present naturally in canola that is composed of brassicasterol, campesterol, and β-sitosterol. In this work, the efficacy of our novel liposomal PS formulation that includes brassicasterol was assessed in a hamster model. Animals were divided into five groups: (i) liposomal PS in orange juice, (ii) liposomal PS in water, (iii) marketed PS in orange juice, (iv) control orange juice, and (v) control water. The animals were fed a high-fat, cholesterol-supplemented (0.5%) diet to induce hypercholesterolemia. The treatment was administered orally once daily for 4 weeks. Fasting blood samples were collected at baseline, week 2, and week 4. The extent of the reduction of total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides was compared among the groups. Liposomal PSs in both orange juice and water significantly reduced LDL-C compared to their controls. Furthermore, the liposomal PS was as effective as a marketed PS-containing product in reducing LDL-C. Liposomal PSs in both orange juice and water showed similar efficacy in LDL-C reduction, highlighting that these vehicles/food matrices do not affect the efficacy of PSs. The liposomal formulation of a natural PS mixture extracted from canola oil, with brassicasterol as a major component, exhibited a significant LDL-C reduction in a hamster model.
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Affiliation(s)
- Asmita Poudel
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon S7N 5E5, Saskatchewan, Canada
| | - George Gachumi
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon S7N 5E5, Saskatchewan, Canada
| | - Phyllis G Paterson
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon S7N 5E5, Saskatchewan, Canada
| | - Anas El-Aneed
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon S7N 5E5, Saskatchewan, Canada
| | - Ildiko Badea
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon S7N 5E5, Saskatchewan, Canada
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Sadeq A, Elnour AA, Farah FH, Ramadan A, Baraka MA, Don J, Amoodi AA, Sam KG, Mazrouei NA, Alkaabi M. A Systematic Review of Randomized Clinical Trials on the Efficacy and Safety of Pitavastatin. Curr Rev Clin Exp Pharmacol 2023; 18:120-147. [PMID: 35642121 DOI: 10.2174/2772432817666220531115314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 02/12/2022] [Accepted: 03/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND A subpopulation of statin users such as subjects with chronic kidney disease (CKD), Human Immune virus (HIV), acute coronary syndrome (ACS), revascularization, metabolic syndrome, and/or diabetes may particularly benefit from pitavastatin pharmacotherapy. AIM The current systematic review aimed systematically to evaluate the effect of pitavastatin on primary cardiac events in subjects receiving pitavastatin in comparison to the other four statin members. METHODS We conducted a systematic review on phases III and IV of randomized controlled trials (RCT-s, 11 trials) for subjects with primary cardiac events who received pitavastatin. Subjects diagnosed with any type of dyslipidemia (population 4804) and received pitavastatin (interventions) versus comparator (comparison) with the primary efficacy endpoint of minimization of LDL-C and non- HDL-C, had an increase in HDL-C and/or reduction in major adverse cardiac events (MACE, cardiovascular death, myocardial infarction (fatal/nonfatal), and stroke (fatal/nonfatal) and/or their composite (outcomes). The secondary safety endpoint was the development of any adverse effects. RESULTS In the included trials (11), participants (4804) were randomized for pitavastatin or its comparators such as atorvastatin, pravastatin, rosuvastatin, simvastatin and followed up for 12 to 52 weeks. In terms of the primary outcome (reduction in LDL-C), pitavastatin 4 mg was superior to pravastatin 40 mg in three trials, while the 2 mg pitavastatin was comparable to atorvastatin 10 mg in four trials and simvastatin 20 and 40 mg in two 2 trials. However, rosuvastatin 2.5 mg was superior to pitavastatin 2 mg in two trials. Pitavastatin increased HDL-C and reduced non-HDL-C in eleven trials. Regarding the safety profile, pitavastatin has proved to be tolerated and safe. CONCLUSION The FDA-approved indications for pitavastatin included primary dyslipidemia and mixed dyslipidemia as a supplementary therapy to dietary changes to lower total cholesterol, LDL-C, apolipoprotein B (Apo B), triglycerides (TG), and enhance HDL-C. Pitavastatin might be suitable for subjects with diabetes, ACS (reduced revascularization), metabolic syndrome, CKD, HIV, and subjects with low levels of HDL-C. We highly recommend rational individualization for the selection of statin.
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Affiliation(s)
- Adel Sadeq
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Al Ain, UAE
| | - Asim Ahmed Elnour
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi campus, Abu Dhabi, UAE
- AAU Health and Biomedical Research Centre, Al Ain University, Abu Dhabi, United Arab Emirates, UAE
| | - Farah Hamad Farah
- Department of Pharmaceutical Sciences, Center of Medical and Bio-allied Health Sciences Research, College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Azza Ramadan
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi Campus, Abu Dhabi, UAE
| | - Mohamed A Baraka
- Clinical Pharmacy Department, College of Pharmacy, Al Ain University, Al Ain campus, United Arab Emirates
- Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Judit Don
- College of Pharmacy, Gulf Medical University, Ajman, UAE
| | - Abdulla Al Amoodi
- Ambulatory Healthcare Services, Academic Affairs, Abu Dhabi Health Services (SEHA), UAE
| | - Kishore Gnana Sam
- Department of Clinical Pharmacy and Pharmacotherapeutics, Dubai College of Pharmacy, Dubai, UAE
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, Faculty of Pharmacy, University of Sharjah, United Arab Emirates
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Yu Q, Xue Q, Liu H, Hu J, Wang R, Song Y, Zhou Y, Zhang W, Zhu Y, Zhao Q. Impact of low-density lipoprotein cholesterol and lipoprotein(a) on mid-term clinical outcomes following coronary artery bypass grafting: A secondary analysis of the DACAB trial. Front Cardiovasc Med 2023; 10:1103681. [PMID: 37034344 PMCID: PMC10080087 DOI: 10.3389/fcvm.2023.1103681] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose The objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG). Methods This is a secondary analysis of a 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three-antiplatelet therapy for 1 year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were stratified into LDL-C <1.8, 1.8-<2.6, and ≥2.6 mmol/L subgroups. Cut-off value for Lp(a) was 30 mg/dL; thus, the patients were divided into Lp(a) <30 and ≥30 mg/dL subgroups. The primary outcome was 4-point major adverse cardiovascular events (MACE-4), a composite of all-cause death, myocardial infarction, stroke, and repeated revascularization. Median follow-up time was 5.2 (interquartile range, 4.2-6.1) years. Results During the follow-up, 129 (28.1%) patients achieved the attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8-<2.6 mmol/L, and 144 (31.4%) remained LDL-C ≥2.6 mmol/L. Compared with the postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was significantly higher in the LDL-C 1.8-<2.6 mmol/L group [adjusted hazard ratio (aHR) = 1.92, 95% CI, 1.12-3.29; P = 0.019] and LDL-C ≥2.6 mmol/L group (aHR = 3.90, 95% CI, 2.29-6.64; P < 0.001). Baseline Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients and was associated with an increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06-2.18; P = 0.022). Conclusions For CABG patients, exposure to increased levels of postoperative LDL-C or baseline Lp(a) was associated with worse mid-term clinical outcomes. Our findings suggested the necessity of achieving LDL-C target and potential benefit of adding Lp(a) targeted lipid-lowering therapy in CABG population.
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Affiliation(s)
- Qixiang Yu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Xue
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai Changhai Hospital, Shanghai, China
| | - Hao Liu
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junlong Hu
- Department of Cardiac Surgery, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Wang
- Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yuanyuan Song
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, Nanjing, China
| | - Yanzai Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yunpeng Zhu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Yunpeng Zhu
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Gao J, Lu J, Sha W, Xu B, Zhang C, Wang H, Xia J, Zhang H, Tang W, Lei T. Relationship between the neutrophil to high-density lipoprotein cholesterol ratio and severity of coronary artery disease in patients with stable coronary artery disease. Front Cardiovasc Med 2022; 9:1015398. [PMID: 36505389 PMCID: PMC9729241 DOI: 10.3389/fcvm.2022.1015398] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the link between the neutrophil to HDL-C ratio (NHR) and the degree of coronary stenosis in patients with stable coronary artery disease (CAD). Materials and methods Totally 766 individuals who attended our clinic for coronary angiography between January 2019 and January 2021 were included in this study. The participants were divided into two groups, including the CAD group and control group. Spearman correlation analysis was used to investigate the association between NHR and Gensini score and logistic regression analysis was performed to determine the influence of NHR on CAD and severe CAD. Receiver operating characteristic (ROC) curve was constructed to analyze the predictive value of NHR for severe CAD. Results The CAD group had a substantially higher median NHR than the control group (3.7 vs. 3.2, P < 0.01). There was a positive correlation between NHR and Gensini score, as well as the frequency of coronary artery plaques. Logistic regression demonstrated that NHR was an independent contributor for CAD and severe CAD. In ROC analysis, the area under the ROC curve (AUC) for NHR was larger than that for neutrophil, HDL-C or LDL-C/HDL-C, and the differences were statistically significant (all P < 0.05). The NHR limit that offered the most accurate prediction of severe CAD according to the greatest possible value of the Youden index, was 3.88, with a sensitivity of 62.6% and a specificity of 66.2%. Conclusion NHR was not only associated with the occurrence and seriousness of CAD, but also a better predictor of severe CAD than neutrophil, HDL-C or LDL-C/HDL-C.
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Affiliation(s)
- Jie Gao
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Lu
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenjun Sha
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bilin Xu
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cuiping Zhang
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongping Wang
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juan Xia
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong Zhang
- Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenjun Tang
- Heart Function Examination Room, Tongji Hospital, Tongji University, Shanghai, China
| | - Tao Lei
- Department of Endocrinology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Guo HL, Dong N, Chen F, Zeng YY, Hu YH, Xia Y, Tian M, Lu XP, Qiu JC. Effect of long-term valproic acid therapy on lipid profiles in paediatric patients with epilepsy: a meta-analysis. Epileptic Disord 2022; 24:1-9. [PMID: 35816100 DOI: 10.1684/epd.2022.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Despite the potential role of valproic acid (VPA) in weight gain, the effects of VPA therapy on lipid profiles remain unclear. This study aimed to review the influence of VPA therapy on serum lipid profiles in children with epilepsy. Methods This meta-analysis was conducted on data from PubMed, Web of Science, Cochrane Library, and Embase databases. Case-controlled studies, which assessed the effects of VPA therapy on lipid profiles, were included. All outcomes were recorded as continuous variables, and the effect size was measured. Results VPA therapy was associated with a significant reduction in total cholesterol (mean difference [MD]=-6.34, 95% confidence interval [CI]: -12.30, -0.37, p=0.04) and low-density lipoprotein cholesterol levels (MD = -7.75, 95% CI: -13.48, -2.0, p=0.008). No significant effects were observed regarding the levels of high-density lipoprotein cholesterol and triglycerides. Significance In conclusion, this meta-analysis indicates that VPA therapy causes a decrease in the levels of total cholesterol and low-density lipoprotein cholesterol.
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Zhao Y, Gagliano Taliun SA. Lipid-lowering drug targets and Parkinson's disease: A sex-specific Mendelian randomization study. Front Neurol 2022; 13:940118. [PMID: 36119674 PMCID: PMC9477004 DOI: 10.3389/fneur.2022.940118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Parkinson's disease (PD) affects millions of individuals worldwide, and it is the second most common late-onset neurodegenerative disorder. There is no cure and current treatments only alleviate symptoms. Modifiable risk factors have been explored as possible options for decreasing risk or developing drug targets to treat PD, including low-density lipoprotein cholesterol (LDL-C). There is evidence of sex differences for cholesterol levels as well as for PD risk. Genetic datasets of increasing size are permitting association analyses with increased power, including sex-stratified analyses. These association results empower Mendelian randomization (MR) studies, which, given certain assumptions, test whether there is a causal relationship between the risk factor and the outcome using genetic instruments. Sex-specific causal inference approaches could highlight sex-specific effects that may otherwise be masked by sex-agnostic approaches. We conducted a sex-specific two-sample cis-MR analysis based on genetic variants in LDL-C target encoding genes to assess the impact of lipid-lowering drug targets on PD risk. To complement the cis-MR analysis, we also conducted a sex-specific standard MR analysis (using genome-wide independent variants). We did not find evidence of a causal relationship between LDL-C levels and PD risk in females [OR (95% CI) = 1.01 (0.60, 1.69), IVW random-effects] or males [OR (95% CI) = 0.93 (0.55, 1.56)]. The sex-specific standard MR analysis also supported this conclusion. We encourage future work assessing sex-specific effects using causal inference techniques to better understand factors that may contribute to complex disease risk differently between the sexes.
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Affiliation(s)
- Yangfan Zhao
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Sarah A Gagliano Taliun
- Department of Medicine, Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Montreal Heart Institute, Montréal, QC, Canada
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Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States and worldwide. A major risk factor for this condition is increased serum low-density lipoprotein cholesterol (LDL-C) levels for which statins have been successful in reducing serum LDL-C to healthy concentrations. However, patients who are statin intolerant or those who do not achieve their treatment goals while on high-intensity statin therapy, such as those with familial hypercholesterolemia, remain at risk. With the discovery of PCSK9 inhibitors, the ability to provide more aggressive treatment for patients with homozygous and heterozygous familial hypercholesterolemia has increased. Ezetimibe reduces LDL-C by 15%-20% when combined with statin.2,3 Protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been found to achieve profound reductions in LDL-C (54%-74%) when added to statins. They have shown dramatic effects at lowering major adverse cardiovascular events (MACE) in high-risk patients4 with LDL-C levels ≥70 mg/dL and can be used in populations that are statin intolerant or not at goal levels with maximally tolerated statin therapy. PCSK9 inhibitors also produce minimal side effects. Myopathy, a common side effect for patients on statins, has been rare in patients on PCSK9 inhibitors. Randomized trials have shown that reduction in LDL-C has translated to clinical benefits even in patients who have not achieved their LDL-C target.
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Affiliation(s)
- Caroline Coppinger
- 8040Pima Community College, Tucson, AZ, USA.,42283University of Arizona, Tucson, AZ, USA
| | - Mohammad Reza Movahed
- 42283University of Arizona, Tucson, AZ, USA.,42283University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Veronica Azemawah
- 8040Pima Community College, Tucson, AZ, USA.,42283University of Arizona, Tucson, AZ, USA
| | - Lee Peyton
- Department of Molecular Pharmacology and Experimental Therapeutics, 12270Mayo Clinic College of Medicine, Rochester, MN, USA
| | - James Gregory
- 8040Pima Community College, Tucson, AZ, USA.,42283University of Arizona, Tucson, AZ, USA
| | - Mehrnoosh Hashemzadeh
- 8040Pima Community College, Tucson, AZ, USA.,42283University of Arizona College of Medicine, Phoenix, AZ, USA
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11
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Ma Y, Zhou Z, Li X, Ding K, Xiao H, Wu Y, Wu T, Chen D. Linear and nonlinear analyses of the association between low-density lipoprotein cholesterol and diabetes: The spurious U-curve in observational study. Front Endocrinol (Lausanne) 2022; 13:1009095. [PMID: 36465637 PMCID: PMC9714469 DOI: 10.3389/fendo.2022.1009095] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Hyperlipidemia is traditionally considered a risk factor for diabetes. The effect of low-density lipoprotein cholesterol (LDL-C) is counterintuitive to diabetes. We sought to investigate the relationship between LDL-C and diabetes for better lipid management. METHODS We tested the shape of association between LDL-C and diabetes and created polygenic risk scores of LDL-C and generated linear Mendelian randomization (MR) estimates for the effect of LDL-C and diabetes. We evaluated for nonlinearity in the observational and genetic relationship between LDL-C and diabetes. RESULTS Traditional observational analysis suggested a complex non-linear association between LDL-C and diabetes while nonlinear MR analyses found no evidence for a non-linear association. Under the assumption of linear association, we found a consistently protective effect of LDL-C against diabetes among the females without lipid-lowering drugs use. The ORs were 0.84 (95% CI, 0.72-0.97, P=0.0168) in an observational analysis which was more prominent in MR analysis and suggested increasing the overall distribution of LDL-C in females led to an overall decrease in the risk of diabetes (P=0.0258). CONCLUSIONS We verified the liner protective effect of LDL-C against diabetes among the females without lipid-lowering drug use. Non-linear associations between LDL-C against diabetes in observational analysis are not causal.
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12
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Zhang M, Zuo HJ, Yang HX, Nan N, Zhang D, Song XT. Trends in low-density lipoprotein cholesterol level among Chinese young adults hospitalized with first acute myocardial infarction. Ann Transl Med 2021; 9:1536. [PMID: 34790742 PMCID: PMC8576691 DOI: 10.21037/atm-21-4480] [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] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022]
Abstract
Background Representative data has shown a linear increase in mean low-density lipoprotein cholesterol (LDL-C) levels among Chinese adults, contributing to the burden of atherosclerotic cardiovascular disease (ASCVD). This study aimed to assess the trends in LDL-C levels and their association with coronary artery stenosis during the first acute myocardial infarction (AMI) in young Chinese adults. Methods A retrospective study including 2,781 adults, aged 18–44 years, hospitalized for their first AMI in Beijing Anzhen hospital between 2007 and 2017 was performed. Results Mean LDL-C level was 2.82±0.97 mmol/L with the prevalence of elevated LDL-C being 21.6% (601/2,781). Of the study, only 4.2% were aware of their elevated LDL-C status. Neither mean LDL-C concentration nor prevalence of elevated LDL-C showed a downward trend between 2007 and 2017 (P>0.05). Patients aged <35 years had the highest LDL-C level and frequency of elevated LDL-C among the three age groups (aged <35, 35–39, and 40–44 years; P<0.01). Patients with LDL-C ≥3.4 mmol/L evinced a more than 50% increased risk of coronary artery stenosis compared with those with LDL-C <1.4 mmol/L [adjusted odds ratio (OR) 3.19; 95% confidence interval (CI): 1.62 to 6.29]. Of the study, 62.0% had at least two conventional risk factors (RFs), and smoking, accompanied by hypertension, obesity, or elevated LDL-C were the most common combinations. Conclusions The current study provides an overview of trends in LDL-C level and elevated LDL-C among young adults at the time of first AMI. Patients had a high prevalence of elevated LDL-C but low awareness of this status. Coronary artery stenosis was positively correlated with LDL-C level. Preventive strategies, including public education regarding cholesterol levels and benefits of maintaining LDL-C below 3.4 mmol/L should be considered for young adults as a primary preventive strategy.
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Affiliation(s)
- Min Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui-Juan Zuo
- Department of Community Health Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Hong-Xia Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Nan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongfeng Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xian-Tao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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13
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Zeng X, Zhou X, Tan XR, Chen YQ. Admission LDL-C and long-term mortality in patients with acute aortic dissection: a survival analysis in China. Ann Transl Med 2021; 9:1345. [PMID: 34532482 PMCID: PMC8422143 DOI: 10.21037/atm-21-3511] [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: 07/16/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The level of blood lipid is closely related to prognosis in cardiovascular diseases. This study aims to analyze the effect of serum low-density lipoprotein cholesterol (LDL-C) levels on the long-term mortality in acute aortic dissection (AAD). A lower admission LDL-C level is associated with an increased risk of long-term mortality in AAD. METHODS We analyzed the data of 284 patients with AAD admitted to the First Affiliated Hospital of Shantou University Medical College from February 2016 to September 2019. Patients were followed up post-discharge. All patients were divided into either an LDL-C low-level group or an LDL-C high-level group according to the optimal cut-off point obtained by the receiver operating characteristic (ROC) curve. The endpoint outcome was long-term mortality in AAD. A survival analysis and Cox proportional hazards model were used. RESULTS According to the Youden index, the optimal cut-off point for LDL-C was 2.755 mmol/L. The Kaplan-Meier survival analysis curves showed that the long-term mortality of the LDL-C low-level group (<2.755 mmol/L) was significantly higher than that of the LDL-C high-level group (≥2.755 mmol/L) (log-rank χ2=13.912, P<0.001). After multivariate Cox regression analysis, LDL-C <2.755 mmol/L was still significantly associated with long-term mortality in AAD (HR=3.287, 95% CI: 1.637-6.600, P=0.001). In addition, cystatin C was also an independent risk factor for the long-term prognosis of AAD (HR=1.253, 95% CI: 1.057-1.486, P=0.009). CONCLUSIONS A lower admission LDL-C level may be associated with an increased risk of long-term mortality in AAD.
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Affiliation(s)
- Xin Zeng
- Department of Geriatrics, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Xuan Zhou
- Department of Internal Medicine, Fujian Medical University Xiamen Humanity Hospital, Xiamen, China
| | - Xue-Rui Tan
- Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Ye-Qun Chen
- Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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14
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Nurtazina A, Kozhakhmetova D, Dautov D, Khaidarova N, Chattu VK. Association of Early Renal Dysfunction with Lipid Profile Parameters among Hypertensives in Kazakhstan. Diagnostics (Basel) 2021; 11:diagnostics11050871. [PMID: 34066182 PMCID: PMC8151416 DOI: 10.3390/diagnostics11050871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Dyslipidemia plays an essential role in chronic kidney disease (CKD). The role of lipids and lipoproteins in the early pre-disease state of CKD in hypertensive patients is still unclear. The study aimed to evaluate the relationship between early renal dysfunction and lipid profile parameters among hypertensive patients in Kazakhstan. From April 2015 to December 2016, 800 Kazakh males and females with primary hypertension who met the inclusion criteria were included in this cross-sectional study. Data were collected on socio-demographics, lifestyle parameters, family history of cardiovascular disease, and hypertension. Additionally, Dietary Quality Score (DQS), anthropometric data, and blood pressure were recorded. Laboratory blood measurements included eGFR (estimated glomerular filtration rate), lipid profile parameters such as Apolipoprotein B, A1, HDL-C, LDL-C, and TG. We found a linear relationship between early renal dysfunction and LDL-C, Apolipoprotein B, and Apolipoprotein B/A1 ratio, which was in all cases negative and small (r = -0.27, -0.23 and -0.16, respectively). Apolipoprotein A1, HDL-C and TG have not revealed a linear relationship with GFR (r = -0.06, r = -0.06, and ρ = -0.045, respectively). The multicollinearity test restricted the linear model to Apolipoprotein B only. Further linear regression analysis confirmed an inverse significant linear association between eGFR and Apolipoprotein B. Age, DQS, and income appear to be positive confounding factors, significantly fitted the final model. ROC analysis had proven the predictive power of Apolipoprotein B in pre-CKD eGFR decline before and after adjustment for age, DQS and income (AUC = 0.62 and AUC = 0.77, respectively). For differentiating non-diabetic subjects with and without pre-CKD eGFR decrease, 1.05 g/L and 0.98 g/L are likely to be optimal cutoff points in males and females, respectively. These findings will help early prediction of renal dysfunction and contribute to a more accurate estimation of CVD risk.
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Affiliation(s)
- Alma Nurtazina
- Department of Epidemiology and Biostatistics, Semey Medical University, Semey 071400, Kazakhstan
- Correspondence: (A.N.); (V.K.C.); Tel.: +1-(416)-864-6060 (V.K.C.)
| | - Dana Kozhakhmetova
- Department of Quality Assurance in Medical Education, Semey Medical University, Semey 071400, Kazakhstan;
| | - Daulet Dautov
- Department of Propaedeutics of Internal Diseases, Kazakh Medical University, Almaty 050010, Kazakhstan;
| | - Nurzhanat Khaidarova
- Department of Therapeutic Dentistry, Semey Medical University, Semey 071400, Kazakhstan;
| | - Vijay Kumar Chattu
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
- Division of Occupational Medicine, Occupational Medicine Clinic, St. Michael’s Hospital, Toronto, ON M5C 2C5, Canada
- Correspondence: (A.N.); (V.K.C.); Tel.: +1-(416)-864-6060 (V.K.C.)
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15
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Abstract
Patients who have achieved very low low-density lipoprotein cholesterol (LDL-C) levels in clinical trials have the lowest cardio-vascular risk. The current clinical guidelines set such concentration for LDL-C as < 1.4 mmol/L. However, the question of minimum permissible target values of the lipids remains unresolved. A number of experimental and clinical studies showed some unfavorable consequences of low LDL-C levels, at the same time, the modern arsenal of lipid lowering drugs allows reducing LDL-C levels to extremely low values.
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Affiliation(s)
- Victoria Korneva
- Petrozavodsk State University, Faculty Therapy Department, 185000 Lenin Ave., 33, Petrozavodsk,. Russian Federation
| | - Tatiana Kuznetsova
- Petrozavodsk State University, Faculty Therapy Department, 185000 Lenin Ave., 33, Petrozavodsk,. Russian Federation
| | - Ulrich Julius
- Lipidology and Lipoprotein Apheresis Center, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universtät Dresden, Fetscherstr. 74, 01307 Dresden,. Germany
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16
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Zhang P, Su Q, Ye X, Guan P, Chen C, Hang Y, Dong J, Xu Z, Hu W. Trends in LDL-C and Non-HDL-C Levels with Age. Aging Dis 2020; 11:1046-1057. [PMID: 33014521 PMCID: PMC7505266 DOI: 10.14336/ad.2019.1025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/25/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022] Open
Abstract
Understanding how blood lipid levels change with age in the general population is a precondition to defining dyslipidemia. To explore age-related trends in LDL-C and non-HDL-C levels in the general population, a large-scale cross-sectional study with 49,201 males and 35,084 females was adopted. Trends of non-HDL-C and LDL-C levels were plotted against each age (18 to 85 years old, one-year increments); the trends, as well as the influence of confounding factors on the trends, were validated and adjusted by linear regression modeling. The trajectory of LDL-C and non-HDL-C levels by age displayed a nonlinear correlation trend. Further multivariate linear regression modeling that incorporated sex-specific age phases showed that age was positively associated with LDL-C and non-HDL-C levels, with coefficients of 0.018 and 0.031, respectively, in females aged ≥18 to ≤56 years and negatively associated with LDL-C and non-HDL-C levels, with coefficients of -0·013 and -0.015, respectively, in females aged ≥57 years. The LDL-C and non-HDL-C levels increased with age in males ≥18 to ≤33 years of age, with coefficients of 0.025 and 0.053, respectively; the lipid levels plateaued at ≥34 to ≤56 years of age and subsequently decreased in those ≥57 years of age, with coefficients of -0.008 and -0.018, respectively. In contrast, pooled analyses without age stratification concealed these details. In conclusion, fluctuating increasing and decreasing lipid levels occurred with phases of aging in both sexes. Well-grounded age stratification is necessary to improve lipid-related pathophysiological studies.
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Affiliation(s)
- Peng Zhang
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Qian Su
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaomiao Ye
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Ping Guan
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Chengjun Chen
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yanwen Hang
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Jian Dong
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
| | - Zhongjie Xu
- 2Shanghai Minhang District Medical Emergency Center, Shanghai, China
| | - Wei Hu
- 1Department of Cardiology, Minhang Hospital, Fudan University, Shanghai, China
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17
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Boccara F, Kumar PN, Caramelli B, Calmy A, López JAG, Bray S, Cyrille M, Rosenson RS. Evolocumab in HIV-Infected Patients With Dyslipidemia: Primary Results of the Randomized, Double-Blind BEIJERINCK Study. J Am Coll Cardiol 2020; 75:2570-2584. [PMID: 32234462 DOI: 10.1016/j.jacc.2020.03.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 02/14/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and are prone to statin-related adverse events from drug-drug interactions with certain antiretroviral regimens. OBJECTIVES This study sought to evaluate the efficacy and safety of evolocumab in dyslipidemic PLHIV. METHODS BEIJERINCK (EvolocumaB Effect on LDL-C Lowering in SubJEcts with Human Immunodeficiency VirRus and INcreased Cardiovascular RisK) is a randomized, double-blind, multinational trial comparing monthly subcutaneous evolocumab 420 mg with placebo in PLHIV with hypercholesterolemia/mixed dyslipidemia taking maximally-tolerated statin therapy. The primary endpoint was the percent change (baseline to week 24) in low-density lipoprotein cholesterol (LDL-C); secondary endpoints included achievement of LDL-C <70 mg/dl and percent change in other plasma lipid and lipoprotein levels. Treatment-emergent adverse events were also examined. RESULTS A total of 464 patients were analyzed (mean age of 56.4 years, 82.5% male, mean duration with HIV of 17.4 years). ASCVD was documented in 35.6% of patients, and statin intolerance/contraindications to statin use were present in 20.7% of patients. Evolocumab reduced LDL-C by 56.9% (95% confidence interval: 61.6% to 52.3%) from baseline to week 24 versus placebo. An LDL-C level of <70 mg/dl was achieved in 73.3% of patients in the evolocumab group versus 7.9% in the placebo group. Evolocumab also significantly reduced other atherogenic lipid levels, including non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein(a) (all p < 0.0001). Evolocumab was well tolerated, and treatment-emergent adverse events patient incidence was similar among evolocumab and placebo groups. CONCLUSIONS Evolocumab was safe and significantly reduced lipid levels in dyslipidemic PLHIV on maximally-tolerated statin therapy. Evolocumab is an effective therapy for lowering atherogenic lipoproteins in PLHIV with high cardiovascular risk. (Safety, Tolerability & Efficacy on LDL-C of Evolocumab in Subjects With HIV & Hyperlipidemia/Mixed Dyslipidemia; NCT02833844).
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Affiliation(s)
- Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France.
| | - Princy N Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington, DC
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, InCor, University of São Paulo, São Paulo, Brazil
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Sarah Bray
- Global Development, Amgen Inc., Thousand Oaks, California
| | | | - Robert S Rosenson
- Cardiometabolics Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
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18
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Zhou H, Zhang S, Sun X, Yang D, Zhuang X, Guo Y, Hu X, Du Z, Zhang M, Liao X. Lipid management for coronary heart disease patients: an appraisal of updated international guidelines applying Appraisal of Guidelines for Research and Evaluation II-clinical practice guideline appraisal for lipid management in coronary heart disease. J Thorac Dis 2019; 11:3534-3546. [PMID: 31559060 DOI: 10.21037/jtd.2019.07.71] [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] [Indexed: 01/04/2023]
Abstract
Background Clinical practice guidelines (CPGs) provide many recommendations for hyperlipidemia management, but some of them are still debatable. Methods We applied the six-domain Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate the quality of guidelines with lipid management recommendations for coronary heart disease (CHD), including dyslipidemia and CHD guidelines published from 2009 to 2019. Meanwhile, we synthesized and compared major recommendations and present the consistency and controversy in current dyslipidemia management. Results Among 19 guidelines included, ten guidelines ("strongly recommended" with AGREE scores 61-94%) performed better than the other nine (38-65% as "recommended with some modification") For blood lipid tests, most CHD guidelines simply required fasting sample while dyslipidemia guidelines preferred non-fasting sample except in high triglycerides state. Most guidelines consistently chose low-density lipoprotein cholesterol (LDL-C) as the primary lipid-lowering target (LLT), while non-high-density lipoprotein cholesterol (non-HDL-C) and apolipoprotein B were mainly selected as secondary LLTs. The specific goals of LDL-C lowering were either to lower than 70 mg/dL or with at least 50% reduction. All guidelines recommended high intensity or maximally tolerable doses of statins, while ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were recommended as second-line therapy. Conclusions The general quality of guidelines for lipid management is satisfactory. Consensus has been reached on the specific goal of lipid reduction and the intensity of statins therapy. Further research is needed to validate the application of non-fasting sample and non-HDL-C target, as well as the efficacy and safety of ezetimibe and PCSK9 inhibitors.
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Affiliation(s)
- Huimin Zhou
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Shaozhao Zhang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xiuting Sun
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Daya Yang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xiaodong Zhuang
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China.,Center for Information Technology & Statistics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yue Guo
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Xun Hu
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Zhimin Du
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou 510080, China
| | - Xinxue Liao
- Cardiology Department, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou 510080, China
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19
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Shen J, Liu T, Liu X, Ge JY, Wang HL, Guo AL, Liu ML, Chang XR. [Effects of herbal-cake-separated moxibustion on the repair of vascular endothelial and SDF-1 in rabbits with atherosclerosis]. Zhongguo Zhen Jiu 2019; 39:173-8. [PMID: 30942037 DOI: 10.13703/j.0255-2930.2019.02.017] [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: 11/06/2022]
Abstract
OBJECTIVE To observe the effects of herbal-cake-separated moxibustion on the repair of damaged vascular endothelium structure and the content of stromal cells derived factor 1 (SDF-1) in rabbits with atherosclerosis. METHODS A total of 75 rabbits were randomly divided into a normal group, a model group, a direct moxibustion group, an atorvastatin calcium group and a herbal-cake-separated moxibustion group, 15 rabbits in each one. The rabbits in the normal group were fed with normal diet, and the remaining rabbits were fed with high-cholesterol diet for 12 weeks to prepare atherosclerotic model. Two groups of acupoints, one was "Juque" (CV 14), "Tianshu" (ST 25) and "Fenglong" (ST 40), the other one was "Xinshu" (BL 15), "Ganshu" (BL 18) and "Pishu" (BL 20), were applied in the direct moxibustion group and herbal-cake-separated moxibustion group; the two groups of acupoints were selected alternatively every other day. The moxibustion was given for 30 min per treatment, once a day for 4 weeks. The rabbits in the atorvastatin calcium group were treated with atorvastatin calcium tablets (1.96 mg•kg-1•d-1) which were crushed into powder and mixed into breakfast. After modeling, the rabbits in the normal group and model group received no treatment, and immobilized at the time when moxibustion was applied in other three groups. The levels of total cholesterol (TC) and triglyceride (TG) were measured by enzymic method; the low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured by colorimetric method; the morphological structure of aortic wall was observed under optical microscope; the serum level of SDF-1 was determined by enzyme-linked immunosorbent assay (ELISA). RESULTS After treatment, compared with the normal group, the levels of TC, TG and LDL-C were significantly increased in the model group (all P<0.01), and the level of HDL-C was decreased (P<0.01). Compared with the model group, the levels of TC, TG and LDL-C were significantly decreased (all P<0.01), and the level of HDL-C was significantly increased in the direct moxibustion group, atorvastatin calcium group and herbal-cake-separated moxibustion group (P<0.01, P<0.05). Compared with the normal group, the morphological structure of aortic wall was significantly damaged in the model group. Compared with the model group, the vascular endothelial structure was improved in the atorvastatin calcium group and herbal-cake-separated moxibustion group, and the pathological change of aorta endothelial in the direct moxibustion group was relieved. After treatment, compared with the model group, the level of SDF-1 was increased in the direct moxibustion group, atorvastatin calcium group and herbal-cake-separated moxibustion group (P<0.05, P<0.01); the level of SDF-1 in the herbal-cake- separated moxibustion group was higher than that in the direct moxibustion group (P<0.05). CONCLUSION The herbal- cake-separated moxibustion can promote the expression of SDF-1 in serum and repair the damaged aortic endothelial structure.
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Affiliation(s)
- Jing Shen
- College of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Tao Liu
- College of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Xia Liu
- College of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Jun-Yun Ge
- College of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | | | - An-Lin Guo
- Changsha Civil Vocational Technical School
| | - Mai-Lan Liu
- College of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
| | - Xiao-Rong Chang
- College of Acupuncture-Moxibustion and Tuina, Hunan University of CM, Changsha 410208, China
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Toth PP, Danese M, Villa G, Qian Y, Beaubrun A, Lira A, Jansen JP. Estimated burden of cardiovascular disease and value-based price range for evolocumab in a high-risk, secondary-prevention population in the US payer context. J Med Econ 2017; 20:555-564. [PMID: 28097904 DOI: 10.1080/13696998.2017.1284078] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 12/17/2022]
Abstract
AIM To estimate real-world cardiovascular disease (CVD) burden and value-based price range of evolocumab for a US-context, high-risk, secondary-prevention population. MATERIALS AND METHODS Burden of CVD was assessed using the UK-based Clinical Practice Research Datalink (CPRD) in order to capture complete CV burden including CV mortality. Patients on standard of care (SOC; high-intensity statins) in CPRD were selected based on eligibility criteria of FOURIER, a phase 3 CV outcomes trial of evolocumab, and categorized into four cohorts: high-risk prevalent atherosclerotic CVD (ASCVD) cohort (n = 1448), acute coronary syndrome (ACS) (n = 602), ischemic stroke (IS) (n = 151), and heart failure (HF) (n = 291) incident cohorts. The value-based price range for evolocumab was assessed using a previously published economic model. The model incorporated CPRD CV event rates and considered CV event reduction rate ratios per 1 mmol/L reduction in low-density lipoprotein-cholesterol (LDL-C) from a meta-analysis of statin trials by the Cholesterol Treatment Trialists Collaboration (CTTC), i.e. CTTC relationship. RESULTS Multiple-event rates of composite CV events (ACS, IS, or coronary revascularization) per 100 patient-years were 12.3 for the high-risk prevalent ASCVD cohort, and 25.7, 13.3, and 23.3, respectively, for incident ACS, IS, and HF cohorts. Approximately one-half (42%) of the high-risk ASCVD patients with a new CV event during follow-up had a subsequent CV event. Combining these real-world event rates and the CTTC relationship in the economic model, the value-based price range (credible interval) under a willingness-to-pay threshold of $150,000/quality-adjusted life-year gained for evolocumab was $11,990 ($9,341-$14,833) to $16,856 ($12,903-$20,678) in ASCVD patients with baseline LDL-C levels ≥70 mg/dL and ≥100 mg/dL, respectively. CONCLUSION Real-world CVD burden is substantial. Using the observed CVD burden in CPRD and the CTTC relationship, the cost-effectiveness analysis showed that, accounting for uncertainties, the expected value-based price for evolocumab is higher than its current annual cost, as long as the payer discount off list price is greater than 20%.
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Affiliation(s)
- Peter P Toth
- a CGH Medical Center , Sterling , IL , USA
- b Ciccarone Center for the Prevention of Heart Disease , Johns Hopkins University School of Medicine , Lutherville , MD , USA
| | - Mark Danese
- c Outcomes Insights, Inc , Westlake Village , CA , USA
| | | | - Yi Qian
- e Amgen Inc. , Thousand Oaks , CA , USA
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21
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Abstract
Examination of the current the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines on the prevention of cardiovascular disease and the management of dyslipidemias finds much common ground. Both note that Atherosclerotic cardiovascular disease (ASCVD) is, in most people, the product of a number of risk factors, notably tobacco exposure, hyperlipidemia, hypertension, inactivity, overweight and diabetes. They stress that risk calculators can help in the assessment of risk in apparently healthy persons. Persons with established ASCVD and many with diabetes or renal impairment are at high to very high risk and warrant intensive risk factor advice and guideline-based preventive therapies. The ACC/AHA guidelines favor the universal use of statins in all high-risk subjects and in primary prevention where the global risk exceeds 7.5% in 10 years, with a percentage reduction in low-density lipoprotein cholesterol (LDL-C) based on statin intensity as the "goal". In contrast, the ESC/EAS guidelines favor a goal or percentage-based reduction in LDL-C based on total risk and baseline LDL-C level. Both guidelines consider certain imaging and other measures to stratify risk as well as the use of non-statin therapies in those not achieving recommended targets. Perhaps the most important challenges are to stress similarities rather than differences, and to simplify communications with both healthcare professionals and the public.
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Affiliation(s)
- Ian M Graham
- Trinity College Dublin, Dublin, Ireland.,Adelaide Health Foundation, Tallaght Hospital, Dublin, Ireland
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular sciences and IRCCS Multimedica, University of Milan, Milan, Italy
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, USA
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22
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Steen DL, Khan I, Ansell D, Sanchez RJ, Ray KK. Retrospective examination of lipid-lowering treatment patterns in a real-world high-risk cohort in the UK in 2014: comparison with the National Institute for Health and Care Excellence (NICE) 2014 lipid modification guidelines. BMJ Open 2017; 7:e013255. [PMID: 28213597 PMCID: PMC5318572 DOI: 10.1136/bmjopen-2016-013255] [Citation(s) in RCA: 28] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In 2014, guidelines from the National Institute for Health and Care Excellence (NICE) provided updated recommendations on lipid-modifying therapy (LMT). We assessed clinical practice contemporaneous to release of these guidelines in a UK general practice setting for secondary and high-risk primary-prevention populations, and extrapolated the findings to UK nation level. METHODS Patients from The Health Improvement Network database with the following criteria were included: lipid profile in 2014 (index date); ≥20 years of age; ≥2 years representation in database prior to index; ≥1 statin indication either for atherosclerotic cardiovascular disease (ASCVD) or the non-ASCVD conditions high-risk diabetes mellitus and/or chronic kidney disease. RESULTS Overall, 183 565 patients met the inclusion criteria (n=91 479 for ASCVD, 92 086 for non-ASCVD). In those with ASCVD, 79% received statin treatment and 31% received high-intensity statin. In the non-ASCVD group, 62% were on a statin and 57% received medium-intensity or high-intensity statin. In the ASCVD and non-ASCVD cohorts, 6% and 15%, respectively, were already treated according to dosing recommendations as per updated NICE guidelines. Extrapolation to the 2014 UK population indicated that, of the 3.3 million individuals with ASCVD, 2.4 million would require statin uptitration and 680 000 would require statin initiation (31% de novo initiation, 60% reinitiation, 9% addition to non-statin LMT) to achieve full concordance with updated guidelines. Of the 3.5 million high-risk non-ASCVD individuals, 1.6 million would require statin uptitration and 1.4 million would require statin initiation (59% de novo initiation, 36% reinitiation, 5% addition to non-statin LMT). CONCLUSIONS A large proportion of UK individuals with ASCVD and high-risk non-ASCVD received statin treatment (79% and 62%, respectively) during the year of NICE 2014 guidelines release. Up to 94% of patients with ASCVD and 85% of high-risk non-ASCVD individuals, representing ∼3 million individuals in each group, would require statin uptitration or initiation to achieve full concordance with updated guidelines.
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Affiliation(s)
- Dylan L Steen
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Irfan Khan
- Global Health Economics and Outcomes Research, Sanofi, Bridgewater, New Jersey, USA
| | | | - Robert J Sanchez
- Global Health Economics and Outcomes Research, Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College, London, UK
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23
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Abstract
The prevalence of atherosclerotic cardiovascular diseases (ASCVDs) is increasing globally and they have become the leading cause of death in most countries. Numerous experimental and clinical studies have been conducted to identify major risk factors and effective control strategies for ASCVDs. The development of imaging modalities with the ability to determine the plaque composition enables us to further identify high-risk plaque and evaluate the effectiveness of different treatment strategies. While intensive lipid-lowering by statins can stabilize or even regress plaque by various mechanisms, such as the reduction of lipid accumulation in a necrotic lipid core, the reduction of inflammation, and improvement of endothelial function, there are still considerable residual risks that need to be understood. We reviewed important findings regarding plaque vulnerability and some encouraging emerging approaches for plaque stabilization.
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Affiliation(s)
- Kohei Takata
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
| | - Satoshi Imaizumi
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
| | - Bo Zhang
- Department of Biochemistry, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
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Kosmas CE, DeJesus E, Rosario D, Vittorio TJ. CETP Inhibition: Past Failures and Future Hopes. Clin Med Insights Cardiol 2016; 10:37-42. [PMID: 26997876 PMCID: PMC4790583 DOI: 10.4137/cmc.s32667] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/05/2016] [Accepted: 02/03/2016] [Indexed: 12/17/2022]
Abstract
The atheroprotective role of high-density lipoprotein cholesterol (HDL-C) in cardiovascular disease has been unequivocally established, and epidemiological data have clearly demonstrated a strong inverse relationship between HDL-C levels and the risk of cardiovascular events, which is independent of the low-density lipoprotein cholesterol (LDL-C) levels. Thus, it would be logical to hypothesize that raising HDL-C might potentially lead to a reduction of cardiovascular risk. Cholesteryl ester transfer protein (CETP) promotes the transfer of cholesteryl esters from HDL to very low-density lipoprotein and LDL. Therefore, CETP inhibition raises HDL-C levels and decreases LDL-C levels. The first trials with CETP inhibitors failed to show a reduction in cardiovascular events. However, newer CETP inhibitors with more favorable effects on lipids are presently being tested in clinical trials with the hope that their use may lead to a reduction in cardiovascular risk. This review aims to provide the current evidence regarding CETP inhibition, as well as the clinical and scientific data pertaining to the new CETP inhibitors in development.
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Affiliation(s)
- Constantine E Kosmas
- Department of Medicine, Division of Cardiology, Mount Sinai Hospital, New York, NY, USA
| | - Eddy DeJesus
- Department of Medicine, Bronx-Lebanon Hospital Center, New York, NY, USA
| | - Digna Rosario
- Cardiology Clinic, Cardiology Unlimited, PC, New York, NY, USA
| | - Timothy J Vittorio
- Center for Advanced Cardiac Therapeutics, St. Francis Hospital - The Heart Center®, Roslyn, NY, USA
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Imes CC, Austin MA. Low-density lipoprotein cholesterol, apolipoprotein B, and risk of coronary heart disease: from familial hyperlipidemia to genomics. Biol Res Nurs 2012; 15:292-308. [PMID: 22531366 DOI: 10.1177/1099800412436967] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Coronary heart disease (CHD) affects 17 million people in the United States and accounts for over a million hospital stays each year. Technological advances, especially in genetics and genomics, have changed our understanding of the risk factors for developing CHD. The purpose of this article is to review low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apo B), and risk of CHD. The article focuses on five topics: (1) a description of lipoprotein classes, normal lipoprotein metabolism, and the biological mechanism of atherosclerosis; (2) a review of selected epidemiologic and clinical trial studies examining the associations between elevated LDL-C and apo B with CHD; (3) a brief review of the familial forms of hyperlipidemia; (4) a description of variants in genes that have been associated with higher LDL-C levels in candidate gene studies and genome-wide association studies (GWAS); and (5) nursing implications, including a discussion on how genetic tests are evaluated and the current clinical utility and validity of genetic tests for CHD.
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