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Non adherence to lipid-lowering therapy and strategies to improve adherence 不坚持降脂治疗和改善坚持治疗的策略。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.01.006
Ashwani Mehta

Lipid lowering therapies is well-established to prevent cardiovascular events in adults with dyslipidemia and multiple risk factors. However, global clinical usage of LLT,particularly statins remains suboptimal, with adherence low rates for primary prevention and secondary prevention. Low adherence is influenced by concerns about side effects, misconceptions about benefits. Patients often discontinue statins due to perceived side effects, despite clinical trials showing no increase in symptoms compared to placebo. Poor understanding of statin benefits, doubts about their necessity, and suspicions of over prescription contribute to nonadherence, which is often amplified by negative portrayal of LLT specialy statins on social media. Strategies to improve adherence include addressing patient concerns, enhancing physician-patient communication, and increasing patient education. Optimizing statin usage and reducing the burden of cardiovascular disease necessitates addressing patient perceptions and improving communication between healthcare providers and patients.

对于血脂异常并存在多种危险因素的成年人来说,降脂疗法在预防心血管事件方面已得到广泛认可。然而,在全球范围内,降脂药物(尤其是他汀类药物)的临床使用情况仍不理想,一级预防和二级预防的依从性较低。患者对他汀类药物副作用的担忧和对其益处的误解影响了患者对他汀类药物的依从性。尽管临床试验表明,与安慰剂相比,他汀类药物的症状并没有增加,但患者往往会因为感觉到的副作用而停用他汀类药物。对他汀类药物的益处缺乏了解、对其必要性存在疑虑以及怀疑处方过量也是导致患者不坚持用药的原因之一,而社交媒体上对低剂量他汀类药物的负面描述往往会加剧这种情况。提高依从性的策略包括解决患者的顾虑、加强医患沟通和加强患者教育。要优化他汀类药物的使用并减轻心血管疾病的负担,就必须解决患者的看法问题,并改善医疗服务提供者与患者之间的沟通。
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引用次数: 0
Pediatric hyperlipidemia 小儿高脂血症
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.11.269
Ankit Garg, S. Radhakrishnan

The leading cause of mortality worldwide is atherosclerotic cardiovascular disease. Atherosclerotic plaques are well known to originate early in the childhood. Identifying hyperlipidemia in early childhood creates an opportunity to prevent major cardiovascular events in adults. Children with identified risk factors are at an increased risk of developing cardiovascular incidents in later life. This article emphasizes the diagnosis and management of pediatric hyperlipidemia with reference to the recent guidelines. In terms of etiology pediatric hyperlipidemia are divided into primary and secondary causes. The mainstay of management includes high-risk target screening, early risk factor identification and lifestyle modifications in vulnerable population. Drug therapy is recommended in primary hyperlipidemia and in children with no response to lifestyle changes.

动脉粥样硬化性心血管疾病是导致全球死亡的主要原因。众所周知,动脉粥样硬化斑块起源于儿童早期。在儿童早期发现高脂血症为预防成年后发生重大心血管事件创造了机会。具有已识别风险因素的儿童日后发生心血管事件的风险会增加。本文将参照最新指南,重点介绍小儿高脂血症的诊断和管理。就病因而言,小儿高脂血症分为原发性和继发性两种。治疗的主要方法包括高危目标筛查、早期危险因素识别以及对易感人群进行生活方式调整。对于原发性高脂血症和对改变生活方式无反应的儿童,建议采用药物治疗。
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引用次数: 0
Familial hypercholesterolemia 家族性高胆固醇血症
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.12.002
J.P.S. Sawhney, Kushal Madan

Familial hypercholesterolemia is a common genetic disorder of autosomal inheritance associated with elevated LDL-cholesterol. It is estimated to affect 1:250 individuals in general population roughly estimated to be 5 million in India. The prevalence of FH is higher in young CAD patients (<55 years in men; <60 years in women). FH is underdiagnosed and undertreated. Screening during childhood and Cascade screening of family members of known FH patients is of utmost importance in order to prevent the burden of CAD. Early identification of FH patients and early initiation of the lifelong lipid lowering therapy is the most effective strategy for managing FH. FH management includes pharmaceutical agents (statins and non statin drugs) and lifestyle modification. Inspite of maximum dose of statin with or without Ezetimibe, if target levels of LDL-C are not achieved, Bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9) Inhibitors/Inclisiran can be added.

家族性高胆固醇血症是一种常见的常染色体遗传疾病,与低密度脂蛋白胆固醇升高有关。据估计,在印度,该病的发病率约为总人口的 1:250,约 500 万人。FH在年轻的CAD患者(男性55岁;女性60岁)中发病率较高。FH诊断不足,治疗不力。在儿童时期进行筛查,并对已知 FH 患者的家庭成员进行级联筛查,对于防止加重 CAD 负担至关重要。早期发现 FH 患者并尽早开始终身降脂治疗是控制 FH 的最有效策略。FH 的治疗包括药物(他汀类和非他汀类药物)和生活方式的改变。尽管服用了最大剂量的他汀类药物(无论是否服用依折麦布),如果低密度脂蛋白胆固醇(LDL-C)仍未达到目标水平,可加用本贝多酸、9 型丙蛋白转换酶枯草酶/kexin(PCSK9)抑制剂/英克利西兰(Inclisiran)。
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引用次数: 0
Balloon pulmonary valvuloplasty: A systematic review 球囊肺动脉瓣成形术:系统综述。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.12.007
P. Syamasundar Rao

There is conclusive evidence for relief of pulmonary valve obstruction immediately after balloon pulmonary valvuloplasty (BPV) and at follow-up. Development of infundibular obstruction is seen in more severe PS cases and in older subjects. Reappearance of PS was observed in approximately 10 % of patients following BPV. The reasons for recurrence were found to be balloon/annulus ratio less than 1.2 and immediate post-BPV pulmonary valve peak gradients greater than 30 mmHg. Recurrent stenosis is successfully addressed by repeating BPV with lager balloons than used initially. Long-term results revealed continue relief of obstruction, but with development of pulmonary insufficiency, some patients requiring replacement of the pulmonary valve. It was concluded that BPV is the treatment of choice in the management valvar PS and that balloon/annuls ratio used for BPV should be lowered to 1.2 to 1.25. It was also suggested that strategies should be developed to prevent/reduce pulmonary insufficiency at long-term follow-up.

有确凿证据表明,球囊肺动脉瓣成形术(BPV)术后和随访期间,肺动脉瓣阻塞立即得到缓解。较严重的 PS 病例和年龄较大的受试者会出现肺底梗阻。约有 10% 的患者在 BPV 术后再次出现 PS。发现复发的原因是球囊/瓣环比小于 1.2,以及 BPV 术后肺动脉瓣峰值梯度大于 30 mmHg。通过使用比最初使用的更大的球囊重复进行 BPV,可以成功解决复发性狭窄问题。长期结果显示,阻塞继续得到缓解,但肺不张有所发展,一些患者需要更换肺动脉瓣。结论是 BPV 是治疗瓣膜 PS 的首选方法,BPV 使用的球囊/annuls 比率应降至 1.2 至 1.25。还有人建议,在长期随访中应制定预防/减少肺不张的策略。
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引用次数: 0
Role of PCSK9 inhibitors in the management of dyslipidaemia PCSK9 抑制剂在治疗血脂异常中的作用。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.12.011
Tiny Nair

Proprotein convertase subtilisin kexin9 (PCSK9) inhibitors are novel agents that lower LDL cholesterol and reduce cardio-vascular event rate. Being expensive, these agents are reserved for those with high risk or very high risk of CV events and with suboptimal response to statins and ezetimibe, with or without bempedoic acid or those intolerant to statins.

Proprotein convertase subtilisin kexin9(PCSK9)抑制剂是一种新型药物,可降低低密度脂蛋白胆固醇并减少心血管事件发生率。由于价格昂贵,这些药物只适用于心血管事件高风险或极高风险患者,以及对他汀类药物和依折麦布(含或不含贝美多酸)反应不佳的患者或对他汀类药物不耐受的患者。
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引用次数: 0
Indian dyslipidaemia guidelines: Need of the hour 印度血脂异常指南:当务之急。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.01.008
Jitendra Pal Singh Sawhney, Rajeev Gupta
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引用次数: 0
Management of dyslipidemia in special groups 特殊群体的血脂异常管理。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.01.018
Jayagopal P B , Prafulla G. Kerkar

Dyslipidemia management in situations like pregnancy, in diseases like rheumatoid arthritis, human immunodeficiency virus (HIV) disease, chronic liver disease, and in the elderly are challenging scenarios. Pregnancy is a contraindication for many drugs. The interaction of various drugs used in HIV infection and rheumatoid arthritis makes it even more difficult to treat with conventional and approved drugs for dyslipidemia. Elderly and chronic renal failure patients often do not tolerate the drugs very well and the data of dyslipidemia management is very different. Lastly, COVID-19 is a unique scenario where clear information is yet to be provided. In this manuscript, the current understanding and available data on the treatment of dyslipidemia in these special situations are discussed.

在妊娠、类风湿性关节炎、人类免疫缺陷病毒(HIV)疾病、慢性肝病等疾病以及老年人等情况下,血脂异常的治疗都具有挑战性。妊娠是许多药物的禁忌症。艾滋病毒感染和类风湿性关节炎所用的各种药物之间的相互作用,使血脂异常的常规和批准药物的治疗变得更加困难。老年患者和慢性肾功能衰竭患者对药物的耐受性往往不佳,血脂异常的治疗数据也大相径庭。最后,COVID-19 是一种尚未提供明确信息的特殊情况。本手稿将讨论目前对这些特殊情况下血脂异常治疗的理解和现有数据。
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引用次数: 0
Trends in epidemiology of dyslipidemias in India 印度血脂异常流行病学趋势。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.11.266
Sonali Sharma , Kiran Gaur , Rajeev Gupta

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. High total cholesterol and its principal subtypes: low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (NHDL) cholesterol are the most important. Epidemiological and Mendelian randomization studies have confirmed role of raised triglycerides and lipoprotein(a). INTERHEART study reported a significant association of raised ApoB/ApoA1, total-, LDL-, and NHDL-cholesterol in South Asians. Prospective Urban Rural Epidemiology (PURE) study identified raised NHDL cholesterol as the most important risk factor. Regional and multisite epidemiological studies in India have reported increasing population levels of total-, LDL-, and NHDL cholesterol and triglycerides. India Heart Watch reported higher prevalence of total and LDL cholesterol in northern and western Indian cities. ICMR-INDIAB study reported regional variations in hypercholesterolemia (≥200 mg/dl) from 4.6 % to 50.3 %, with greater prevalence in northern states, Kerala, Goa, and West Bengal. Non-Communicable Disease Risk Factor Collaboration and Global Burden of Diseases Studies have reported increasing LDL- and NHDL-cholesterol in India. Studies among emigrant Indians in UK and USA have reported higher triglycerides in compared to Caucasians. Identification of regional variations and trends in dyslipidemias need more nationwide surveys. Prospective studies are needed to assess quantum of risk with CAD incidence.

血脂异常是最重要的冠状动脉疾病(CAD)风险因素。高总胆固醇及其主要亚型:低密度脂蛋白(LDL)胆固醇和非高密度脂蛋白(NHDL)胆固醇是最重要的因素。流行病学和孟德尔随机研究证实了甘油三酯和脂蛋白(a)升高的作用。INTERHEART 研究报告称,南亚人的载脂蛋白 B/载脂蛋白 A1、总胆固醇、低密度脂蛋白和非高密度脂蛋白胆固醇升高有显著关联。前瞻性城市农村流行病学(PURE)研究发现,NHDL 胆固醇升高是最重要的风险因素。印度的地区性和多地点流行病学研究报告显示,总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇和甘油三酯的人群水平不断上升。印度心脏观察报告称,印度北部和西部城市的总胆固醇和低密度脂蛋白胆固醇患病率较高。ICMR-INDIAB 研究报告显示,高胆固醇血症(≥200 mg/dl)的地区差异从 4.6 % 到 50.3 % 不等,北部各邦、喀拉拉邦、果阿邦和西孟加拉邦的发病率更高。非传染性疾病危险因素合作组织和全球疾病负担研究报告称,印度的低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇不断增加。对英国和美国移民印度人的研究报告显示,他们的甘油三酯高于白种人。要确定血脂异常的地区差异和趋势,需要进行更多的全国性调查。需要进行前瞻性研究,以评估与 CAD 发病率相关的风险量子。
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引用次数: 0
The potential influence of GSTT1 null genetic polymorphism on coronary artery disease: A pilot study in a South Indian cohort GSTT1 空基因多态性对冠心病的潜在影响:一项在南印度队列中进行的试点研究。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.03.002
Pranesh Rajamuthiah , Sabari Krishnan B B , Sharon Benita Antony , Teena Koshy

Background

Indians are known to have the highest rates of coronary artery disease (CAD), with the conventional risk factors failing to explain the increased risk. Possible candidate genes to study both the environmental and genetic risk associated with CAD is the glutathione S-transferase (GST) family, as it is involved in detoxification.

Methods

This case–control assessed the association between GSTM1 and GSTT1 polymorphisms in Indian patients with CAD. Fifty patients with CAD and 50 healthy volunteers were genotyped for the two polymorphisms by polymerase chain reaction. The genotype frequencies between the groups were compared, where a p-value of less than 0.05 was considered as statistically significant.

Results

There was a significant inverse association between GSTT1 null polymorphism and CAD susceptibility.

背景:众所周知,印度人罹患冠状动脉疾病(CAD)的比例最高,而传统的风险因素无法解释这种风险的增加。研究与 CAD 相关的环境和遗传风险的可能候选基因是谷胱甘肽 S-转移酶(GST)家族,因为它参与解毒:该病例对照评估了印度 CAD 患者中 GSTM1 和 GSTT1 多态性之间的关联。通过聚合酶链反应对 50 名 CAD 患者和 50 名健康志愿者进行了这两种多态性的基因分型。比较两组之间的基因型频率,P 值小于 0.05 即为具有统计学意义:结果:GSTT1 空多态性与 CAD 易感性之间存在明显的反相关性。
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引用次数: 0
CSI clinical practice guidelines for dyslipidemia management: Executive summary CSI 血脂异常管理临床实践指南:执行摘要。
IF 1.5 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.11.271
Jitendra PS. Sawhney , Sivasubramanian Ramakrishnan , Kushal Madan , Saumitra Ray , P Balagopalan Jayagopal , Dorairaj Prabhakaran , Tiny Nair , Geevar Zachariah , Peeyush Jain , Jamshed Dalal , Sitaraman Radhakrishnan , Arun Chopra , Sanjay Kalra , Ashwani Mehta , Arvind K. Pancholia , Nitin K. Kabra , Dhiman Kahali , Tapan Ghose , Satyavir Yadav , Prafulla Kerkar , Rajeev Gupta

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the ‘CSI: Clinical Practice Guidelines for Dyslipidemia Management’ published in this issue of the Indian Heart Journal. The summary is focused on the busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttransplant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also presented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the individual clinician judgement who remains the sole arbiter in management of the patient.

血脂异常是冠状动脉疾病(CAD)最重要的危险因素。适当的血脂异常管理是控制早发性冠心病在印度流行的关键。印度心脏病学会努力制定基于共识的指南,以更好地预防和治疗冠心病的脂质管理。执行摘要提供了“CSI:血脂异常管理临床实践指南”的鸟瞰图,发表在本期《印度心脏杂志》上。摘要的重点是忙碌的临床医生,并鼓励循证管理的病人和高危个体。摘要对脂质管理的各个方面进行了序列化,包括流行病学和冠心病风险分类。重点是管理与印度饲养的低密度脂蛋白(LDL)胆固醇、非高密度脂蛋白胆固醇(non-HDL-C)、载脂蛋白、甘油三酯和脂蛋白(a)相关的特异性血脂异常。本文总结了降低血脂的药物治疗(他汀类药物、非他汀类药物和其他药物)和生活方式管理(饮食干预、体育活动和瑜伽)。血脂异常的管理经常被忽视的患者表型-老年人,年轻人和儿童,以及合并症-中风,外周动脉疾病,肾衰竭,移植后,HIV(人类免疫缺陷病毒),Covid-19和家族性高胆固醇血症的患者也被提出。这一共识声明是基于主要的国际指南(主要是欧洲)和来自印度的脂质管理领导者的专家意见,重点是格言:越早越好,越低越好,越长越好,一起越好。这些共识指南不能取代个人临床医生的判断,谁仍然是唯一的仲裁者在病人的管理。
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引用次数: 0
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Indian heart journal
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