Pub Date : 2023-11-01DOI: 10.1016/j.artere.2023.04.003
Agustín Blanco Echevarría , Juan De Dios García Díaz , Assumpta Caixas , Núria Plana Gil , Miguel Ángel Rico Corral , Ian Bridges , Nafeesa Dhalwani , Sònia Gatell Menchen , Kausik K. Ray
Aims
Limited data exist on low-density lipoprotein-cholesterol (LDL-C) level variability or long-term persistence with the monoclonal antibody evolocumab in routine clinical practice. HEYMANS (NCT02770131) is the first multi-country, multicenter, observational study of European patients initiating evolocumab as part of their routine clinical management, based on local reimbursement criteria (overall data recently published). The aim of this analysis is to describe clinical characteristics, baseline and changes in LDL-C levels, treatment patterns and persistence to evolocumab over 30 months in the Spanish cohort using data from the HEYMANS Registry.
Methods
HEYMANS was a prospective study of adult patients (≥18 years) who received at least one dose of evolocumab. A total of 1951 patients were enrolled from 12 countries and were followed up for 30 months after evolocumab initiation. Data were collected for 6 months before evolocumab initiation and up to 30 months thereafter. The Spanish cohort included patients who started evolocumab in routine clinical practice from March 2016 to September 2019. Demographic and clinical characteristics, lipid-lowering therapies (LLT), and lipid levels were collected.
Results
In total, 201 patients were included in the Spanish cohort. Median follow-up (Q1–Q3) was 30.0 (12–30) months. A total of 61.7% of patients were men and the mean (standard deviation) age was 59.5 (10.8) years. Most patients (68.7%) had experienced a prior cardiovascular event, 45.3% had coronary artery disease or stable angina, and 60.2% had a diagnosis of familial hypercholesterolemia. Overall, 57.7% of patients were receiving treatment with statins, most of them with high-intensity statins (85.3%); 45.8% of patients were intolerant to statins, and 26.4% of patients did not receive any LLT. At baseline, median (Q1–Q3) LDL-C levels were 151 (123–197) mg/dL. After 3 months of treatment, baseline LDL-C decreased by 66% to a median of 50 (30–83) mg/dL and these levels were maintained over time, with a median LDL-C of 55 (40–99) mg/dL at 30 months. At months 10–12 of treatment, LDL-C levels < 55 mg/dL were achieved by 56.3% of patients. LDL-C levels < 70 mg/dL were achieved by 70.1% of patients, and a lowering of LDL-C levels ≥50% was achieved by 76.8% of patients. The percentage of patients on evolocumab treatment was 95% at 12 months and 93% at 30 months.
Conclusions
In the Spanish cohort in routine clinical practice, evolocumab therapy provided a reduction in LDL-C levels consistent with that reported in previous clinical trials, which was sustained during 30 months of follow-up. Treatment with evolocumab was started at LDL-C levels 50% higher than those recommended by The Spanish Society of Arteriosclerosis and the Therapeutic Positioning Re
{"title":"Long-term treatment persistence and maintained reduction of LDL-cholesterol levels with evolocumab over 30 months: Results from the Spanish cohort of the European prospective HEYMANS study","authors":"Agustín Blanco Echevarría , Juan De Dios García Díaz , Assumpta Caixas , Núria Plana Gil , Miguel Ángel Rico Corral , Ian Bridges , Nafeesa Dhalwani , Sònia Gatell Menchen , Kausik K. Ray","doi":"10.1016/j.artere.2023.04.003","DOIUrl":"https://doi.org/10.1016/j.artere.2023.04.003","url":null,"abstract":"<div><h3>Aims</h3><p><span>Limited data exist on low-density lipoprotein-cholesterol (LDL-C) level variability or long-term persistence with the monoclonal antibody evolocumab in routine clinical practice. HEYMANS (</span><span>NCT02770131</span><svg><path></path></svg>) is the first multi-country, multicenter, observational study of European patients initiating evolocumab as part of their routine clinical management, based on local reimbursement criteria (overall data recently published). The aim of this analysis is to describe clinical characteristics, baseline and changes in LDL-C levels, treatment patterns and persistence to evolocumab over 30 months in the Spanish cohort using data from the HEYMANS Registry.</p></div><div><h3>Methods</h3><p>HEYMANS was a prospective study of adult patients (≥18 years) who received at least one dose of evolocumab. A total of 1951 patients were enrolled from 12 countries and were followed up for 30 months after evolocumab initiation. Data were collected for 6 months before evolocumab initiation and up to 30 months thereafter. The Spanish cohort included patients who started evolocumab in routine clinical practice from March 2016 to September 2019. Demographic and clinical characteristics, lipid-lowering therapies (LLT), and lipid levels were collected.</p></div><div><h3>Results</h3><p>In total, 201 patients were included in the Spanish cohort. Median follow-up (Q1–Q3) was 30.0 (12–30) months. A total of 61.7% of patients were men and the mean (standard deviation) age was 59.5 (10.8) years. Most patients (68.7%) had experienced a prior cardiovascular event, 45.3% had coronary artery disease or stable angina, and 60.2% had a diagnosis of familial hypercholesterolemia. Overall, 57.7% of patients were receiving treatment with statins, most of them with high-intensity statins (85.3%); 45.8% of patients were intolerant to statins, and 26.4% of patients did not receive any LLT. At baseline, median (Q1–Q3) LDL-C levels were 151 (123–197) mg/dL. After 3 months of treatment, baseline LDL-C decreased by 66% to a median of 50 (30–83) mg/dL and these levels were maintained over time, with a median LDL-C of 55 (40–99) mg/dL at 30 months. At months 10–12 of treatment, LDL-C levels<!--> <!--><<!--> <!-->55<!--> <!-->mg/dL were achieved by 56.3% of patients. LDL-C levels<!--> <!--><<!--> <!-->70<!--> <!-->mg/dL were achieved by 70.1% of patients, and a lowering of LDL-C levels ≥50% was achieved by 76.8% of patients. The percentage of patients on evolocumab treatment was 95% at 12 months and 93% at 30 months.</p></div><div><h3>Conclusions</h3><p>In the Spanish cohort in routine clinical practice, evolocumab therapy provided a reduction in LDL-C levels consistent with that reported in previous clinical trials, which was sustained during 30 months of follow-up. Treatment with evolocumab was started at LDL-C levels 50% higher than those recommended by The Spanish Society of Arteriosclerosis and the Therapeutic Positioning Re","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 6","pages":"Pages 263-271"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.artere.2023.06.003
Àlex Vila , Estel Pons , Patricia Trinidad García , Daniel Vidal , Sara López , Armand Grau
Objectives
To evaluate the achievement of low-density lipoprotein cholesterol (LDLc) goals established by the 2019 European Guidelines for the Management of Dyslipidemias and 2021 Cardiovascular Disease Prevention Guidelines, describe the lipid-lowering treatment received, analyze the achievement of goals according to the lipid-lowering treatment received and study the factors associated with therapeutic success.
Design
Observational study that included 185 patients of both sexes aged 18 or over undergoing lipid-lowering treatment for primary or secondary prevention, attended at the Lipid Unit.
Results
62,1% of the patients had a very high cardiovascular risk (CVR) according to the 2019 guidelines, and 60,5% according to the 2021 guidelines. Of the total cases, 22,7% achieved adequate control of LDLc according to the 2019 guidelines and 20% according to the 2021 guidelines. 47,6% of the patients received very high intensity lipid-lowering treatment, and 14,1% received extremely high intensity lipid-lowering treatment. 76% of subjects with very high CVR on extremely high intensity lipid-lowering treatment achieved the therapeutic objectives of both guides. In the multivariate analysis, factors associated with therapeutic success were the presence of arteriosclerotic cardiovascular disease, the intensity of lipid-lowering treatment, diabetes mellitus, and low to moderate alcohol consumption.
Conclusions
Dyslipidemia control is improvable. High or extremely high intensity lipid-lowering treatments can contribute to optimizing control of patients with higher CVR.
{"title":"Observational study of patients from a Lipid Unit on lipid-modifying therapy for primary and secondary prevention: ULFI Study","authors":"Àlex Vila , Estel Pons , Patricia Trinidad García , Daniel Vidal , Sara López , Armand Grau","doi":"10.1016/j.artere.2023.06.003","DOIUrl":"10.1016/j.artere.2023.06.003","url":null,"abstract":"<div><h3>Objectives</h3><p>To evaluate the achievement of low-density lipoprotein cholesterol (LDLc) goals established by the 2019 European Guidelines for the Management of Dyslipidemias<span> and 2021 Cardiovascular Disease Prevention<span> Guidelines, describe the lipid-lowering treatment received, analyze the achievement of goals according to the lipid-lowering treatment received and study the factors associated with therapeutic success.</span></span></p></div><div><h3>Design</h3><p>Observational study that included 185 patients of both sexes aged 18 or over undergoing lipid-lowering treatment for primary or secondary prevention, attended at the Lipid Unit.</p></div><div><h3>Results</h3><p>62,1% of the patients had a very high cardiovascular risk (CVR) according to the 2019 guidelines, and 60,5% according to the 2021 guidelines. Of the total cases, 22,7% achieved adequate control of LDLc according to the 2019 guidelines and 20% according to the 2021 guidelines. 47,6% of the patients received very high intensity lipid-lowering treatment, and 14,1% received extremely high intensity lipid-lowering treatment. 76% of subjects with very high CVR on extremely high intensity lipid-lowering treatment achieved the therapeutic objectives of both guides. In the multivariate analysis, factors associated with therapeutic success were the presence of arteriosclerotic cardiovascular disease, the intensity of lipid-lowering treatment, diabetes mellitus, and low to moderate alcohol consumption.</p></div><div><h3>Conclusions</h3><p>Dyslipidemia control is improvable. High or extremely high intensity lipid-lowering treatments can contribute to optimizing control of patients with higher CVR.</p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 6","pages":"Pages 272-279"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136152164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.artere.2023.05.011
Javier Espíldora-Hernández , Salvador Martín-Cortés , María José Benítez-Toledo , Inmaculada Coca-Prieto , Miguel Ángel Sánchez-Chaparro , Pedro Valdivielso
Introduction
The consumption of red wine has historically been associated with a reduction in cardiovascular risk, with sometimes controversial scientific evidence.
Method
A survey was carried out via whatsapp dated 09/01/22 to a cohort of doctors from the province of Malaga, asking about possible healthy red wine consumption habits, differentiating: never, 3–4 glasses per week, 5–6 weekly drinks and 1 daily drink.
Results
184 physicians answered, with a mean age of 35 years ± 11.1, of which 84 (45.6%) were women, distributed in different specialties, the majority being Internal Medicine with 52 (28.2%). The most frequently chosen option was D (59.2%), followed by A (21.2%), C (14.7%) and B (5%).
Conclusions
More than half of the doctors surveyed recommended zero consumption, and only 20% indicated that a daily drink could be healthy in non-drinkers.
{"title":"Doctors’ perception of red wine consumption and cardiovascular health","authors":"Javier Espíldora-Hernández , Salvador Martín-Cortés , María José Benítez-Toledo , Inmaculada Coca-Prieto , Miguel Ángel Sánchez-Chaparro , Pedro Valdivielso","doi":"10.1016/j.artere.2023.05.011","DOIUrl":"10.1016/j.artere.2023.05.011","url":null,"abstract":"<div><h3>Introduction</h3><p>The consumption of red wine has historically been associated with a reduction in cardiovascular risk, with sometimes controversial scientific evidence.</p></div><div><h3>Method</h3><p>A survey was carried out via whatsapp dated 09/01/22 to a cohort of doctors from the province of Malaga, asking about possible healthy red wine consumption habits, differentiating: never, 3–4 glasses per week, 5–6 weekly drinks and 1 daily drink.</p></div><div><h3>Results</h3><p>184 physicians answered, with a mean age of 35 years<!--> <!-->±<!--> <span>11.1, of which 84 (45.6%) were women, distributed in different specialties, the majority being Internal Medicine with 52 (28.2%). The most frequently chosen option was D (59.2%), followed by A (21.2%), C (14.7%) and B (5%).</span></p></div><div><h3>Conclusions</h3><p>More than half of the doctors surveyed recommended zero consumption, and only 20% indicated that a daily drink could be healthy in non-drinkers.</p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 6","pages":"Pages 290-293"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136152165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.artere.2023.09.002
Ana Camacho , María José Ariza , Nuria Amigó , Patricia Macías Guillén , Miguel Ángel Sánchez Chaparro , Pedro Valdivielso
Primary hypocholesterolemia (or hypobetalipoproteinemia) is a rare disorder of lipoprotein metabolism that may be due to a polygenic predisposition or a monogenic disease. Among these, it is possible to differentiate between symptomatic and asymptomatic forms, in which, in the absence of secondary causes, the initial clinical suspicion is plasma ApoB levels below the 5th percentile of the distribution by age and sex. Here we describe the differential diagnosis of a case of asymptomatic hypocholesterolemia. We studied proband’s clinical data, the lipid profile of the proband and her relatives and the clinical data of the family relevant to carry out the differential diagnosis. We performed a genetic study as the diagnostic test. The information obtained from the differential diagnosis suggested a heterozygous hypobetalipoproteinemia due to PCSK9 loss-of-function variants. The diagnostic test revealed, in the proband, the presence of a heterozygous PCSK9 frame-shift variant of a maternal origin. Plasma levels of LDL cholesterol and PCSK9 of the patient and her relatives were compatible with the segregation of the variant revealed. In conclusion, the diagnostic test performed confirmed the suspected diagnosis of the proband as asymptomatic familial hypobetalipoproteinemia due to a loss-of-function variant in the PCSK9 gene.
{"title":"A case of hypocholesterolemia under research","authors":"Ana Camacho , María José Ariza , Nuria Amigó , Patricia Macías Guillén , Miguel Ángel Sánchez Chaparro , Pedro Valdivielso","doi":"10.1016/j.artere.2023.09.002","DOIUrl":"https://doi.org/10.1016/j.artere.2023.09.002","url":null,"abstract":"<div><p><span><span>Primary hypocholesterolemia (or hypobetalipoproteinemia) is a </span>rare disorder<span> of lipoprotein metabolism that may be due to a polygenic predisposition or a monogenic disease. Among these, it is possible to differentiate between symptomatic and asymptomatic forms, in which, in the absence of secondary causes, the initial clinical suspicion is plasma ApoB levels below the 5th percentile of the distribution by age and sex. Here we describe the differential diagnosis of a case of asymptomatic hypocholesterolemia. We studied proband’s clinical data, the lipid profile of the proband and her relatives and the clinical data of the family relevant to carry out the differential diagnosis. We performed a genetic study as the diagnostic test. The information obtained from the differential diagnosis suggested a heterozygous hypobetalipoproteinemia due to </span></span><em>PCSK9</em> loss-of-function variants. The diagnostic test revealed, in the proband, the presence of a heterozygous <em>PCSK9</em><span> frame-shift variant of a maternal origin. Plasma levels of LDL cholesterol<span> and PCSK9 of the patient and her relatives were compatible with the segregation of the variant revealed. In conclusion, the diagnostic test performed confirmed the suspected diagnosis of the proband as asymptomatic familial hypobetalipoproteinemia due to a loss-of-function variant in the </span></span><em>PCSK9</em> gene.</p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 5","pages":"Pages 244-247"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49706683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.artere.2023.09.006
Josep Ribalta, Carlos Lahoz, Xavier Pintó
{"title":"“Methodological notes”: a new and important section in Clínica e Investigación en Arteriosclerosis","authors":"Josep Ribalta, Carlos Lahoz, Xavier Pintó","doi":"10.1016/j.artere.2023.09.006","DOIUrl":"https://doi.org/10.1016/j.artere.2023.09.006","url":null,"abstract":"","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 5","pages":"Page 243"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49706964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.artere.2023.09.004
Rocío Mateo-Gallego , Sofía Pérez-Calahorra , Ana M. Bea , Irene Gracia-Rubio , Carmen Rodrigo-Carbo , Belen Moreno-Franco , Fernando Civeira , Martín Laclaustra , Itziar Lamiquiz-Moneo
Background
APOE gene encoded a multifunctional protein in lipid metabolism, also associated with inflammatory markers. Type 2 diabetes (T2D) is a complex metabolic disease related to increased blood glucose, triglycerides and VLDL and associated with different dyslipidaemias. The aim of this study was to analyze whether the APOE genotype could determining the risk of developing T2D in a large cohort of workers.
Material and methods
Data from the Aragon Workers Health Study (AWHS) (n = 4895) were used to investigate the relationship between glycemic levels and APOE genotype. All patients in the AWHS cohort had their blood drawn after an overnight fast and laboratory tests were performed on the same day as the blood drawn. Dietary and physical assessment was assessed by face-to-face interview. APOE genotype was determined by the Sanger sequencing method.
Results
The relationship between APOE genotype and glycemic profile showed that glucose, Hb1Ac, insulin and HOMA levels did not seem to be associated with the APOE genotype (p = 0.563, p = 0.605, p = 0.333 and p = 0.276, respectively). In addition, the T2D prevalence did not show an association with the APOE genotype (p = 0.354). Along the same lines, blood glucose levels and T2D prevalence did not show association with the APOE allele. Shift work had some effect on the glycaemic profile, showing that night shift workers have significantly lower levels of glucose, insulin and HOMA (p < 0.001). However, the APOE genotype did not show difference in the concentration of glycaemic parameters adjusting by sex, age and BMI, work shift and dietary parameters.
Conclusion
Glycemic profile and T2D prevalence did not show any significant association with the APOE genotype. Besides, individuals, who worked in non-rotating night shift showed significantly lower glycemic levels, while workers in the morning-afternoon-night shift showed significantly higher values.
{"title":"Absence of the influence of the APOE gene on the incidence of type 2 diabetes mellitus in a cohort of workers: Effect of diet and shift work","authors":"Rocío Mateo-Gallego , Sofía Pérez-Calahorra , Ana M. Bea , Irene Gracia-Rubio , Carmen Rodrigo-Carbo , Belen Moreno-Franco , Fernando Civeira , Martín Laclaustra , Itziar Lamiquiz-Moneo","doi":"10.1016/j.artere.2023.09.004","DOIUrl":"https://doi.org/10.1016/j.artere.2023.09.004","url":null,"abstract":"<div><h3>Background</h3><p><em>APOE</em><span> gene encoded a multifunctional protein in lipid metabolism, also associated with inflammatory markers. Type 2 diabetes (T2D) is a complex metabolic disease related to increased blood glucose, triglycerides and VLDL and associated with different dyslipidaemias. The aim of this study was to analyze whether the </span><em>APOE</em> genotype could determining the risk of developing T2D in a large cohort of workers.</p></div><div><h3>Material and methods</h3><p>Data from the Aragon Workers Health Study (AWHS) (<em>n</em> <!-->=<!--> <!-->4895) were used to investigate the relationship between glycemic levels and <em>APOE</em> genotype. All patients in the AWHS cohort had their blood drawn after an overnight fast and laboratory tests were performed on the same day as the blood drawn. Dietary and physical assessment was assessed by face-to-face interview. <em>APOE</em> genotype was determined by the Sanger sequencing method.</p></div><div><h3>Results</h3><p>The relationship between <em>APOE</em><span> genotype and glycemic profile showed that glucose, Hb1Ac, insulin and HOMA levels did not seem to be associated with the </span><em>APOE</em> genotype (<em>p</em> <!-->=<!--> <!-->0.563, <em>p</em> <!-->=<!--> <!-->0.605, <em>p</em> <!-->=<!--> <!-->0.333 and <em>p</em> <!-->=<!--> <!-->0.276, respectively). In addition, the T2D prevalence did not show an association with the <em>APOE</em> genotype (<em>p</em> <!-->=<!--> <!-->0.354). Along the same lines, blood glucose levels and T2D prevalence did not show association with the <em>APOE</em> allele. Shift work had some effect on the glycaemic profile, showing that night shift workers have significantly lower levels of glucose, insulin and HOMA (<em>p</em> <!--><<!--> <!-->0.001). However, the <em>APOE</em> genotype did not show difference in the concentration of glycaemic parameters adjusting by sex, age and BMI, work shift and dietary parameters.</p></div><div><h3>Conclusion</h3><p>Glycemic profile and T2D prevalence did not show any significant association with the <em>APOE</em> genotype. Besides, individuals, who worked in non-rotating night shift showed significantly lower glycemic levels, while workers in the morning-afternoon-night shift showed significantly higher values.</p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 5","pages":"Pages 226-235"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49706958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.artere.2023.09.005
Ana Maria Gonçalvez Milla , Eduardo B.F. Chagas , Vitor Fernando Bordin Miola , Bárbara de Oliveira Zanuso , Elen Landgraf Guiguer , Adriano Cressoni Araújo , Ricardo José Tofano , Karina R. Quesada , Lucas F. Laurindo , Sandra M. Barbalho
Introduction
The lipid accumulation product (LAP) and visceral adipose index (VAI) are clinical markers of visceral obesity and were proposed as simple tools to estimate cardiovascular risk and mortality. The objective of this study was to analyze the accuracy of the VAI and LAP for high cardiovascular risk patients.
Methods
A cross-sectional observational study of accuracy was carried out in 193 patients of both sexes. In addition to the variables VAI and LAP, presence of comorbidities, education, level of physical activity and anthropometric data were obtained. Cardiovascular risk was determined by the Framingham score.
Results
No significant difference was observed in the sample in gender distribution (44.6% women; 55.4% men), 24.4% had low cardiovascular risk, 48.7% intermediate risk and 26.9% high cardiovascular risk. Linear regression analysis showed that VAI and LAP explain, respectively, only 2.4% and 5.2% of the variation in cardiovascular risk expressed by the Framingham score. The analysis of areas under the curve (AUC) for receiver operating characteristic (ROC) indicated a significant effect only of LAP to diagnose individuals with high cardiovascular risk, but with low sensitivity and specificity.
Conclusion
Our results indicate that VAI and LAP explain only a small percentage of the variation in the Framingham cardiovascular risk score. LAP index still deserves more attention in a cohort study, because, even with the limitations of a cross-sectional study, we observed an acceptable sensitivity for it so that the LAP can be used as a screening criterion for requesting more accurate tests.
{"title":"Accuracy of visceral adiposity indices and lipid accumulation products in the identification of adults at high cardiovascular risk","authors":"Ana Maria Gonçalvez Milla , Eduardo B.F. Chagas , Vitor Fernando Bordin Miola , Bárbara de Oliveira Zanuso , Elen Landgraf Guiguer , Adriano Cressoni Araújo , Ricardo José Tofano , Karina R. Quesada , Lucas F. Laurindo , Sandra M. Barbalho","doi":"10.1016/j.artere.2023.09.005","DOIUrl":"https://doi.org/10.1016/j.artere.2023.09.005","url":null,"abstract":"<div><h3>Introduction</h3><p>The lipid accumulation product (LAP) and visceral adipose index (VAI) are clinical markers of visceral obesity and were proposed as simple tools to estimate cardiovascular risk and mortality. The objective of this study was to analyze the accuracy of the VAI and LAP for high cardiovascular risk patients.</p></div><div><h3>Methods</h3><p>A cross-sectional observational study of accuracy was carried out in 193 patients of both sexes. In addition to the variables VAI and LAP, presence of comorbidities, education, level of physical activity and anthropometric data were obtained. Cardiovascular risk was determined by the Framingham score.</p></div><div><h3>Results</h3><p>No significant difference was observed in the sample in gender distribution (44.6% women; 55.4% men), 24.4% had low cardiovascular risk, 48.7% intermediate risk and 26.9% high cardiovascular risk. Linear regression analysis showed that VAI and LAP explain, respectively, only 2.4% and 5.2% of the variation in cardiovascular risk expressed by the Framingham score. The analysis of areas under the curve (AUC) for receiver operating characteristic (ROC) indicated a significant effect only of LAP to diagnose individuals with high cardiovascular risk, but with low sensitivity and specificity.</p></div><div><h3>Conclusion</h3><p>Our results indicate that VAI and LAP explain only a small percentage of the variation in the Framingham cardiovascular risk score. LAP index still deserves more attention in a cohort study, because, even with the limitations of a cross-sectional study, we observed an acceptable sensitivity for it so that the LAP can be used as a screening criterion for requesting more accurate tests.</p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 5","pages":"Pages 236-242"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49706961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.artere.2023.09.001
Juan Pedro-Botet , Núria Plana , José María Mostaza , Juan José Gómez-Doblas , María Rosa Fernández Olmo , Carlos Escobar Cervantes , José Luis Díaz-Díaz , Raquel Campuzano Ruiz , Pedro Valdivielso , Juan Cosín-Sales
Introduction and objectives
The cardiovascular prevention strategy by autonomous communities can be variable since the competences in health are transferred. The objective of the study was to determine the degree of dyslipidaemia control and the lipid-lowering pharmacological therapy used in patients at high/very high cardiovascular risk (CVR) by autonomous communities.
Methods
Observational, cross-sectional, descriptive study based on a consensus methodology. Information on the clinical practice of 145 health areas belonging to 17 Spanish autonomous communities was collected through face-to-face meetings and questionnaires administered to the 435 participating physicians. Furthermore, aggregate non-identifiable data were compiled from 10 consecutive dyslipidaemic patients that each participant had recently visited.
Results
Of the 4,010 patients collected, 649 (16%) had high and 2,458 (61%) very high CVR. The distribution of the 3,107 high/very high CVR patients was balanced across regions, but there were inter-regional differences (P < 0.0001) in the achievement of target LDL-C<70 and <55 mg/dL, respectively. High-intensity statins in monotherapy or in combination with ezetimibe and/or PCSK9 inhibitors were used in 44, 21 and 4% of high CVR patients, while in those at very high CVR it rose to 38, 45 and 6%, respectively. The use of these lipid-lowering therapies at national level was significantly different between regions (P = 0.0079).
Conclusions
Even though the distribution of patients at high/very high CVR was similar between autonomous communities, inter-territorial differences were identified in the degree of achievement of LDL cholesterol therapeutic goal and use of lipid-lowering therapy.
{"title":"Hypercholesterolaemia control in Spain: The same situation with different regional realities","authors":"Juan Pedro-Botet , Núria Plana , José María Mostaza , Juan José Gómez-Doblas , María Rosa Fernández Olmo , Carlos Escobar Cervantes , José Luis Díaz-Díaz , Raquel Campuzano Ruiz , Pedro Valdivielso , Juan Cosín-Sales","doi":"10.1016/j.artere.2023.09.001","DOIUrl":"https://doi.org/10.1016/j.artere.2023.09.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p><span>The cardiovascular prevention strategy by autonomous communities can be variable since the competences in health are transferred. The objective of the study was to determine the degree of dyslipidaemia control and the lipid-lowering pharmacological therapy used </span>in patients at high/very high cardiovascular risk (CVR) by autonomous communities.</p></div><div><h3>Methods</h3><p>Observational, cross-sectional, descriptive study based on a consensus methodology. Information on the clinical practice of 145 health areas belonging to 17 Spanish autonomous communities was collected through face-to-face meetings and questionnaires administered to the 435 participating physicians. Furthermore, aggregate non-identifiable data were compiled from 10 consecutive dyslipidaemic patients that each participant had recently visited.</p></div><div><h3>Results</h3><p><span><span>Of the 4,010 patients collected, 649 (16%) had high and 2,458 (61%) very high CVR. The distribution of the 3,107 high/very high CVR patients was balanced across regions, but there were inter-regional differences (P < 0.0001) in the achievement of target LDL-C<70 and <55 mg/dL, respectively. High-intensity statins in monotherapy or in combination with </span>ezetimibe and/or </span>PCSK9<span> inhibitors were used in 44, 21 and 4% of high CVR patients, while in those at very high CVR it rose to 38, 45 and 6%, respectively. The use of these lipid-lowering therapies at national level was significantly different between regions (P = 0.0079).</span></p></div><div><h3>Conclusions</h3><p>Even though the distribution of patients at high/very high CVR was similar between autonomous communities, inter-territorial differences were identified in the degree of achievement of LDL cholesterol therapeutic goal and use of lipid-lowering therapy.</p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 5","pages":"Pages 219-225"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49706984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1016/j.artere.2023.09.003
Pablo Pérez-Martínez , Emilio Ros , Juan Pedro-Botet , Fernando Civeira , Vicente Pascual , Carmen Garcés , Rosa Solá , Francisco Pérez-Jiménez , José M. Mostaza
Given the progressive increase in the number of these products and their rising use by the population, the Spanish Society of Arteriosclerosis (SEA) has considered it appropriate to review the available information, select the results of the scientifically more robust studies and take a position on their usefulness, to recommend to health professionals and the general population their potential utility in terms of efficacy and their possible benefits and limitations. The following clinical scenarios have been identified in which these products could be used and will be analyzed in more detail in this document: (1) Hypolipidemic treatment in subjects with statin intolerance. (2) Hypolipidemic treatment "a la carte" in individuals in primary prevention. (3) Long-term cardiovascular prevention in individuals with no indication for lipid-lowering therapy. (4) Patients with optimized lipid-lowering treatment who do not achieve therapeutic objectives.
{"title":"Functional foods and nutraceuticals in the treatment of hypercholesterolemia: Statement of the Spanish Society of Arteriosclerosis 2023","authors":"Pablo Pérez-Martínez , Emilio Ros , Juan Pedro-Botet , Fernando Civeira , Vicente Pascual , Carmen Garcés , Rosa Solá , Francisco Pérez-Jiménez , José M. Mostaza","doi":"10.1016/j.artere.2023.09.003","DOIUrl":"https://doi.org/10.1016/j.artere.2023.09.003","url":null,"abstract":"<div><p>Given the progressive increase in the number of these products and their rising use by the population, the Spanish Society of Arteriosclerosis (SEA) has considered it appropriate to review the available information, select the results of the scientifically more robust studies and take a position on their usefulness, to recommend to health professionals and the general population their potential utility in terms of efficacy and their possible benefits and limitations. The following clinical scenarios have been identified in which these products could be used and will be analyzed in more detail in this document: (1) Hypolipidemic treatment in subjects with statin intolerance. (2) Hypolipidemic treatment \"a la carte\" in individuals in primary prevention. (3) Long-term cardiovascular prevention in individuals with no indication for lipid-lowering therapy. (4) Patients with optimized lipid-lowering treatment who do not achieve therapeutic objectives.</p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 5","pages":"Pages 248-261"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49760781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-01DOI: 10.1016/j.artere.2023.07.005
Xavier Pintó , Marta Fanlo , Virginia Esteve , Jesús Millán , on behalf of the Atherogenic Dyslipidemia Working Group, Spanish Society of Arteriosclerosis (SEA)
In patients who have achieved optimal LDL-C control, there remains a residual risk of atherothrombotic cardiovascular disease (ACVD) related to alterations in lipid metabolism, where alterations in triglyceride-rich lipoproteins (TGRLP) and the cholesterol they contain, called remnant cholesterol, play a major role. Remnant cholesterol has an association with residual risk of CVD that is independent of LDL-C and has been demonstrated in epidemiological and Mendelian randomisation studies, and in analyses of clinical trials of lipid-lowering drugs. Remnant TGRLP particles are highly atherogenic, due to their ability to enter and be retained in the arterial wall, their high cholesterol content, their ability to generate “foam cells” and an inflammatory response. Assessment of remnant cholesterol may provide information on residual risk of ACVD beyond the information provided by LDL-C, Non-HDL-C, and apoB, particularly in individuals with hypertriglyceridaemia, type 2 diabetes, or metabolic syndrome. In the Reduce-It study, icosapent ethyl was shown to have a preventive effect against CVD in very high cardiovascular risk patients with hypertriglyceridaemia treated with statins and target LDL-C. New lipid-lowering drugs will help to define efficacy and criteria in the treatment of excess remnant cholesterol and hypertriglyceridaemia in the prevention of ACVD.
{"title":"Remnant cholesterol, vascular risk, and prevention of atherosclerosis","authors":"Xavier Pintó , Marta Fanlo , Virginia Esteve , Jesús Millán , on behalf of the Atherogenic Dyslipidemia Working Group, Spanish Society of Arteriosclerosis (SEA)","doi":"10.1016/j.artere.2023.07.005","DOIUrl":"https://doi.org/10.1016/j.artere.2023.07.005","url":null,"abstract":"<div><p><span>In patients<span> who have achieved optimal LDL-C control, there remains a residual risk of atherothrombotic cardiovascular disease (ACVD) related to alterations in lipid metabolism, where alterations in triglyceride-rich lipoproteins (TGRLP) and the cholesterol they contain, called </span></span><em>remnant cholesterol</em><span><span>, play a major role. Remnant cholesterol has an association with residual risk of CVD that is independent of LDL-C and has been demonstrated in epidemiological and Mendelian randomisation studies, and in analyses of </span>clinical trials<span> of lipid-lowering drugs. Remnant TGRLP particles are highly atherogenic, due to their ability to enter and be retained in the arterial wall, their high cholesterol content, their ability to generate “foam cells” and an inflammatory response. Assessment of remnant cholesterol may provide information on residual risk of ACVD beyond the information provided by LDL-C, Non-HDL-C, and apoB, particularly in individuals with hypertriglyceridaemia<span>, type 2 diabetes, or metabolic syndrome<span><span>. In the Reduce-It study, icosapent ethyl was shown to have a preventive effect against CVD in very high cardiovascular risk patients with hypertriglyceridaemia treated with statins and target LDL-C. New lipid-lowering drugs will help to define efficacy and criteria in the </span>treatment of excess remnant cholesterol and hypertriglyceridaemia in the prevention of ACVD.</span></span></span></span></p></div>","PeriodicalId":100263,"journal":{"name":"Clínica e Investigación en Arteriosclerosis (English Edition)","volume":"35 4","pages":"Pages 206-217"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49706054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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