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Alonso R, Arroyo-Olivares R, Muñiz-Grijalvo O, Díaz-Díaz JL, Muñoz-Torrero JS, Romero MJ, de Andrés R, Zambón D, Mañas MD, Fuentes-Jiménez F, Aguado R, Alvarez-Baños P, Arrieta F, Gonzalez-Bustos P, Cepeda J, Martin-Ordiales M, Mosquera D, Michan A, de Isla LP, Argueso R, Mata P. Persistence with long-term PCSK9 inhibitor treatment and its effectiveness in familial hypercholesterolaemia: data from the SAFEHEART study. Eur J Prev Cardiol 2023; 30:320-328. [PMID: 36416136 DOI: 10.1093/eurjpc/zwac277] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Abstract
AIMS Most heterozygous familial hypercholesterolaemia (FH) patients require intensive lipid-lowering therapy (LLT) including PCSK9 inhibitors (PCSK9is) to reach current low-density lipoprotein cholesterol (LDL-C) goals. Persistence with chronic treatment is important to reduce the burden of atherosclerotic cardiovascular disease. We analysed persistence, efficacy, and impact on quality of life (QoL) of PCSK9i in FH patients in clinical practice setting. METHODS AND RESULTS Spanish Familial Hypercholesterolaemia Cohort Study (SAFEHEART) is an open, prospective study in genetically defined FH patients in Spain. Patients ≥18 years of age (n = 696, 46% females) on stable LLT treated with PCSK9i were analysed. Median LDL-C at starting PCSK9i was 145 mg/dL [interquartile range (IQR), 123-177], 3.8 mmol/L (IQR 3.2-4.6). After a median follow up of 3.7 years (IQR 2.3-4.8), 27 patients (4%) discontinued PCSK9i treatment: 5 temporarily (0.7%) and 22 permanently (3.2%). Persistence with PCSK9i was 96.1% in the whole period. Median LDL-C levels and % LDL-C reduction attained after 1 year of treatment and in the last follow-up visit were 63 mg/dL (IQR 43-88), 1.6 mmol/L (IQR 1.1-2.23); 61 mg/dL (IQR 44-82), 1.6 mmol/L (IQR 1.1-2.1); 57.6% (IQR 39.5-69); and 58% (IQR 44-68), respectively. 2016 and 2019 ESC/EAS LDL-C goals were attained by 77 and 48% of patients, respectively, at the last follow-up visit (P < 0.001). Mean QoL score increased slightly in the first year and remained stable. CONCLUSION Long-term persistence with PCSK9i in FH patients is very high, with a good QoL. Effectiveness in LDL-C reduction and LDL-C goal achievement dramatically improved with PCSK9i in this high-risk population in clinical practice setting. TRIAL REGISTRATION ClinicalTrials.gov number NCT02693548.
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Affiliation(s)
- Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, C/General Álvarez de Castro 14, 28010 Madrid, Spain
- Center for Advanced Metabolic Medicine and Nutrition, Santiago de Chile, Fundación hipercolesterolemia Familiar, Madrid, Spain
| | - Raquel Arroyo-Olivares
- Fundación Hipercolesterolemia Familiar, C/General Álvarez de Castro 14, 28010 Madrid, Spain
| | | | | | | | - Manuel J Romero
- Department of Internal Medicine, Hospital Infanta Elena, Huelva, Spain
| | | | | | | | - Francisco Fuentes-Jiménez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofia University Hospital, CIBERObn, Córdoba, Spain
| | - Rocío Aguado
- Department of Endocrinology, Hospital General de León, León, Spain
| | - Pilar Alvarez-Baños
- Department of Endocrinology, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Pablo Gonzalez-Bustos
- Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - José Cepeda
- Department of Internal Medicine, Hospital Comarcal Vega Baja, Orihuela, Spain
| | | | - Daniel Mosquera
- Department of Internal Medicine, Hospital San Pedro, Logroño, Spain
| | - Alfredo Michan
- Department of Internal Medicine, Hospital de Jerez, Jerez, Spain
| | | | - Rosa Argueso
- Department of Endocrinology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, C/General Álvarez de Castro 14, 28010 Madrid, Spain
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Pérez de Isla L, Watts GF, Muñiz-Grijalvo O, Díaz-Díaz JL, Alonso R, Zambón D, Fuentes-Jimenez F, Mauri M, Padró T, Vidal-Pardo JI, Barba MA, Ruiz-Pérez E, Michán A, Mediavilla JD, Hernandez AM, Romero-Jimenez MJ, Badimon L, Mata P. A resilient type of familial hypercholesterolaemia: case-control follow-up of genetically characterized older patients in the SAFEHEART cohort. Eur J Prev Cardiol 2021; 29:795-801. [PMID: 34864959 DOI: 10.1093/eurjpc/zwab185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/08/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022]
Abstract
AIMS Knowledge of the features of patients with familial hypercholesterolaemia (FH) who are protected from atherosclerotic cardiovascular disease (ASCVD) is important for the clinical and prognostic care of this apparently high-risk condition. Our aim was to investigate the determinant and characteristics of patients with FH who are protected from ASCVD and have normal life expectancy, so-called 'resilient' FH (R-FH). METHODS AND RESULTS Spanish Familial Hypercholesterolaemia cohort study (SAFEHEART) is an open, multicentre, nation-wide, long-term prospective cohort study in genetically defined patients with heterozygous FH in Spain. Patients in the registry who at the time of analysis were at least 65 years or those who would have reached that age had they not died from an ASCVD event were analysed as a case-control study. Resilient FH was defined as the presence of a pathogenic mutation causative of FH in a patient aged ≥65 years without clinical ASCVD. Nine hundred and thirty registrants with FH met the study criteria. A defective low-density lipoprotein (LDL)-receptor mutation, higher plasma level of high-density lipoprotein cholesterol (HDL-C), younger age, female gender, absence of hypertension, and lower plasma lipoprotein (a) [Lp(a)] concentration were independently predictive of R-FH. In a second model, higher levels of HDL-C and lower 10-year score in SAFEHEART-RE were also independently predictive of R-FH. CONCLUSION Resilient FH may be typified as being female and having a defective LDL-receptor mutation, higher levels of plasma HDL-C, lower levels of Lp(a), and an absence of hypertension. The implications of this type of FH for clinical practice guidelines and the value for service design and optional care of FH remains to be established. TRIAL REGISTRATION ClinicalTrials.gov number NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, C/Profesor Martín Lagos s/n, 28040 Madrid, Spain.,Fundación Hipercolesterolemia Familiar, C/General Alvarez de Castro 14, 28010 Madrid, Spain
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Lipid Disorders Clinic, Cardiometabolic Services, Perth, Western Australia, Australia
| | | | | | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, C/General Alvarez de Castro 14, 28010 Madrid, Spain.,Center for Advanced Metabolic Medicine and Nutrition, Santiago, Chile
| | - Daniel Zambón
- Department of Endocrinology, Hospital Clinic, Barcelona, Spain
| | | | - Marta Mauri
- Internal Medicine Department, Hospital de Terrassa, Barcelona, Spain
| | - Teresa Padró
- ICCC Cardiovascular, Institut de Recerca del Hospital Santa Creu i Sant Pau, IIB Santa Pau, Barcelona, Spain
| | - José I Vidal-Pardo
- Department of Endocrinology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Miguel A Barba
- Internal Medicine Department, Complejo Hospitalario Universitario, Albacete, Spain
| | - Enrique Ruiz-Pérez
- Department of Endocrinology, Hospital Universitario de Burgos, Burgos, Spain
| | - Alfredo Michán
- Internal Medicine Department, Hospital Jerez de la Frontera, Cadiz, Spain
| | - Juan D Mediavilla
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio M Hernandez
- Department of Endocrinology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Lina Badimon
- Department of Endocrinology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, C/General Alvarez de Castro 14, 28010 Madrid, Spain
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Pérez de Isla L, Watts GF, Alonso R, Díaz-Díaz JL, Muñiz-Grijalvo O, Zambón D, Fuentes F, de Andrés R, Padró T, López-Miranda J, Mata P. Lipoprotein(a), LDL-cholesterol, and hypertension: predictors of the need for aortic valve replacement in familial hypercholesterolaemia. Eur Heart J 2021; 42:2201-2211. [PMID: 33437997 DOI: 10.1093/eurheartj/ehaa1066] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/23/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS Familial hypercholesterolaemia (FH) and elevated lipoprotein(a) [Lp(a)] are inherited disorders associated with premature atherosclerotic cardiovascular disease (ASCVD). Aortic valve stenosis (AVS) is the most prevalent valvular heart disease and low-density lipoprotein cholesterol (LDL-C) and Lp(a) may be involved in its pathobiology. We investigated the frequency and predictors of severe AVS requiring aortic valve replacement (AVR) in molecularly defined patients with FH. METHODS AND RESULTS SAFEHEART is a long-term prospective cohort study of a population with FH and non-affected relatives (NAR). We analysed the frequency and predictors of the need for AVR due to AVS in this cohort. Five thousand and twenty-two subjects were enrolled (3712 with FH; 1310 NAR). Fifty patients with FH (1.48%) and 3 NAR (0.27%) required AVR [odds ratio 5.71; 95% confidence interval (CI): 1.78-18.4; P = 0.003] after a mean follow-up of 7.48 (3.75) years. The incidence of AVR was significantly higher in patients with FH (log-rank 5.93; P = 0.015). Cox regression analysis demonstrated an association between FH and AVR (hazard ratio: 3.89; 95% CI: 1.20-12.63; P = 0.024), with older age, previous ASCVD, hypertension, increased LDL-CLp(a)-years, and elevated Lp(a) being independently predictive of an event. CONCLUSION The need for AVR due to AVS is significantly increased in FH patients, particularly in those who are older and have previous ASCVD, hypertension, increased LDL-CLp(a)-years and elevated Lp(a). Reduction in LDL-C and Lp(a) together with control of hypertension could retard the progression of AVS in FH, but this needs testing in clinical trials.ClinicalTrials.gov number NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, C/Profesor Martín Lagos s/n, 28040 Madrid, Spain.,Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.,Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain.,Center for Advanced Metabolic Medicine and Nutrition, Santiago de Chile, Chile
| | | | | | - Daniel Zambón
- Department of Endocrinology, Hospital Clinic, Barcelona, Spain
| | - Francisco Fuentes
- Lipids and Atherosclerosis Unit, CIBERObn, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | | | - Teresa Padró
- Programa-ICCC Cardiovascular, Institut de Recerca del Hospital Santa Creu i Sant Pau, IIB Santa Pau, Barcelona, Spain
| | - José López-Miranda
- Lipids and Atherosclerosis Unit, CIBERObn, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
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Alonso R, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, de Andrés R, Arroyo-Olivares R, Fuentes-Jimenez F, Muñoz-Torrero JS, Cepeda J, Aguado R, Alvarez-Baños P, Casañas M, Dieguez M, Mañas MD, Rubio P, Argueso R, Arrieta F, Gonzalez-Bustos P, Perez-Isla L, Mata P. Efficacy of PCSK9 inhibitors in the treatment of heterozygous familial hypercholesterolemia: A clinical practice experience. J Clin Lipidol 2021; 15:584-592. [PMID: 34052174 DOI: 10.1016/j.jacl.2021.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND PCSK9 inhibitors are a treatment option for patients with familial hypercholesterolemia not on low-density lipoprotein cholesterol goals despite the use of maximally tolerated high intensity-statins dose. OBJECTIVE To evaluate the efficacy of alirocumab and evolocumab in LDL-C reduction and targets attainment in patients with heterozygous familial hypercholesterolemia in clinical practice setting. METHODS SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of familial hypercholesterolemia. This study analyze subjects ≥ 20 years of age on stable lipid-lowering therapy, who received PCSK9 inhibitors during the period 2016 to January 2020. RESULTS 433 patients (mean age 55 years, 53% male, 39% with cardiovascular disease) were included and followed-up for a median of 2.5 years (IQR 1.6-3.0). Median LDL-C level prior to PCSK9 inhibitors was 145 mg/dL (IQR 125-173). The addition of PCSK9 inhibitors (211 alirocumab, 222 evolocumab) reduced LDL-C by 58% (IQR 41-70) p<0.001, in men and women, achieving a median LDL-C level of 62 mg/dL (IQR 44-87) without differences between both PCSK9 inhibitors. Out of them 67% with and 80% without cardiovascular disease reached 2016 ESC/EAS LDL-C targets, and 46% very high risk and 50% high risk patients achieved 2019 ESC/EAS LDL-C goals. Independent predictor factors for attainment of 2019 ESC/EAS LDL-C goals were to be male, smoking and the use of statins with ezetimibe. Both inhibitors were well tolerated. CONCLUSIONS PCSK9 inhibitors on top of maximum lipid-lowering treatment significantly reduced LDL-C levels in patients with familial hypercholesterolemia and improved the achievement of LDL-C targets.
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Affiliation(s)
- Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, General Alvarez de Castro 14, E 2800 Madrid, Spain; Center for Advanced Metabolic Medicine and Nutrition, Av. Las Condes 9460, of 501, Santiago, Chile.
| | | | | | | | | | - Raquel Arroyo-Olivares
- Fundación Hipercolesterolemia Familiar, General Alvarez de Castro 14, E 2800 Madrid, Spain
| | | | | | - Jose Cepeda
- Internal Medicine Department, Hospital Comarcal Vega Baja, Orihuela, Spain
| | - Rocío Aguado
- Department of Endocrinology, Hospital General de León, León, Spain
| | - Pilar Alvarez-Baños
- Department of Endocrinology, Hospital Universitario de Burgos, Burgos, Spain
| | - Marta Casañas
- Internal Medicine Department, Hospital San Pedro, Logroño, Spain
| | - Marta Dieguez
- Department of Endocrinology, Hospital de Cabueñes, Gijón, Spain
| | | | - Patricia Rubio
- Internal Medicine Department, Hospital Jerez de la Frontera, Cadiz, Spain
| | - Rosa Argueso
- Department of Endocrinology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | - Pablo Gonzalez-Bustos
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Leopoldo Perez-Isla
- Fundación Hipercolesterolemia Familiar, General Alvarez de Castro 14, E 2800 Madrid, Spain; Department of Cardiology, Hospital Clínico San Carlos, IDISSC, Madrid, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, General Alvarez de Castro 14, E 2800 Madrid, Spain.
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Viñals C, Zambón D, Yago G, Domenech M, Ortega E. Secondary hypertriglyceridemia. Clin Investig Arterioscler 2021; 33 Suppl 2:29-36. [PMID: 34006351 DOI: 10.1016/j.arteri.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/14/2021] [Indexed: 12/22/2022]
Abstract
Secondary hypertriglyceridemia (HTG) are the most common cause of excess triglyceride rich particles in plasma. Faced with HTG, the first thing to do is rule out if there is a secondary cause since it can interact with genetic susceptibility and further aggravate the HTG. The most common causes are diet with high fat and high glycemic index, obesity, diabetes mellitus, alcohol consumption, renal disease like nephrotic syndrome, hepatic disorders and medications. The most important medications that can influence in HTG are oestrogen, isotretinoin, immunosuppressant therapy, L-asparaginase and with less effect thiazides, beta blockers, atypical antipsychotics and glucocorticoids. Other causes less frequent are endocrinological diseases such as Cushing's syndrome, acromegaly, hypothyroidism; pregnancy, lipodystrophies and autoimmune diseases. Lastly, the identifications and treatment or correction of secondary causes is a corner stone in the treatment of this disease.
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Affiliation(s)
- Clara Viñals
- Servicio Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España
| | - Daniel Zambón
- Servicio Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Gema Yago
- Servicio Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España
| | - Mònica Domenech
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN). Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Emilio Ortega
- Servicio Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN). Instituto de Salud Carlos III (ISCIII), Madrid, España.
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Pérez de Isla L, Alonso R, Gómez de Diego JJ, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, Miramontes JP, Fuentes F, de Andrés R, Werenitzky J, Padró T, Saltijeral A, Mata P. Coronary plaque burden, plaque characterization and their prognostic implications in familial hypercholesterolemia: A computed tomographic angiography study. Atherosclerosis 2020; 317:52-58. [PMID: 33261814 DOI: 10.1016/j.atherosclerosis.2020.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 06/11/2020] [Revised: 10/20/2020] [Accepted: 11/12/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Heterozygous familial hypercholesterolemia (FH) is associated with premature atherosclerotic cardiovascular disease. Semi-automated plaque characterization (SAPC) by coronary computed tomographic angiography (CTA) provides information regarding coronary plaque burden and plaque characterization. Our aim was to quantify and characterize the coronary plaque burden of patients with FH using SAPC analysis and to identify which factors are related to plaque burden and plaque characteristics. A second aim was to analyse the prognostic implications of these parameters. METHODS Two hundred and fifty-nine asymptomatic individuals with molecularly determined FH were enrolled in this follow-up cohort study and underwent a coronary CTA analysed with SAPC. RESULTS Mean follow-up time after coronary CTA was 3.9 ± 2 years. Mean age was 46.9 (10.7) years (130 women, 50.2%). Median plaque burden was 25.0% (19.0-29.0), non-calcified plaque burden 22.83% (17.94-26.88), calcified plaque-burden 1.12% (0.31-2.86) and CCS 8.9 (0-93). Five-year risk was independently related to plaque burden, non-calcified plaque burden, calcified plaque burden and coronary calcium score (B:3.75, 95%CI:2.92-4.58; p < 0.001, B:2.9, 95%CI:2.15-3.66; p < 0.001, B:0.75, 95%CI 0.4-1.1; p < 0.001 and B:82.2, 95%CI:49.28-115.16; p < 0.001 respectively). During follow-up, there were 15 (5.81%) nonfatal events and 1 (0.4%) fatal event. Plaque burden was significantly related to event-free survival during follow-up (HR:1.11; 95%CI:1.05-1.18; p < 0.001). CONCLUSIONS Coronary atherosclerosis and its qualitative components may be quantified by means of SAPC in patients with FH. Plaque burden, calcified plaque burden and non-calcified plaque burden were independently related to the estimated cardiovascular risk. Plaque burden was also related to prognosis.
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Affiliation(s)
- Leopoldo Pérez de Isla
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina Universidad Complutense, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain.
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Center for Advanced Metabolic Medicine and Nutrition, Santiago de Chile, Chile
| | - José Juan Gómez de Diego
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina Universidad Complutense, Madrid, Spain
| | | | | | - Daniel Zambón
- Lipids Clinic. Department of Endocrinology, Hospital Clinic, (IDIBAPS) Institut D'Investigacions Biomèdiques August Pi I Sunyer University of Barcelona, Barcelona, Spain
| | | | - Francisco Fuentes
- Lipids and Atherosclerosis Unit, CIBERObn, IMIBIC/Reina Sofia University Hospital/University of Cordoba, Spain
| | | | - José Werenitzky
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina Universidad Complutense, Madrid, Spain
| | - Teresa Padró
- Programa-ICCC Cardiovascular, Institut de Recerca Del Hospital Santa Creu I Sant Pau, IIB Santa Pau, Barcelona, Spain
| | - Adriana Saltijeral
- Cardiology Department, Hospital Del Tajo, Aranjuez, Universidad Alfonso X El Sabio, Madrid, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain.
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Pérez de Isla L, Arroyo-Olivares R, Alonso R, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, Fuentes F, Mata N, Piedecausa M, Mañas MD, Sánchez Muñoz-Torrero JF, Miramontes-González JP, de Andrés R, Mauri M, Aguado R, Brea Á, Cepeda JM, Vidal-Pardo JI, Martínez-Faedo C, Barba MÁ, Argüeso R, Ruiz-Pérez E, Michán A, Arrieta F, Riestra Fernández M, Pérez L, Pinilla JM, Díaz-Soto G, Pintó X, Padró T, Badimón L, Mata P, Aguado R, Perez-Corral B, Almagro F, Alonso R, Arroyo R, Mata N, Mata P, Isla LPD, Saltijeral A, Arrieta F, Badimón L, Padró T, Barba MÁ, Brea Á, Mosquera D, Casañas M, Carbayo J, Cepeda JM, De Andrés R, Díaz JL, Díaz-Soto G, Diéguez M, Riestra M, Fuentes F, López-Miranda J, Galiana J, Mañas MD, García-Cruces J, Garrido JA, Irigoyen L, Martínez PL, Martínez-Faedo C, Suárez L, Mauri M, Borrallo RM, Mediavilla JD, Jaén F, González P, Michán A, Rubio P, Miramontes P, Morera JL, Muñiz O, González A, Pereyra F, Pérez L, Piedecausa M, Pastor J, Pinilla JM, Pintó X, Romero MJ, Ruiz E, Álvarez MP, Sáenz P, Sánchez JF, Sanz C, Vidal JI, Argüeso R, Zambón D. Incidencia de eventos cardiovasculares y cambios en el riesgo estimado y en el tratamiento de la hipercolesterolemia familiar: registro SAFEHEART. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Pérez de Isla L, Arroyo-Olivares R, Alonso R, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, Fuentes F, Mata N, Piedecausa M, Mañas MD, Sánchez Muñoz-Torrero JF, Miramontes-González JP, de Andrés R, Mauri M, Aguado R, Brea Á, Cepeda JM, Vidal-Pardo JI, Martínez-Faedo C, Barba MÁ, Argüeso R, Ruiz-Pérez E, Michán A, Arrieta F, Riestra Fernández M, Pérez L, Pinilla JM, Díaz-Soto G, Pintó X, Padró T, Badimón L, Mata P. Incidence of cardiovascular events and changes in the estimated risk and treatment of familial hypercholesterolemia: the SAFEHEART registry. Rev Esp Cardiol (Engl Ed) 2020; 73:828-834. [PMID: 32201274 DOI: 10.1016/j.rec.2019.10.028] [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] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/21/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES The SAFEHEART study was designed to analyze the situation of familial heterozygous hypercholesterolemia (FHH) and improve knowledge of this disease in Spain. Our objective was to determine the incidence rate of cardiovascular events, the estimated risk of developing an event and its modification, the use of lipid-lowering treatment, and the achievement of low-density lipoprotein cholesterol targets in patients with FHH. METHODS SAFEHEART is a prospective, open, multicenter, nationwide cohort study, with long-term protocol-based follow-up in a population of individuals with molecularly-characterized FHH. We analyzed patients older than 18 years with complete follow-up. RESULTS We included 2648 patients with FHH. The median follow-up was 6.6 (4.8-9.7) years. The overall incidence rate of cardiovascular events was 1.3 events/100 patient-years. After the follow-up, the 10-year estimated risk of developing a cardiovascular event was reduced from 1.6% to 1.3% (P <.001). In the last follow-up, 20.6% and 22.2% of the patients in primary and secondary prevention achieved low-density lipoprotein cholesterol values <100mg/dL and <70mg/dL, respectively. CONCLUSIONS This study was performed in the largest population of patients with FHH in Spain. We identified the incidence rate of cardiovascular events, the estimated risk of developing a cardiovascular event and its modification, the achievement of low-density lipoprotein cholesterol targets, and the therapeutic management in this population. Although the cardiovascular risk of FHH is high, appropriate treatment reduces the likelihood of an event. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Identifier: NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- Servicio de Cardiología, Hospital Clínico San Carlos, IDISSC, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain.
| | | | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Departamento de Nutrición, Clínica Las Condes, Santiago de Chile, Chile
| | | | | | - Daniel Zambón
- Servicio de Endocrinología, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Francisco Fuentes
- Unidad de Lípidos y Arteriosclerosis, IMIBIC, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Nelva Mata
- Departamento de Epidemiología, Consejería de Sanidad, Madrid, Spain
| | - Mar Piedecausa
- Servicio de Medicina Interna, Hospital de Elche, Elche, Alicante, Spain
| | - M Dolores Mañas
- Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Marta Mauri
- Servicio de Medicina Interna, Hospital de Terrassa, Terrassa, Barcelona, Spain
| | - Rocío Aguado
- Servicio de Endocrinología, Hospital Universitario de León, León, Spain
| | - Ángel Brea
- Servicio de Medicina Interna, Hospital San Pedro, Logroño, Spain
| | - José M Cepeda
- Servicio de Medicina Interna, Hospital Comarcal Vega Baja, Orihuela, Alicante, Spain
| | | | | | - Miguel Ángel Barba
- Servicio de Medicina Interna, Hospital General de Albacete, Albacete, Spain
| | - Rosa Argüeso
- Servicio de Endocrinología, Hospital Lucus Augusti, Lugo, Spain
| | - Enrique Ruiz-Pérez
- Servicio de Endocrinología, Hospital Universitario de Burgos, Burgos, Spain
| | - Alfredo Michán
- Servicio de Medicina Interna, Hospital de Jerez de la Frontera, Cádiz, Spain
| | | | | | - Leire Pérez
- Servicio de Endocrinología, Hospital Universitario de Álava, Vitoria, Spain
| | | | - Gonzalo Díaz-Soto
- Servicio de Endocrinología, Hospital Clínico Universitario, Valladolid, Spain
| | - Xavier Pintó
- Servicio de Medicina Interna, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Padró
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Lina Badimón
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
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9
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Miramontes-González JP, Usategui-Martín R, Pérez de Isla L, Alonso R, Muñiz-Grijalvo O, Díaz-Díaz JL, Zambón D, Jiménez FF, Martín-Vallejo J, Rodríguez Gude AE, Jiménez DL, Padro T, González-Sarmiento R, Mata P. VEGFR2 and OPG genes modify the risk of subclinical coronary atherosclerosis in patients with familial hypercholesterolemia. Atherosclerosis 2019; 285:17-22. [PMID: 30991288 DOI: 10.1016/j.atherosclerosis.2019.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/18/2019] [Accepted: 03/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS Heterozygous familial hypercholesterolemia (FH) is a genetic disorder characterized by high levels of low-density lipoprotein cholesterol (LDL-C). The magnitude of atherosclerotic cardiovascular disease (ASCVD) risk in FH patients is highly variable, and this can result from genetic factors. The aim of our study was to characterize whether polymorphisms in VEGFR2 and OPG genes could influence the expression of ASCVD in FH patients. METHODS We studied 318 FH patients from the SAFEHEART registry, without clinical diagnosis of ASCVD. A coronary tomographic angiography (CTA) was performed to determine and evaluate the presence of coronary stenosis and coronary artery calcium, as measured by coronary calcium score (CCS). Genotyping of OPG rs2073618 and VEGFR2 rs2071559 polymorphisms was performed using TaqMan 5'-exonuclease allelic discrimination assays. RESULTS Homozygous GG genotype and G allele of VEGFR2 rs2071559 polymorphism were associated with decreased risk of developing coronary artery stenosis. In the analysis of OPG rs2073618 and VEGFR2 rs2071559 polymorphisms, according to the presence of coronary artery calcium, we found significant differences in both polymorphisms. Homozygous GG genotype and G allele of VEGFR2 rs2071559 polymorphism were associated with decreased risk of accumulation of coronary artery calcium measured by CCS in CTA. Moreover, being a carrier of the GG genotype and G allele of the OPG rs2073618 polymorphism increased the risk of the presence of coronary artery calcium measured by CCS in CTA. CONCLUSIONS Polymorphisms in VEGFR2 and OPG genes modify the risk of ASCVD in FH patients.
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Affiliation(s)
- José Pablo Miramontes-González
- Unidad de Lípidos, Medicina Interna Hospital Universitario de Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain.
| | - Ricardo Usategui-Martín
- Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Leopoldo Pérez de Isla
- Cardiology Departament, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain; Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Nutrition Departament, Clínica Las Condes, Santiago de Chile, Chile
| | | | | | - Daniel Zambón
- Lipids Clinic, Department of Endocrinology, Hospital Clinic, (IDIBAPS) Institut d'Investigacions Biomèdiques August Pi i Sunyer University of Barcelona, Barcelona, Spain
| | - Francisco Fuentes Jiménez
- Lipids and Atherosclerosis Unit, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Cordoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Martín-Vallejo
- Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Ana Elisa Rodríguez Gude
- Unidad de Lípidos, Medicina Interna Hospital Universitario de Salamanca, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - David León Jiménez
- Medicina Interna, Hospital Universitario Virgen Macarena de Sevilla, Sevilla, Spain
| | - Teresa Padro
- Instituto Catalán Ciencias Cardiovasculares, IIB-Sant Pau, Barcelona, Spain
| | - Rogelio González-Sarmiento
- Instituto de Investigación Biomédica de Salamanca, IBSAL, Spain; Unidad de Medicina Molecular, Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain.
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Pérez de Isla L, Alonso R, Mata N, Fernández-Pérez C, Muñiz O, Díaz-Díaz JL, Saltijeral A, Fuentes-Jiménez F, de Andrés R, Zambón D, Piedecausa M, Cepeda JM, Mauri M, Galiana J, Brea Á, Sanchez Muñoz-Torrero JF, Padró T, Argueso R, Miramontes-González JP, Badimón L, Santos RD, Watts GF, Mata P. Predicting Cardiovascular Events in Familial Hypercholesterolemia: The SAFEHEART Registry (Spanish Familial Hypercholesterolemia Cohort Study). Circulation 2017; 135:2133-2144. [PMID: 28275165 DOI: 10.1161/circulationaha.116.024541] [Citation(s) in RCA: 236] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/24/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although risk factors for atherosclerotic cardiovascular disease (ASCVD) in familial hypercholesterolemia (FH) have been described, models for predicting incident ASCVD have not been reported. Our aim was to use the SAFEHEART registry (Spanish Familial Hypercholesterolemia Cohort Study) to define key risk factors for predicting incident ASCVD in patients with FH. METHODS SAFEHEART is a multicenter, nationwide, long-term prospective cohort study of a molecularly defined population with FH with or without previous ASCVD. Analyses to define risk factors and to build a risk prediction equation were developed, and the risk prediction equation was tested for its ability to discriminate patients who experience incident ASCVD from those who did not over time. RESULTS We recruited 2404 adult patients with FH who were followed up for a mean of 5.5 years (SD, 3.2 years), during which 12 (0.5%) and 122 (5.1%) suffered fatal and nonfatal incident ASCVD, respectively. Age, male sex, history of previous ASCVD, high blood pressure, increased body mass index, active smoking, and low-density lipoprotein cholesterol and lipoprotein(a) levels were independent predictors of incident ASCVD from which a risk equation with a Harrell C index of 0.85 was derived. The bootstrap resampling (100 randomized samples) of the original set for internal validation showed a degree of overoptimism of 0.003. Individual risk was estimated for each person without an established diagnosis of ASCVD before enrollment in the registry by use of the SAFEHEART risk equation, the modified Framingham risk equation, and the American College of Cardiology/American Heart Association ASCVD Pooled Cohort Risk Equations. The Harrell C index for these models was 0.81, 0.78, and 0.8, respectively, and differences between the SAFEHEART risk equation and the other 2 were significant (P=0.023 and P=0.045). CONCLUSIONS The risk of incident ASCVD may be estimated in patients with FH with simple clinical predictors. This finding may improve risk stratification and could be used to guide therapy in patients with FH. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Rodrigo Alonso
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Nelva Mata
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Cristina Fernández-Pérez
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Ovidio Muñiz
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - José Luis Díaz-Díaz
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Adriana Saltijeral
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Francisco Fuentes-Jiménez
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Raimundo de Andrés
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Daniel Zambón
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Mar Piedecausa
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - José María Cepeda
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Marta Mauri
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Jesús Galiana
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Ángel Brea
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Juan Francisco Sanchez Muñoz-Torrero
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Teresa Padró
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Rosa Argueso
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - José Pablo Miramontes-González
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Lina Badimón
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Raúl D Santos
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Gerald F Watts
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.)
| | - Pedro Mata
- From Cardiology Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R. Alonso, N.M., A.S., P.M.); Clínica las Condes, Santiago, Chile (R. Alonso); Department of Epidemiology, Madrid Health Authority, Madrid, Spain (N.M.); Clinical Epidemiology Unit, Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense, Madrid, Spain (C.F.-P.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital Abente y Lago, A Coruña, Spain (J.L.D.-D.); Cardiology Department, Hospital del Tajo, Universidad Alfonso X el Sabio, Madrid, Spain (A.S.); Lipids and Atherosclerosis Unit, Instituto Maimónides de Investigación Biomédica de Córdoba/Reina Sofia University Hospital/University of Cordoba, Cordoba, Spain (F.F.-J.); Department of Internal Medicine, Fundación Jiménez Díaz, IIS, Madrid, Spain (R.d.A.); Department of Endocrinology, Hospital Clinic, Barcelona, Spain (D.Z.); Department of Internal Medicine, Hospital Universitario de Elche, Alicante, Spain (M.P.); Department of Internal Medicine, Hospital de Vega Baja, Orihuela, Alicante, Spain (J.M.C.); Department of Internal Medicine, Hospital de Terrassa, Barcelona, Spain (M.M.); Department of Internal Medicine, Hospital de Ciudad Real, Spain (J.G.); Department of Internal Medicine, Hospital de San Pedro, Logroño, Spain (A.B.); Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain (J.F.S.M.-T.); Instituto Catalán Ciencias Cardiovasculares, Instituto de Investigación Biomédica-Sant Pau, Barcelona, Spain (T.P., L.B.); Department of Endocrinology, Hospital Universitario de Lugo, Spain (R. Argueso); Department of Internal Medicine, Hospital Universitariode Salamanca, Spain (J.P.M.-G.); Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital and Preventive Centre and Cardiology Program, Hospital Israelita Albert Einstein, Brazil (R.D.S.); and Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia (G.F.W.).
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Ramírez R, Pedro-Botet J, García M, Corbella E, Merino J, Zambón D, Corbella X, Pintó X. Erectile dysfunction and cardiovascular risk factors in a Mediterranean diet cohort. Intern Med J 2016; 46:52-6. [PMID: 26482327 DOI: 10.1111/imj.12937] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/06/2015] [Accepted: 10/09/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Erectile dysfunction affects more than 100 million men worldwide, with a wide variability in prevalence. An overall association of cardiovascular risk factors, lifestyle and diet in the context of ED in a Mediterranean population is lacking. AIM To assess ED prevalence and associated factors in a Mediterranean cohort of non-diabetic patients with cardiovascular risk factors. METHODS Observational, cross-sectional study of patients aged over 40 treated at cardiovascular risk units in Catalonia. Anthropometric data, risk factors, lifestyle and diet habits were recorded. ED was assessed using the International Index of Erectile Function. RESULTS Four hundred and forty patients included, 186 (42.3%) with ED (24.8% mild, 6.8% moderate and 10.7% severe). ED presence and severity were associated with age, obesity, waist circumference, hypertension, antihypertensive treatment and ischaemic disease. Patients with ED were more frequently smokers, sedentary and consumed more alcohol. In multivariate analysis, consumption of nuts (> twice a week) (OR 0.41 (95% CI 0.25 to 0.67) and vegetables (≥ once a day) (OR 0.47 (95% CI 0.28-0,77)), were inversely related to ED. Obesity (as BMI ≥ 30 kg/m(2) ) (OR 2.49 (95% CI 1.48-4.17)), ischaemic disease (OR 2.30 (95% CI 1.22 to 4.33), alcohol consumption (alcohol-units a day) (OR 1.14 (95% CI 1.04 to 1.26), and age (year) (OR = 1.07 (95% CI 1.04-1.10) were directly related to ED. CONCLUSION Erectile dysfunction is a common disorder in patients treated in lipid units in Catalonia for cardiovascular risk factors. This condition is associated with age, obesity, ischaemic disease and unhealthy lifestyle habits.
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Pérez de Isla L, Alonso R, Mata N, Saltijeral A, Muñiz O, Rubio-Marin P, Diaz-Diaz JL, Fuentes F, de Andrés R, Zambón D, Galiana J, Piedecausa M, Aguado R, Mosquera D, Vidal JI, Ruiz E, Manjón L, Mauri M, Padró T, Miramontes JP, Mata P. Coronary Heart Disease, Peripheral Arterial Disease, and Stroke in Familial Hypercholesterolaemia. Arterioscler Thromb Vasc Biol 2016; 36:2004-10. [DOI: 10.1161/atvbaha.116.307514] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
Objective—
Heterozygous familial hypercholesterolemia (FH) is the most common premature atherosclerotic cardiovascular disease (ASCVD)–related monogenic disorder, and it is associated with ischemic heart disease. There is limited information whether FH increases the risk of peripheral arterial and cerebrovascular disease. Our aim was to analyze ASCVD prevalence and characteristics in different arterial territories in a large FH population, to compare them with an unaffected control population and to determine which factors are associated to ASCVD.
Approach and Results—
SAFEHEART (Spanish Familial Hypercholesterolaemia Cohort Study) is an ongoing registry of molecularly defined patients with heterozygous FH in Spain. ASCVD in the different arterial territories was analyzed, as well as individual characteristics, genetic variables, and lipid-lowering therapies. The study recruited 4132 subjects (3745 ≥18 years); 2,752 of those enrolled were molecularly diagnosed FH cases. Median age was 44.0 years (45.9% men) and 40 years (46.6% men) in FH patients and unaffected relatives (
P
<0.001). ASCVD was present in 358 (13.0%) and 47 (4.7%) FH patients and unaffected relatives, respectively (
P
<0.001). History of premature ASCVD was more prevalent in FH patients (9.4% and 2.4% in FH patients and unaffected relatives, respectively;
P
<0.001). Coronary artery–related manifestations and peripheral artery disease were more prevalent in FH patients than in controls, but no significant differences were found for cerebrovascular events. Age, body mass index, type 2 diabetes mellitus, high blood pressure, previous use of tobacco, and lipoprotein(a) >50 mg/dL were independently associated with ASCVD.
Conclusions—
The prevalence of ASCVD is higher, and the involvement of the arterial territories is different in FH patients when compared with their unaffected relatives. Age, male sex, increased body mass index, hypertension, type 2 diabetes mellitus, smoking habit, and lipoprotein(a) >50 mg/dL were independently associated to ASCVD.
Clinical Trial Registration—
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02693548.
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Affiliation(s)
- Leopoldo Pérez de Isla
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Rodrigo Alonso
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Nelva Mata
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Adriana Saltijeral
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Ovidio Muñiz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Patricia Rubio-Marin
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José L. Diaz-Diaz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Francisco Fuentes
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Raimundo de Andrés
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Daniel Zambón
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Jesús Galiana
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Mar Piedecausa
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Rocio Aguado
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Daniel Mosquera
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José I Vidal
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Enrique Ruiz
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Laura Manjón
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Marta Mauri
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Teresa Padró
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - José P. Miramontes
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
| | - Pedro Mata
- From the Cardiology Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain (L.P.d.I.); Fundación Hipercolesterolemia Familiar, Madrid, Spain (L.P.d.I., R.A., N.M., A.S., P.M.); Clínica las Condes, Santiago de Chile, Chile (R.A.); Department of Epidemiology, Madrid Health Authority, Spain (N.M.); Cardiology Department, Hospital del Tajo, Aranjuez, Madrid, Spain (A.S.); Department of Internal Medicine, Hospital Virgen del Rocío, Sevilla, Spain (O.M.); Department of Internal Medicine, Hospital
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Alonso R, Mata P, Muñiz O, Fuentes-Jimenez F, Díaz JL, Zambón D, Tomás M, Martin C, Moyon T, Croyal M, Thedrez A, Lambert G. PCSK9 and lipoprotein (a) levels are two predictors of coronary artery calcification in asymptomatic patients with familial hypercholesterolemia. Atherosclerosis 2016; 254:249-253. [PMID: 27594539 DOI: 10.1016/j.atherosclerosis.2016.08.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/14/2016] [Accepted: 08/25/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS We aimed to assess whether elevated PCSK9 and lipoprotein (a) [Lp(a)] levels associate with coronary artery calcification (CAC), a good marker of atherosclerosis burden, in asymptomatic familial hypercholesterolemia. METHODS We selected 161 molecularly defined FH patients treated with stable doses of statins for more than a year. CAC was measured using the Agatston method and quantified as categorical variable. Fasting plasma samples were collected and analyzed for lipids and lipoproteins. PCSK9 was measured by ELISA, Lp(a) and apolipoprotein (a) concentrations by inmunoturbidimetry and LC-MS/MS, respectively. RESULTS Circulating PCSK9 levels were significantly reduced in patients without CAC (n = 63), compared to those with CAC (n = 99). Patients with the highest CAC scores (above 100) had the highest levels of circulating PCSK9 and Lp(a). In multivariable regression analyses, the main predictors for a positive CAC score was age and sex followed by circulating PCSK9 and Lp(a) levels. CONCLUSIONS In statin treated asymptomatic FH patients, elevated PCSK9 and Lp(a) levels are independently associated with the presence and severity of CAC, a good predictor of coronary artery disease.
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Affiliation(s)
- Rodrigo Alonso
- Spanish Familial Hypercholesterolemia Foundation, Madrid, Spain; Department of Nutrition, Clínica Las Condes, Santiago, Chile
| | - Pedro Mata
- Spanish Familial Hypercholesterolemia Foundation, Madrid, Spain
| | - Ovidio Muñiz
- Internal Medicine Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Francisco Fuentes-Jimenez
- IMIBIC Hospital Universitario Reina Sofia, Universidad de Cordoba, Cordoba, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion, Instituto de Salud Carlos III, Cordoba, Spain
| | - Jose Luis Díaz
- Internal Medicine Department, Hospital Avente y Lago, A Coruña, Spain
| | - Daniel Zambón
- Lipid Clinic Endocrinology Service Clinic Hospital, Barcelona, Spain
| | - Marta Tomás
- Department of Radiology, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Cesar Martin
- Unidad de Biofísica (CSIC, UPV/EHU) and Departamento de Bioquimica y Biologia Molecular, Universidad del Pais Vasco, Bilbao, Spain
| | - Thomas Moyon
- Inra UMR 1280, Université de Nantes, Faculté de Médecine, Nantes, France
| | - Mikaël Croyal
- Inra UMR 1280, Université de Nantes, Faculté de Médecine, Nantes, France
| | - Aurélie Thedrez
- Inra UMR 1280, Université de Nantes, Faculté de Médecine, Nantes, France
| | - Gilles Lambert
- Inra UMR 1280, Université de Nantes, Faculté de Médecine, Nantes, France; Inserm UMR 1188, Sainte Clotilde, France; Université de la Réunion, Faculté de Médecine, Saint-Denis, France; CHU de la Réunion, Saint-Denis, France.
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Perez de Isla L, Alonso R, Watts GF, Mata N, Saltijeral Cerezo A, Muñiz O, Fuentes F, Diaz-Diaz JL, de Andrés R, Zambón D, Rubio-Marin P, Barba-Romero MA, Saenz P, Sanchez Muñoz-Torrero JF, Martinez-Faedo C, Miramontes-Gonzalez JP, Badimón L, Mata P, Aguado R, Almagro F, Arrieta F, Barba MÁ, Brea Á, Cepeda JM, De Andrés R, Díaz G, Díaz JL, Fuentes F, Galiana J, Garrido JA, Irigoyen L, Manjón L, Martin A, Piedecausa M, Martínez-Faedo C, Mauri M, Miramontes P, Muñiz O, Pereyra F, Pérez L, Pintó X, Pujante P, Ruiz E, Sáenz P, Sánchez JF, Vidal JI, Argüeso R, Zambón D. Attainment of LDL-Cholesterol Treatment Goals in Patients With Familial Hypercholesterolemia. J Am Coll Cardiol 2016; 67:1278-85. [DOI: 10.1016/j.jacc.2016.01.008] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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Alonso R, Mata P, Zambón D, Mata N, Fuentes-Jiménez F. Early diagnosis and treatment of familial hypercholesterolemia: improving patient outcomes. Expert Rev Cardiovasc Ther 2014; 11:327-42. [DOI: 10.1586/erc.13.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mansilla E, Díaz Aquino V, Zambón D, Marin GH, Mártire K, Roque G, Ichim T, Riordan NH, Patel A, Sturla F, Larsen G, Spretz R, Núñez L, Soratti C, Ibar R, van Leeuwen M, Tau JM, Drago H, Maceira A. Could metabolic syndrome, lipodystrophy, and aging be mesenchymal stem cell exhaustion syndromes? Stem Cells Int 2011; 2011:943216. [PMID: 21716667 PMCID: PMC3118295 DOI: 10.4061/2011/943216] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 03/22/2011] [Indexed: 12/15/2022] Open
Abstract
One of the most
important and complex diseases of modern society
is metabolic syndrome. This syndrome has not
been completely understood, and therefore an
effective treatment is not available yet. We
propose a possible stem cell mechanism involved
in the development of metabolic syndrome. This
way of thinking lets us consider also other
significant pathologies that could have similar
etiopathogenic pathways, like lipodystrophic
syndromes, progeria, and aging. All these
clinical situations could be the consequence of
a progressive and persistent stem cell
exhaustion syndrome (SCES). The main outcome of
this SCES would be an irreversible loss of the
effective regenerative mesenchymal stem cells
(MSCs) pools. In this way, the normal repairing
capacities of the organism could become
inefficient. Our point of view could open the
possibility for a new strategy of treatment in
metabolic syndrome, lipodystrophic syndromes,
progeria, and even aging: stem cell
therapies.
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Affiliation(s)
- Eduardo Mansilla
- Tissue Engineering, Regenerative Medicine and Cell Therapies Laboratory, CUCAIBA, Ministry of Health, Province of Buenos Aires, 1900 La Plata, Argentina
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De Castro Orós I, García Otín Á, Pueyo M, Mozas P, Gómez L, Fabiani F, Álvarez-Sala L, Ros E, Zambón D, Dalmau J, Civeira F, Pocoví M. MS530 NEW LPL AND APOA5 GEN MUTATIONS IDENTIFIED IN SUBJECTS WITH SEVERE HYPERTRIGLYCERIDEMIA. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)71030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Zambón D, Quintana M, Mata P, Alonso R, Benavent J, Cruz-Sánchez F, Gich J, Pocoví M, Civeira F, Capurro S, Bachman D, Sambamurti K, Nicholas J, Pappolla MA. Higher incidence of mild cognitive impairment in familial hypercholesterolemia. Am J Med 2010; 123:267-74. [PMID: 20193836 PMCID: PMC2844655 DOI: 10.1016/j.amjmed.2009.08.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [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: 11/20/2008] [Revised: 08/06/2009] [Accepted: 08/29/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Hypercholesterolemia is an early risk factor for Alzheimer's disease. Low-density lipoprotein (LDL) receptors might be involved in this disorder. Our objective was to determine the risk of mild cognitive impairment in a population of patients with heterozygous familial hypercholesterolemia, a condition involving LDL receptor dysfunction and lifelong hypercholesterolemia. METHODS By using a cohort study design, patients with familial hypercholesterolemia (N=47) meeting inclusion criteria and comparison patients without familial hypercholesterolemia (N=70) were consecutively selected from academic specialty and primary care clinics, respectively. All patients were older than 50 years. Those with disorders that could affect cognition, including history of stroke or transient ischemic attacks, were excluded from both groups. Thirteen standardized neuropsychologic tests were performed in all subjects. Mutational analysis was performed in patients with familial hypercholesterolemia, and brain imaging was obtained in those with familial hypercholesterolemia and mild cognitive impairment. RESULTS Patients with familial hypercholesterolemia showed a high incidence of mild cognitive impairment compared with those without familial hypercholesterolemia (21.3% vs 2.9%; P=.00). This diagnosis was unrelated to structural pathology or white matter disease. There were significant differences, independent of apolipoprotein E4 or E2 status, between those with familial hypercholesterolemia and those with no familial hypercholesterolemia in several cognitive measures, all in the direction of worse performance for those with familial hypercholesterolemia. CONCLUSION Because prior studies have shown that older patients with sporadic hypercholesterolemia do not show a higher incidence of mild cognitive impairment, the findings presented suggest that early exposure to elevated cholesterol or LDL receptor dysfunction may be risk factors for mild cognitive impairment.
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Affiliation(s)
- Daniel Zambón
- Institut d'Investigacions Biomédiques August Pi Sunyer, Hospital Clinic, Barcelona, Spain
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Junyent M, Gilabert R, Jarauta E, Núñez I, Cofán M, Civeira F, Pocoví M, Mallén M, Zambón D, Almagro F, Vega J, Tejedor D, Ros E. Impact of low-density lipoprotein receptor mutational class on carotid atherosclerosis in patients with familial hypercholesterolemia. Atherosclerosis 2010; 208:437-41. [DOI: 10.1016/j.atherosclerosis.2009.07.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 07/23/2009] [Accepted: 07/31/2009] [Indexed: 11/25/2022]
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Sala-Vila A, Cofán M, Junyent M, Zambón D, García-Otín Á, Cenarro A, Civeira F, Ros E. Abstract: P462 THE CONTENT OF MARINE N-3 FATTY ACIDS IN SERUM PHOSPHATIDYLCHOLINE IS INVERSELY ASSOCIATED WITH SMALL AND VERY SMALL LDL PARTICLE CONCENTRATION INDEPENDENTLY OF TRIGLYCERIDES IN PATIENTS WITH A MOLECULAR DIAGNOSIS OF FAMILIAL HYPERCHOLESTEROLEMIA. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Llaverias G, Pou J, Ros E, Zambón D, Cofán M, Sánchez A, Vázquez-Carrera M, Sánchez RM, Laguna JC, Alegret M. Monocyte gene-expression profile in men with familial combined hyperlipidemia and its modification by atorvastatin treatment. Pharmacogenomics 2009; 9:1035-54. [PMID: 18681780 DOI: 10.2217/14622416.9.8.1035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The genetic origin of familial combined hyperlipidemia (FCH) is not well understood. We used microarray profiling of peripheral blood monocytes to search novel genes and pathways involved in FCH. METHODS Fasting plasma for determination of lipid profiles, inflammatory molecules and adipokines was obtained and peripheral blood monocytes were isolated from male FCH patients basally and after 4 weeks of atorvastatin treatment. Sex-, age- and adiposity-matched controls were also studied. Gene-expression profiles were analyzed using Affymetrix Human Genome U133A 2.0 GeneChip arrays. RESULTS Analysis of gene expression by cDNA microarrays showed that 82 genes were differentially expressed in FCH monocytes compared with controls. Atorvastatin treatment modified the expression of 86 genes. Pathway analysis revealed the over-representation of the complement and coagulation cascades, the hematopoietic cell lineage and the arachidonic acid metabolism pathways. Changes in the expression of some genes, confirmed by real-time RT-PCR, (CD36, leucine-rich repeats and immunoglobulin-like domains-1, tissue factor pathway inhibitor 2, myeloid cell nuclear differentiation antigen, tumor necrosis factor receptor superfamily, member 25, CD96 and lipoprotein lipase), may be related to a proinflammatory environment in FCH monocytes, which is partially reversed by atorvastatin. Higher plasma levels of triglycerides and free fatty acids and lower levels of adiponectin in FCH patients could also trigger changes in gene expression that atorvastatin cannot modify. CONCLUSION Our results show clear differences in gene expression in FCH monocytes compared with those of matched healthy controls, some of which are influenced by atorvastatin treatment.
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Affiliation(s)
- Gemma Llaverias
- Pharmacology Department, Faculty of Pharmacy and Biomedicine Institute (IBUB), University of Barcelona and Ciber Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Instituto de Salud Carlos III, Diagonal 643. E-08028, Spain
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22
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Junyent M, Gilabert R, Núñez I, Corbella E, Cofán M, Zambón D, Ros E. Ecografía femoral en la evaluación de la aterosclerosis preclínica. Distribución de valores del grosor íntima-media y frecuencia de placas de ateroma en una cohorte comunitaria española. Med Clin (Barc) 2008; 131:566-71. [DOI: 10.1157/13128017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Junyent M, Zambón D, Gilabert R, Cofán M, Núñez I, Ros E. Carotid atherosclerosis in familial combined hyperlipidemia associated with the APOB/APOA-I ratio. Atherosclerosis 2008; 197:740-6. [PMID: 17698072 DOI: 10.1016/j.atherosclerosis.2007.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 06/29/2007] [Accepted: 07/11/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The effects of risk factors on carotid atherosclerosis in familial combined hyperlipidemia (FCHL) remain unclear. We assessed carotid intima-media thickness (IMT) and plaque in relation to classical risk factors and apolipoprotein A-I (apoA-I) and B (apoB) levels in patients with FCHL. METHODS AND RESULTS We included 131 unrelated FCHL patients (27 with prior cardiovascular disease (CVD)) diagnosed by standard criteria and 190 age- and sex-matched control subjects. Cardiovascular risk factors were assessed and IMT in the far wall of all carotid segments and plaque burden were determined in FCHL patients and controls. All carotid measurements were increased in FCHL patients compared to controls (P<0.001), irrespective of CVD status. For asymptomatic FCHL, the adjusted difference in mean common carotid IMT was 0.08 mm, corresponding to approximately 16 years of physiological IMT increase. By multivariate analysis in a model with all risk factors, inclusive of the metabolic syndrome, independent associations of IMT were age, the apoB/apoA-I ratio, systolic blood pressure, fasting glucose, family history of CVD and total/HDL cholesterol ratio (r(2)=0.475, P<0.001). The strongest determinant of IMT was the apoB/apoA-I ratio (beta=0.422, P<0.001). CONCLUSIONS Patients with FCHL have increased carotid IMT that is strongly related to the apoB/apoA-I ratio, a measure of overall lipid abnormalities. The findings support the atherogenicity of the lipid phenotype in FCHL beyond associated risk factors. They also have implications for diagnosis and management of CVD risk in this condition.
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Affiliation(s)
- Mireia Junyent
- Unitat de Lípids, Servei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain.
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24
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Junyent M, Zambón D, Gilabert R, Núñez I, Cofán M, Ros E. Carotid atherosclerosis and vascular age in the assessment of coronary heart disease risk beyond the Framingham Risk Score. Atherosclerosis 2008; 196:803-9. [PMID: 17320091 DOI: 10.1016/j.atherosclerosis.2007.01.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 12/28/2006] [Accepted: 01/17/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess how ultrasound measurements of carotid intima-media thickness (CIMT) and plaque burden compare with the Framingham Risk Score (FRS) in a clinical setting. METHODS AND RESULTS In a cross-sectional study, we determined CIMT and plaque in 409 asymptomatic, non-diabetic hyperlipidemic subjects (242 men, age 49+/-11 years) who were assessed for risk factors and classified into FRS categories: 10-year risk < or =5% (n=191), 6-20% (n=176), and >20% (n=42). Percentiles of CIMT and plaque height and regression equations of CIMT against age obtained in 250 controls subjects were used to define atherosclerosis and estimate vascular age, respectively. There was a wide dispersion of CIMT for each FRS category. CIMT values were discordant in 242 (59%) subjects, 80% of them showing more atherosclerosis than predicted. Smoking and the metabolic syndrome explained part of the discrepancies in the intermediate-risk group. Triglycerides, homocysteine, and lipoprotein(a) did not predict atherosclerotic burden. Mean vascular age was 14.5 years older than chronological age. CONCLUSIONS Carotid atherosclerosis findings readjust FRS categories in many asymptomatic subjects. Both carotid atherosclerotic burden and vascular age may be used to refine CHD risk and tailor preventive treatment beyond the FRS.
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Affiliation(s)
- Mireia Junyent
- Unitat de Lípids, Servei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
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25
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Junyent M, Gilabert R, Zambón D, Pocoví M, Mallén M, Cofán M, Núñez I, Civeira F, Tejedor D, Ros E. Femoral atherosclerosis in heterozygous familial hypercholesterolemia: influence of the genetic defect. Arterioscler Thromb Vasc Biol 2007; 28:580-6. [PMID: 18096825 DOI: 10.1161/atvbaha.107.153841] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to assess femoral atherosclerosis by ultrasound in patients with molecularly defined heterozygous familial hypercholesterolemia (FH) in comparison with matched control subjects and in relation to mutational class in the LDL receptor and apolipoprotein B (APOB) genes. METHODS AND RESULTS Femoral intima-media thickness (IMT) and plaque were evaluated in 146 FH patients carrying null alleles (n=48), defective-receptor alleles (n=62), undetermined-function alleles (n=25), or APOB defects (n=11) and in 193 healthy subjects. Twenty-three patients had coronary heart disease (CHD). The frequency of both tendon xanthomas and CHD was approximately 2-fold higher and average LDL cholesterol was 30 mg/dL higher in null-allele genotype compared with receptor-defective mutations. All femoral measurements were increased in FH patients versus controls (P<0.001), and null-allele mutations showed higher age-, sex-, and LDL cholesterol-adjusted maximum IMT than receptor-defective or APOB defects (P for trend, 0.001). By multivariate analysis, independent associations of mean IMT, a measure of early atherosclerosis, were age, LDL cholesterol, sex, and systolic blood pressure. Age, null-allele genotype, sex, and smoking explained 42% of the variability of maximum IMT, a measure of advanced atherosclerosis. CONCLUSIONS FH patients have increased femoral IMT in relation to mutational class. The findings support the usefulness of genetic testing in FH beyond securing the diagnosis.
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Affiliation(s)
- Mireia Junyent
- Unitat de Lípids, Servei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain
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26
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Meriño-Ibarra E, Puzo J, Jarauta E, Cenarro A, Recalde D, García-Otín AL, Ros E, Martorell E, Pintó X, Franco M, Zambón D, Brea A, Pocoví M, Civeira F. Hyperlipoproteinaemia(a) is a common cause of autosomal dominant hypercholesterolaemia. J Inherit Metab Dis 2007; 30:970-7. [PMID: 17955342 DOI: 10.1007/s10545-007-0585-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 05/03/2007] [Accepted: 07/17/2007] [Indexed: 11/25/2022]
Abstract
UNLABELLED Autosomal dominant hypercholesterolaemia (ADH) are a heterogeneous group of monogenic lipid disorders. The plasma level of lipoprotein(a) (Lp(a)) is a heritable trait associated with increased coronary heart disease (CHD) risk. OBJECTIVE To evaluate the frequency of elevated Lp(a) as a cause of ADH and the characteristics of subjects with high Lp(a) (hyperLp(a)). MATERIAL AND METHODS 200 healthy subjects and 933 unrelated Spanish subjects with a clinical diagnosis of ADH who were screened for low-density lipoprotein receptor (LDLR) and apolipoprotein B (APOB) gene mutations. Standard cardiovascular risk factors and blood lipid levels, including Lp(a), were evaluated. HyperLp(a) was defined as Lp(a) levels >or=95th centile of control values. RESULTS Lp(a) was higher in 263 subjects without LDLR or APOB mutations (nonLDLR/nonAPOB group) than in 670 subjects with mutations (FH group): 40.0 mg/dl (interquartile range (IR) 15.0-89.0) versus 31.0 mg/dl (IR 11.0-73.7) respectively, p = 0.002. HyperLp(a) was present in 23% of ADH subjects (odds ratio (OR) 5.6 (95% CI, 2.9 to 10.7) versus controls) and 29% of nonLDLR/nonAPOB subjects (OR 7.7; 3.9 to 15.4). After adjusting for Lp(a), LDL cholesterol levels were <95th centile in 28 (10.6%) nonLDLR/nonAPOB subjects and in 9 (1.3%) FH subjects. Lp(a) levels were nonsignificantly higher in ADH subjects with early-onset CHD than in those without (43.5 mg/dl, (IR, 12.0-82.0) versus 31.7 mg/dl (11.8-76.5), respectively). CONCLUSIONS HyperLp(a) is responsible for ADH in approximately 6% of nonLDLR/nonAPOB subjects. HyperLp(a) would not appear to be a risk factor for early-onset CHD in ADH, independently of whether genetic defects have or have not been demonstrated.
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Affiliation(s)
- E Meriño-Ibarra
- Lipid Unit and Molecular Research Laboratory, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud, Avda Isabel La Católica 1-3, 50009, Zaragoza, Spain
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Cofan F, Arias M, Nuñez I, Cofan M, Corbella E, Rosich E, Zambón D, Ros E, Gilabert R, Oppenheimer F, Campistol JM. Impact of Carotid Atherosclerosis as Assessed by B-Mode Ultrasonography on the Evolution of Kidney Transplantation. Transplant Proc 2007; 39:2236-8. [PMID: 17889149 DOI: 10.1016/j.transproceed.2007.06.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
UNLABELLED Carotid arteriosclerosis is a marker of cardiovascular risk in the general population. Cardiovascular disease is highly prevalent in kidney transplant recipients. This study analyzed the impact of arteriosclerotic carotid lesions on the evolution of renal transplant recipients. METHODS This prospective study was performed in 70 patients with renal transplantations (mean age 52 +/- 12 years; 67% men (n = 47). High-resolution B-mode ultrasonography (7.5 MHz) of both carotid arteries was performed at baseline to assess carotid caliber, mean and maximum intima-media thickness (IMT), presence of arteriosclerotic plaques (number and maximum height), and percentage stenosis. We analyzed the impact of carotid arteriosclerosis and various donor-recipient clinical covariables on long-term patient and graft survival. RESULTS Mean follow-up was 9.7 +/- 2.5 years (2-14). Atheroma plaques were detected in 74% of patients (n = 52). The mean number of plaques was 3.96 +/- 2.88 and maximum plaque height was 2.49 +/- 0.97 mm. IMT was 0.71 +/- 0.21 mm (0.4-1.5) with 27% of patients (n = 19) having an IMT value greater than 0.8 mm. Sonographic signs of occlusion were evident in 13% (n = 9) and the mean occlusion was 33 +/- 11% (range 20%-45%). The presence of plaques was significantly associated with age (P = .002), hypertension and diabetes (P = .016), and hypercholesterolemia (P = .01). There was an association between age and arterial wall thickness (P = .042). Acute rejection was an independent risk factor for graft loss (OR 8.14, P = .003). The multivariate study identified carotid wall thickness as an independent risk factor for patient death (OR 12.7, P = .017). CONCLUSION Carotid arteriosclerosis is highly prevalent among renal transplant recipients. Carotid lesions were an independent risk factor for long-term patient death. High-resolution ultrasound imaging of the carotid arteries was a useful, noninvasive diagnostic technique for accurate assessment of cardiovascular risk in renal transplant recipients.
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Affiliation(s)
- F Cofan
- Renal Transplant Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Junyent M, Cofán M, Núñez I, Gilabert R, Zambón D, Ros E. Influence of HDL cholesterol on preclinical carotid atherosclerosis in familial hypercholesterolemia. Arterioscler Thromb Vasc Biol 2006; 26:1107-13. [PMID: 16556855 DOI: 10.1161/01.atv.0000218507.95149.42] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The effect of risk factors on carotid atherosclerosis in heterozygous familial hypercholesterolemia (FH) is unclear. We evaluated carotid intima-media thickness (IMT) by sonography in relation to classical and emergent risk factors in a large FH cohort. METHODS AND RESULTS Risk factors and carotid IMT were assessed in 196 asymptomatic subjects aged > or =25 years fulfilling strict diagnostic criteria for clinical FH who were either undertreated or treatment-naive. Conventional risk factors, but not lipoprotein(a), homocysteine, or apolipoprotein E (apoE) genotypes were univariately related to IMT. Age-adjusted and gender-adjusted IMT increased with increasing low-density lipoprotein (LDL) cholesterol and decreased with increasing high-density lipoprotein (HDL) cholesterol. Compared with a total cholesterol/HDL ratio >5.0, a ratio < or =5.0 was associated with a lower adjusted IMT, with a mean difference of -0. 09 mm (95% confidence interval, -0.13 to -0.04). By multivariate analysis, age, HDL cholesterol (negatively), physical exercise, family history of early-onset coronary heart disease, LDL cholesterol, and leukocyte count, in this order, were independent associations of IMT (r2=0.429, P<0.001). CONCLUSIONS Traditional risk factors account for a sizeable proportion of variation in carotid IMT in FH. Because the HDL cholesterol level and the total cholesterol/HDL ratio are strong predictors of preclinical carotid atherosclerosis, HDL cholesterol-raising strategies should have an important therapeutic role in FH.
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Affiliation(s)
- Mireia Junyent
- Servei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain
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Junyent M, Gilabert R, Núñez I, Corbella E, Vela M, Zambón D, Ros E. [Carotid ultrasound in the assessment of preclinical atherosclerosis. Distribution of intima-media thickness values and plaque frequency in a Spanish community cohort]. Med Clin (Barc) 2006; 125:770-4. [PMID: 16373026 DOI: 10.1016/s0025-7753(05)72186-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE High-resolution B-mode ultrasound measurements of carotid intima-media thickness (IMT) and determination of plaque presence are useful to assess preclinical atherosclerosis. Normal IMT values have not been reported in Spanish subjects. Our aim was to define normality data of carotid ultrasound by sex and age. SUBJECTS AND METHODS We studied 250 healthy, normolipidemic subjects, 125 men and 125 women, with mean age 49 years (range, 20-81). We assessed cardiovascular risk factors and performed ultrasound determination of mean and maximum IMT in the far wall of the common carotid artery, plaque occurrence, and maximum plaque height. RESULTS Reference values for carotid IMT, expressed as 25th, 50th, and 75th percentiles by sex and 5 age groups, have been obtained. The 50th percentiles of mean IMT ranged from 0.50 to 0.74 mm in men in the age groups 35 years or younger and 65 years or older, respectively. For women, corresponding IMT values ranged from 0.40 to 0.65 mm. IMT was strongly related (p < 0.001) to age, both in men (r = 0.57) and women (r = 0.61). From the regression equations, the estimated yearly increase in IMT was 0.005 mm in men and 0.007 mm in women. More than 50% of men aged 55 years and older, and of women aged 65 years and older, had carotid plaques. CONCLUSIONS Both IMT and plaque frequency were associated with age in men and women. Carotid IMT values in a Spanish community cohort were lower than those reported for countries with higher cardiovascular risk, such as Northern European countries and the US.
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Affiliation(s)
- Mireia Junyent
- Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, España
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Junyent M, Cofán M, Núñez I, Gilabert R, Zambón D, Ros E. Tu-P9:349 Influence of the HDL cholesterol level on preclinical carotid atherosclerosis in familial hypercholesterolemia. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Junyent M, Gilabert R, Núñez I, Corbella E, Zambón D, Ros E. Tu-P9:350 Effect of carotid intima-media thickness measurements on framingham risk stratification in patients with primary dyslipidemia. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Junyent M, Gilabert R, Zambón D, Núñez I, Vela M, Civeira F, Pocoví M, Ros E. The use of Achilles tendon sonography to distinguish familial hypercholesterolemia from other genetic dyslipidemias. Arterioscler Thromb Vasc Biol 2005; 25:2203-8. [PMID: 16123315 DOI: 10.1161/01.atv.0000183888.48105.d1] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Achilles tendon (AT) xanthomas, specific for familial hypercholesterolemia (FH), may be clinically undetectable. We assessed the usefulness of AT sonography in the diagnosis of FH. METHODS AND RESULTS Sonographic AT characteristics were evaluated in 127 subjects with FH (81 genetically ascertained), 84 familial combined hyperlipidemia, 79 polygenic hypercholesterolemia, and 88 normolipidemic controls. Abnormal echostructure (sonographic xanthoma) was noted only in FH. AT thickness was higher (P<0.001) in FH men and women compared with all of the other groups and, in FH mutation carriers but not in others, correlated positively with low-density lipoprotein cholesterol (r=0.345; P<0.001) and negatively with high-density lipoprotein cholesterol (r=-0.265, P=0.015). Thickness thresholds for the diagnosis of FH with specificity >80%, as were derived from receiver operating curves, were 5.3 and 5.7 mm in men < and >45 years, and 4.8 and 4.9 mm in women < and >50 years, respectively. In FH mutation carriers, sonographic findings increased the clinical diagnosis of xanthomas from 35 (43%) to 55 (68%). Using thresholds in validation sets of 70 genetically identified FH and 54 dyslipidemic non-FH correctly classified 80% and 88%, respectively. CONCLUSIONS Sonographic AT characteristics are normal in non-FH dyslipidemias. Identification of suspected FH by ultrasound using sex- and age-specific AT thickness thresholds is recommended.
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Affiliation(s)
- Mireia Junyent
- Unitat de Lípids, Servei d'Endocrinologia i Nutrició, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain
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Junyent M, Gilabert R, Núnez I, Vela M, Zambón D, Ros E. T07-P-005 Achilles tendon sonography in control subjects, familial hypercholesterolemia with and without molecular diagnosis and other genetic hyperlipidemias. ATHEROSCLEROSIS SUPP 2005. [DOI: 10.1016/s1567-5688(05)80671-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jiménez S, García-Criado MA, Tàssies D, Reverter JC, Cervera R, Gilabert MR, Zambón D, Ros E, Bru C, Font J. Preclinical vascular disease in systemic lupus erythematosus and primary antiphospholipid syndrome. Rheumatology (Oxford) 2005; 44:756-61. [PMID: 15757967 DOI: 10.1093/rheumatology/keh581] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To determine the prevalence of preclinical vascular disease and associated risk factors in patients with systemic lupus erythematosus (SLE) or primary antiphospholipid syndrome (APS). METHODS We consecutively studied 70 SLE patients and 25 primary APS patients without clinical coronary artery disease. The control group included 40 healthy women. Carotid ultrasound was performed and the intima-media wall thickness (IMT) and presence of plaque was investigated in all patients and controls. Traditional vascular risk factors and SLE-disease and treatment related factors were also analysed. RESULTS SLE patients had a higher prevalence of traditional atherosclerosis risk factors: hypertension (P<0.005) and dyslipidaemia (P<0.05) and higher levels of total cholesterol (P = 0.03), triglycerides (P = 0.004) and apolipoprotein B (P = 0.04). The prevalence of carotid plaque was higher and appeared earlier in SLE patients than in the primary APS patients or controls (P<0.001). The IMT was similar in the three groups. SLE patients with secondary APS had a higher prevalence of carotid plaque than patients with primary APS (37.5% vs 8%, P = 0.03). The presence of plaque in SLE patients was associated with a higher SLICC score (2.40 +/- 1.78 vs 1.02 +/- 1.18, P = 0.002), higher ECLAM score (3.10 +/- 2.32 vs 1.84 +/- 1.59, P = 0.02) and older age (47.3 +/- 8.44 vs 37.38 +/- 11.28, P = 0.003) at the time of carotid ultrasound study. CONCLUSION Plaque prevalence in patients with primary APS is similar to that of controls and inferior to that of SLE patients with secondary APS. SLE patients have a high prevalence of early carotid atherosclerosis that is associated with cumulative disease damage and disease activity.
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Affiliation(s)
- Sònia Jiménez
- Servicio de Enfermedades Autoinmunes, ICMiD, Hospital Clínic, C/Villaroel 170, 08036 Barcelona, Spain
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Navarro S, Cubiella J, Feu F, Zambón D, Fernández-Cruz L, Ros E. [Hypertriglyceridemic acute pancreatitis. Is its clinical course different from lithiasic acute pancreatitis?]. Med Clin (Barc) 2005; 123:567-70. [PMID: 15535937 DOI: 10.1016/s0025-7753(04)74599-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Although hypertriglyceridemia is an accepted cause of acute pancreatitis, its clinical course is not well defined. What is more, lipemic serum may interfere with an accurate pancreatic enzyme measurement and may hinder the diagnosis of acute pancreatitis. The objective was to analyze the clinical performance of hypertriglyceridemic acute pancreatitis and the diagnosis value of the serum measurement of pancreatic enzymes. PATIENTS AND METHOD 31 demographic, clinical, analytical and radiological data of 19 hypertriglyceridemic acute pancreatitis were retrospectively analyzed and their results were compared with data of 19 lithiasic acute pancreatitis without hypertriglyceridemia. Diagnosis of acute pancreatitis was based on clinical, radiological and/or laparotomical findings. Serum levels of triglycerides higher than 1,000 mg/dl were considered the cause of acute pancreatitis when other causes were excluded. Acute pancreatitis was considered lithiasic when gallstones were identified by ultrasonography, serum levels of triglycerides were lower than 200 mg/dl and there was no history of alcohol consumption. RESULTS Compared with lithiasic acute pancreatitis, hypertriglyceridemic acute pancreatitis showed more personal and family hypertriglyceridemia (9 vs 0), more previous episodes of pancreatitis (13 vs 2), pancreatitis was more severe (13 vs 5) and had more complications (29 vs 5). There was no mortality in either group. The serum levels of amylase and lipase supported the diagnosis in 26% and 58% of patients with hypertriglyceridemic acute pancreatitis compared with 58% and 79% of patients with lithiasic acute pancreatitis, respectively. Hospital stay was longer in hypertriglyceridemic than in lithiasic acute pancreatitis (24 [45] vs 7.6 [3.1] days; p = NS). Demographic and analytical factors which could permit to predict the severity of acute pancreatitis could not be identified. CONCLUSIONS Hypertriglyceridemic acute pancreatitis is relapsing and its clinical course is more severe than lithiasic acute pancreatitis. The measurement of amylase and lipase levels is less useful in the diagnosis of hypertriglyceridemic than in lithiasic acute pancreatitis.
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Affiliation(s)
- Salvador Navarro
- Servicio de Gastroenterología, Institut de Malalties Digestives, Hospital Clínic de Barcelona, Barcelona, Spain.
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Roglans N, Vázquez-Carrera M, Alegret M, Novell F, Zambón D, Ros E, Laguna JC, Sánchez RM. Fibrates modify the expression of key factors involved in bile-acid synthesis and biliary-lipid secretion in gallstone patients. Eur J Clin Pharmacol 2003; 59:855-61. [PMID: 14685799 DOI: 10.1007/s00228-003-0704-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Accepted: 11/07/2003] [Indexed: 11/28/2022]
Abstract
AIMS Fibrate treatment induces adverse changes in biliary-lipid and bile-acid composition. Since the molecular mechanisms underlying these changes are still unclear, we have investigated the effect of fibrate treatment on key factors involved in bile-acid synthesis, biliary-lipid secretion and cholesterol metabolism in gallstone patients. METHODS Patients with uncomplicated gallstones and a serum level of low-density lipoprotein (LDL) cholesterol >130 mg/dl were randomly assigned to open-label treatment with bezafibrate, fenofibrate, gemfibrozil, or placebo for 8 weeks before elective cholecystectomy. A liver specimen was obtained at operation, and the mRNA relative levels for cholesterol 7alpha-hydroxylase (CYP7A1), hepatocyte nuclear factor-4 (HNF-4), ATP-binding cassette transporters MDR3, ABCG5, and ABCG8, human homologue scavenger receptor BI, sterol response element binding protein-2 (SREBP-2), 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase and LDL receptor were determined by means of reverse-transcriptase polymerase chain reaction. RESULTS Bezafibrate, fenofibrate and gemfibrozil significantly reduced CYP7A1 mRNA levels. The three fibrates tested raised the mRNA levels of ABCG5 and SREBP-2, but only bezafibrate induced significant changes. Although MDR-3 mRNA levels were slightly increased by the three fibrates, no significant differences were obtained. CONCLUSIONS These results show for the first time that fibrate administration to humans downregulates CYP7A1. Although ABCG5 and SREBP-2 mRNA levels were slightly increased by all treatment groups, only bezafibrate induced significant changes.
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Affiliation(s)
- Núria Roglans
- Pharmacology Unit, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
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Jové M, Planavila A, Cabrero A, Novell F, Ros E, Zambón D, Laguna JC, Carrera MV. Reductions in plasma cholesterol levels after fenofibrate treatment are negatively correlated with resistin expression in human adipose tissue. Metabolism 2003; 52:351-5. [PMID: 12647275 DOI: 10.1053/meta.2003.50055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The adipocyte-derived cytokine, resistin, has been proposed as the link between obesity and type 2 diabetes mellitus in murine models. In humans, resistin is identical to FIZZ3 (found in inflammatory zone 3), which belongs to a family of proteins that appears to be involved in inflammatory processes. To study the mechanisms by which fibrates improve glucose homeostasis, we determined resistin mRNA levels by using relative quantitative reverse-transcriptase-polymerase chain reaction (RT-PCR) in omental white adipose tissue samples obtained from patients treated with placebo or fenofibrate (200 mg/d) for 8 weeks before elective cholecystectomy. Fenofibrate treatment reduced total plasma cholesterol and low-density lipoprotein (LDL)-cholesterol levels by 24% and 35%, respectively. Compared with placebo values, a 2.4-fold induction in resistin mRNA levels was observed in white adipose tissue of fenofibrate-treated patients, whereas no changes were observed in the mRNA levels of the well-known perosixome proliferator-activated receptor (PPAR) target genes CD36, acyl-CoA oxidase, and carnitine palmitoyltransferase. These findings indicate that resistin changes were not related to PPAR activation by fenofibrate. Interestingly, resistin mRNA levels showed a negative correlation with plasma cholesterol levels (r2 =.53, P =.039, n = 8), but not with triglyceride levels (r2 =.02, P =.73, n = 8). These results suggest that cholesterol regulates resistin expression in human white adipose tissue.
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Affiliation(s)
- Mireia Jové
- Pharmacology Unit, Faculty of Pharmacy and the Surgical Department and Lipid Clinic, Nutrition and Dietetics Service, Hospital Clínic i Provincial, University of Barcelona, Barcelona, Spain
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Ros E, Oliván J, Mostaza JM, Vilardell M, Pintó X, Civeira F, Hernández A, Marqués da Silva P, Rodriguez-Botaro A, Zambón D, Lima J, Gómez-Gerique JA, Díaz C, Arístegui R, Sol JM, Hernández G. Atorvastatin versus Bezafibrate in Mixed Hyperlipidaemia : Randomised Clinical Trial of Efficacy and Safety (the ATOMIX Study). Clin Drug Investig 2003; 23:153-65. [PMID: 23340922 DOI: 10.2165/00044011-200323030-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Combined hyperlipidaemia is a common and highly atherogenic lipid phenotype with multiple lipoprotein abnormalities that are difficult to normalise with single-drug therapy. The ATOMIX multicentre, controlled clinical trial compared the efficacy and safety of atorvastatin and bezafibrate in patients with diet-resistant combined hyperlipidaemia. PATIENTS AND STUDY DESIGN Following a 6-week placebo run-in period, 138 patients received atorvastatin 10mg or bezafibrate 400mg once daily in a randomised, double-blind, placebo-controlled trial. To meet predefined low-density lipoprotein-cholesterol (LDL-C) target levels, atorvastatin dosages were increased to 20mg or 40mg once daily after 8 and 16 weeks, respectively. RESULTS After 52 weeks, atorvastatin achieved greater reductions in LDL-C than bezafibrate (percentage decrease 35 vs 5; p < 0.0001), while bezafibrate achieved greater reductions in triglyceride than atorvastatin (percentage decrease 33 vs 21; p < 0.05) and greater increases in high-density lipoprotein-cholesterol (HDL-C) [percentage increase 28 vs 17; p < 0.01 ]. Target LDL-C levels (according to global risk) were attained in 62% of atorvastatin recipients and 6% of bezafibrate recipients, and triglyceride levels <200 mg/dL were achieved in 52% and 60% of patients, respectively. In patients with normal baseline HDL-C, bezafibrate was superior to atorvastatin for raising HDL-C, while in those with baseline HDL-C <35 mg/dL, the two drugs raised HDL-C to a similar extent after adjustment for baseline values. Both drugs were well tolerated. CONCLUSION The results show that atorvastatin has an overall better efficacy than bezafibrate in concomitantly reaching LDL-C and triglyceride target levels in combined hyperlipidaemia, thus supporting its use as monotherapy in patients with this lipid phenotype.
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Affiliation(s)
- Emilio Ros
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic i Provincial, Barcelona, Spain,
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Roglans N, Bellido A, Rodríguez C, Cabrero A, Novell F, Ros E, Zambón D, Laguna JC. Fibrate treatment does not modify the expression of acyl coenzyme A oxidase in human liver. Clin Pharmacol Ther 2002; 72:692-701. [PMID: 12496750 DOI: 10.1067/mcp.2002.128605] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Fibrates induce hepatic peroxisome proliferation and carcinogenesis in rodents by activating peroxisome proliferator-activated receptor alpha (PPAR(alpha)). There is no conclusive evidence that humans are unresponsive to peroxisome proliferation, and concern exists about the long-term safety of fibrate treatment. METHODS In a university hospital setting, 48 patients with uncomplicated gallstones and a serum level of low-density lipoprotein cholesterol greater than 130 mg/dL were randomly assigned to open-label treatment with bezafibrate (400 mg/d), fenofibrate (200 mg/d), gemfibrozil (900 mg/d), or placebo for 8 weeks before elective cholecystectomy. Serum samples for lipid determinations were obtained at baseline and before surgery. A liver specimen was obtained at operation, and the relative levels of messenger ribonucleic acid (mRNA) for the wild and truncated forms of PPAR(alpha), acyl coenzyme A oxidase, liver carnitine palmitoyltransferase I, apolipoprotein A-I, and stearoyl coenzyme A desaturase were determined. RESULTS Fenofibrate, bezafibrate, and gemfibrozil reduced plasma low-density lipoprotein cholesterol levels by 22% (P =.009), 14% (P =.042), and 11% (not significant), respectively. Plasma triglyceride levels decreased significantly (24%-36%; P <.05), whereas high-density lipoprotein cholesterol levels rose nonsignificantly after treatment with the 3 fibrates. Except for a 35% increase of apolipoprotein A-I mRNA after fenofibrate administration (P <.05), none of the individual fibrates induced significant changes in the mRNAs tested, although as a group they increased the mRNA for liver carnitine palmitoyltransferase I by 40%(P =.08; marginally significant). CONCLUSIONS Fibrate administration to humans at pharmacologic doses able to activate PPAR(alpha) and to induce a hypolipidemic effect does not increase the hepatic expression of acyl coenzyme A oxidase, a well-known marker of peroxisome proliferation in rodents.
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Affiliation(s)
- Núria Roglans
- Pharmacology Unit, Faculty of Pharmacy, University of Barcelona, Surgical Department and Lipid Clinic, Nutrition and Dietetics Service, Hospital Clínic i Provincial, Spain
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Gómez-Gerique JA, Ros E, Oliván J, Mostaza JM, Vilardell M, Pintó X, Civeira F, Hernández A, da Silva PM, Rodriguez-Botaro A, Zambón D, Lima J, Díaz C, Aristegui R, Sol JM, Chaves J, Hernández G. Effect of atorvastatin and bezafibrate on plasma levels of C-reactive protein in combined (mixed) hyperlipidemia. Atherosclerosis 2002; 162:245-51. [PMID: 11996943 DOI: 10.1016/s0021-9150(01)00708-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
C-reactive protein (CRP) is a non-specific but sensitive marker of underlying systemic inflammation. High CRP plasma levels correlate with risk for future cardiovascular events. The present study evaluated the effects of atorvastatin (10-40 mg) and bezafibrate (400 mg) on CRP concentrations after 6 and 12 months of treatment in 103 patients with combined (mixed) hyperlipidemia. The number of cardiovascular risk factors present in a given patient was associated with baseline CRP levels. After 6 months and 1 year, atorvastatin treatment was associated with significant (P<0.001) decreases from baseline of CRP concentrations by 29 and 43%, respectively, while bezafibrate-treated patients showed non-significant reductions of 2.3 and 14.6%, respectively (P=0.056 and 0.005 for the respective differences between the two treatment arms at 6 months and 1 year). The magnitude of change in CRP after 1 year was directly related to baseline CRP levels. Covariance analysis showed that CRP decreases in the atorvastatin group were unrelated to total cholesterol and LDL cholesterol reductions; however, they were directly related to triglyceride changes (r=0.28, P=0.047) and inversely related to HDL cholesterol changes (r=-0.28, P=0.045). A model including baseline CRP values and treatment effect showed that atorvastatin use was a significant predictor of change in CRP levels over time (beta=0.82, P=0.023). These results suggest a potential anti-atherosclerotic additional benefit of atorvastatin in patients at a risk of cardiovascular disease.
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Affiliation(s)
- Juan A Gómez-Gerique
- Biochemistry Service, Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain.
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Muñoz S, Merlos M, Zambón D, Rodríguez C, Sabaté J, Ros E, Laguna JC. Walnut-enriched diet increases the association of LDL from hypercholesterolemic men with human HepG2 cells. J Lipid Res 2001. [DOI: 10.1016/s0022-2275(20)31536-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Muñoz S, Merlos M, Zambón D, Rodríguez C, Sabaté J, Ros E, Laguna JC. Walnut-enriched diet increases the association of LDL from hypercholesterolemic men with human HepG2 cells. J Lipid Res 2001; 42:2069-76. [PMID: 11734580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
In a randomized, cross-over feeding trial involving 10 men with polygenic hypercholesterolemia, a control, Mediterranean-type cholesterol-lowering diet, and a diet of similar composition in which walnuts replaced approximately 35% of energy from unsaturated fat, were given for 6 weeks each. Compared with the control diet, the walnut diet reduced serum total and LDL cholesterol by 4.2% (P = 0.176), and 6.0% (P = 0.087), respectively. No changes were observed in HDL cholesterol, triglycerides, and apolipoprotein A-I levels or in the relative proportion of protein, triglycerides, phospholipids, and cholesteryl esters in LDL particles. The apolipoprotein B level declined in parallel with LDL cholesterol (6.0% reduction). Whole LDL, particularly the triglyceride fraction, was enriched in polyunsaturated fatty acids from walnuts (linoleic and alpha-linolenic acids). In comparison with LDL obtained during the control diet, LDL obtained during the walnut diet showed a 50% increase in association rates to the LDL receptor in human hepatoma HepG2 cells. LDL uptake by HepG2 cells was correlated with alpha-linolenic acid content of the triglyceride plus cholesteryl ester fractions of LDL particles (r(2) = 0.42, P < 0.05). Changes in the quantity and quality of LDL lipid fatty acids after a walnut-enriched diet facilitate receptor-mediated LDL clearance and may contribute to the cholesterol-lowering effect of walnut consumption.
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MESH Headings
- Adult
- Aged
- Apolipoproteins/blood
- Apolipoproteins/metabolism
- Cholesterol, HDL/blood
- Cholesterol, HDL/metabolism
- Cholesterol, LDL/blood
- Cholesterol, LDL/metabolism
- Cholesterol, VLDL/blood
- Cholesterol, VLDL/metabolism
- Dietary Fats/administration & dosage
- Dietary Fats/pharmacology
- Dietary Fats/therapeutic use
- Endocytosis
- Fatty Acids/analysis
- Hepatocytes/metabolism
- Hepatocytes/pathology
- Humans
- Hypercholesterolemia/blood
- Hypercholesterolemia/diet therapy
- Hypercholesterolemia/metabolism
- Kinetics
- Lipoproteins, LDL/blood
- Lipoproteins, LDL/chemistry
- Lipoproteins, LDL/metabolism
- Male
- Mediterranean Region
- Middle Aged
- Nuts
- Oxidation-Reduction
- Receptors, LDL/metabolism
- Tumor Cells, Cultured
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Affiliation(s)
- S Muñoz
- Pharmacology Unit, School of Pharmacy, University of Barcelona, Barcelona, Spain
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Rodríguez-Villar C, Manzanares JM, Casals E, Pérez-Heras A, Zambón D, Gomis R, Ros E. High-monounsaturated fat, olive oil-rich diet has effects similar to a high-carbohydrate diet on fasting and postprandial state and metabolic profiles of patients with type 2 diabetes. Metabolism 2000; 49:1511-7. [PMID: 11145109 DOI: 10.1053/meta.2000.18573] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Whether metabolic control in type 2 diabetes mellitus (DM) is best achieved with the traditional high-carbohydrate (CHO), low-fat diet or a low-CHO, high-fat diet is still controversial. In a randomized crossover study, we compared the effects of a low-fat (30% of daily energy) diet and a high-fat (40% of daily energy), high-monounsaturated-fat diet for 6 weeks each on fasting and postprandial glucose, insulin, and lipoprotein concentrations in 12 patients with well-controlled type 2 DM (fasting blood glucose, 176 +/- 54 mg/dL; hemoglobin A1c, 6.4% +/- 0.7%) and no overt dyslipidemia (serum total cholesterol, 235 +/- 43 mg/dL; triglycerides, 180 +/- 63 mg/dL). Home-prepared foods were used and olive oil was the main edible fat, accounting for 8% and 25% of daily energy requirements in the low-fat and high-fat diets, respectively. For postprandial studies, the same mixed meal containing 36% fat was used in both dietary periods. Body weight and fasting and 6-hour postprandial blood glucose, insulin, and lipoprotein levels were similar after the two diets. The mean incremental area under the curve of serum triglycerides 0 to 6 hours after the challenge meal, adjusted for baseline levels, did not change significantly after the high-fat diet compared with the low-fat diet (1,484 +/- 546 v 1,714 +/- 709 mg x 6 h/dL, respectively, P = .099). Mean postprandial triglyceride levels at 6 hours were increased about 2 times over fasting levels and were still greater than 300 mg/dL after either diet. A diet high in total and monounsaturated fat at the expense of olive oil is a good alternative diet to the traditional low-fat diet for patients with type 2 DM. However, ongoing postprandial hypertriglyceridemia with either diet points to the need for other therapies to decrease triglyceride-rich lipoproteins (TRL) and the inherent atherogenic risk in type 2 diabetics.
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Affiliation(s)
- C Rodríguez-Villar
- Lipid Clinic, Nutrition and Dietetics Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic i Provincial, Barcelona, Spain
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Cruz-Sánchez FF, Durany N, Thome J, Riederer P, Zambón D. Correlation between Apolipoprotein-E polymorphism and Alzheimer's disease pathology. J Alzheimers Dis 2000; 2:223-9. [PMID: 12214086 DOI: 10.3233/jad-2000-23-404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease (AD) and small vessel disease dementia (SVDD) are common causes of dementia. The ApoE genotype has been proposed as a risk factor for AD. The frequency of the three ApoE alleles was correlated with the neuropathological changes of AD (senile plaques, neurofibrillary tangles and amyloid angiopathy) and SVDD (status lacunaris, status cribosus, leucoencephalopathy, micronecrosis and vascular fibrohyalinosis) in order to validate previous ApoE genotyping results in AD and to identify pre-clinical AD. Representative cerebral regions (cortex, gyrus cinguli, putamen, hippocampus, white matter) from 28 AD cases, 7 SVDD and 38 non-neurological controls were studied using classical histological techniques and immunohistochemistry for tau protein and amyloid-beta. The frequency of the ApoE allele 4 was significantly increased not only in AD patients but also in aged controls. However, following a detailed histopathological examination was found 62% of this group to exhibit histological changes associated with AD in limited brain areas (entorhinal region, hippocampus and adjacent temporal cortex or entorhinal region and hippocampus, or only in the entorhinal region), but 87% of these cases were found to be ApoE4 positive. The significant differences found in the distribution of ApoE allele frequencies were more marked when these cases were excluded from the control group and included as AD cases. In contrast, the frequency of the ApoE allele 2 is significantly increased in SVDD patients. Using histological techniques we confirmed the clinical diagnoses of all cases and classified the AD patients according to the severity of cortical pathology related to AD, while re-grouping from the control group those cases which had no clinical history of the disease but exhibited typical AD and SVDD histological lessions which could be considered as "pre-clinical" forms of these diseases.
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Affiliation(s)
- F F Cruz-Sánchez
- Institut of Neurological and Gerontological Sciences, International University of Catalonia, Barcelona, Spain
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Zambón D, Sabaté J, Muñoz S, Campero B, Casals E, Merlos M, Laguna JC, Ros E. Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. A randomized crossover trial. Ann Intern Med 2000; 132:538-46. [PMID: 10744590 DOI: 10.7326/0003-4819-132-7-200004040-00005] [Citation(s) in RCA: 178] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It has been reported that walnuts reduce serum cholesterol levels in normal young men. OBJECTIVE To assess the acceptability of walnuts and their effects on serum lipid levels and low-density lipoprotein (LDL) oxidizability in free-living hypercholesterolemic persons. DESIGN Randomized, crossover feeding trial. SETTING Lipid clinic at a university hospital. PATIENTS 55 men and women (mean age, 56 years) with polygenic hypercholesterolemia. INTERVENTION A cholesterol-lowering Mediterranean diet and a diet of similar energy and fat content in which walnuts replaced approximately 35% of the energy obtained from monounsaturated fat. Patients followed each diet for 6 weeks. MEASUREMENTS Low-density lipoprotein fatty acids (to assess compliance), serum lipid levels, lipoprotein(a) levels, and LDL resistance to in vitro oxidative stress. RESULTS 49 persons completed the trial. The walnut diet was well tolerated. Planned and observed diets were closely matched. Compared with the Mediterranean diet, the walnut diet produced mean changes of -4.1% in total cholesterol level, -5.9% in LDL cholesterol level, and -6.2% in lipoprotein(a) level. The mean differences in the changes in serum lipid levels were -0.28 mmol/L (95% CI, -0.43 to -0.12 mmol/L) (-10.8 mg/dL [-16.8 to -4.8 mg/dL]) (P<0.001) for total cholesterol level, -0.29 mmol/L (CI, -0.41 to -0.15 mmol/L) (-11.2 mg/dL [-16.3 to -6.1 mg/dL]) (P<0.001) for LDL cholesterol level, and -0.021 g/L (CI, -0.042 to -0.001 g/L) (P = 0.042) for lipoprotein(a) level. Lipid changes were similar in men and women except for lipoprotein(a) levels, which decreased only in men. Low-density lipoprotein particles were enriched with polyunsaturated fatty acids from walnuts, but their resistance to oxidation was preserved. CONCLUSION Substituting walnuts for part of the mono-unsaturated fat in a cholesterol-lowering Mediterranean diet further reduced total and LDL cholesterol levels in men and women with hypercholesterolemia.
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Affiliation(s)
- D Zambón
- Hospital Clínic and School of Pharmacy, University of Barcelona, Spain
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46
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Zambón D, Ros E, Rodriguez-Villar C, Laguna JC, Vázquez M, Sanllehy C, Casals E, Sol JM, Hernández G. Randomized crossover study of gemfibrozil versus lovastatin in familial combined hyperlipidemia: additive effects of combination treatment on lipid regulation. Metabolism 1999; 48:47-54. [PMID: 9920144 DOI: 10.1016/s0026-0495(99)90009-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The most appropriate therapy for combined hyperlipidemia remains to be determined. We compared the lipid-regulating effects of gemfibrozil and lovastatin in 30 patients with familial combined hyperlipidemia (FCHL) in a randomized, double-blind, placebo-controlled crossover study including 8-week courses of one drug followed by a washout period and a crossover phase to the alternate drug. After completion of the trial, open-label combination therapy was given for up to 12 months. Lovastatin was more efficacious than gemfibrozil in the reduction of total cholesterol (23% v. 9%, P<.001) and low-density lipoprotein (LDL) cholesterol (28% v. 2%, P<.001), whereas gemfibrozil surpassed lovastatin in the reduction of triglycerides (48% v. 0%, P<.001) and very-low-density lipoprotein (VLDL) cholesterol (50% v. 19%, P = .005) and the increase of high-density lipoprotein (HDL) cholesterol (18% v. 4%, P = .005). Lovastatin caused a greater decline in total apolipoprotein B (apo B) and LDL apo B than gemfibrozil, whereas VLDL apo B decreased only after gemfibrozil therapy. Drug-induced changes in lipoprotein composition indicated that gemfibrozil reduced both the number and size of VLDL particles and lovastatin decreased the number of LDL particles. Combined treatment was safe and had additive effects on lipids, causing significant (P<.001) reductions in total cholesterol (32%), triglycerides (51%), LDL cholesterol (34%), and apo B (26%) and an increase in HDL cholesterol (19%). Target LDL cholesterol levels were achieved only in 11% of patients given gemfibrozil alone and triglycerides decreased to target levels in 22% after lovastatin alone, whereas combined therapy normalized both lipid fractions in 96% of patients. Thus, in FCHL, gemfibrozil has no effect on LDL cholesterol levels but favorably influences the putative atherogenic alterations of lipoprotein composition that are related to hypertriglyceridemia. Conversely, lovastatin markedly decreases LDL cholesterol but has little effect on triglyceride-rich lipoproteins. Combination treatment safely corrects all of the lipid abnormalities in most patients.
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Affiliation(s)
- D Zambón
- Nutrition and Dietetics Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic i Provincial, Barcelona, Spain
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Sanllehy C, Casals E, Rodriguez-Villar C, Zambón D, Ojuel J, Ballesta AM, Ros E. Lack of interaction of apolipoprotein E phenotype with the lipoprotein response to lovastatin or gemfibrozil in patients with primary hypercholesterolemia. Metabolism 1998; 47:560-5. [PMID: 9591747 DOI: 10.1016/s0026-0495(98)90240-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The magnitude of serum lipid changes in response to hypolipidemic drugs varies considerably between individuals. These differences may be due to interactions between genetic and environmental factors that effect drug bioavailability or the capacity of the lipid-regulating enzyme and receptor targets to be affected. The apolipoprotein E (apoE) gene locus has been examined in this regard, but reports are conflicting on the effect of its variability on the response to hypolipidemic drugs. We investigated the effect of apoE polymorphism on the serum lipid response to the hepatic hydroxymethyl glutaryl coenzyme A (HMG CoA) reductase inhibitor lovastatin and the fibric acid derivative gemfibrozil. Lipoprotein changes were assessed after 12 weeks of therapy in 106 patients with primary hypercholesterolemia and combined hyperlipidemia treated with lovastastin and in 63 given gemfibrozil therapy. No significant effect of the apoE phenotypes E3/2, E3/3, or E4/3 on the heterogeneity of lipid responses to either drug was found.
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Affiliation(s)
- C Sanllehy
- Clinical Biochemistry Department, Nutrition and Dietetics Service, Hospital Clínic i Provincial, Barcelona, Spain
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48
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Vázquez M, Zambón D, Hernández Y, Adzet T, Merlos M, Ros E, Laguna JC. Lipoprotein composition and oxidative modification during therapy with gemfibrozil and lovastatin in patients with combined hyperlipidaemia. Br J Clin Pharmacol 1998; 45:265-9. [PMID: 9517370 PMCID: PMC1873371 DOI: 10.1046/j.1365-2125.1998.00672.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 02/06/2023] Open
Abstract
AIM To evaluate the resistance to oxidation of human lipoproteins after hypolipidaemic therapy. METHODS VLDL and LDL samples were obtained from patients with Familial Combined Hyperlipidaemia included in a randomized, double-blind, cross-over study, with 8 weeks of active treatment (gemfibrozil, 600 mg twice daily, or lovastatin, 40 mg daily) and a 4-week wash-out period. Oxidation related analytes after Cu-induced oxidation of VLDL and LDL have been investigated. Further, in order to relate possible changes in oxidative behaviour to lipoprotein composition, the proportion of the lipid species transported by lipoproteins (triglycerides, phospholipids, and cholesteryl esters), the molar composition of fatty acids for each lipoprotein lipid, and the content of antioxidant vitamins in plasma (vitamin C) and lipoproteins (vitamin E) have been studied. RESULTS Both drugs reduced the plasma concentration of apo-B lipoproteins (-23% gemfibrozil, -26% lovastatin), but whereas lovastatin affected mainly LDL-cholesterol (-30%), gemfibrozil reduced triglycerides (-49%) and VLDL-cholesterol (-48%). Lovastatin treatment had no effect on the lipid and protein composition, the fatty acid profile, or the vitamin E content of either VLDL or LDL; likewise, lipoprotein oxidation markers (Cu-induced conjugated dienes, thiobarbituric acid reactive substances formation, and lysine residues) were similar before and after lovastatin treatment. Gemfibrozil therapy also had no effect on lipoprotein oxidation; nevertheless, it consistently: a) decreased the proportion of LDL-triglycerides (-32%), and b) increased the proportion (molar%) of 18:3 n-6 in VLDL triglycerides (+140%), phospholipids (+363%) and cholesteryl esters (+53%). CONCLUSIONS Based on these results, lovastatin and gemfibrozil do not adversely affect lipoprotein oxidation in patients with mixed dyslipidaemia. In the case of gemfibrozil, this occurs in spite of an increased proportion of some polyunsaturated fatty acids in VLDL. In the context of a fixed dietary intake, such modifications suggest that the drug influences liver enzyme activities involved in fatty acid chain synthesis (elongases and desaturases).
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Affiliation(s)
- M Vázquez
- Unidad de Farmacología y Farmacognosia, Facultad de Farmacia (UB), Hospital Clínic i Provincial, Barcelona, Spain
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Muñoz S, Zambón D, Rodríguez C, Sabate J, Ros E, Merlos M, Laguna J. 4.P.169 Increase uptake of human LDL by human HepG2 hepatoma cells after a vegetal PUFA-enriched diet. Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)89695-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Abstract
BACKGROUND & AIMS Apolipoprotein (apo) E is a genetically polymorphic protein influencing lipoprotein metabolism and the risk of both atherosclerosis and Alzheimer's disease. As opposed to common apo E3, apo E2 decreases and apo E4 increases hepatic lipoprotein uptake; hence, apo E4 could promote gallstone formation by increasing hepatic and biliary cholesterol concentrations. This study was designed to evaluate whether apo E polymorphism is related to gallstone risk. METHODS apo E phenotype was determined in subjects older than 40 years of age (160 with and 125 without gallstones) and in 61 patients with cholesterol gallstones who underwent cholecystectomy. Bile composition, nucleation time, and gallstone features were analyzed in surgical patients. RESULTS The E4/3 phenotype was enriched in both patients with gallstones and those who underwent cholecystectomy, with significantly (P < 0.006) higher epsilon 4 allele frequencies than in gallstone-free subjects (odds ratio, 2.67 [95% confidence limits, 1.23-5.93] and 3.62 [95% confidence limits, 1.49-8.91], respectively); women, but not men, accounted for these differences. The prevalence of the epsilon 4 allele increased with age in patients with gallstones, whereas the opposite occurred in gallstone-free subjects. Biliary lipid and gallstone cholesterol content tended to increase in the sequence E4 > E3 > E2 in patients who underwent cholecystectomy. CONCLUSIONS Carrying the apo E4 isoform is a genetic risk factor for cholelithiasis in humans, thus adding another adverse effect of apo E polymorphism on health.
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Affiliation(s)
- A Bertomeu
- Lipid Clinic, Hospital Clínic i Provincial, Barcelona, Spain
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