Pub Date : 2025-03-12DOI: 10.1016/j.jacl.2025.02.008
Seyedmohammad Saadatagah, Mohammadreza Naderian, Miriam Larouche, Daniel Gaudet, Iftikhar J Kullo, Christie M Ballantyne
Background: Chylomicronemia is characterized by fasting triglyceride (TG) ≥1000 mg/dL; its longitudinal course is not well studied.
Methods: Using National Health and Nutrition Examination Survey (NHANES) data (1999-2018; n = 21,998), we determined chylomicronemia prevalence and temporal trend. Using Mayo Clinic data (4,524,506 TG measurements for 1,294,044 individuals), we studied the longitudinal course and ascertained persistent chylomicronemia (PC), defined as TG ≥1000 mg/dL in more than half the measurements for individuals with ≥3 measurements. We used logistic regression to assess factors associated with PC.
Results: In NHANES, the prevalence of chylomicronemia was 0.20% overall, with higher prevalence in men (0.32%) and Hispanics (0.33%). Chylomicronemia prevalence declined from 0.34% in 1999-2004 to 0.11% in 2013-2018, while lipid-lowering pharmacotherapy use in chylomicronemia patients increased from 5.3% to 51.9%. In the Mayo Clinic data, 5618 individuals (0.43%) had at least 1 episode of chylomicronemia. Of these, 8.8% (390 of 4443 with ≥3 measurements) met the operational definition for PC. In individuals with TG <150 mg/dL, 1.3% had a diagnosis of acute pancreatitis, and 0.6% had chronic pancreatitis. Respective figures for individuals with nonpersistent chylomicronemia were 12.5% and 5.1%, and for individuals with PC were 26.2% and 11.5%. Younger age, Hispanic ethnicity, prior pancreatitis, and higher TG levels were associated with PC.
Conclusion: In the US, 1 in ∼500 adults has chylomicronemia and 1 in ∼5500 has PC. Individuals with PC have high occurrence of acute and chronic pancreatitis and may need more effective treatment.
{"title":"Epidemiology and longitudinal course of chylomicronemia: Insights from NHANES and a large health care system.","authors":"Seyedmohammad Saadatagah, Mohammadreza Naderian, Miriam Larouche, Daniel Gaudet, Iftikhar J Kullo, Christie M Ballantyne","doi":"10.1016/j.jacl.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>Chylomicronemia is characterized by fasting triglyceride (TG) ≥1000 mg/dL; its longitudinal course is not well studied.</p><p><strong>Methods: </strong>Using National Health and Nutrition Examination Survey (NHANES) data (1999-2018; n = 21,998), we determined chylomicronemia prevalence and temporal trend. Using Mayo Clinic data (4,524,506 TG measurements for 1,294,044 individuals), we studied the longitudinal course and ascertained persistent chylomicronemia (PC), defined as TG ≥1000 mg/dL in more than half the measurements for individuals with ≥3 measurements. We used logistic regression to assess factors associated with PC.</p><p><strong>Results: </strong>In NHANES, the prevalence of chylomicronemia was 0.20% overall, with higher prevalence in men (0.32%) and Hispanics (0.33%). Chylomicronemia prevalence declined from 0.34% in 1999-2004 to 0.11% in 2013-2018, while lipid-lowering pharmacotherapy use in chylomicronemia patients increased from 5.3% to 51.9%. In the Mayo Clinic data, 5618 individuals (0.43%) had at least 1 episode of chylomicronemia. Of these, 8.8% (390 of 4443 with ≥3 measurements) met the operational definition for PC. In individuals with TG <150 mg/dL, 1.3% had a diagnosis of acute pancreatitis, and 0.6% had chronic pancreatitis. Respective figures for individuals with nonpersistent chylomicronemia were 12.5% and 5.1%, and for individuals with PC were 26.2% and 11.5%. Younger age, Hispanic ethnicity, prior pancreatitis, and higher TG levels were associated with PC.</p><p><strong>Conclusion: </strong>In the US, 1 in ∼500 adults has chylomicronemia and 1 in ∼5500 has PC. Individuals with PC have high occurrence of acute and chronic pancreatitis and may need more effective treatment.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-10DOI: 10.1016/j.jacl.2025.03.003
Christine Brichta, Justin R Ryder
{"title":"Metabolic syndrome in youth - Rite of passage or cause for concern?","authors":"Christine Brichta, Justin R Ryder","doi":"10.1016/j.jacl.2025.03.003","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.03.003","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-06DOI: 10.1016/j.jacl.2025.03.001
Xiangming Hu, Can Wang, Dejing Feng, Zhe Li, Yang Chen, Guannan Niu, Zheng Zhou, Hongliang Zhang, Yunqing Ye, Moyang Wang, Yongjian Wu
Background: Lipoprotein(a) (Lp[a]) has been identified as a significant risk factor for aortic stenosis (AS). However, its impact on outcomes post-transcatheter aortic valve replacement (TAVR) remains unknown.
Objective: To investigate the association between Lp(a) levels and long-term outcomes as well as its impact on the bioprosthetic valve degeneration in patients post-TAVR.
Methods: Patients with severe AS who underwent TAVR were consecutively recruited. Lp(a) was measured before TAVR procedure. The subjects were divided according to levels of Lp(a). The outcomes were all-cause mortality and possible structural valve degeneration (SVD) measured by Doppler echocardiography. Cox regression models and competing risk models were used to explore the association between Lp(a) levels and outcomes.
Results: Of the 601 included patients (mean age: 75.5 ± 7.2, male: 58.7%), 137 patients (22.7%) experienced mortality after a median follow-up of 3.9 years. After multivariable adjustment, elevated Lp(a) (defined as ≥30 mg/dL) was identified as an independent predictor of all-cause mortality (hazard ratio [HR]: 1.81, 95% CI: 1.27-2.57, P = .001) and cardiovascular mortality (HR: 2.02, 95% CI: 1.12-3.66, P = .020). Elevated Lp(a) was also associated with increased risk of possible SVD (subdistribution HR: 3.40, 95% CI: 1.32-8.79, P = .012). Using a threshold value of 50 mg/dL for elevated Lp(a) still supported the main findings.
Conclusions: Elevated baseline Lp(a) levels are associated with poor clinical outcomes and possible SVD in patients with severe AS undergoing TAVR. Further research is warranted to confirm these findings.
{"title":"Association between lipoprotein(a) and long-term prognosis in patients receiving transcatheter aortic valve replacement.","authors":"Xiangming Hu, Can Wang, Dejing Feng, Zhe Li, Yang Chen, Guannan Niu, Zheng Zhou, Hongliang Zhang, Yunqing Ye, Moyang Wang, Yongjian Wu","doi":"10.1016/j.jacl.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) (Lp[a]) has been identified as a significant risk factor for aortic stenosis (AS). However, its impact on outcomes post-transcatheter aortic valve replacement (TAVR) remains unknown.</p><p><strong>Objective: </strong>To investigate the association between Lp(a) levels and long-term outcomes as well as its impact on the bioprosthetic valve degeneration in patients post-TAVR.</p><p><strong>Methods: </strong>Patients with severe AS who underwent TAVR were consecutively recruited. Lp(a) was measured before TAVR procedure. The subjects were divided according to levels of Lp(a). The outcomes were all-cause mortality and possible structural valve degeneration (SVD) measured by Doppler echocardiography. Cox regression models and competing risk models were used to explore the association between Lp(a) levels and outcomes.</p><p><strong>Results: </strong>Of the 601 included patients (mean age: 75.5 ± 7.2, male: 58.7%), 137 patients (22.7%) experienced mortality after a median follow-up of 3.9 years. After multivariable adjustment, elevated Lp(a) (defined as ≥30 mg/dL) was identified as an independent predictor of all-cause mortality (hazard ratio [HR]: 1.81, 95% CI: 1.27-2.57, P = .001) and cardiovascular mortality (HR: 2.02, 95% CI: 1.12-3.66, P = .020). Elevated Lp(a) was also associated with increased risk of possible SVD (subdistribution HR: 3.40, 95% CI: 1.32-8.79, P = .012). Using a threshold value of 50 mg/dL for elevated Lp(a) still supported the main findings.</p><p><strong>Conclusions: </strong>Elevated baseline Lp(a) levels are associated with poor clinical outcomes and possible SVD in patients with severe AS undergoing TAVR. Further research is warranted to confirm these findings.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-05DOI: 10.1016/j.jacl.2025.03.002
Yi Chen, Yi Wang, Bingqian Ni, Guoli Ying, Jinshun Zhang
Background: Hypertriglyceridemia (HTG) is a prevalent metabolic disorder closely linked to cardiovascular diseases, diabetes, and other metabolic conditions. However, research examining the relationship between Helicobacter pylori (H. pylori) and HTG is limited. This study aimed to investigate the influence of H. pylori on HTG.
Methods: The study participants were individuals who underwent health examinations at Taizhou Hospital between 2017 and 2024. The subjects underwent hematological tests, anthropometric measurements, and urea breath tests. Logistic regression analysis was used to assess the relationship between H. pylori and HTG. Kaplan-Meier curves were utilized to compare HTG incidence between groups, and Cox regression models were applied to calculate associated hazard ratios.
Results: Logistic regression confirmed that H. pylori was a risk factor for HTG. Further cohort study indicated that prolonged H. pylori infection increased the risk of HTG, whereas H. pylori eradication led to a decrease in HTG incidence. Subgroup analyses demonstrated that the impact of H. pylori on HTG did not exhibit heterogeneity.
Conclusion: H. pylori was associated with an increased risk of HTG, and its eradication was crucial for reducing this risk.
{"title":"Relationship between Helicobacter pylori and hypertriglyceridemia in the population.","authors":"Yi Chen, Yi Wang, Bingqian Ni, Guoli Ying, Jinshun Zhang","doi":"10.1016/j.jacl.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.03.002","url":null,"abstract":"<p><strong>Background: </strong>Hypertriglyceridemia (HTG) is a prevalent metabolic disorder closely linked to cardiovascular diseases, diabetes, and other metabolic conditions. However, research examining the relationship between Helicobacter pylori (H. pylori) and HTG is limited. This study aimed to investigate the influence of H. pylori on HTG.</p><p><strong>Methods: </strong>The study participants were individuals who underwent health examinations at Taizhou Hospital between 2017 and 2024. The subjects underwent hematological tests, anthropometric measurements, and urea breath tests. Logistic regression analysis was used to assess the relationship between H. pylori and HTG. Kaplan-Meier curves were utilized to compare HTG incidence between groups, and Cox regression models were applied to calculate associated hazard ratios.</p><p><strong>Results: </strong>Logistic regression confirmed that H. pylori was a risk factor for HTG. Further cohort study indicated that prolonged H. pylori infection increased the risk of HTG, whereas H. pylori eradication led to a decrease in HTG incidence. Subgroup analyses demonstrated that the impact of H. pylori on HTG did not exhibit heterogeneity.</p><p><strong>Conclusion: </strong>H. pylori was associated with an increased risk of HTG, and its eradication was crucial for reducing this risk.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Current guidelines advocate achieving a fixed low-density lipoprotein cholesterol (LDL-C) target and ≥50% reduction in LDL-C levels. However, sufficient LDL-C reduction is often not achieved even in patients achieving a fixed LDL-C target.
OBJECTIVE
This study investigated the clinical impact of insufficient LDL-C reduction following lipid lowering therapy on cardiovascular outcomes in acute coronary syndrome (ACS) patients.
METHODS
A total of 561 consecutive ACS patients who had undergone percutaneous coronary intervention (PCI) and LDL-C level measurement at index PCI and 12 months afterwards were evaluated retrospectively. We investigated a relationship between ≥50% LDL-C reduction and cardiovascular events including the composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis.
RESULTS
Of the patients, 145 (25.8%) achieved ≥50% LDL-C reduction within 12 months. There were no significant differences in cardiovascular events between patients achieving the LDL-C target of 55 mg/dL and those not achieving it (23.6% vs 19.3%, P = .77), whereas the incidence of cardiovascular events was higher in the <50% LDL-C reduction group than the ≥50% LDL-C reduction group (26.0% vs 12.4%, P = .009). Even in patients with LDL-C < 55 mg/dL, cardiovascular events were more frequently in the <50% LDL-C reduction group than the ≥50% LDL-C reduction group (28.8% vs 13.2%, P = .04). Cox proportional hazard models revealed that <50% LDL-C reduction was an independent predictor of cardiovascular outcomes (hazard ratio: 2.03, 95% CI: 1.23-3.36).
CONCLUSION
The current study underscores the significance of achieving ≥50% LDL-C reduction in addition to a target of 55 mg/dL in preventing additional cardiovascular events in ACS patients.
{"title":"Clinical impact of ≥50% reduction of low density lipoprotein cholesterol following lipid lowering therapy on cardiovascular outcomes in patients with acute coronary syndrome","authors":"Shimpei Fujioka MD, Daisuke Shishikura MD, PhD, Hirofumi Kusumoto MD, Yohei Yamauchi MD, PhD, Kazushi Sakane MD, PhD, Tomohiro Fujisaka MD, PhD, Kensaku Shibata MD, PhD, Hideaki Morita MD, PhD, Yumiko Kanzaki MD, PhD, Masahito Michikura PhD, Mariko Harada-Shiba MD, PhD, Masaaki Hoshiga MD, PhD","doi":"10.1016/j.jacl.2024.10.010","DOIUrl":"10.1016/j.jacl.2024.10.010","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Current guidelines advocate achieving a fixed low-density lipoprotein cholesterol (LDL-C) target and ≥50% reduction in LDL-C levels. However, sufficient LDL-C reduction is often not achieved even in patients achieving a fixed LDL-C target.</div></div><div><h3>OBJECTIVE</h3><div>This study investigated the clinical impact of insufficient LDL-C reduction following lipid lowering therapy on cardiovascular outcomes in acute coronary syndrome (ACS) patients.</div></div><div><h3>METHODS</h3><div>A total of 561 consecutive ACS patients who had undergone percutaneous coronary intervention (PCI) and LDL-C level measurement at index PCI and 12 months afterwards were evaluated retrospectively. We investigated a relationship between ≥50% LDL-C reduction and cardiovascular events including the composite of cardiac death, myocardial infarction, target vessel revascularization and stent thrombosis.</div></div><div><h3>RESULTS</h3><div>Of the patients, 145 (25.8%) achieved ≥50% LDL-C reduction within 12 months. There were no significant differences in cardiovascular events between patients achieving the LDL-C target of 55 mg/dL and those not achieving it (23.6% vs 19.3%, <em>P</em> = .77), whereas the incidence of cardiovascular events was higher in the <50% LDL-C reduction group than the ≥50% LDL-C reduction group (26.0% vs 12.4%, <em>P</em> = .009). Even in patients with LDL-C < 55 mg/dL, cardiovascular events were more frequently in the <50% LDL-C reduction group than the ≥50% LDL-C reduction group (28.8% vs 13.2%, <em>P</em> = .04). Cox proportional hazard models revealed that <50% LDL-C reduction was an independent predictor of cardiovascular outcomes (hazard ratio: 2.03, 95% CI: 1.23-3.36).</div></div><div><h3>CONCLUSION</h3><div>The current study underscores the significance of achieving ≥50% LDL-C reduction in addition to a target of 55 mg/dL in preventing additional cardiovascular events in ACS patients.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 2","pages":"Pages 247-255"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jacl.2024.11.002
Kaye-Eileen Willard MD, FNLA , Don P. Wilson MD, FNLA , Elizabeth J. Jackson MSN, ACNS-BC, CLS, FNLA , Carol F. Kirkpatrick PhD, RDN, CLS, FNLA , Mary Katherine Cheeley PharmD, CLS, FNLA , Dinesh K. Kalra MD, FNLA
{"title":"Lipidology: The time is now for specialty recognition","authors":"Kaye-Eileen Willard MD, FNLA , Don P. Wilson MD, FNLA , Elizabeth J. Jackson MSN, ACNS-BC, CLS, FNLA , Carol F. Kirkpatrick PhD, RDN, CLS, FNLA , Mary Katherine Cheeley PharmD, CLS, FNLA , Dinesh K. Kalra MD, FNLA","doi":"10.1016/j.jacl.2024.11.002","DOIUrl":"10.1016/j.jacl.2024.11.002","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 2","pages":"Pages 197-204"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jacl.2025.04.001
P. Barton Duell MD, Kevin C. Maki PhD
{"title":"Oral semaglutide and reduction in major adverse cardiovascular events","authors":"P. Barton Duell MD, Kevin C. Maki PhD","doi":"10.1016/j.jacl.2025.04.001","DOIUrl":"10.1016/j.jacl.2025.04.001","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 2","pages":"Pages 195-196"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jacl.2024.12.014
Ulrich Laufs MD, PhD , A. Michael Lincoff MD , Stephen J. Nicholls MBBS, PhD , Na Li PhD , LeAnne Bloedon MS , William J. Sasiela PhD , Heather A. Powell PharmD , Peter M. Herout PharmD , Paul D. Thompson MD , Steven E. Nissen MD
BACKGROUND
Cholesterol Lowering via bEmpedoic Acid Regimen (CLEAR) outcomes, a randomized, double-blind, placebo-controlled cardiovascular outcomes trial, and the largest prospective database of patients with statin intolerance (SI), demonstrated that bempedoic acid reduces low-density lipoprotein cholesterol and cardiovascular risk in patients at high cardiovascular risk.
OBJECTIVE
Assess baseline differences in SI symptoms and whether these influenced the clinical course during CLEAR outcomes.
METHODS
Symptoms and impact of SI on daily living were recorded prior to randomization. This posthoc analysis grouped patients as reporting statin-associated muscle symptoms only (SAMS), nonmuscle adverse effects only (nonSAMS), or BOTH.
RESULTS
Of the 13,970 patients at baseline, 49% reported SAMS, 18% nonSAMS, and 33% BOTH. Moderate/severe impact on daily living was recorded for 62% SAMS, 48% nonSAMS, and 69% BOTH. Baseline lipid modifying treatment (LMT) was used in 43% SAMS, 36% nonSAMS, and 42% BOTH. Drop-in use of moderate/high-intensity statin at any time during the study was higher in the placebo group in all SI groups and higher in SAMS and BOTH vs nonSAMS, but was not generally maintained at study end. SAMS and BOTH groups had more muscle symptoms and higher rates of treatment discontinuation vs. nonSAMS but there was no difference between treatments.
CONCLUSION
Patients who reported SAMS, regardless of randomization to bempedoic acid or placebo, had higher rates of discontinuation, higher rates of skeletal muscle symptoms, and a greater percentage of patients to attempt statin rechallenge. These findings indicate patients with history of SAMS may have background factors impacting their tolerance to LMT and may require more focused clinical management.
ClinicalTrials.gov Identifier
NCT02993406
{"title":"Characteristics and outcomes of patients with and without statin-associated muscle symptoms treated with bempedoic acid in the CLEAR Outcomes trial","authors":"Ulrich Laufs MD, PhD , A. Michael Lincoff MD , Stephen J. Nicholls MBBS, PhD , Na Li PhD , LeAnne Bloedon MS , William J. Sasiela PhD , Heather A. Powell PharmD , Peter M. Herout PharmD , Paul D. Thompson MD , Steven E. Nissen MD","doi":"10.1016/j.jacl.2024.12.014","DOIUrl":"10.1016/j.jacl.2024.12.014","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Cholesterol Lowering via bEmpedoic Acid Regimen (CLEAR) outcomes, a randomized, double-blind, placebo-controlled cardiovascular outcomes trial, and the largest prospective database of patients with statin intolerance (SI), demonstrated that bempedoic acid reduces low-density lipoprotein cholesterol and cardiovascular risk in patients at high cardiovascular risk.</div></div><div><h3>OBJECTIVE</h3><div>Assess baseline differences in SI symptoms and whether these influenced the clinical course during CLEAR outcomes.</div></div><div><h3>METHODS</h3><div>Symptoms and impact of SI on daily living were recorded prior to randomization. This posthoc analysis grouped patients as reporting statin-associated muscle symptoms only (SAMS), nonmuscle adverse effects only (nonSAMS), or BOTH.</div></div><div><h3>RESULTS</h3><div>Of the 13,970 patients at baseline, 49% reported SAMS, 18% nonSAMS, and 33% BOTH. Moderate/severe impact on daily living was recorded for 62% SAMS, 48% nonSAMS, and 69% BOTH. Baseline lipid modifying treatment (LMT) was used in 43% SAMS, 36% nonSAMS, and 42% BOTH. Drop-in use of moderate/high-intensity statin at any time during the study was higher in the placebo group in all SI groups and higher in SAMS and BOTH vs nonSAMS, but was not generally maintained at study end. SAMS and BOTH groups had more muscle symptoms and higher rates of treatment discontinuation vs. nonSAMS but there was no difference between treatments.</div></div><div><h3>CONCLUSION</h3><div>Patients who reported SAMS, regardless of randomization to bempedoic acid or placebo, had higher rates of discontinuation, higher rates of skeletal muscle symptoms, and a greater percentage of patients to attempt statin rechallenge. These findings indicate patients with history of SAMS may have background factors impacting their tolerance to LMT and may require more focused clinical management.</div></div><div><h3>ClinicalTrials.gov Identifier</h3><div>NCT02993406</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 2","pages":"Pages 337-347"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Beyond glucose-lowering, sodium-glucose co-transporter 2 (SGLT2) inhibitors have cardioprotective effects with unclear mechanisms. We examined changes in an extensive panel of plasma lipids, lipoproteins, and apolipoproteins and whether these changes were independent of weight loss, hemoglobin A1c, and hematocrit in patients treated with empagliflozin vs placebo to better understand the observed cardioprotective effects.
METHODS
Post-hoc analyses of 2 double-blind, placebo-controlled trials, the Empire HF trial including 190 patients with heart failure and reduced ejection fraction and the SIMPLE trial including 90 patients with type 2 diabetes randomized to, respectively, 10 mg and 25 mg empagliflozin daily or placebo for 12 weeks.
RESULTS
In studies combined, empagliflozin reduced age and sex adjusted body weight by 1.40 kg (SEM: 0.10; P < .001) and hemoglobin A1c by 2.71 mmol/mol (SEM: 0.24; P < .001); and increased hematocrit by 1.9% (SEM: 0.12; P < .001) compared to placebo. No mean changes were seen in concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, small dense LDL cholesterol, very low-density lipoprotein cholesterol, triglyceride rich lipoprotein cholesterol, non-high-density lipoprotein (non-HDL) cholesterol, apolipoprotein B, lipoprotein(a), HDL cholesterol, and triglycerides adjusted for body weight, hemoglobin A1c, and hematocrit with empagliflozin compared to placebo.
CONCLUSION
Empagliflozin treatment reduced body weight and hemoglobin A1c, and increased hematocrit. No changes were seen in concentrations of lipids and lipoproteins with empagliflozin compared to placebo. This suggests that the cardioprotective effects of SGLT2 inhibitors are independent of lipid and lipoprotein concentrations.
{"title":"Effect of empagliflozin on plasma lipids and lipoproteins in type 2 diabetes and heart failure – Empire HF and SIMPLE","authors":"Frida Emanuelsson MD, PhD , Jesper Jensen MD, PhD , Massar Omar MD, PhD , Mikkel Jürgens MD, PhD , Caroline Kistorp MD, PhD , Niels H. Brandt-Jacobsen MD, PhD , Jacob Eifer Møller MD, PhD , Morten Schou MD, PhD , Louise Ellegaard Bechmann MD, PhD , Emil List Larsen MD, PhD , Børge G. Nordestgaard MD, PhD, DMSc , Marianne Benn MD, PhD, DMSc","doi":"10.1016/j.jacl.2024.12.015","DOIUrl":"10.1016/j.jacl.2024.12.015","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Beyond glucose-lowering, sodium-glucose co-transporter 2 (SGLT2) inhibitors have cardioprotective effects with unclear mechanisms. We examined changes in an extensive panel of plasma lipids, lipoproteins, and apolipoproteins and whether these changes were independent of weight loss, hemoglobin A1c, and hematocrit in patients treated with empagliflozin vs placebo to better understand the observed cardioprotective effects.</div></div><div><h3>METHODS</h3><div>Post-hoc analyses of 2 double-blind, placebo-controlled trials, the Empire HF trial including 190 patients with heart failure and reduced ejection fraction and the SIMPLE trial including 90 patients with type 2 diabetes randomized to, respectively, 10 mg and 25 mg empagliflozin daily or placebo for 12 weeks.</div></div><div><h3>RESULTS</h3><div>In studies combined, empagliflozin reduced age and sex adjusted body weight by 1.40 kg (SEM: 0.10; <em>P</em> < .001) and hemoglobin A1c by 2.71 mmol/mol (SEM: 0.24; <em>P</em> < .001); and increased hematocrit by 1.9% (SEM: 0.12; <em>P</em> < .001) compared to placebo. No mean changes were seen in concentrations of total cholesterol, low-density lipoprotein (LDL) cholesterol, small dense LDL cholesterol, very low-density lipoprotein cholesterol, triglyceride rich lipoprotein cholesterol, non-high-density lipoprotein (non-HDL) cholesterol, apolipoprotein B, lipoprotein(a), HDL cholesterol, and triglycerides adjusted for body weight, hemoglobin A1c, and hematocrit with empagliflozin compared to placebo.</div></div><div><h3>CONCLUSION</h3><div>Empagliflozin treatment reduced body weight and hemoglobin A1c, and increased hematocrit. No changes were seen in concentrations of lipids and lipoproteins with empagliflozin compared to placebo. This suggests that the cardioprotective effects of SGLT2 inhibitors are independent of lipid and lipoprotein concentrations.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 2","pages":"Pages 276-285"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.jacl.2024.12.012
Anish Adhikari MD , Aya Haghamad PharmD , Xueqi Huang MS , Joanna Fishbein MPH , Georgeta Vaidean MD, MPH, PhD , Jamie S. Hirsch MD , James M. Crawford MD, PhD , Maya Rubin MD , Monique Carrero-Tagle MS , Eugenia Gianos MD
Lipid goal attainment remains suboptimal due to patient, provider, and system level factors. We aimed to assess whether updated, guideline-based lipid reporting and clinical decision support was associated with different lipid-lowering therapy (LLT) prescription patterns. We conducted a retrospective study in our electronic health record (EHR) comparing prescriptions within 90 days of lab reporting both prior to the reporting change (21,417 patients in 2019-2020) and after (39,866 patients in 2020-2021). We found a significant increase in the initiation of LLT in patients > 40 years of age with low-density lipoprotein cholesterol (LDL-C) ≥ 100 mg/dL, with 2377 (11.6%) initiated prior to compared to 6205 (16.3%) after the reporting change (P < .001). Among 4469 adult patients with atherosclerotic cardiovascular disease and LDL-C ≥ 70 mg/dL prior to (n = 2040) and after (n = 3277) the reporting change, there was a significantly higher rate of LLT initiation, 444 (25.9%) prior to vs 875 (31.8%) after; P < .001. In conclusion, after implementation of updated guideline-based lipid test reporting, we observed higher initiation rates of LLT for indicated patients. Our study suggests that guideline-based reporting of lipid test results may aid in guideline implementation.
{"title":"Implementation of guideline-based lipid reporting and rate of lipid lowering therapy prescription","authors":"Anish Adhikari MD , Aya Haghamad PharmD , Xueqi Huang MS , Joanna Fishbein MPH , Georgeta Vaidean MD, MPH, PhD , Jamie S. Hirsch MD , James M. Crawford MD, PhD , Maya Rubin MD , Monique Carrero-Tagle MS , Eugenia Gianos MD","doi":"10.1016/j.jacl.2024.12.012","DOIUrl":"10.1016/j.jacl.2024.12.012","url":null,"abstract":"<div><div>Lipid goal attainment remains suboptimal due to patient, provider, and system level factors. We aimed to assess whether updated, guideline-based lipid reporting and clinical decision support was associated with different lipid-lowering therapy (LLT) prescription patterns. We conducted a retrospective study in our electronic health record (EHR) comparing prescriptions within 90 days of lab reporting both prior to the reporting change (21,417 patients in 2019-2020) and after (39,866 patients in 2020-2021). We found a significant increase in the initiation of LLT in patients > 40 years of age with low-density lipoprotein cholesterol (LDL-C) ≥ 100 mg/dL, with 2377 (11.6%) initiated prior to compared to 6205 (16.3%) after the reporting change (<em>P</em> < .001). Among 4469 adult patients with atherosclerotic cardiovascular disease and LDL-C ≥ 70 mg/dL prior to (n = 2040) and after (n = 3277) the reporting change, there was a significantly higher rate of LLT initiation, 444 (25.9%) prior to vs 875 (31.8%) after; <em>P</em> < .001. In conclusion, after implementation of updated guideline-based lipid test reporting, we observed higher initiation rates of LLT for indicated patients. Our study suggests that guideline-based reporting of lipid test results may aid in guideline implementation.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 2","pages":"Pages 358-363"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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