Journal of clinical lipidology最新文献

{"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 ,&nbsp;Alessandro Maloberti MD, PhD ,&nbsp;Marco Ambrosetti MD ,&nbsp;Francesco Giallauria MD, PhD ,&nbsp;Gianfrancesco Mureddu MD ,&nbsp;Elio Venturini MD ,&nbsp;Matteo Ruzzolini MD ,&nbsp;Francesco Maranta MD ,&nbsp;Marco Vatri MD ,&nbsp;Lana Zadre BSc ,&nbsp;Stefano Carugo MD ,&nbsp;Massimiliano Ruscica BSc, PhD ,&nbsp;Francesco Fattirolli MD, PhD ,&nbsp;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 (&lt;55 mg/dL or &lt;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 (&lt;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}

{"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}

{"title":"Association between relative fat mass and sleep disorder among US adults: Results from NHANES 2007 to 2014","authors":"Junliang Shen MM,&nbsp;Xiuqin Que MM,&nbsp;Jianjun Li MM,&nbsp;Ping Fu MM,&nbsp;Yi Lu MB,&nbsp;Qiping Zhu MB","doi":"10.1016/j.jacl.2025.10.055","DOIUrl":"10.1016/j.jacl.2025.10.055","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Sleep disorders affect a large share of adults, and excess body fat is a recognized risk factor. Relative fat mass (RFM) is a recently developed anthropometric index intended to estimate body fat percentage more closely than body mass index (BMI). This study examined the association between RFM and physician-diagnosed sleep disorders in a nationally representative sample of U.S. adults.</div></div><div><h3>METHODS</h3><div>We analyzed data on 21,115 participants (≥20 years) from the National Health and Nutrition Examination Survey 2007 to 2014. RFM was calculated from measured waist circumference and height with adjustment for gender. Logistic regression assessed associations between RFM (continuous and quartile) and sleep disorder, adjusting sequentially for demographic, socioeconomic, lifestyle, and clinical factors. Restricted cubic splines and segmented models explored nonlinear trends, and stratified analyses evaluated consistency across subgroups.</div></div><div><h3>RESULTS</h3><div>Participants with sleep disorders had markedly higher mean RFM than those without. After full adjustment, higher RFM remained positively linked to sleep disorder, with risk rising steeply up to an inflection around RFM = 39.3 and then attenuating. The pattern was consistent across age, gender, smoking, alcohol use, and comorbidity strata, indicating a broad, dose-dependent relationship between adiposity and impaired sleep.</div></div><div><h3>CONCLUSIONS</h3><div>This cross-sectional analysis suggests a strong association between elevated RFM and a greater prevalence of sleep disorders among U.S. adults. These findings highlight adiposity as a modifiable contributor to poor sleep health and support integrating body fat reduction into preventive and therapeutic strategies. Prospective and interventional research is needed to clarify causality, mechanisms, and the potential sleep benefits of targeted fat-loss interventions.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 145-153"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556958","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}

{"title":"Disruption of HDL antioxidant properties in children and adolescents with obesity","authors":"Belén Davico BSc ,&nbsp;Ezequiel Lozano Chiappe PhD ,&nbsp;Laura Gaete MD ,&nbsp;Amanda Yánez Sanchez BSc ,&nbsp;Walter F. Tetzlaff PhD ,&nbsp;Valeria Martinez PhD ,&nbsp;Verónica De Giusti PhD ,&nbsp;Augusto Bava BSc ,&nbsp;Cynthia Rodriguez BSc ,&nbsp;Ivana Masci BSc ,&nbsp;Melisa Kurtz PhD ,&nbsp;Deborah Tasat PhD ,&nbsp;María G. Ballerini PhD ,&nbsp;Leonardo Gómez Rosso PhD ,&nbsp;Fernando Brites PhD ,&nbsp;Maximiliano Martin PhD","doi":"10.1016/j.jacl.2025.11.002","DOIUrl":"10.1016/j.jacl.2025.11.002","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Childhood obesity is associated with alterations in lipoprotein metabolism and increased oxidative stress, assessed by lipid peroxidation products, reactive oxygen species (ROS) and nitric oxide (NO) levels, oxidized/reduced glutathione (GSH/GSSG) ratio, and the activities of superoxide dismutase (SOD) and catalase. High-density lipoproteins (HDL) play an antioxidant role, conditioned by cholesteryl ester transfer protein (CETP), paraoxonase (PON) 1, lecithin:cholesterol acyltransferase (LCAT), lipoprotein-associated phospholipase A₂ (Lp-PLA₂), and apolipoprotein (apo) A-I.</div></div><div><h3>OBJECTIVE</h3><div>This study aims to evaluate HDL antioxidant capacity in children and adolescents with obesity and the status of its conditioning factors.</div></div><div><h3>METHODS</h3><div>Thirty children and adolescents, 15 with obesity and 15 normal-weight controls were studied in a cross-sectional observational study. Lipid profile and high-sensitivity C-reactive protein were assessed using standardized methods. Lipid peroxidation products, ROS, NO, GSH and GSSG levels, and catalase, SOD, CETP, LCAT, PON 1 (PON and arylesterase [ARE]) and Lp-PLA₂ activities were assessed by developed techniques. Total HDL antioxidant activity and its intrinsic oxidation were evaluated.</div></div><div><h3>RESULTS</h3><div>Children with obesity showed lower HDL cholesterol and apo A-I levels (<em>P</em> &lt; .01), reduced CETP (<em>P</em> &lt; .05), ARE (Lp-PLA₂ &lt; .05), LCAT (<em>P</em> &lt; .05), and HDL-associated Lp-PLA₂ (<em>P</em> &lt; .01) activities, increased HDL intrinsic oxidation (<em>P</em> &lt; 0.01) and reduced total HDL antioxidant activity (<em>P</em> &lt; .05). Patients revealed increased oxidative stress: higher ROS (<em>P</em> &lt; .001) and NO levels (<em>P</em> &lt; .05), lower GSH/GSSG ratio (<em>P</em> &lt; .01) and catalase activity (<em>P</em> &lt; .001).</div></div><div><h3>CONCLUSIONS</h3><div>Children and adolescents with obesity exhibited reduced HDL antioxidant activity, alterations in its conditioning factors, intrinsic oxidative modification of HDL particles, and increased oxidative stress. These alterations may affect long-term cardiovascular risk in children and adolescents with obesity.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 154-166"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743026","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}

{"title":"“Reconsidering uric acid to HDL ratio as a predictor of vascular calcification” author response to letter to the editor","authors":"Lishan Bai BS,&nbsp;Yuanming Li BS","doi":"10.1016/j.jacl.2025.10.064","DOIUrl":"10.1016/j.jacl.2025.10.064","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 222-223"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957754","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}

{"title":"Response to letter to the editor by Matsubara and colleagues","authors":"Julianna West MD ,&nbsp;Amit Khera MD ,&nbsp;Weiyi Tan MD ,&nbsp;Abhimanyu Garg MD","doi":"10.1016/j.jacl.2025.09.025","DOIUrl":"10.1016/j.jacl.2025.09.025","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 226-227"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145957771","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}

{"title":"The impact of electronic health messaging on diagnosis of familial hypercholesterolemia and management of patients with LDL-C ≥190 mg/dL","authors":"Yihang Fan MPH ,&nbsp;Lingling Li MS ,&nbsp;Wenjun Fan MD, PhD ,&nbsp;Jing Gu PhD ,&nbsp;Robert J. Sanchez PhD ,&nbsp;Nathan D. Wong PhD, MPH, FNLA","doi":"10.1016/j.jacl.2025.10.074","DOIUrl":"10.1016/j.jacl.2025.10.074","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Patients with elevated low-density lipoprotein-cholesterol (LDL-C) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) and are often undertreated with lipid-lowering therapies (LLT). The impact of electronic health record (EHR) messaging on improving diagnosis and management remains unclear.</div></div><div><h3>OBJECTIVE</h3><div>We implemented a best practice advisory (BPA) alert for physicians prompted by an LDL-C ≥190 mg/dL in their patients, recommending evaluation for familial hypercholesterolemia (FH) with appropriate guideline-directed treatment.</div></div><div><h3>METHODS</h3><div>Data on patients with BPAs triggered from August 2021 to June 2024, and with at least 3 months follow-up, were analyzed for changes in diagnoses, medication use, and lipid levels.</div></div><div><h3>RESULTS</h3><div>Among 665 patients (mean age 58 years, 55% female, 29% Hispanic, and 28% Asian), FH diagnoses (limited to ICD-10 and SNOMED codes) increased from 2.3% to 6%. Statin use rose from 39.4% to 61.7% (<em>P</em> &lt; .0001), with high-intensity statins from 22.9% to 39.0% (<em>P</em> &lt; .0001). LDL-C declined from before to after the BPA alert (adjusted mean change −84.1 mg/dL, <em>P</em> &lt; .0001).</div></div><div><h3>CONCLUSION</h3><div>BPA alerts for patients with LDL-C ≥ 190 mg/dL improve diagnosis rates for hyperlipidemia and FH, increase LLT use, and reduce LDL-C levels.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 204-209"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634033","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}

{"title":"Breakthrough LDL-C reduction in a patient with autosomal recessive homozygous familial hypercholesterolemia: Efficacy of evinacumab after LDL-apheresis discontinuation","authors":"Pablo González-Bustos MD ,&nbsp;Francisco Fuentes-Jiménez MD, PhD ,&nbsp;Javier Delgado-Lista MD, PhD ,&nbsp;Raquel Ojeda-López MD, PhD ,&nbsp;Juan Diego Mediavilla-García MD, PhD","doi":"10.1016/j.jacl.2025.09.028","DOIUrl":"10.1016/j.jacl.2025.09.028","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Autosomal recessive homozygous familial hypercholesterolemia (AR-HoFH) is a severe lipid disorder leading to early-onset atherosclerotic cardiovascular disease (ASCVD) due to extreme low-density lipoprotein cholesterol (LDL-C) elevations. Despite high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors, many patients require LDL-apheresis for LDL-C control.</div></div><div><h3>CASE REPORT</h3><div>We present the case of a male in his late fifties diagnosed with AR-HoFH, confirmed by genetic testing revealing biallelic pathogenic <em>LDLRAP1</em> variations (<em>NM_015627.2: c.928_930del/p.Gln310del</em>, homozygous). The patient showed extreme hypercholesterolemia with an LDL-C exceeding 500 mg/dL (12.9 mmol/L) at diagnosis, despite high-intensity statins. At 39 years of age, he suffered a myocardial infarction with multivessel coronary artery disease requiring percutaneous coronary intervention. Despite escalation to rosuvastatin 40 mg daily, ezetimibe 10 mg daily, and alirocumab 150 mg every 2 weeks, LDL-C levels remained persistently elevated. In 2023, recurrent angina prompted coronary angiography, revealing in-stent restenosis in the right coronary artery (RCA) and a new critical stenosis in the left anterior descending (LAD) artery, requiring further revascularization. Given persistently high LDL-C levels averaging 171 mg/dL prior to apheresis despite maximal lipid-lowering therapy, biweekly LDL-apheresis was initiated and continued for 1 year. In December 2024, evinacumab (15 mg/kg intravenous monthly) was introduced following regulatory approval. Over the first 3 months, average LDL-C was reduced to 79.6 mg/dL, representing a 53.5% reduction compared to the mean preapheresis baseline, and permitting discontinuation of apheresis after the final session on January 3, 2025. By March 2025, LDL-C remained stable at 62 mg/dL (1.6 mmol/L), approaching but not fully meeting the &lt;55 mg/dL LDL-C target recommended for secondary prevention according to current European guidelines. The patient tolerated evinacumab well, with comprehensive biochemical monitoring showing no hepatic, renal, or hematologic abnormalities. Although reintroduction of LDL-apheresis remains a potential strategy, lomitapide could also be considered in combination with evinacumab to enhance LDL-C lowering. However, its use in our setting is currently limited by economic constraints.</div></div><div><h3>CONCLUSION</h3><div>The introduction of evinacumab, an LDL receptor-independent lipid-lowering therapy, achieved robust and sustained LDL-C reduction, while eliminating the need for LDL-apheresis and reducing the indirect logistical burden of frequent hospital-based treatments in this patient with AR-HoFH.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 210-214"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573809","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}

{"title":"Comparative outcomes of moderate-intensity statin with ezetimibe vs high-intensity statin therapy: A retrospective observational cohort study","authors":"Junpil Yun MD ,&nbsp;Seokhun Yang MD, PhD ,&nbsp;Doyeon Hwang MD ,&nbsp;Jeehoon Kang MD, PhD ,&nbsp;Han-Mo Yang MD, PhD ,&nbsp;Kyung Woo Park MD, PhD ,&nbsp;Hyun-Jae Kang MD, PhD ,&nbsp;Bon-Kwon Koo MD, PhD ,&nbsp;Jung-Kyu Han MD, PhD","doi":"10.1016/j.jacl.2025.09.020","DOIUrl":"10.1016/j.jacl.2025.09.020","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Evidence supports that more aggressive low-density lipoprotein cholesterol (LDL-C) lowering improves outcomes in patients at high cardiovascular risk, but whether one therapeutic strategy is superior to another remains unclear.</div></div><div><h3>OBJECTIVE</h3><div>This study compared the effectiveness of moderate-intensity statin therapy combined with ezetimibe vs high-intensity statin monotherapy.</div></div><div><h3>METHODS</h3><div>We conducted a retrospective observational cohort study at a large tertiary university hospital. The study included patients prescribed either moderate-intensity statin with ezetimibe or high-intensity statin between January 1, 2018, and December 31, 2020. Propensity score matching was performed to balance clinical characteristics between the groups. The primary endpoint was an ischemic outcome, defined as a composite of cardiovascular death, non-fatal myocardial infarction, and ischemic stroke. Secondary outcomes included cardiovascular death, myocardial infarction, ischemic stroke, revascularization, and all-cause mortality.</div></div><div><h3>RESULTS</h3><div>Before matching, 1380 patients were prescribed moderate-intensity statin–ezetimibe combination therapy, and 1105 patients were prescribed high-intensity statin therapy. After matching, 971 patients were included in each group. Over a median follow-up of 3.8 years, the primary endpoint occurred in 1.7% of patients in the moderate-intensity statin with ezetimibe group and in 2.1% of patients in the high-intensity statin group. The incidence of major adverse cardiovascular events did not differ significantly between the 2 groups (hazard ratio 0.82, 95% CI: 0.41-1.61, <em>P</em> = .558). No statistically significant differences were observed in secondary outcomes, including cardiovascular death, myocardial infarction, ischemic stroke, revascularization, and all-cause mortality.</div></div><div><h3>CONCLUSION</h3><div>In this retrospective cohort study, moderate-intensity statin combined with ezetimibe was as effective as high-intensity statin monotherapy in preventing cardiovascular events.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 87-95"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504670","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}

{"title":"Lack of impact of adjunctive lipid-modifying therapy in the CLEAR Outcomes trial","authors":"Venu Menon MD ,&nbsp;LeAnne Bloedon MS ,&nbsp;Na Li PhD ,&nbsp;A. Michael Lincoff MD ,&nbsp;Stephen J. Nicholls MBBS, PhD ,&nbsp;Heather A. Powell PharmD ,&nbsp;Steven E. Nissen MD","doi":"10.1016/j.jacl.2025.10.072","DOIUrl":"10.1016/j.jacl.2025.10.072","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Bempedoic acid is a prodrug that reduces circulating low-density lipoprotein (LDL) cholesterol levels by inhibiting the liver enzyme adenosine triphosphate-citrate lyase. Treatment of statin intolerant patients with bempedoic acid was associated with a significantly reduced risk of the primary composite endpoint (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization) in the CLEAR (Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen) Outcomes Trial.</div></div><div><h3>OBJECTIVE</h3><div>To evaluate impact of additional lipid modifying therapy (LMT) on the primary composite endpoint of the CLEAR Outcomes Trial.</div></div><div><h3>RESULTS</h3><div>Utilization of adjunctive LMT was observed in 1749 (12.5%) enrolled patients. The most common adjunctive LMTs reported were statins (4.0% vs 6.5%), ezetimibe (2.7% vs 5.5%), and proprotein convertase subtilisin/kexin type 9 inhibitors (2.8% vs 4.4%) in the bempedoic acid and placebo groups, respectively. The majority of first MACE-4 events (92.9% of events in bempedoic acid and 90.9% of events in placebo) preceded the initiation of adjunctive LMT. When censored at the time of initiating adjunctive LMT, primary event reduction was observed in favor of bempedoic acid compared to placebo (hazard ratio [HR]: 0.86 [95% CI, 0.77-0.94]) which was similar to the reduction noted with bempedoic acid in the overall trial (HR of 0.87 [95% CI, 0.79-0.96], <em>P</em> = .004).</div></div><div><h3>CONCLUSIONS</h3><div>The utilization of additional LMT following randomization had no impact on the observed results of the CLEAR Outcomes trial.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":"Pages 196-199"},"PeriodicalIF":4.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145756793","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}