Journal of clinical lipidology最新文献

Background: Current guidelines advocate achieving a fixed 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 acute coronary syndrome (ACS) patients.

Methods: A total of 561 consecutive ACS patients who had undergone 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/d/L, 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 (HR: 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.

Background: Cardiac Allograft Vasculopathy (CAV) is a leading cause of morbidity and mortality after heart transplantation. There are limited contemporary studies examining post-transplant lipid management and cardiometabolic health.

Objective: We study the burden of cardiometabolic derangements post transplantation and its impact on CAV in a modern cohort of heart transplant recipients.

Methods: All heart transplant (HTx) recipients between January 2019 and December 2020, with two lipid assessments and angiographic surveillance were included. Logistic regression was used to assess association of lipid levels with cardiovascular outcomes and CAV.

Results: Among 87 HTx recipients, atherogenic lipids were significantly elevated after Htx. Median LDL-C increased from a baseline level of 69.5 mg/dL to 86.5 mg/dL, p = 0.002, non-HDL-C 91.5 mg/dL to 118 mg/dL, p < 0.001, triglycerides 94.5 mg/dL to 133 mg/dL, p < 0.001, and remnant cholesterol 19 mg/dL to 27 mg/dL, p < 0.001. Increases in non-HDL-C, triglycerides, and remnant cholesterol were significantly associated with increased risk of CAV (Stanford Grade 4 and intimal thickness). Increases in triglycerides and remnant-C were associated with increased risk of composite major adverse cardiovascular events.

Conclusion: We demonstrate a significant increase in atherogenic lipids two years following transplantation with low use (20 %) of high-intensity statin. Increase in atherogenic lipids was associated with increased risk of CAV and increase in triglycerides and remnant cholesterol with increased MACE. Future studies examining cardiometabolic consequences of heart transplantation and optimal treatment strategies to reduce risk of CAV and MACE are needed.

Background: Familial chylomicronemia syndrome (FCS) is an ultrarare inherited disorder. Genetic testing is not always feasible or conclusive. European clinicians developed a "FCS score" to differentiate between FCS and multifactorial chylomicronemia syndrome (MCS), a more common condition with overlapping features. A diagnostic score has not been developed for use in the North American context.

Objective: To develop and validate a diagnostic score for North American patients based on signs, symptoms and biochemical traits of FCS.

Methods: Using the RAND/UCLA modified Delphi process, we convened ten US/Canadian physicians with experience recognizing and treating FCS and one adult patient with FCS. The panel developed and rated 296 scenarios describing patients with FCS. Linear regression analyses used median post-meeting ratings to develop score parameters. We tested the score's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in patients with classical FCS, functional FCS, and MCS from Western University's Lipid Genetics Clinic's registry.

Results: Numerical scores were attributed based upon the following: age, hypertriglyceridemia onset, body mass index, history of abdominal pain/pancreatitis, presence of secondary factors, triglyceride (TG) levels, ratio of TG/total cholesterol, and apolipoprotein B level. Scores ≥60 indicate definite classical FCS; the score distinguished patients with FCS from MCS in a real-world registry (100.0 % specificity, 66.7 % sensitivity, 100.0 % PPV, 95.5 % NPV). Scores ≥45 were "very likely" to have classical FCS (96.9 % specificity, 88.9 % sensitivity).

Conclusion: Given its simplicity and high specificity for distinguishing patients with FCS from MCS, the NAFCS Score could be used in lieu of - or while awaiting - genetic testing to optimize treatment.

Background: Homozygous familial hypercholesterolemia (HoFH) is a rare genetic disease of low-density lipoprotein cholesterol (LDL-C) metabolism. Despite the devastating effect of this disease on atherosclerotic cardiovascular health, the disease phenotype and severity are more heterogeneous than previously thought. The predictors of atherosclerotic cardiovascular disease (ASCVD) in HoFH patients have never been systematically studied.

Objective: To investigate the univariate and multivariate predictors of ASCVD in HoFH patients.

Methods: Patients from the Canadian HoFH Registry were included in the present retrospective longitudinal study. Data for these patients were collected using a standardized questionnaire between 2019 and 2022 in 19 academic sites across Canada. Predictors of ASCVD were evaluated using Cox proportional hazards models.

Results: Among 48 HoFH patients, 26 (54 %) of them had at least one ASCVD event. The average age at baseline was 19 ± 15 years and women represented 56 % of the cohort. The independent predictors of ASCVD events were male sex (HR 2.57 (1.13-5.84)), diabetes (HR 16.22 (3.38-77.97)), and LDL-C above the median of 14.45 mmol/L [559 mg/dL] (HR 3.10 (1.24-7.76)). When performing subgroup analysis according to sex, the presence of LDL-C above median was associated with a significantly higher probability of ASCVD (88 % vs. 43 %, p = 0.005) in women, but not in men (100 % at age 40 in both groups, p = 0.98).

Conclusion: This study reported for the first time the univariate and multivariate predictors of ASCVD in HoFH patients. We demonstrate that predictors of ASCVD in HoFH differ in males and females with respect to LDL-C levels.

Background: Olpasiran and pelacarsen are gene-silencing therapies that lower lipoprotein(a). Cardiovascular outcome trials are ongoing. Mendelian randomization studies estimated clinical benefits from lipoprotein(a) lowering.

Objective: Our study estimated prices at which olpasiran and pelacarsen, in addition to standard-of-care, would be deemed cost-effective in reducing risk of recurrent coronary heart disease (CHD) events in the Australian healthcare system.

Methods: We developed a decision tree and lifetime Markov model. For olpasiran, participants had CHD and lipoprotein(a) 260 nmol/L at baseline and three-monthly injections, profiled on OCEAN(a) Outcomes trial (NCT05581303). Baseline risks of CHD, costs and utilities were obtained from published sources. Clinical trial data were used to derive reductions in lipoprotein(a) from treatment. Mendelian randomization study data were used to estimate downstream clinical benefits. Annual discounting was 5%. For pelacarsen, participants had CHD and lipoprotein(a) 226 nmol/L at baseline and one-monthly injections, profiled on Lp(a) HORIZON (NCT04023552) trial.

Results: Olpasiran in addition to standard-of-care saved 0.87 discounted quality-adjusted life years (QALYs) per person. Olpasiran in addition to standard-of-care would be cost-effective at annual prices of AU$1867 (AU$467 per dose) at threshold AU$28,000 per QALY. Pelacarsen would be cost-effective at annual prices of AU$984 (AU$82 per dose). For incremental cost-effectiveness ratio (ICER) threshold AU$50,000 per QALY, olpasiran and pelacarsen would be cost-effective at annual prices AU$4207 and AU$2464, respectively.

Conclusion: This early health technology assessment model used inclusion criteria from clinical trials. Olpasiran and pelacarsen would be cost-effective if annual treatment prices were AU$1867 and AU$984, respectively, from the Australian healthcare perspective.

Background: Familial chylomicronemia syndrome (FCS) comprises a group of ultrarare disorders caused by biallelic variants in LPL or, less frequently, by GPIHBP1, APOC2, APOA5, or LMF1.

Objectives: To evaluate the phenotypes and management of eight non-lipoprotein lipase (LPL)-FCS patients.

Methods: Seven pediatric and one adult patients with non-LPL-FCS were enrolled. Clinical features, treatment outcomes, and genetic profiles were assessed.

Results: Among the 33 patients with FCS, 25 (76%) had LPL-FCS and eight (24%) had non-LPL-FCS; five had variants in GPIHBP1, one each in the LMF1, APOC2, and one with composite heterozygous variants in APOA5 and LPL. Twelve non-LPL variants were identified, five of which were novel variants in GPIHBP1 and two in LMF1. In silico predictions indicated that all novel variants might impact protein function. Elevated baseline triglyceride (TG) levels [22.9 (17.4-30.8) mmol/L, 2026.7 (1540.0-2728.5) mg/dL] were observed in all patients. Among the pediatric patients (7/7), chylomicronemia was the most common onset symptom. Acute pancreatitis was observed in only one patient with LMF1-FCS during pregnancy. The frequency of symptoms and lipid levels in the non-LPL-FCS group were slightly lower than those in the LPL-FCS group (P > 0.05). Dietary fat restriction reduced TG levels by 84.0% to 4.21 mmol/L (372.6 mg/dL, P < 0.01). Compared with other non-LPL-FCS patients, GPIHBP1-FCS patients experienced greater challenges in managing TG levels (P < 0.05).

Conclusion: This study unveiled the genetic profile of the Chinese FCS cohort and enriched the mutation spectrum of non-LPL-FCS. The clinical characteristics and treatment outcomes of patients with non-LPL-FCS were delineated.

Background: Predictors of neoatherosclerosis in patients who received primary percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remain unclear.

Objective: The aim of this study is to investigate the frequency and risk factors of neoatherosclerosis 1-year after the onset of ACS.

Methods: This study investigated 83 patients who underwent PCI for ACS followed by 1-year follow-up optical coherence tomography. The patients were categorized into the neoatherosclerosis (n = 11) and non-neoatherosclerosis groups (n = 72). Baseline characteristics, PCI procedures, medical therapies, and blood tests at 1-year, including detailed lipid profiles, were compared between the two groups.

Results: Diabetes mellitus was more prominent in the neoatherosclerosis than in the non-neoatherosclerosis group (45% vs. 17%, respectively, p = 0.03). Total cholesterol (171 ± 37 mg/dL vs. 145 ± 25 mg/dL, respectively, p < 0.01), non-high-density lipoprotein cholesterol (non-HDL-C) (124 ± 36 mg/dL vs. 94 ± 24 mg/dL, respectively, p < 0.01), low-density lipoprotein cholesterol (94 ± 36 mg/dL vs. 72 ± 19 mg/dL, respectively, p < 0.01), and lipoprotein (a) (Lp[a]) (70 [19-112] mg/dL vs. 10 [3-25] mg/dL, respectively, p = 0.03) at follow-up were significantly higher in the neoatherosclerosis group. Multivariate analysis revealed that neoatherosclerosis was associated with high serum non-HDL-C (odds ratio [OR]: 1.075; 95% confidence interval [CI]: 1.011-1.144; p < 0.01) and high serum Lp(a) levels (> 30 mg/dL) (OR: 11.0; 95% CI: 1.492-81.02; p = 0.02).

Conclusion: Poorly controlled non-HDL-C and Lp(a) would be risk factors of neoatherosclerosis in patients 1-year after ACS.

Background: Although direct measurement of low-density lipoprotein cholesterol (LDL-C) in blood is possible, there are several formulas for its estimation. The performance and concordance of these formulas have not been evaluated in Colombia.

Objective: To determine the concordance between LDL-C directly measured using the enzymatic technique and existing methods to calculate it.

Methods: Study of diagnostic tests, and concordance. We analyzed complete lipid profile samples, which included direct measurement of LDL-C, from 2014 to 2022 at Hospital Universitario San Ignacio (Bogotá, Colombia). The direct LDL-C measurements were compared with estimations using the DeLong, Sampson, Friedewald, extended Martin/Hopkins, Anandaraja, and Cordova methods. Lin's concordance correlation coefficient (CCC) and Bland-Altman plots were employed, conducting subgroup analyses based on triglycerides (TG), and LDL-C levels. Kappa coefficients assessed agreement in LDL-C risk categories according to dyslipidemia guidelines.

Results: A total of 2144 samples were evaluated. The formulas with the best CCC were DeLong (0.971) and Sampson (0.969), with no relevant differences. The extended Martin/Hopkins formula (0.964) and the Friedewald formula (0.964) also performed well. The Anandaraja (0.921) and Cordova (0.881) equations exhibited inferior performance. For all formulas, a decrease in concordance was observed when TG were ≥ 400 mg/dL or when LDL-C was <100 mg/dL. Most formulas demonstrated optimal agreement when assessed using risk categories according to dyslipidemia guidelines, except for Anandaraja and Cordova.

Conclusions: The DeLong, Sampson, extended Martin/Hopkins, and Friedewald formulas show the best concordance with directly measured LDL-C, so in most cases the results can be considered interchangeable. However, the Anandaraja and Cordova formulas are not recommended.