Pub Date : 2024-09-01DOI: 10.1016/j.jacl.2024.07.003
Marianna Pavlyha MD , Yihao Li MS , Sarah Crook MS , Brett R. Anderson MD , Gissette Reyes-Soffer MD
BACKGROUND AND OBJECTIVE
High lipoprotein(a) [Lp(a)] levels are a risk factor for atherosclerotic cardiovascular disease (ASCVD), however Lp(a) ordering in clinical practice is low. This study examines how race/ethnicity and socioeconomic status influence Lp(a) ordering.
METHODS
This is a single center, retrospective study (2/1/2020-6/30/2023) using electronic medical records of adults with at least one personal ICD-10 diagnosis of ASCVD, aortic valve stenosis, resistant hypercholesterolemia (low-density lipoprotein cholesterol >160 mg/dL on statin therapy), and family history of ASCVD or high Lp(a). We evaluated Lp(a) level differences among racial/ethnic groups and sexes. We also assessed associations between diagnosis type, diagnosis number, age at diagnosis, race/ethnicity, socioeconomic score (based on zip codes), public health coverage and the presence of Lp(a) orders.
RESULTS
4% of our cohort (N=2,249 in 56,833) had an Lp(a) order (17.3% of whom identified as Hispanic, 8.7% non-Hispanic Black, 47.5% non-Hispanic White, and 27% Asian/other). Non-Hispanic Black and Hispanic patients had lower rates of Lp(a) orders (0.17% and 0.28%, respectively) when compared to non-Hispanic White patients (2.35%), p < 0.001, however, their median Lp(a) levels were higher, p < 0.001. Individuals on Medicaid or belonging to deprived socioeconomic groups were less likely to have an Lp(a) order (incidence rate ratio [IRR] = 0.40, p < 0.001 and IRR = 0.39, p < 0.001 respectively). Certain diagnosis (carotid stenosis, family history of ASCVD and familial hypercholesterolemia) and multiple diagnoses (>2) resulted in more Lp(a) orders compared to only one diagnosis (p < 0.001).
CONCLUSIONS
Lp(a) ordering is low in patients with or at risk for ASCVD. Non-Hispanic Black and Hispanic patients are less likely to have an Lp(a) order. Individuals on Medicaid and residing in socioeconomically deprived neighborhoods are less likely to have an Lp(a) order. Lp(a) orders depend on the type and number of patients’ diagnoses.
{"title":"Race/ethnicity and socioeconomic status affect the assessment of lipoprotein(a) levels in clinical practice","authors":"Marianna Pavlyha MD , Yihao Li MS , Sarah Crook MS , Brett R. Anderson MD , Gissette Reyes-Soffer MD","doi":"10.1016/j.jacl.2024.07.003","DOIUrl":"10.1016/j.jacl.2024.07.003","url":null,"abstract":"<div><h3>BACKGROUND AND OBJECTIVE</h3><div>High lipoprotein(a) [Lp(a)] levels are a risk factor for atherosclerotic cardiovascular disease (ASCVD), however Lp(a) ordering in clinical practice is low. This study examines how race/ethnicity and socioeconomic status influence Lp(a) ordering.</div></div><div><h3>METHODS</h3><div>This is a single center, retrospective study (2/1/2020-6/30/2023) using electronic medical records of adults with at least one personal ICD-10 diagnosis of ASCVD, aortic valve stenosis, resistant hypercholesterolemia (low-density lipoprotein cholesterol >160 mg/dL on statin therapy), and family history of ASCVD or high Lp(a). We evaluated Lp(a) level differences among racial/ethnic groups and sexes. We also assessed associations between diagnosis type, diagnosis number, age at diagnosis, race/ethnicity, socioeconomic score (based on zip codes), public health coverage and the presence of Lp(a) orders.</div></div><div><h3>RESULTS</h3><div>4% of our cohort (N=2,249 in 56,833) had an Lp(a) order (17.3% of whom identified as Hispanic, 8.7% non-Hispanic Black, 47.5% non-Hispanic White, and 27% Asian/other). Non-Hispanic Black and Hispanic patients had lower rates of Lp(a) orders (0.17% and 0.28%, respectively) when compared to non-Hispanic White patients (2.35%), <em>p</em> < 0.001, however, their median Lp(a) levels were higher, <em>p</em> < 0.001. Individuals on Medicaid or belonging to deprived socioeconomic groups were less likely to have an Lp(a) order (incidence rate ratio [IRR] = 0.40, <em>p</em> < 0.001 and IRR = 0.39, <em>p</em> < 0.001 respectively). Certain diagnosis (carotid stenosis, family history of ASCVD and familial hypercholesterolemia) and multiple diagnoses (>2) resulted in more Lp(a) orders compared to only one diagnosis (<em>p</em> < 0.001).</div></div><div><h3>CONCLUSIONS</h3><div>Lp(a) ordering is low in patients with or at risk for ASCVD. Non-Hispanic Black and Hispanic patients are less likely to have an Lp(a) order. Individuals on Medicaid and residing in socioeconomically deprived neighborhoods are less likely to have an Lp(a) order. Lp(a) orders depend on the type and number of patients’ diagnoses.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 5","pages":"Pages e720-e728"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141881476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.jacl.2024.06.001
Kunal Mahajan DM , Raman Puri DM , P. Barton Duell MD , Deep Dutta DM , Rahul Yadav DM , Surender Kumar DM , Jai Bharat Sharma DM , Prashant Patel MBBS , Savio Dsouza DM , Ashu Gupta DM , Aziz Khan DM , Nathan D. Wong PhD
Rapid reduction of low-density lipoprotein cholesterol (LDL-C) to target levels immediately following acute coronary syndrome (ACS) event is critical to prevent future events. High-dose statins alone often fail to achieve LDL-C goals. Proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) combined with high-dose statins improves LDL-C goal attainment, but is unaffordable for many patients in India and worldwide. In a real-world open-label study, we demonstrated in a cohort of 122 patients with ACS, concurrent triple therapy with rosuvastatin 40 mg/d, ezetimibe 10 mg/d, and bempedoic acid 180 mg/d (REB) started at the time of hospital admission was associated with 57.7%, 61.7%, 61.9% and 60.6% reductions in LDL-C from 115.6 mg/dl at baseline to 48.9 mg/dl at week 1, 44.3 mg/dl at week 2, 44.1 mg/dl at week 4, and 45.6 mg/dl at week 6, respectively (each p < 0.001 compared to baseline; p < 0.001 across repeated measures). REB provided significant reductions in LDL-C within as early as one week and enabled 76.3% and 92.2% of patients to achieve the Lipid Association of India and American College of Cardiology recommended LDL-C targets of <50 mg/dl and <70 mg/dl within 2-weeks, respectively, which were sustained at 4–6 weeks. REB was generally well tolerated. Our study demonstrates the capacity to rapidly achieve LDL-C goals after ACS with triple REB therapy, an affordable regimen in India.
{"title":"Rapid achievement of low-density lipoprotein cholesterol goals within 1 month after acute coronary syndrome during combination therapy with rosuvastatin, ezetimibe and bempedoic acid: Initial experience from the LAI-REACT study","authors":"Kunal Mahajan DM , Raman Puri DM , P. Barton Duell MD , Deep Dutta DM , Rahul Yadav DM , Surender Kumar DM , Jai Bharat Sharma DM , Prashant Patel MBBS , Savio Dsouza DM , Ashu Gupta DM , Aziz Khan DM , Nathan D. Wong PhD","doi":"10.1016/j.jacl.2024.06.001","DOIUrl":"10.1016/j.jacl.2024.06.001","url":null,"abstract":"<div><div>Rapid reduction of low-density lipoprotein cholesterol (LDL-C) to target levels immediately following acute coronary syndrome (ACS) event is critical to prevent future events. High-dose statins alone often fail to achieve LDL-C goals. Proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) combined with high-dose statins improves LDL-C goal attainment, but is unaffordable for many patients in India and worldwide. In a real-world open-label study, we demonstrated in a cohort of 122 patients with ACS, concurrent triple therapy with rosuvastatin 40 mg/d, ezetimibe 10 mg/d, and bempedoic acid 180 mg/d (REB) started at the time of hospital admission was associated with 57.7%, 61.7%, 61.9% and 60.6% reductions in LDL-C from 115.6 mg/dl at baseline to 48.9 mg/dl at week 1, 44.3 mg/dl at week 2, 44.1 mg/dl at week 4, and 45.6 mg/dl at week 6, respectively (each <em>p</em> < 0.001 compared to baseline; <em>p</em> < 0.001 across repeated measures). REB provided significant reductions in LDL-C within as early as one week and enabled 76.3% and 92.2% of patients to achieve the Lipid Association of India and American College of Cardiology recommended LDL-C targets of <50 mg/dl and <70 mg/dl within 2-weeks, respectively, which were sustained at 4–6 weeks. REB was generally well tolerated. Our study demonstrates the capacity to rapidly achieve LDL-C goals after ACS with triple REB therapy, an affordable regimen in India.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 5","pages":"Pages e867-e872"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141406096","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 : 2024-09-01DOI: 10.1016/j.jacl.2024.06.002
Isadora Mamede , Marcelo Antonio Pinheiro Braga , Otavio C. Martins , Anne E.O. Franchini MD , Rodrigo B. Silveira Filho , Marcel C.F. Santos MD
BACKGROUND
Recent research has raised questions about the assumed cardiovascular (CV) benefits of high-density lipoprotein cholesterol (HDL-C) and the potential for adverse outcomes with extremely high levels.
OBJECTIVE
We conducted a meta-analysis to investigate the association between very high HDL-C levels (≥80 mg/dL) and mortality outcomes in individuals without coronary artery disease (CAD).
METHODS
We systematically searched PubMed, Embase, and Cochrane databases for studies comparing very high HDL-C levels to normal levels (40–60 mg/dL) in CAD-free individuals. We assessed heterogeneity using I2 statistics with a random-effects model.
RESULTS
Our analysis included 1,004,584 individuals from 8 studies, of whom 133,646 (13.3%) had very high HDL-C levels. All-cause mortality did not significantly differ between groups (p = 0.55), nor did cancer mortality (p = 0.45). Cardiovascular mortality showed no change in those with very high HDL-C (hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.94–1.17; p = 0.37). Fatal and non-fatal coronary heart disease events were less frequent in the very high HDL-C group (HR 0.79; 95% CI 0.73–0.86; p < 0.00001). Subgroup dose-response analysis revealed that very high HDL-C levels increased cardiovascular death in women above 116 mg/dL (HR 1.47; 95% CI 1.01–2.15) and in men above 94 mg/dL (HR 1.29; 95% CI 1.01–1.65) (p_nonlinearity <0.01).
CONCLUSIONS
These findings suggest that very high HDL-C levels are not protective against CV mortality and may, in fact, increase CV mortality risk especially in men.
{"title":"Association between very high HDL-C levels and mortality: A systematic review and meta-analysis","authors":"Isadora Mamede , Marcelo Antonio Pinheiro Braga , Otavio C. Martins , Anne E.O. Franchini MD , Rodrigo B. Silveira Filho , Marcel C.F. Santos MD","doi":"10.1016/j.jacl.2024.06.002","DOIUrl":"10.1016/j.jacl.2024.06.002","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Recent research has raised questions about the assumed cardiovascular (CV) benefits of high-density lipoprotein cholesterol (HDL-C) and the potential for adverse outcomes with extremely high levels.</div></div><div><h3>OBJECTIVE</h3><div>We conducted a meta-analysis to investigate the association between very high HDL-C levels (≥80 mg/dL) and mortality outcomes in individuals without coronary artery disease (CAD).</div></div><div><h3>METHODS</h3><div>We systematically searched PubMed, Embase, and Cochrane databases for studies comparing very high HDL-C levels to normal levels (40–60 mg/dL) in CAD-free individuals. We assessed heterogeneity using I<sup>2</sup> statistics with a random-effects model.</div></div><div><h3>RESULTS</h3><div>Our analysis included 1,004,584 individuals from 8 studies, of whom 133,646 (13.3%) had very high HDL-C levels. All-cause mortality did not significantly differ between groups (<em>p</em> = 0.55), nor did cancer mortality (<em>p</em> = 0.45). Cardiovascular mortality showed no change in those with very high HDL-C (hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.94–1.17; <em>p</em> = 0.37). Fatal and non-fatal coronary heart disease events were less frequent in the very high HDL-C group (HR 0.79; 95% CI 0.73–0.86; <em>p</em> < 0.00001). Subgroup dose-response analysis revealed that very high HDL-C levels increased cardiovascular death in women above 116 mg/dL (HR 1.47; 95% CI 1.01–2.15) and in men above 94 mg/dL (HR 1.29; 95% CI 1.01–1.65) (<em>p_nonlinearity</em> <0.01).</div></div><div><h3>CONCLUSIONS</h3><div>These findings suggest that very high HDL-C levels are not protective against CV mortality and may, in fact, increase CV mortality risk especially in men.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 5","pages":"Pages e701-e709"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141405793","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 : 2024-09-01DOI: 10.1016/j.jacl.2024.06.003
Yu Geng PhD , Bin Wang MD , Lianfeng Liu PhD , Changhua Lv BD, Hao Qian PhD, Tingting Lv PhD, Ping Zhang MD
BACKGROUND
Past research has shown an inverse correlation between high-density lipoprotein (HDL) and coronary heart disease (CHD), while recent studies have shown that extremely high or low HDL levels increase the risk of cardiovascular death.
OBJECTIVE
To explore the relationships between HDL subtypes and the degree of coronary artery stenosis in patients with acute myocardial infarction (AMI).
METHODS
This was a single-center cross-sectional study. Ultimately, we included 1,200 adult participants with AMI hospitalized from 2017 to 2023. Patients were classified into mild and moderate-severe groups according to their Gensini score. Restricted cubic spline and multivariate logistic regression models were used to explore the associations between HDL subclasses and the severity of coronary stenosis.
RESULTS
The adjusted odds ratios (ORs), 95% confidence intervals (CIs), and p values for HDL subclasses in the multivariate logistic model (adjusted for age, gender, hypertension status, diabetes status, stroke status, and kidney disease status) were as follows: HDL-2b: 0.97 (0.95–1.00, p= 0.018) and HDL-3: 0.98 (0.97–0.99, p= 0.008). Subgroup analysis revealed that HDL-3 exhibited a statistically significant impact on the severity of coronary stenosis among individuals <75 years of age and among men, and the influence of HDL-2b on the severity of coronary stenosis was statistically significant only in individuals aged ≥75 years.
Conclusion
The relationship between reduced levels of HDL-2b and HDL-3 and the risk of coronary stenosis exhibited a linear pattern and was significantly modified by age. Subgroup analysis identified specific populations that warrant attention regarding HDL-2b and HDL-3.
{"title":"Association between the proportion of HDL-cholesterol subclasses and the severity of coronary artery stenosis in patients with acute myocardial infarction","authors":"Yu Geng PhD , Bin Wang MD , Lianfeng Liu PhD , Changhua Lv BD, Hao Qian PhD, Tingting Lv PhD, Ping Zhang MD","doi":"10.1016/j.jacl.2024.06.003","DOIUrl":"10.1016/j.jacl.2024.06.003","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Past research has shown an inverse correlation between high-density lipoprotein (HDL) and coronary heart disease (CHD), while recent studies have shown that extremely high or low HDL levels increase the risk of cardiovascular death.</div></div><div><h3>OBJECTIVE</h3><div>To explore the relationships between HDL subtypes and the degree of coronary artery stenosis in patients with acute myocardial infarction (AMI).</div></div><div><h3>METHODS</h3><div>This was a single-center cross-sectional study. Ultimately, we included 1,200 adult participants with AMI hospitalized from 2017 to 2023. Patients were classified into mild and moderate-severe groups according to their Gensini score. Restricted cubic spline and multivariate logistic regression models were used to explore the associations between HDL subclasses and the severity of coronary stenosis.</div></div><div><h3>RESULTS</h3><div>The adjusted odds ratios (ORs), 95% confidence intervals (CIs), and p values for HDL subclasses in the multivariate logistic model (adjusted for age, gender, hypertension status, diabetes status, stroke status, and kidney disease status) were as follows: HDL-2b: 0.97 (0.95–1.00, <em>p</em>= 0.018) and HDL-3: 0.98 (0.97–0.99, <em>p</em>= 0.008). Subgroup analysis revealed that HDL-3 exhibited a statistically significant impact on the severity of coronary stenosis among individuals <75 years of age and among men, and the influence of HDL-2b on the severity of coronary stenosis was statistically significant only in individuals aged ≥75 years.</div></div><div><h3>Conclusion</h3><div>The relationship between reduced levels of HDL-2b and HDL-3 and the risk of coronary stenosis exhibited a linear pattern and was significantly modified by age. Subgroup analysis identified specific populations that warrant attention regarding HDL-2b and HDL-3.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 5","pages":"Pages e710-e719"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141415963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.jacl.2024.06.006
Maral Amangurbanova MD , Ralph Daher MD , Abdul Aziz Asbeutah MD , Bhavya Vemuri MD , Hasan Mirza MD , Smaha Waseem MD , Abdulaziz Malik MD , Francine K. Welty MD, PhD
BACKGROUND
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation lower triglyceride levels. The impact on epicardial adipose tissue volume (EATV), which is associated with cardiovascular events, is unclear.
OBJECTIVE
To determine if triglyceride reduction with EPA+DHA supplementation decreases EATV and whether EATV affects coronary plaque.
METHODS
139 subjects with coronary artery disease (CAD) on statins were randomized to 3.36 g EPA+DHA daily or none (control) for 30 months. EATV, coronary plaque volumes and coronary artery calcium score were measured with coronary computed tomographic angiography.
RESULTS
Change in triglyceride level correlated with change in EATV (r=0.236; p=0.006). Despite a 6.7% triglyceride reduction (p=0.021) with EPA+DHA supplementation compared to no change in control (between group p=0.034); both groups had similar reductions in EATV possibly due to statin treatment. EATV above the median (>115.6 cm3) was the only determinant of baseline coronary fatty plaque volume (β=2.4, p=0.010). After multivariate adjustment, waist circumference, a surrogate of abdominal visceral adiposity, was the only determinant of baseline EATV (odds ratio {OR]:1.093; 95% confidence interval [CI]:1.003-1.192, p=0.042). Moreover, increase in waist circumference was the only predictor of an increase in EATV at 30 months (β=0.320, p=0.018).
CONCLUSIONS
EATV is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation at 30-month follow-up in CAD patients on statin treatment. The direct correlation between waist circumference and EATV suggests that maintaining a healthy weight may limit EATV and coronary fatty plaque volume, potentially leading to a decrease in cardiovascular events.
{"title":"Higher epicardial adipose tissue volume is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation","authors":"Maral Amangurbanova MD , Ralph Daher MD , Abdul Aziz Asbeutah MD , Bhavya Vemuri MD , Hasan Mirza MD , Smaha Waseem MD , Abdulaziz Malik MD , Francine K. Welty MD, PhD","doi":"10.1016/j.jacl.2024.06.006","DOIUrl":"10.1016/j.jacl.2024.06.006","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementation lower triglyceride levels. The impact on epicardial adipose tissue volume (EATV), which is associated with cardiovascular events, is unclear.</div></div><div><h3>OBJECTIVE</h3><div>To determine if triglyceride reduction with EPA+DHA supplementation decreases EATV and whether EATV affects coronary plaque.</div></div><div><h3>METHODS</h3><div>139 subjects with coronary artery disease (CAD) on statins were randomized to 3.36 g EPA+DHA daily or none (control) for 30 months. EATV, coronary plaque volumes and coronary artery calcium score were measured with coronary computed tomographic angiography.</div></div><div><h3>RESULTS</h3><div>Change in triglyceride level correlated with change in EATV (<em>r</em>=0.236; <em>p</em>=0.006). Despite a 6.7% triglyceride reduction (<em>p</em>=0.021) with EPA+DHA supplementation compared to no change in control (between group <em>p</em>=0.034); both groups had similar reductions in EATV possibly due to statin treatment. EATV above the median (>115.6 cm<sup>3</sup>) was the only determinant of baseline coronary fatty plaque volume (β=2.4, <em>p</em>=0.010). After multivariate adjustment, waist circumference, a surrogate of abdominal visceral adiposity, was the only determinant of baseline EATV (odds ratio {OR]:1.093; 95% confidence interval [CI]:1.003-1.192, <em>p</em>=0.042). Moreover, increase in waist circumference was the only predictor of an increase in EATV at 30 months (β=0.320, <em>p</em>=0.018).</div></div><div><h3>CONCLUSIONS</h3><div>EATV is associated with higher coronary fatty plaque volume and is regulated by waist circumference but not EPA+DHA supplementation at 30-month follow-up in CAD patients on statin treatment. The direct correlation between waist circumference and EATV suggests that maintaining a healthy weight may limit EATV and coronary fatty plaque volume, potentially leading to a decrease in cardiovascular events.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 5","pages":"Pages e773-e786"},"PeriodicalIF":3.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141611953","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 : 2024-08-31DOI: 10.1016/j.jacl.2024.08.012
Angela Burvill, Gerald F Watts, Richard Norman, Zanfina Ademi
Background: Olpasiran and pelacarsen are gene-silencing therapies that lower lipoprotein(a). Cardiovascular outcome trials are ongoing. Mendelian randomisation 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 randomisation 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 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.
{"title":"Early health technology assessment of gene silencing therapies for lowering lipoprotein(a) in the secondary prevention of coronary heart disease.","authors":"Angela Burvill, Gerald F Watts, Richard Norman, Zanfina Ademi","doi":"10.1016/j.jacl.2024.08.012","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.012","url":null,"abstract":"<p><strong>Background: </strong>Olpasiran and pelacarsen are gene-silencing therapies that lower lipoprotein(a). Cardiovascular outcome trials are ongoing. Mendelian randomisation studies estimated clinical benefits from lipoprotein(a) lowering.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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 randomisation 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.</p><p><strong>Results: </strong>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 ICER threshold AU$50,000 per QALY, olpasiran and pelacarsen would be cost-effective at annual prices AU$4207 and AU$2464 respectively.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347473","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}
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 (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.
{"title":"Lipid profile and risk factors for neoatherosclerosis after drug-eluting stent implantation in acute coronary syndrome.","authors":"Norihito Nakamura, Katsuaki Sakai, Sho Torii, Yuki Aoki, Frederic Turcotte-Gosselin, Kazuki Fujinuma, Ami Ohwaki, Kazuki Aihara, Satoshi Noda, Junichi Miyamoto, Yu Sato, Manabu Shiozaki, Makoto Natsumeda, Yohei Ohno, Masataka Nakano, Fuminobu Yoshimachi, Gaku Nakazawa, Yuji Ikari","doi":"10.1016/j.jacl.2024.08.011","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.011","url":null,"abstract":"<p><strong>Background: </strong>Predictors of neoatherosclerosis in patients who received primary percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remain unclear.</p><p><strong>Objective: </strong>The aim of this study is to investigate the frequency and risk factors of neoatherosclerosis 1-year after the onset of ACS.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (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).</p><p><strong>Conclusion: </strong>Poorly controlled non-HDL-C and Lp(a) would be risk factors of neoatherosclerosis in patients 1-year after ACS.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288260","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 : 2024-08-31DOI: 10.1016/j.jacl.2024.08.009
David Gabriel David-Pardo, Álvaro J Ruiz, Óscar Mauricio Muñoz Velandia, Ángel Alberto García Peña, Diana Ximena Salgado García, Julieth Andrea Arcila Matiz
Background: Although direct measurement of LDL 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 triglycerides 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.
{"title":"Concordance between LDL-C estimated by various formulas and directly measured LDL-C.","authors":"David Gabriel David-Pardo, Álvaro J Ruiz, Óscar Mauricio Muñoz Velandia, Ángel Alberto García Peña, Diana Ximena Salgado García, Julieth Andrea Arcila Matiz","doi":"10.1016/j.jacl.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.009","url":null,"abstract":"<p><strong>Background: </strong>Although direct measurement of LDL 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.</p><p><strong>Objective: </strong>To determine the concordance between LDL-C directly measured using the enzymatic technique and existing methods to calculate it.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 triglycerides 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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347472","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 : 2024-08-31DOI: 10.1016/j.jacl.2024.08.010
Huseyin Bilgin, Ilyas Yolbas, Selahattin Tekes
Aim: The aim of this study was to examine the clinical, laboratory and demographic characteristics of patients diagnosed with cerebrotendinous xanthomatosis.
Materials and methods: This study included 11 patients followed up in the Paediatric Metabolism Polyclinic for a diagnosis of CTX. The diagnosis of CTX was made from high blood cholestanol level and CYP27A1 gene analysis. All the cases diagnosed with CTX for whom clinical and laboratory findings were evaluated were included in the study.
Results: Evaluation was made of 11 patients from 5 different families. The diagnosis was established 25 years after the symptoms first appeared. The diagnosis was made because of bilateral cataracts in 2 patients, tendon xanthomas in 2, and as a result of family screening in 7. Tendon xanthomas were present in 36.3 % of the patients, and there was a history of cataract in 54.5 %. In the current study, mental retardation was determined in 72 % of the patients, psychiatric findings in 36 %, epilepsy in 36 %, pyramidal-extrapyramidal findings in 45 %, and postural tremor in 54 %. In addition, neuropsychiatric symptoms were seen at different rates in patients with different gene alleles. No tendon xanthomas were determined in the cases with c.1263 + 4A>T and c.808C>T mutations. Cataract was determined in all the cases with homozygote c.1263 + 4A>T mutation.
Conclusion: In this study, it was determined that the cases were diagnosed late despite the onset of symptoms providing clues for diagnosis at an early age. It was determined that the delay in diagnosis was 25 years.
{"title":"The clinical and demographic characteristics of patients with late-diagnosed cerebrotendinous xanthomatosis in a Turkish population.","authors":"Huseyin Bilgin, Ilyas Yolbas, Selahattin Tekes","doi":"10.1016/j.jacl.2024.08.010","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.010","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to examine the clinical, laboratory and demographic characteristics of patients diagnosed with cerebrotendinous xanthomatosis.</p><p><strong>Materials and methods: </strong>This study included 11 patients followed up in the Paediatric Metabolism Polyclinic for a diagnosis of CTX. The diagnosis of CTX was made from high blood cholestanol level and CYP27A1 gene analysis. All the cases diagnosed with CTX for whom clinical and laboratory findings were evaluated were included in the study.</p><p><strong>Results: </strong>Evaluation was made of 11 patients from 5 different families. The diagnosis was established 25 years after the symptoms first appeared. The diagnosis was made because of bilateral cataracts in 2 patients, tendon xanthomas in 2, and as a result of family screening in 7. Tendon xanthomas were present in 36.3 % of the patients, and there was a history of cataract in 54.5 %. In the current study, mental retardation was determined in 72 % of the patients, psychiatric findings in 36 %, epilepsy in 36 %, pyramidal-extrapyramidal findings in 45 %, and postural tremor in 54 %. In addition, neuropsychiatric symptoms were seen at different rates in patients with different gene alleles. No tendon xanthomas were determined in the cases with c.1263 + 4A>T and c.808C>T mutations. Cataract was determined in all the cases with homozygote c.1263 + 4A>T mutation.</p><p><strong>Conclusion: </strong>In this study, it was determined that the cases were diagnosed late despite the onset of symptoms providing clues for diagnosis at an early age. It was determined that the delay in diagnosis was 25 years.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621434","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}
Background and aims: The monocyte/lymphocyte ratio (MLR), an inflammatory marker, has an unclear relationship with the risk of residual inflammation in patients with coronary artery disease (CAD) and low-density lipoprotein cholesterol (LDL-C) below 1.4 mmol/L. This study aimed to assess the association between the MLR and cardiovascular and all-cause mortalities in these patients.
Methods: A total of 2747 patients diagnosed with CAD via coronary angiography (CAG) and presenting with LDL-C levels < 1.4 mmol/L were enrolled in this observational study conducted from January 2007 to December 2020. Patients were categorized into four groups based on the MLR quartiles. We used Kaplan-Meier analysis and Cox regression models to evaluate the relationship between baseline MLR and cardiovascular and all-cause mortalities.
Results: Among the 2747 participants followed up for a median duration of 6 years, there were 184 cardiovascular and 462 all-cause deaths. Elevated MLR levels were found to be associated with an increased risk of both cardiovascular and all-cause mortalities according to the Kaplan-Meier analysis. Multivariate Cox regression analysis demonstrated a significant association between higher MLR and an elevated risk of cardiovascular and all-cause mortality. Compared to the older group, with an increase in MLR levels, the younger group showed a higher hazard ratio for cardiovascular death. Similar results were obtained in the single-vessel disease group.
Conclusions: In patients with CAD and LDL-C levels < 1.4 mmol/L, MLR can serve as a risk factor for both cardiovascular and all-cause mortalities owing to the risk of residual inflammation.
{"title":"Monocyte/lymphocyte ratio as a risk factor of cardiovascular and all-cause mortality in coronary artery disease with low-density lipoprotein cholesterol levels below 1.4 mmol/L: A large longitudinal multicenter study.","authors":"Rengui Jiang, Huangtao Ruan, Wanying Wu, Yueting Wang, Haozhang Huang, Xiaozhao Lu, Weipeng Liang, Yang Zhou, Jielan Wu, Xianlin Ruan, Jinming Chen, Weipeng Zhang, Yulong Xiang, Zhitao Yan, Yong Liu, Ning Tan","doi":"10.1016/j.jacl.2024.08.005","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.005","url":null,"abstract":"<p><strong>Background and aims: </strong>The monocyte/lymphocyte ratio (MLR), an inflammatory marker, has an unclear relationship with the risk of residual inflammation in patients with coronary artery disease (CAD) and low-density lipoprotein cholesterol (LDL-C) below 1.4 mmol/L. This study aimed to assess the association between the MLR and cardiovascular and all-cause mortalities in these patients.</p><p><strong>Methods: </strong>A total of 2747 patients diagnosed with CAD via coronary angiography (CAG) and presenting with LDL-C levels < 1.4 mmol/L were enrolled in this observational study conducted from January 2007 to December 2020. Patients were categorized into four groups based on the MLR quartiles. We used Kaplan-Meier analysis and Cox regression models to evaluate the relationship between baseline MLR and cardiovascular and all-cause mortalities.</p><p><strong>Results: </strong>Among the 2747 participants followed up for a median duration of 6 years, there were 184 cardiovascular and 462 all-cause deaths. Elevated MLR levels were found to be associated with an increased risk of both cardiovascular and all-cause mortalities according to the Kaplan-Meier analysis. Multivariate Cox regression analysis demonstrated a significant association between higher MLR and an elevated risk of cardiovascular and all-cause mortality. Compared to the older group, with an increase in MLR levels, the younger group showed a higher hazard ratio for cardiovascular death. Similar results were obtained in the single-vessel disease group.</p><p><strong>Conclusions: </strong>In patients with CAD and LDL-C levels < 1.4 mmol/L, MLR can serve as a risk factor for both cardiovascular and all-cause mortalities owing to the risk of residual inflammation.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288261","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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