Clínica e Investigación en Arteriosclerosis (English Edition)最新文献

Objectives

MEMOGAL study (NCT04319081) is aimed at evaluating changes in cognitive function in patients treated with PCSK9 inhibitors (PCSK9i). This is the first analysis: (1) discussion about the role of the Hospital Pharmacists during the pandemic, and also the assessment of the impact of COVID-19 in the lipid control; (2) descriptive analysis; (3) effectiveness in LDL cholesterol (LDL-c) reduction of alirocumab and evolocumab; (4) communicate PCSK9i safety.

Material and methods

It is a prospective Real-World Evidence analysis of patients that take PCSK9i for the first time in the usual clinical practice, and they are included after the first dispensation in the public pharmacy consultations of 12 Hospitals in Galicia from May 2020 to April 2021. Baseline values of LDL-c are the previous values before taking PCSK9 and the follow-up values are in 6 months time.

Results

89 patients were included. 86.5% with cardiovascular disease and 53.9% with statin intolerances. 78.8% of the patients were treated with high intensity statins. Statins most used were rosuvastatin (34.1%) and atorvastatin (20.5%). Baseline value of LDL-c was 148 mg/dl and the follow-up value was 71 mg/dl. The baseline value of patients treated with alirocumab (N = 43) was 144 mg/dl and 73 mg/dl in the follow-up. With evolocumab (N = 46) was 151 mg/dl in basaline and 69 mg/dl in follow-up. The LDLc- reduction was 51.21% with evolocumab and 51.05% with alirocumab. 43.1% of the patients showed values >70 mg/dl in six month time; 19.4% between 69 mg/dl and 55 mg/dl and 37.5% <55 mg/dL. 58.3% of the patients achieved a reduction >50% of LDL-c. The adverse events were: injection point reaction (N = 2), myalgias (N = 1), flu-like symptoms (N = 1) and neurocognitive worsening (N = 1).

Conclusions

(1) Despite the number of prescriptions was reduced because of the pandemic, the lipid control was not affected. (2) Half of the patients treated with PSCK9i is due to statins intolerance and the 86% is for secondary prevention. (2) The reduction results were similar to pivotal clinical trials. Despite this, 39% of the total of the patients and 60% of patients with dual teraphy did not reach the goal of ESC/EAS guidelines (< 55 mg/dl and/or reduction > 50%). There were not significant differences between evolocumab and alirocumab: 51.21% vs 51.05% (P = .972). (3) There were not any adverse events of special interest. The possible neurocognitive worsening will be studied as the primary endpoint once the MEMOGAL study has been completed.

Introduction

Metabolic syndrome is a pathological entity associated with a high risk of cardiovascular disease. Data regarding the frequency of this syndrome, lipid profile, and atherogenic index of plasma in patients with radiographic axial spondyloarthritis are scarce.

We aim to determine the prevalence of metabolic syndrome in patients with spondyloarthritis. We also aim to determine discriminative values of atherogenic indexes between patients with and without metabolic syndrome.

Methods

We conducted a cross-sectional study including 51 patients meeting the ASAS 2009 criteria for radiographic axial spondyloarthritis. We measured the following parameters: triglyceride (TG), high-density lipoproteins (HDL_c), low-density lipoprotein cholesterol (LDL_c), and total cholesterol (TC). We calculated TC/HDL_c, TG/HDL_c, LDL_c/HDL_c ratios, and atherogenic index of plasma (LogTG/HDL_c).

Results

Metabolic syndrome was noted in 33% of cases. Patients with active disease had a higher body mass index (26.89 ± 5.88 versus 23.63 ± 4.47 kg/m², p = 0.03), higher TG (1.41 ± 0.64 versus 0.89 ± 0.5 mmol/L, p = 0.05) and a lower HDL_c level (1 ± 0.28 versus 1.31 ± 0.22 mmol/L, p = 0.01). However, the LogTG/HDL_c and TG/HDL_c were higher in patients under TNFα inhibitors. The ability of the TG/HDL_c ratio and LogTG/HDL_c to distinguish patients with or without metabolic syndrome were good at cut-offs of 1.33 and 0.22, respectively (specificity: 91.2% and sensitivity 70.6% for both ratios).

Conclusion

Our study showed that metabolic syndrome is frequent in patients with axial spondyloarthritis. Atherogenic indexes can be used for predicting metabolic syndrome in these patients.

Cardiovascular disease (CVD) is an important challenge for clinicians, researchers and governments to reduce the impact on the global health burden and socioeconomic costs. Moreover, far from diminishing, cardiometabolic risk factors leading to CVD development are on the rise. In order to stop the CVD pandemic, it is not enough to merely attempt to control traditional risk factors. In this regard, chronobiology, the science that studies biological rhythms, has become an important field in research in the last years. Circadian disruption or chronodisruption, defined as a relevant disturbance of the internal temporal order of physiological circadian rhythms significantly increases the risk of CVD. In this article we review some of the evidence that has made chronobiology one of the most emerging scenarios to take into account in routine clinical practice in which a translation of all this evidence should be mandatory.

Non-alcoholic fatty liver disease (NAFLD) is the most frequent hepatic disease globally. NAFLD patients are at an increased risk of both liver and cardiovascular morbidity and mortality, as well as all-cause death. NAFLD prevalence is rapidly increasing worldwide and, thus, there is an urgent need for health policies to tackle its development and complications. Currently, since there is no drug therapy officially indicated for this disease, lifestyle interventions remain the first-line therapeutic option.

In the present narrative review, we discuss the effects of certain dietary patterns on NAFLD incidence and progression. The Mediterranean diet is regarded as the diet of choice for the prevention/treatment of NAFLD and its complications, based on the available evidence. Other plant-based dietary patterns (poor in saturated fat, refined carbohydrates, red and processed meats) are also beneficial [i.e., Dietary Approaches to Stop Hypertension (DASH) and vegetarian/vegan diets], whereas more data are needed to establish the role of ketogenic, intermittent fasting and paleo diets in NAFLD.

Nevertheless, there is no “one-size-fits-all” dietary intervention for NAFLD management. Clinicians should discuss with their patients and define the diet that each individual prefers and is able to implement in his/her daily life.

Food habits and preferences of our population are continuously changing throughout the world, especially in the wealthier countries. One of the consequences in our environment is the abandonment of the Mediterranean Diet, in accordance with an increased consumption of processed and ultraprocessed food, with negative effects on our health by the progressive increase of obesity and its multiple metabolic consequences. On the other hand, foods production is one of the most important reasons for the global warming of the planet, triggered by an increased demand of foods, caused by the grow up of the world population and by the introduction of technologies no respectful with the planet. Fortunately, every day the population is more and more awareness of the need for changing the alimentary model and the news technologies, looking for minimizing such deleterious consequence, always thinking in the health of the people and the planet. This concept, looking for a global welfare for the present and for the future, is discussed in this manuscript.

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences.

The updated SCORE algorithm—SCORE2, SCORE-OP— is recommended in these guidelines, which estimates an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40–89 years. Another new and important recommendation is the use of different categories of risk according different age groups (<50, 50−69, ≥70 years).

Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.