Current opinion in lipidology最新文献

Purpose of review: Elevated plasma lipoprotein(a) [Lp(a)] is a causal and independent risk factor for atherosclerotic cardiovascular disease and an emerging therapeutic target. Over the past 15 years, many medical bodies from around the world have released scientific statements and clinical guidelines regarding Lp(a). This review tracks how recommendations on Lp(a) have evolved over this timeframe.

Recent findings: Powerful studies demonstrating the independent association of elevated Lp(a) in large numbers of patients have been published. The data allowed a more precise formulation of risk categories for Lp(a) levels and of models for how a given level of Lp(a) in a moderate-risk to high-risk primary prevention patient might inform management of modifiable risk factors such as LDL cholesterol. Guidelines and statements have increasingly recommended universal screening for elevated Lp(a) and have identified elevated Lp(a) as a risk-enhancing or amplifying factor. However, some gaps and inconsistencies remain.

Summary: Ongoing cardiovascular outcomes trials of potent Lp(a)-lowering therapies will inform clinical use of Lp(a) in the future. Presently, consensus is building for measurement of Lp(a) in all adults and for incorporation of Lp(a) levels into clinical decision-making for prevention of cardiovascular disease. However, caution is warranted as the evidence base underlying this consensus has several important missing pieces.

Purpose of review: Low-grade systemic inflammation, as determined by high-sensitivity C-Reactive Protein (hsCRP), plays a significant role in the progression and development of atherosclerotic cardiovascular disease (ASCVD) and is recognized as a risk enhancer for increased incidence of major adverse cardiovascular events (MACE). (In 2024, the US Food and Drug Administration approved colchicine, as the first anti-inflammatory agent for secondary cardiovascular prevention. While this step signified a translational milestone, recent neutral colchicine trials such as CLEAR- SYNERGY, have reignited controversy regarding the overall efficacy of colchicine, and the need for alternative anti-inflammatory therapies. As the understanding of inflammation's role in atherosclerosis grows, questions persist about the best management strategies and future therapeutic options. This review aims to provide an updated summary that includes insights from recent key trials, explores investigational anti-inflammatory treatments, and discusses considerations for future trial designs.

Recent findings: This review will encompass recent trials involving colchicine, IL-1 antagonists, and interluekin-6 Inhibitors.

Summary: In this review, we will discuss mechanisms of inflammation as they pertain to ASCVD, significant contemporary trials, novel anti-inflammatory therapies, and considerations for future trial designs.

Purpose of review: Triglyceride-rich lipoproteins (TRLs) and LDL remain major drivers of atherosclerotic cardiovascular disease, and angiopoietin-like protein 3 (ANGPTL3) has emerged as a promising target to lower both triglycerides and LDL cholesterol (LDL-C). This review provides an overview on ANGPTL3 inhibition, including genetic insights and clinical evidence, and examines patient groups in which therapies may be particularly well suited to reduce residual cardiovascular risk.

Recent findings: Genetic studies have shown that carriers of ANGPTL3 loss-of-function variants exhibit lower levels of triglycerides and LDL-C, and a reduced cardiovascular risk. Evinacumab, a monoclonal antibody targeting ANGPTL3, lowers LDL-C by approximately 50% in patients with homozygous familial hypercholesterolemia (HoFH), in whom traditional lipid-lowering therapies are largely ineffective. In patients with mixed dyslipidemia, small interfering RNAs (e.g. zodasiran and solbinsiran) and antisense oligonucleotides (e.g. vupanorsen) achieve approximately 60% triglyceride and 20% LDL-C lowering, with the small interfering RNAs having a generally favorable safety profile.

Summary: ANGPTL3 inhibition offers an LDL receptor-independent means to lower atherogenic particles spanning from TRLs to LDL, complementing traditional lipid-lowering therapies. Evinacumab is practice-changing in HoFH, and RNA agents may soon broaden applicability to patients with mixed dyslipidemia and residual cardiovascular risk, pending cardiovascular outcomes trials.

Purpose of review: This review explores the evolving understanding of efferocytosis - the clearance of dead or dying cells by phagocytes - in the context of atherosclerosis. It highlights recent discovers in cell death modalities, impaired clearance mechanisms and emerging therapeutic strategies aimed at restoring efferocytosis to stabilize plaques and resolve inflammation.

Recent findings: Recent studies have expanded the scope of efferocytosis beyond apoptotic cells to include other pro-inflammatory cell death modes, including pyroptosis, necroptosis and ferroptosis, revealing context-dependent clearance efficiency and immunological outcomes. Novel mechanisms of impaired efferocytosis have been identified, including CD47- or CD147-mediated inhibition, efferocyte metabolic reprogramming and age-related MerTK cleavage. Therapeutic advances include nanoparticle-mediated delivery of SHP-1 inhibitors, engineered efferocytotic receptors, and treatment with resolvin D1 to enhance efferocytosis and reduce inflammation.

Summary: Efferocytosis is a critical process in maintaining vascular homeostasis and preventing plaque rupture in atherosclerosis. Its impairment contributes to necrotic core expansion and chronic inflammation. Advances in understanding the molecular regulation of efferocytosis and its therapeutic modulation offer new avenues for intervention. Targeting efferocytosis may complement lipid-lowering and/or anti-inflammatory therapies, representing a promising strategy for cardiovascular disease management.

Purpose of review: The causal role of LDL in atherosclerotic cardiovascular disease (ASCVD) is well established, but the contribution of HDL has proven more complex. CETP inhibitors were originally developed to increase HDL-cholesterol (HDL-C), but the failure of clinical trials and genetic evidence have changed our understanding of CETP biology. With the development of obicetrapib, a next-generation CETP inhibitor, there has been renewed interest in its therapeutic potential. This review summarizes the latest findings on CETP inhibition and highlights the evolving perspectives from lipid modulation to broader clinical applications.

Recent findings: Clinical trials and Mendelian randomisation consistently show that increasing HDL-C alone does not reduce cardiovascular risk, while lowering apoB-containing lipoproteins is associated with benefit. Off-target effects, modest efficacy or insufficient follow-up limited previous CETP inhibitors. Obicetrapib, in contrast, achieves a significant LDL-C and apoB reduction, a marked HDL-C increase and favourable safety. Beyond ASCVD, CETP inhibition may also have an impact on diabetes risk, cognitive function and possibly other conditions, although data are still preliminary.

Summary: The therapeutic focus has shifted from HDL-C elevation to apoB lowering as the determinant of cardiovascular benefit. Obicetrapib shows promise, with ongoing trials designed to define its role in ASCVD management.

Purpose of review: The review focusses on the role of liver transplantation, and rarely combined liver and heart transplantation, in the current management of homozygous familial hypercholesterolaemia (HoFH).

Recent findings: The review features world-wide reports published during the past 10 years describing the rationale and outcomes of liver transplantation for children and adults with HoFH. It also provides information on the scale of liver and heart transplantation for a variety of other disorders.

Summary: Liver transplantation provides a more effective means of lowering LDL than currently available alternatives such as apheresis and lomitapide but carries with it an unacceptably high risk of posttransplant morbidity and mortality. This is mainly due to the adverse effects of life-long immunosuppressive drug therapy, which restricts the use of liver transplantation to those HoFH patients in whom optimal medical therapy has failed.

Purpose of review: In 1994, the 4S trial was revolutionary by showing that cholesterol lowering with simvastatin reduced, not only atherosclerotic vascular disease (ASCVD) events, but also all-cause mortality as compared to placebo. During the following 30 years, statins have proved to be well tolerated and effective and also paved way for new innovations in the field of dyslipidaemia therapy.

Recent findings: The aim of this review is to summarize current knowledge about statins and effects of cholesterol-lowering accumulated in the wake of 4S trial: both vascular and nonvascular benefits, adverse effects, adherence, and statin intolerance. While secondary prevention of ASCVD has emphasized 'the lower the better' in LDL-cholesterol lowering, emerging topic is 'the longer the better' to reduce lifetime LDL burden and achieve full potential of ASCVD prevention. With statins as backbone therapy, new treatment innovations are in trials to better manage all atherosclerotic lipoproteins and residual risk.

Summary: After becoming generic, statins are inexpensive and well tolerated therapy with potential to substantially reduce the burden of atherosclerotic vascular disease world-wide. To achieve these goals, both accessibility and adherence are fundamental issues.

Purpose of review: Well conducted, prospective, blood-based biomarker studies on dementia risk are growing, providing valuable insights into disease mechanisms that precede clinical symptoms. These investigations are crucial for advancing our understanding of dementia pathology and identifying early biological changes.

Recent findings: Emerging evidence shows that proteins detected in peripheral tissues and the circulatory system can also play a role in neurological diseases. Both neuronal and nonbrain-specific proteins have been associated with dementia prior to symptom onset, highlighting the complex and multisystem nature of disease development. Of the 11 studies included in this review that focused on prospective studies of dementia that applied plasma proteomics, 36 proteins were identified in at least two independent cohorts, suggesting that blood-based proteomics detects consistent protein levels that may be altered years before dementia diagnosis.

Summary: Blood-based biomarkers hold promise for early diagnosis, patient stratification, and mechanistic research in dementia. The observed overlap in protein profiles across studies suggests we are beginning to uncover systemic biological differences that contribute to disease progression.

Purpose of review: Type 2 diabetes (T2D) is a heterogeneous, progressive metabolic disease and a major contributor to cardiovascular disease worldwide. Current prevention strategies, centred on population-level lifestyle recommendations, have had limited success, highlighting the need for more comprehensive approaches that account for interindividual variation in intervention response.

Recent findings: Although discrete T2D subtypes using genomics or clinical variables have been proposed for targeted diabetes prevention and care strategies, emerging evidence supports a more dynamic view of heterogeneity as a continuous spectrum of metabolic dysfunction. Continuous glucose monitoring and multiomics profiling have shown promises in detecting early metabolic dysfunction in individuals with normal glycemia.

Summary: In this review, we synthesize advances in modelling T2D phenotypic continuum and highlight how emerging technologies, including continuous glucose monitoring and multiomics profiling, can detect early metabolic dysregulation. We also discuss methodological challenges, such as the need for standardized deep phenotyping, robust analytic frameworks, and inclusion of diverse populations to ensure equity in translation. Finally, we outline future directions for translating these insights into scalable, mechanism-informed interventions that address glycaemic progression from subclinical changes to more advanced forms of the disease.

Purpose of review: Lipid metabolism and de-novo lipogenesis (DNL) is broadly controlled by the SREBP transcription factors. These transcription factors are matured from membrane-anchored precursor proteins by the proteolytic actions of the proteases S1P and S2P. In this review, we summarize the current understanding of SPRING, a recently identified activator of S1P.

Recent findings: Recent studies of SPRING using animal, cellular, biochemical, and biophysical methods have established SPRING as a core component of the SREBP machinery. Deletion of SPRING in cells and animal livers specifically reduces SREBP activity yet leaves other S1P substrates intact, demonstrating an SREBP-specific role for SPRING in licensing S1P activity. Mechanistic biochemical and structural studies revealed that SPRING activates S1P by competitively displacing its inhibitory pro-domain and elucidated how small molecule inhibition of S1P can be accomplished.

Summary: Current studies have shown how SPRING activates S1P and uncovered a critical role for SPRING in the SREBP pathway. Further studies are warranted to understand this emerging, connection between SPRING and the regulation of DNL through SREBP.