Pub Date : 2026-01-01DOI: 10.1016/j.jacl.2025.09.006
Macit Kalçık MD
{"title":"Reconsidering uric acid to HDL ratio as a predictor of vascular calcification","authors":"Macit Kalçık MD","doi":"10.1016/j.jacl.2025.09.006","DOIUrl":"10.1016/j.jacl.2025.09.006","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 220-221"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957753","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 : 2026-01-01DOI: 10.1016/j.jacl.2025.10.057
Adam Chang MD , Andrew Cyr MD , Spencer Weintraub MD , Rahul Rege MD , Merle Myerson MD, EdD, FACC, FNLA , Benjamin J Hirsh MD, FACC, FAHA, FNLA
The global obesity epidemic poses significant challenges for patients, providers, and our public health system. Early identification of patients at risk for obesity-related disease is essential to address these challenges and requires clear definitions and characterizations of obesity at all stages of disease. Reliance on body mass index (BMI) to define obesity overlooks crucial phenotypic heterogeneity and its impact on cardiometabolic risk. This review summarizes the benefits and disadvantages of current and proposed measures to characterize obesity. We summarize methods to diagnose obesity that have a greater association with atherosclerotic cardiovascular disease and mortality. These methods include anthropometric measurements, inflammatory biomarkers, dual energy X-ray absorptiometry (DEXA) and magnetic resonance imaging (MRI)-measured visceral adiposity, and cardiorespiratory fitness. We further review proposed frameworks for defining obesity and assess their ability for early and appropriate identification of patients with and without obesity-related organ dysfunction. The way we define obesity has implications for clinical diagnosis and management and can impact how third-party payors reimburse for specific interventions.
{"title":"How is obesity defined? Moving beyond the limitations of current measures to redefine obesity","authors":"Adam Chang MD , Andrew Cyr MD , Spencer Weintraub MD , Rahul Rege MD , Merle Myerson MD, EdD, FACC, FNLA , Benjamin J Hirsh MD, FACC, FAHA, FNLA","doi":"10.1016/j.jacl.2025.10.057","DOIUrl":"10.1016/j.jacl.2025.10.057","url":null,"abstract":"<div><div>The global obesity epidemic poses significant challenges for patients, providers, and our public health system. Early identification of patients at risk for obesity-related disease is essential to address these challenges and requires clear definitions and characterizations of obesity at all stages of disease. Reliance on body mass index (BMI) to define obesity overlooks crucial phenotypic heterogeneity and its impact on cardiometabolic risk. This review summarizes the benefits and disadvantages of current and proposed measures to characterize obesity. We summarize methods to diagnose obesity that have a greater association with atherosclerotic cardiovascular disease and mortality. These methods include anthropometric measurements, inflammatory biomarkers, dual energy X-ray absorptiometry (DEXA) and magnetic resonance imaging (MRI)-measured visceral adiposity, and cardiorespiratory fitness. We further review proposed frameworks for defining obesity and assess their ability for early and appropriate identification of patients with and without obesity-related organ dysfunction. The way we define obesity has implications for clinical diagnosis and management and can impact how third-party payors reimburse for specific interventions.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 9-20"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196885","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}
Obesity is a global epidemic with rapidly increasing prevalence over the recent years. Its rise is paralleled by a similar trend in cardiovascular disease (CVD) risk factors and events, which have become the leading cause of death in many countries.
SOURCES OF MATERIAL
This review focuses on the relationship between obesity, CVD risk, and risk factors and the management strategies that can treat both the resulting co-morbidities as well as the underlying obesity.
ABSTRACT OF FINDINGS
Obesity is associated with overall CVD events and atherosclerosis as well as the individual risk factors including diabetes mellitus, obstructive sleep apnea, dyslipidemia, hypertension, arrhythmias, preeclampsia and gestational diabetes. Treatment with lifestyle interventions, approved medications and surgical procedures lead to improvements in CVD risk factors and events, proportional to the rates' and the effects' duration of weight loss achieved. Resources used to prepare this review include the latest international clinical practice guidelines, the largest meta-analyses of prospective, randomized, controlled trials, observational studies and obesity treatment studies, along with pertinent review articles on the effects of obesity and its treatments on CVD risk and risk factors.
CONCLUSION
Diagnosis and management of CVD risk factors is an important aspect of an obesity management plan along with the overarching goal of addressing the causes of this global epidemic through collaboration and incorporation of preventive, diagnostic and therapeutic strategies individualized to the ethnic, social and financial needs of each population with the aim to reduce the prevalence of CVD risk factors and the incidence of CVD events.
{"title":"The association of obesity with cardiovascular disease risk and risk-enhancing factors","authors":"Rodis D. Paparodis MD, FNLA , Dimitra Bantouna MD , Sarantis Livadas MD, PhD , Nicholaos Angelopoulos MD, MSc, PhDc","doi":"10.1016/j.jacl.2025.08.018","DOIUrl":"10.1016/j.jacl.2025.08.018","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Obesity is a global epidemic with rapidly increasing prevalence over the recent years. Its rise is paralleled by a similar trend in cardiovascular disease (CVD) risk factors and events, which have become the leading cause of death in many countries.</div></div><div><h3>SOURCES OF MATERIAL</h3><div>This review focuses on the relationship between obesity, CVD risk, and risk factors and the management strategies that can treat both the resulting co-morbidities as well as the underlying obesity.</div></div><div><h3>ABSTRACT OF FINDINGS</h3><div>Obesity is associated with overall CVD events and atherosclerosis as well as the individual risk factors including diabetes mellitus, obstructive sleep apnea, dyslipidemia, hypertension, arrhythmias, preeclampsia and gestational diabetes. Treatment with lifestyle interventions, approved medications and surgical procedures lead to improvements in CVD risk factors and events, proportional to the rates' and the effects' duration of weight loss achieved. Resources used to prepare this review include the latest international clinical practice guidelines, the largest meta-analyses of prospective, randomized, controlled trials, observational studies and obesity treatment studies, along with pertinent review articles on the effects of obesity and its treatments on CVD risk and risk factors.</div></div><div><h3>CONCLUSION</h3><div>Diagnosis and management of CVD risk factors is an important aspect of an obesity management plan along with the overarching goal of addressing the causes of this global epidemic through collaboration and incorporation of preventive, diagnostic and therapeutic strategies individualized to the ethnic, social and financial needs of each population with the aim to reduce the prevalence of CVD risk factors and the incidence of CVD events.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 26-37"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196887","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 : 2026-01-01DOI: 10.1016/j.jacl.2025.07.004
Casey Berman MD , Brenda Kohn MD , Don Wilson MD
BACKGROUND
The obesity epidemic in the United States affects not only adults, but children and adolescents.
SOURCES OF MATERIAL
An extensive review of the literature including 85 articles has been completed with the aim of providing the most current definitions and recommendations for this chronic condition.
ABSTACT OF FINDINGS
This article reviews the definition of pediatric obesity, the increasing prevalence of obesity in children and adolescents, genetic and environmental risk factors, as well as the unique aspects and implications of this condition and its associated comorbidities for this population in comparison to adults. Current management recommendations are also discussed which include Intensive Health Behavioral and Lifestyle Treatment (IHBLT), metabolic surgery, and pharmacologic therapy including glucago-like peptide-1 receptor agonists (GLP-1RAs).
CONCLUSION
Childhood obesity is a unique condition in its progression and management requirements, and should be approached with a focus on prevention as well as on the high-risk individual.
{"title":"Obesity in children and adolescents","authors":"Casey Berman MD , Brenda Kohn MD , Don Wilson MD","doi":"10.1016/j.jacl.2025.07.004","DOIUrl":"10.1016/j.jacl.2025.07.004","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The obesity epidemic in the United States affects not only adults, but children and adolescents.</div></div><div><h3>SOURCES OF MATERIAL</h3><div>An extensive review of the literature including 85 articles has been completed with the aim of providing the most current definitions and recommendations for this chronic condition.</div></div><div><h3>ABSTACT OF FINDINGS</h3><div>This article reviews the definition of pediatric obesity, the increasing prevalence of obesity in children and adolescents, genetic and environmental risk factors, as well as the unique aspects and implications of this condition and its associated comorbidities for this population in comparison to adults. Current management recommendations are also discussed which include Intensive Health Behavioral and Lifestyle Treatment (IHBLT), metabolic surgery, and pharmacologic therapy including glucago-like peptide-1 receptor agonists (GLP-1RAs).</div></div><div><h3>CONCLUSION</h3><div>Childhood obesity is a unique condition in its progression and management requirements, and should be approached with a focus on prevention as well as on the high-risk individual.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 97-110"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196891","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 : 2026-01-01DOI: 10.1016/j.jacl.2025.10.067
Elizabeth J. Jackson MSN, ACNS-BC, CLS, FNLA, FACC , Mariana Henry MD, MPH , Kaye-Eileen Willard MD, FNLA
BACKGROUND
Obesity is a complex, chronic disease influenced by genetic, environmental, behavioral, and psychosocial factors. While lifestyle modification remains the foundation of treatment, it is often insufficient for sustained weight loss and cardiometabolic risk reduction. The rising prevalence of obesity and its link to comorbidities such as type 2 diabetes, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease necessitate a comprehensive, multidisciplinary approach to care.
OBJECTIVES
To correlate the pathophysiology of adiposopathic atherogenic dyslipidemia with the need for patient-centered, team-based management strategies that improve long-term outcomes.
METHODS
This review describes the structure and function of interdisciplinary obesity care teams, highlighting the roles of lipid specialists, physicians, advanced practice providers, clinical pharmacists, registered dietitians, behavioral health professionals, and exercise specialists. The use of shared care plans, case reviews, electronic health record tools, and emerging technologies such as nutrigenetic testing is explored.
RESULTS
Multidisciplinary care improves outcomes by addressing obesity’s complexity, supporting adherence to evidence-based therapies, and reducing barriers to treatment. Challenges such as payer-related prior authorization delays and the social stigma of obesity remain obstacles to engagement and long-term success, underscoring the need for scalable, collaborative care models.
CONCLUSIONS
Team-based, proactive, and individualized care is essential for effective obesity management. Health systems that invest in interdisciplinary approaches are better positioned to reduce the clinical, psychological, and economic burden of obesity and its complications.
{"title":"Team-based care and the role of the lipid specialist in obesity management","authors":"Elizabeth J. Jackson MSN, ACNS-BC, CLS, FNLA, FACC , Mariana Henry MD, MPH , Kaye-Eileen Willard MD, FNLA","doi":"10.1016/j.jacl.2025.10.067","DOIUrl":"10.1016/j.jacl.2025.10.067","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Obesity is a complex, chronic disease influenced by genetic, environmental, behavioral, and psychosocial factors. While lifestyle modification remains the foundation of treatment, it is often insufficient for sustained weight loss and cardiometabolic risk reduction. The rising prevalence of obesity and its link to comorbidities such as type 2 diabetes, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease necessitate a comprehensive, multidisciplinary approach to care.</div></div><div><h3>OBJECTIVES</h3><div>To correlate the pathophysiology of adiposopathic atherogenic dyslipidemia with the need for patient-centered, team-based management strategies that improve long-term outcomes.</div></div><div><h3>METHODS</h3><div>This review describes the structure and function of interdisciplinary obesity care teams, highlighting the roles of lipid specialists, physicians, advanced practice providers, clinical pharmacists, registered dietitians, behavioral health professionals, and exercise specialists. The use of shared care plans, case reviews, electronic health record tools, and emerging technologies such as nutrigenetic testing is explored.</div></div><div><h3>RESULTS</h3><div>Multidisciplinary care improves outcomes by addressing obesity’s complexity, supporting adherence to evidence-based therapies, and reducing barriers to treatment. Challenges such as payer-related prior authorization delays and the social stigma of obesity remain obstacles to engagement and long-term success, underscoring the need for scalable, collaborative care models.</div></div><div><h3>CONCLUSIONS</h3><div>Team-based, proactive, and individualized care is essential for effective obesity management. Health systems that invest in interdisciplinary approaches are better positioned to reduce the clinical, psychological, and economic burden of obesity and its complications.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 111-125"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196892","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 : 2026-01-01DOI: 10.1016/j.jacl.2025.10.062
Manuel Castro Cabezas PhD, MD , Mattea Orsini PhD , Lale Tokgözoğlu MD , Nikolaus Marx MD , José Tuñón MD , Michal Vrablík MD, PhD , Hagai Tavori PhD , Deepak L. Bhatt MD, MPH, MBA , Pasquale Perrone-Filardi MD
BACKGROUND
This post hoc analysis aimed to determine the efficacy and safety of alirocumab vs placebo or ezetimibe in patients with established atherosclerotic cardiovascular disease (ASCVD), but without previous acute coronary syndrome (ACS; myocardial infarction/unstable angina) or stroke.
METHODS
Data were pooled from 12 phase 3 ODYSSEY studies with alirocumab. Adults with established ASCVD, without prior ischemic event (ACS or stroke) were included. Data were analyzed in 3 pools: pool 1 (alirocumab 75/150 mg once every 2 weeks [Q2W] vs ezetimibe), and pools 2 and 3 (alirocumab 75/150 mg Q2W or 150 mg Q2W, respectively, vs placebo). Primary objectives were percentage change in calculated low-density lipoprotein cholesterol (LDL-C) levels from baseline to week 24 and percentage of patients with treatment-emergent adverse events (TEAEs).
RESULTS
Overall, 963 patients were identified with ASCVD (without previous ACS or stroke). At baseline, mean calculated LDL-C levels ranged from 112.0 to 123.5 mg/dL across all pools. Alirocumab resulted in a significantly greater reduction in LDL-C levels at week 24 (pool 1: 51.5% reduction; pool 2: 47.8% reduction; pool 3: 60.9% reduction; P < .0001 for all), vs ezetimibe and placebo across all pools. The percentage of patients who experienced TEAEs was similar in the alirocumab and comparator arms (pool 1: 74.8% for alirocumab and 76.5% for ezetimibe; pools 2 and 3: 81.4% for alirocumab and 78.9% for placebo).
CONCLUSION
Among patients with ASCVD without previous ACS or stroke, alirocumab significantly reduced calculated LDL-C levels vs controls and was well tolerated.
{"title":"Efficacy and safety of alirocumab in patients with established atherosclerotic vascular disease before the first cardiovascular event: Pooled analysis of phase 3 ODYSSEY studies","authors":"Manuel Castro Cabezas PhD, MD , Mattea Orsini PhD , Lale Tokgözoğlu MD , Nikolaus Marx MD , José Tuñón MD , Michal Vrablík MD, PhD , Hagai Tavori PhD , Deepak L. Bhatt MD, MPH, MBA , Pasquale Perrone-Filardi MD","doi":"10.1016/j.jacl.2025.10.062","DOIUrl":"10.1016/j.jacl.2025.10.062","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>This post hoc analysis aimed to determine the efficacy and safety of alirocumab vs placebo or ezetimibe in patients with established atherosclerotic cardiovascular disease (ASCVD), but without previous acute coronary syndrome (ACS; myocardial infarction/unstable angina) or stroke.</div></div><div><h3>METHODS</h3><div>Data were pooled from 12 phase 3 ODYSSEY studies with alirocumab. Adults with established ASCVD, without prior ischemic event (ACS or stroke) were included. Data were analyzed in 3 pools: pool 1 (alirocumab 75/150 mg once every 2 weeks [Q2W] vs ezetimibe), and pools 2 and 3 (alirocumab 75/150 mg Q2W or 150 mg Q2W, respectively, vs placebo). Primary objectives were percentage change in calculated low-density lipoprotein cholesterol (LDL-C) levels from baseline to week 24 and percentage of patients with treatment-emergent adverse events (TEAEs).</div></div><div><h3>RESULTS</h3><div>Overall, 963 patients were identified with ASCVD (without previous ACS or stroke). At baseline, mean calculated LDL-C levels ranged from 112.0 to 123.5 mg/dL across all pools. Alirocumab resulted in a significantly greater reduction in LDL-C levels at week 24 (pool 1: 51.5% reduction; pool 2: 47.8% reduction; pool 3: 60.9% reduction; <em>P</em> < .0001 for all), vs ezetimibe and placebo across all pools. The percentage of patients who experienced TEAEs was similar in the alirocumab and comparator arms (pool 1: 74.8% for alirocumab and 76.5% for ezetimibe; pools 2 and 3: 81.4% for alirocumab and 78.9% for placebo).</div></div><div><h3>CONCLUSION</h3><div>Among patients with ASCVD without previous ACS or stroke, alirocumab significantly reduced calculated LDL-C levels vs controls and was well tolerated.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 44-55"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633991","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 : 2026-01-01DOI: 10.1016/j.jacl.2025.09.015
Vinh Q.T. Ho , Nghi Bao Tran , Nhan Nguyen MD , David Downes , Giang Son Arrighini , Mrunalini Dandamudi MD , Rhanderson Cardoso MD, FACC , Juliana Giorgi MD
BACKGROUND
Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are effective lipid-lowering therapies that reduce cardiovascular risk in hypercholesterolemia. Recent advances include oral PCSK9i, which may offer advantages over injectables.
PURPOSE
We aimed to assess the efficacy and safety of oral PCSK9i in reducing low-density lipoprotein cholesterol (LDL-C) levels, triglycerides, apolipoprotein B, and lipoprotein(a) compared with placebo on the background of standard medical therapy (SMT) in hypercholesterolemic populations.
METHODS
This systematic review and meta-analysis included randomized controlled trials of oral PCSK9i vs placebo in patients with hypercholesterolemia at varying levels of atherosclerotic cardiovascular disease risk, and on stable lipid-lowering therapies. PubMed, Embase, and Cochrane were searched. Mean difference (MD) and odds ratio (OR) with 95% CI were pooled across trials for continuous and binary endpoints, respectively.
RESULTS
We included 3 randomized controlled trials, with 1020 patients, of whom 804 (78.9%) received oral PCSK9i. The average patient age was 61.6 years, and 55.2% were male. Mean percent changes from baseline of LDL-C levels (MD = −47.83%; 95% CI: −54.91, −40.74; P < .00001), triglycerides (MD = −11.65%; 95% CI: −15.44, −7.87; P < .0001), apolipoprotein B (MD = −38.71%; 95% CI: −45.48, −31.93; P < .00001), and lipoprotein(a) (MD = −19.80; 95% CI: −25.60, −14; P < .0001) were significantly reduced in patients treated with oral PCSK9i compared with placebo on the background of SMT. Serious adverse events were not increased with oral PCSK9i (OR = 0.74; 95% CI: 0.34, 1.62; P = .45).
CONCLUSION
Oral PCSK9i significantly reduced LDL-C, triglycerides, apolipoprotein B, and lipoprotein(a) without increasing serious adverse events. They show promise as effective, well-tolerated, and accessible lipid-lowering therapies for cardiovascular risk management.
{"title":"Oral PCSK9 inhibitors as an emerging frontier in lipid management: A meta-analysis","authors":"Vinh Q.T. Ho , Nghi Bao Tran , Nhan Nguyen MD , David Downes , Giang Son Arrighini , Mrunalini Dandamudi MD , Rhanderson Cardoso MD, FACC , Juliana Giorgi MD","doi":"10.1016/j.jacl.2025.09.015","DOIUrl":"10.1016/j.jacl.2025.09.015","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are effective lipid-lowering therapies that reduce cardiovascular risk in hypercholesterolemia. Recent advances include oral PCSK9i, which may offer advantages over injectables.</div></div><div><h3>PURPOSE</h3><div>We aimed to assess the efficacy and safety of oral PCSK9i in reducing low-density lipoprotein cholesterol (LDL-C) levels, triglycerides, apolipoprotein B, and lipoprotein(a) compared with placebo on the background of standard medical therapy (SMT) in hypercholesterolemic populations.</div></div><div><h3>METHODS</h3><div>This systematic review and meta-analysis included randomized controlled trials of oral PCSK9i vs placebo in patients with hypercholesterolemia at varying levels of atherosclerotic cardiovascular disease risk, and on stable lipid-lowering therapies. PubMed, Embase, and Cochrane were searched. Mean difference (MD) and odds ratio (OR) with 95% CI were pooled across trials for continuous and binary endpoints, respectively.</div></div><div><h3>RESULTS</h3><div>We included 3 randomized controlled trials, with 1020 patients, of whom 804 (78.9%) received oral PCSK9i. The average patient age was 61.6 years, and 55.2% were male. Mean percent changes from baseline of LDL-C levels (MD = −47.83%; 95% CI: −54.91, −40.74; <em>P</em> < .00001), triglycerides (MD = −11.65%; 95% CI: −15.44, −7.87; <em>P</em> < .0001), apolipoprotein B (MD = −38.71%; 95% CI: −45.48, −31.93; <em>P</em> < .00001), and lipoprotein(a) (MD = −19.80; 95% CI: −25.60, −14; <em>P</em> < .0001) were significantly reduced in patients treated with oral PCSK9i compared with placebo on the background of SMT. Serious adverse events were not increased with oral PCSK9i (OR = 0.74; 95% CI: 0.34, 1.62; <em>P</em> = .45).</div></div><div><h3>CONCLUSION</h3><div>Oral PCSK9i significantly reduced LDL-C, triglycerides, apolipoprotein B, and lipoprotein(a) without increasing serious adverse events. They show promise as effective, well-tolerated, and accessible lipid-lowering therapies for cardiovascular risk management.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 31-43"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512952","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 : 2026-01-01DOI: 10.1016/j.jacl.2025.11.010
Andrea Faggiano MD , Alessandro Maloberti MD, PhD , Marco Ambrosetti MD , Francesco Giallauria MD, PhD , Gianfrancesco Mureddu MD , Elio Venturini MD , Matteo Ruzzolini MD , Francesco Maranta MD , Marco Vatri MD , Lana Zadre BSc , Stefano Carugo MD , Massimiliano Ruscica BSc, PhD , Francesco Fattirolli MD, PhD , Pompilio Faggiano MD
BACKGROUND
Despite the intensive approach recommended by the 2019 European Society of Cardiology/European Atherosclerosis Society guidelines, low-density lipoprotein cholesterol (LDL-C) target attainment (<55 mg/dL or <40 mg/dL for patients with recurrent events within 2 years) in atherosclerotic cardiovascular disease (ASCVD) patients remains low, with clinical inertia and lack of lipid-lowering therapy (LLT) optimization as major barriers.
METHODS
We analyzed real-world LLT patterns in the ITACARE-P registry, enrolling 1909 Italian ASCVD patients referred to cardiovascular rehabilitation or secondary prevention programs. Baseline LLT and LDL-C levels were recorded. For patients not at LDL-C target, a Monte Carlo simulation with 10,000 iterations was performed using efficacy data from pivotal randomized trials to model sequential addition of ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and inclisiran to estimate potential LDL-C goal attainment rates.
RESULTS
Among 1909 patients (mean age 66 ± 10 years, 26% women), 41.3% were at LDL-C target. Most (90%) were on statins, predominantly at moderate or high intensity, whereas only 3% were untreated. Among patients not at LDL-C target, the Monte Carlo simulation predicted a stepwise increase in goal attainment from 43% to 50% after ezetimibe, 63% after bempedoic acid, 95% after PCSK9 inhibitors, and 90% after inclisiran. A baseline percentage distance of 23.66% from the LDL-C target was identified as a threshold beyond which the addition of bempedoic acid alone was rarely sufficient (<5% success), supporting direct escalation to injectables.
CONCLUSION
A structured, guideline-based intensification strategy in secondary prevention could close the treatment gap and enable near-universal LDL-C target achievement, supporting early implementation of combination therapy.
{"title":"From clinical inertia to therapeutic optimization in patients with atherosclerotic cardiovascular disease: A Monte Carlo simulation within the ITACARE-P registry","authors":"Andrea Faggiano MD , Alessandro Maloberti MD, PhD , Marco Ambrosetti MD , Francesco Giallauria MD, PhD , Gianfrancesco Mureddu MD , Elio Venturini MD , Matteo Ruzzolini MD , Francesco Maranta MD , Marco Vatri MD , Lana Zadre BSc , Stefano Carugo MD , Massimiliano Ruscica BSc, PhD , Francesco Fattirolli MD, PhD , Pompilio Faggiano MD","doi":"10.1016/j.jacl.2025.11.010","DOIUrl":"10.1016/j.jacl.2025.11.010","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Despite the intensive approach recommended by the 2019 European Society of Cardiology/European Atherosclerosis Society guidelines, low-density lipoprotein cholesterol (LDL-C) target attainment (<55 mg/dL or <40 mg/dL for patients with recurrent events within 2 years) in atherosclerotic cardiovascular disease (ASCVD) patients remains low, with clinical inertia and lack of lipid-lowering therapy (LLT) optimization as major barriers.</div></div><div><h3>METHODS</h3><div>We analyzed real-world LLT patterns in the ITACARE-P registry, enrolling 1909 Italian ASCVD patients referred to cardiovascular rehabilitation or secondary prevention programs. Baseline LLT and LDL-C levels were recorded. For patients not at LDL-C target, a Monte Carlo simulation with 10,000 iterations was performed using efficacy data from pivotal randomized trials to model sequential addition of ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and inclisiran to estimate potential LDL-C goal attainment rates.</div></div><div><h3>RESULTS</h3><div>Among 1909 patients (mean age 66 ± 10 years, 26% women), 41.3% were at LDL-C target. Most (90%) were on statins, predominantly at moderate or high intensity, whereas only 3% were untreated. Among patients not at LDL-C target, the Monte Carlo simulation predicted a stepwise increase in goal attainment from 43% to 50% after ezetimibe, 63% after bempedoic acid, 95% after PCSK9 inhibitors, and 90% after inclisiran. A baseline percentage distance of 23.66% from the LDL-C target was identified as a threshold beyond which the addition of bempedoic acid alone was rarely sufficient (<5% success), supporting direct escalation to injectables.</div></div><div><h3>CONCLUSION</h3><div>A structured, guideline-based intensification strategy in secondary prevention could close the treatment gap and enable near-universal LDL-C target achievement, supporting early implementation of combination therapy.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 21-30"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756692","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 : 2026-01-01DOI: 10.1016/j.jacl.2025.05.013
Merle Myerson MD, EdD, FACC, FNLA
BACKGROUND
The prevalence of obesity in the U.S. continues in epidemic proportions—for both children and adults. We have a growing body of information and resources with which to understand and manage obesity including scientific research on the pathophysiology and how socioeconomic impact on the disease, as well as potent new drugs and proposed legislative changes.
SOURCES OF MATERIAL
This paper reviews population studies, clinical studies, and review of current legislation regarding obesity in the United States.
ABSTRACT OF FINDINGS
Obesity is highly prevalent with predictions of continued growth. Medications, specifically newer GLP-1 receptor agonists are available but concerns remain regarding cost, accessibility, and long-terms safety. Proposed changes to public health laws and policies have the potential to improve management and access to effective treatments but the path forward for these remains unclear.
CONCLUSIONS
Despite the growing prevalence that was first realized decades ago, we have not been able to address the many complex issues that have resulted in the current epidemic of obesity.
{"title":"Obesity in the United States: A public health perspective","authors":"Merle Myerson MD, EdD, FACC, FNLA","doi":"10.1016/j.jacl.2025.05.013","DOIUrl":"10.1016/j.jacl.2025.05.013","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>The prevalence of obesity in the U.S. continues in epidemic proportions—for both children and adults. We have a growing body of information and resources with which to understand and manage obesity including scientific research on the pathophysiology and how socioeconomic impact on the disease, as well as potent new drugs and proposed legislative changes.</div></div><div><h3>SOURCES OF MATERIAL</h3><div>This paper reviews population studies, clinical studies, and review of current legislation regarding obesity in the United States.</div></div><div><h3>ABSTRACT OF FINDINGS</h3><div>Obesity is highly prevalent with predictions of continued growth. Medications, specifically newer GLP-1 receptor agonists are available but concerns remain regarding cost, accessibility, and long-terms safety. Proposed changes to public health laws and policies have the potential to improve management and access to effective treatments but the path forward for these remains unclear.</div></div><div><h3>CONCLUSIONS</h3><div>Despite the growing prevalence that was first realized decades ago, we have not been able to address the many complex issues that have resulted in the current epidemic of obesity.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 3-8"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196884","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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