Pub Date : 2025-11-01DOI: 10.1016/j.arteri.2025.500772
María Gordito Soler , José Ignacio Ramírez-Manent , Pedro Juan Tárraga López , Emilio Martínez-Almoyna Rifá , Hernán Paublini , Ángel Arturo López González
Introduction
Obesity and atherogenesis are two highly prevalent pathological processes worldwide that also share several pathophysiological mechanisms.
Objectives
Descriptive and cross-sectional study in 8,590 Spanish workers (4,104 men and 4,486 women) with an average age of 41.5 years, in which the usefulness of four scales of overweight and obesity such as body mass index (BMI), waist circumference and percentages of body and visceral fat determined by bioimpedance measurement to identify high levels of atherogenic risk determined by atherogenic dyslipidemia (AD), lipid triad (LT) and several atherogenic indices is assessed.
Results
All the overweight and obesity scales show a predictive value between moderate and good, determined by the AUC of the ROC curves, with values ranging from 0.727 to 0.886 in women and 0.676 to 0.885 in men. Of all of them, the one with the highest AUC is visceral fat with values exceeding 0.800 and the lowest are for BMI. In all cases, the AUC is higher in women.
Conclusions
The overweight and obesity scales analysed (BMI, waist circumference and percentage of body and visceral fat) show AUCs for predicting atherogenic risk between moderate and high, with visceral fat being the most useful of all.
{"title":"Utilidad de la grasa corporal y visceral determinada por bioimpedanciometría frente al índice de masa corporal y el perímetro de cintura en la identificación de valores elevados de diferentes escalas de riesgo de aterogénesis","authors":"María Gordito Soler , José Ignacio Ramírez-Manent , Pedro Juan Tárraga López , Emilio Martínez-Almoyna Rifá , Hernán Paublini , Ángel Arturo López González","doi":"10.1016/j.arteri.2025.500772","DOIUrl":"10.1016/j.arteri.2025.500772","url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity and atherogenesis are two highly prevalent pathological processes worldwide that also share several pathophysiological mechanisms.</div></div><div><h3>Objectives</h3><div>Descriptive and cross-sectional study in 8,590 Spanish workers (4,104 men and 4,486 women) with an average age of 41.5<!--> <!-->years, in which the usefulness of four scales of overweight and obesity such as body mass index (BMI), waist circumference and percentages of body and visceral fat determined by bioimpedance measurement to identify high levels of atherogenic risk determined by atherogenic dyslipidemia (AD), lipid triad (LT) and several atherogenic indices is assessed.</div></div><div><h3>Results</h3><div>All the overweight and obesity scales show a predictive value between moderate and good, determined by the AUC of the ROC curves, with values ranging from 0.727 to 0.886 in women and 0.676 to 0.885 in men. Of all of them, the one with the highest AUC is visceral fat with values exceeding 0.800 and the lowest are for BMI. In all cases, the AUC is higher in women.</div></div><div><h3>Conclusions</h3><div>The overweight and obesity scales analysed (BMI, waist circumference and percentage of body and visceral fat) show AUCs for predicting atherogenic risk between moderate and high, with visceral fat being the most useful of all.</div></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"37 6","pages":"Article 500772"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arteri.2025.500767
Santiago Redondo
In the last decade, the coming of next-generation sequencing and its application to large human populations is breaking the barrier between inflammation and cancer. Indeed, acquired mutations in key genes that regulate hematopoiesis and thus confer a selective advantage in the proliferation of hematopoietic progenitors have established the concept of clonal hematopoiesis of indeterminate potential or CHIP. A growing body of clinical and experimental evidence is highlighting the link between CHIP and adverse outcomes, in particular atherosclerotic cardiovascular disease and cancer. The apparent surprise about how these two different entities share common mechanisms can be explained by myeloproliferation and inflammation. These mechanisms are involved not only in the development of myeloid tumors but also in atherogenesis. Myeloproliferative neoplasms or MPN are a type of myeloid tumors where thrombotic risk is increased not only by higher blood counts but also by means of an accelerated atherosclerosis. Therefore, myeloproliferative neoplasms are a model of the link between clonal hematopoiesis and atherosclerotic cardiovascular disease. The concept of CHIP has important clinical applications. A deeper understanding of these mechanisms may pave the way for the future early diagnosis and potential pre-emptive treatments of these two major causes of death.
{"title":"Myeloproliferative neoplasms: A model of the journey from clonal hematopoiesis to cardiovascular disease and cancer","authors":"Santiago Redondo","doi":"10.1016/j.arteri.2025.500767","DOIUrl":"10.1016/j.arteri.2025.500767","url":null,"abstract":"<div><div>In the last decade, the coming of next-generation sequencing and its application to large human populations is breaking the barrier between inflammation and cancer. Indeed, acquired mutations in key genes that regulate hematopoiesis and thus confer a selective advantage in the proliferation of hematopoietic progenitors have established the concept of clonal hematopoiesis of indeterminate potential or CHIP. A growing body of clinical and experimental evidence is highlighting the link between CHIP and adverse outcomes, in particular atherosclerotic cardiovascular disease and cancer. The apparent surprise about how these two different entities share common mechanisms can be explained by myeloproliferation and inflammation. These mechanisms are involved not only in the development of myeloid tumors but also in atherogenesis. Myeloproliferative neoplasms or MPN are a type of myeloid tumors where thrombotic risk is increased not only by higher blood counts but also by means of an accelerated atherosclerosis. Therefore, myeloproliferative neoplasms are a model of the link between clonal hematopoiesis and atherosclerotic cardiovascular disease. The concept of CHIP has important clinical applications. A deeper understanding of these mechanisms may pave the way for the future early diagnosis and potential pre-emptive treatments of these two major causes of death.</div></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"37 6","pages":"Article 500767"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arteri.2025.500773
Juan Cosín Sales , Carlos Escobar Cervantes , José Javier Gómez-Barrado , José Manuel Andreu Cayuelas , Abel García del Egido , Jorge Joaquín Castro Martín , Ana Isabel Huelmos Rodrigo , Miguel Corbi-Pascual , Ariana Varela Cancelo , Rafael Vidal-Pérez , Leticia Fernandez-Friera , Enrique Santas Olmeda , Almudena Aguilera-Saborido , Antonio Fernández Romero , Antonio Sánchez Hidalgo , Francisco Pérez-Sádaba , Román Freixa-Pamias
Aims
A high number of patients do not achieve the therapeutic goals set by clinical practice guidelines, despite the therapeutic alternatives that currently exist in lipid-lowering treatment (LLT). This study aimed to estimate the proportion of patients who have recently suffered an acute coronary syndrome (ACS) who do not meet the therapeutic goal with LLT and the proportion of routine follow-up visits where therapeutic inertia (TI) occurs.
Methods
A retrospective study chart review was conducted in 13 Spanish centres. Patients aged ≥18 years who suffered an ACS event in the last two years and had received LLT were included. Sociodemographic, clinical, treatment and participating centre/physician-related variables were collected. TI was considered when a visit did not result in a change in the patient's therapy despite the non-achievement of therapeutic goals. Descriptive analysis was performed, and factors associated with TI were evaluated using logistic regression.
Results
159 patients were included (mean age 63.08 years old, 80.5% male) and 338 follow-up visits were analysed. Over 50% of the patients did not meet the therapeutic target and TI was estimated in 39.13% of visits. Some factors were associated with a lower risk of TI: professional experience, number of vessels affected, and diabetes. And others with higher risk: being female, previous CV pathology and a complete revascularisation.
Conclusion
The management of patients after ACS is still suboptimal. The importance of clinical inertia in ACS remains a real awareness and active strategies will help mitigate this phenomenon due to the risk of recurrent ACS.
{"title":"Impact of therapeutic inertia in lipid-lowering therapy in patients at very high cardiovascular risk","authors":"Juan Cosín Sales , Carlos Escobar Cervantes , José Javier Gómez-Barrado , José Manuel Andreu Cayuelas , Abel García del Egido , Jorge Joaquín Castro Martín , Ana Isabel Huelmos Rodrigo , Miguel Corbi-Pascual , Ariana Varela Cancelo , Rafael Vidal-Pérez , Leticia Fernandez-Friera , Enrique Santas Olmeda , Almudena Aguilera-Saborido , Antonio Fernández Romero , Antonio Sánchez Hidalgo , Francisco Pérez-Sádaba , Román Freixa-Pamias","doi":"10.1016/j.arteri.2025.500773","DOIUrl":"10.1016/j.arteri.2025.500773","url":null,"abstract":"<div><h3>Aims</h3><div>A high number of patients do not achieve the therapeutic goals set by clinical practice guidelines, despite the therapeutic alternatives that currently exist in lipid-lowering treatment (LLT). This study aimed to estimate the proportion of patients who have recently suffered an acute coronary syndrome (ACS) who do not meet the therapeutic goal with LLT and the proportion of routine follow-up visits where therapeutic inertia (TI) occurs.</div></div><div><h3>Methods</h3><div>A retrospective study chart review was conducted in 13 Spanish centres. Patients aged ≥18 years who suffered an ACS event in the last two years and had received LLT were included. Sociodemographic, clinical, treatment and participating centre/physician-related variables were collected. TI was considered when a visit did not result in a change in the patient's therapy despite the non-achievement of therapeutic goals. Descriptive analysis was performed, and factors associated with TI were evaluated using logistic regression.</div></div><div><h3>Results</h3><div>159 patients were included (mean age 63.08 years old, 80.5% male) and 338 follow-up visits were analysed. Over 50% of the patients did not meet the therapeutic target and TI was estimated in 39.13% of visits. Some factors were associated with a lower risk of TI: professional experience, number of vessels affected, and diabetes. And others with higher risk: being female, previous CV pathology and a complete revascularisation.</div></div><div><h3>Conclusion</h3><div>The management of patients after ACS is still suboptimal. The importance of clinical inertia in ACS remains a real awareness and active strategies will help mitigate this phenomenon due to the risk of recurrent ACS.</div></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"37 6","pages":"Article 500773"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arteri.2025.500874
Francisco Martín Luján , Rosa Solà Alberich
{"title":"Utilidad del estudio de la grasa visceral para una estratificación precoz del riesgo aterogénico: de la antropometría convencional a las medidas más precisas","authors":"Francisco Martín Luján , Rosa Solà Alberich","doi":"10.1016/j.arteri.2025.500874","DOIUrl":"10.1016/j.arteri.2025.500874","url":null,"abstract":"","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"37 6","pages":"Article 500874"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arteri.2025.500846
Joanna Popiolek-Kalisz
Background
Although aggressive low-density lipoprotein cholesterol (LDL-C) reduction has demonstrated significant cardiovascular benefits, concerns have emerged regarding potential adverse effects of very low LDL-C on cellular functions, particularly membrane integrity as cholesterol constitutes an essential component of cellular membranes. The phase angle (PhA), derived from bioelectrical impedance analysis (BIA) reflects cellular membranes integrity and nutritional status. The MALIPID study aimed to assess if LDL-C levels are associated with PhA in high cardiovascular risk patients.
Methods
A cross-sectional study was conducted in 140 patients matched 1:1 for age, sex, and body mass index, stratified by LDL-C levels (<55 vs. ≥55 mg/dL). Laboratory parameters, anthropometry, and BIA measurements were collected with PhA at 50 kHz as the primary outcome.
Results
Median PhA values were comparable between LDL-C groups (4.88 vs. 4.93; p = 0.67). LDL-C was not significantly associated with PhA multivariable regression models adjusted for age, sex, fat-free mass, and biochemical parameters. PhA significantly inversely correlated with age (R = −0.60, p < 0.0001) and positively with eGFR (R = 0.38, p < 0.0001), but not with LDL-C. Subgroup analyses in patients aged >75 years also presented lack of relationship between LDL-C and PhA.
Conclusions
No association was found between LDL-C levels and cellular membrane integrity assessed by PhA. These findings potentially support the physiological safety of intensive LDL-C reduction and highlight the dominant role of age and body composition in determining PhA. Larger, prospective studies are needed to confirm these results.
背景：尽管积极降低低密度脂蛋白胆固醇（LDL-C）已显示出显著的心血管益处，但人们开始关注极低的LDL-C对细胞功能的潜在不良影响，特别是膜完整性，因为胆固醇是细胞膜的重要组成部分。由生物电阻抗分析（BIA）得出的相位角（PhA）反映了细胞膜的完整性和营养状况。MALIPID研究旨在评估高危心血管患者LDL-C水平是否与PhA相关。方法：对140例年龄、性别和体重指数1:1匹配的患者进行横断面研究，按LDL-C水平分层(结果：LDL-C组间PhA值中位数具有可比性（4.88 vs 4.93; p=0.67）。LDL-C与PhA多变量回归模型无显著相关性，校正了年龄、性别、无脂量和生化参数。PhA与年龄呈显著负相关（R=-0.60， p75岁时LDL-C与PhA也无相关性）。结论：LDL-C水平与PhA评估的细胞膜完整性之间没有关联。这些发现潜在地支持了强化LDL-C降低的生理安全性，并强调了年龄和身体成分在决定PhA中的主导作用。需要更大规模的前瞻性研究来证实这些结果。
{"title":"No association between LDL cholesterol levels and cellular membrane integrity assessed with phase angle: Insights from the MALIPID study","authors":"Joanna Popiolek-Kalisz","doi":"10.1016/j.arteri.2025.500846","DOIUrl":"10.1016/j.arteri.2025.500846","url":null,"abstract":"<div><h3>Background</h3><div>Although aggressive low-density lipoprotein cholesterol (LDL-C) reduction has demonstrated significant cardiovascular benefits, concerns have emerged regarding potential adverse effects of very low LDL-C on cellular functions, particularly membrane integrity as cholesterol constitutes an essential component of cellular membranes. The phase angle (PhA), derived from bioelectrical impedance analysis (BIA) reflects cellular membranes integrity and nutritional status. The MALIPID study aimed to assess if LDL-C levels are associated with PhA in high cardiovascular risk patients.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in 140 patients matched 1:1 for age, sex, and body mass index, stratified by LDL-C levels (<55 vs. ≥55<!--> <!-->mg/dL). Laboratory parameters, anthropometry, and BIA measurements were collected with PhA at 50<!--> <!-->kHz as the primary outcome.</div></div><div><h3>Results</h3><div>Median PhA values were comparable between LDL-C groups (4.88 vs. 4.93; <em>p</em> <!-->=<!--> <!-->0.67). LDL-C was not significantly associated with PhA multivariable regression models adjusted for age, sex, fat-free mass, and biochemical parameters. PhA significantly inversely correlated with age (<em>R</em> <!-->=<!--> <!-->−0.60, <em>p</em> <!--><<!--> <!-->0.0001) and positively with eGFR (<em>R</em> <!-->=<!--> <!-->0.38, <em>p</em> <!--><<!--> <!-->0.0001), but not with LDL-C. Subgroup analyses in patients aged >75 years also presented lack of relationship between LDL-C and PhA.</div></div><div><h3>Conclusions</h3><div>No association was found between LDL-C levels and cellular membrane integrity assessed by PhA. These findings potentially support the physiological safety of intensive LDL-C reduction and highlight the dominant role of age and body composition in determining PhA. Larger, prospective studies are needed to confirm these results.</div></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"37 6","pages":"Article 500846"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arteri.2025.500798
Teresa Arrobas Velilla , Salomon Martin Perez , Carla Fernández Prendes , Maria Jose Castro Castro , Silvia Camos Anguila , Antonio Leon Justel
Introduction
Lipoprotein a is considered an independent factor of atherosclerotic cardiovascular disease with high prevalence, but the availability of real and updated data in Spain as well as determination protocols are limited.
Main objective
Analyze the current state of the pre-analytical, analytical and post-analytical process of Lp (a) and assess the relationship with other variables.
Material and method
Retrospective, observational, multicenter, anonymized study carried out in 2022 by survey of clinical laboratories.
Results
21,926 determinations were obtained corresponding to 49 Laboratories. The values obtained were: Lp(a) >30 mg/dl = 46.87%, Lp(a) >50 mg/dl 35.31%, Lp(a) >70 mg/dl = 26.8% Lp(a) >90 mg/dl = 19.3% with predominance of superiority in female gender in all established cut-off points.
Almost 30% of primary care doctors do not have access to their application. 56.9% do not have a rejection criterion. 70.6% do not have protocols for its determination.
There are two predominant analytical techniques, Immunophelometry (40%) and immunoturbidimetry (60%), 24% use nmon/L, 68% mg/dL and 8% report both.
Conclusions
There is a low number of patients who have Lp(a) measured and of them the percentage of patients according to risk cut-off points are higher than those described. There is a lack of uniformity in pre-analytical, analytical and post-analytical processes in which it is necessary to work in a multidisciplinary manner to avoid future cardiovascular events.
{"title":"Análisis de la determinación de lipoproteína (a) en una selección de laboratorios clínicos españoles. Estudio Batary","authors":"Teresa Arrobas Velilla , Salomon Martin Perez , Carla Fernández Prendes , Maria Jose Castro Castro , Silvia Camos Anguila , Antonio Leon Justel","doi":"10.1016/j.arteri.2025.500798","DOIUrl":"10.1016/j.arteri.2025.500798","url":null,"abstract":"<div><h3>Introduction</h3><div>Lipoprotein a is considered an independent factor of atherosclerotic cardiovascular disease with high prevalence, but the availability of real and updated data in Spain as well as determination protocols are limited.</div></div><div><h3>Main objective</h3><div>Analyze the current state of the pre-analytical, analytical and post-analytical process of Lp (a) and assess the relationship with other variables.</div></div><div><h3>Material and method</h3><div>Retrospective, observational, multicenter, anonymized study carried out in 2022 by survey of clinical laboratories.</div></div><div><h3>Results</h3><div>21,926 determinations were obtained corresponding to 49 Laboratories. The values obtained were: Lp(a)<!--> <!-->>30<!--> <!-->mg/dl<!--> <!-->=<!--> <!-->46.87%, Lp(a)<!--> <!-->>50<!--> <!-->mg/dl 35.31%, Lp(a)<!--> <!-->>70<!--> <!-->mg/dl<!--> <!-->=<!--> <!-->26.8% Lp(a)<!--> <!-->>90<!--> <!-->mg/dl<!--> <!-->=<!--> <!-->19.3% with predominance of superiority in female gender in all established cut-off points.</div><div>Almost 30% of primary care doctors do not have access to their application. 56.9% do not have a rejection criterion. 70.6% do not have protocols for its determination.</div><div>There are two predominant analytical techniques, Immunophelometry (40%) and immunoturbidimetry (60%), 24% use nmon/L, 68% mg/dL and 8% report both.</div></div><div><h3>Conclusions</h3><div>There is a low number of patients who have Lp(a) measured and of them the percentage of patients according to risk cut-off points are higher than those described. There is a lack of uniformity in pre-analytical, analytical and post-analytical processes in which it is necessary to work in a multidisciplinary manner to avoid future cardiovascular events.</div></div>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":"37 6","pages":"Article 500798"},"PeriodicalIF":1.9,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-21DOI: 10.1016/j.arteri.2025.500871
Claudia Isabella Tirado Cabrera, Daniel Guzmán Capote, Pedro Juan Tárraga López, Ángel Arturo López-González
Background: Atherogenic dyslipidemia is a significant but often underrecognized cardiovascular risk factor in individuals with normal weight. Traditional metrics such as body mass index (BMI) may fail to identify metabolically unhealthy phenotypes. This study aimed to assess the prevalence and sociodemographic and lifestyle determinants of atherogenic risk using lipid-based indices in a large cohort of normal-weight Spanish workers.
Methods: A cross-sectional study was conducted in a sample of 166,008 normal-weight workers (BMI 18.5-24.9kg/m2). Four atherogenic risk indices were calculated: TC/HDL-c, LDL/HDL-c, TG/HDL-c, and a composite Dyslipidemia Atherogenic Index (DA). Multivariate logistic regression analyses were performed to assess associations with age, sex, educational level, occupational category (CNAE-11), physical activity (IPAQ), adherence to the Mediterranean diet (MEDAS), smoking, and alcohol consumption.
Results: Male sex, older age, low physical activity, and poor adherence to the Mediterranean diet were independently associated with elevated values in all four atherogenic indices. The strongest associations were observed for DA with sedentary lifestyle (OR: 9.15; 95% CI: 8.08-10.23) and poor diet quality (OR: 5.23; 95% CI: 4.39-6.07). Notably, 17-22% of normal-weight workers showed abnormal lipid ratios suggestive of increased cardiometabolic risk.
Conclusions: Normal BMI does not guarantee cardiometabolic health. A considerable proportion of normal-weight individuals exhibit lipid profiles consistent with atherogenic dyslipidemia, largely driven by modifiable lifestyle factors. Lipid-based indices are valuable tools for early risk identification in occupational settings and should complement traditional anthropometric screening.
{"title":"Atherogenic risk in normal-weight workers: Associations with sociodemographic and healthy lifestyle factors using lipid-based indexes.","authors":"Claudia Isabella Tirado Cabrera, Daniel Guzmán Capote, Pedro Juan Tárraga López, Ángel Arturo López-González","doi":"10.1016/j.arteri.2025.500871","DOIUrl":"https://doi.org/10.1016/j.arteri.2025.500871","url":null,"abstract":"<p><strong>Background: </strong>Atherogenic dyslipidemia is a significant but often underrecognized cardiovascular risk factor in individuals with normal weight. Traditional metrics such as body mass index (BMI) may fail to identify metabolically unhealthy phenotypes. This study aimed to assess the prevalence and sociodemographic and lifestyle determinants of atherogenic risk using lipid-based indices in a large cohort of normal-weight Spanish workers.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in a sample of 166,008 normal-weight workers (BMI 18.5-24.9kg/m<sup>2</sup>). Four atherogenic risk indices were calculated: TC/HDL-c, LDL/HDL-c, TG/HDL-c, and a composite Dyslipidemia Atherogenic Index (DA). Multivariate logistic regression analyses were performed to assess associations with age, sex, educational level, occupational category (CNAE-11), physical activity (IPAQ), adherence to the Mediterranean diet (MEDAS), smoking, and alcohol consumption.</p><p><strong>Results: </strong>Male sex, older age, low physical activity, and poor adherence to the Mediterranean diet were independently associated with elevated values in all four atherogenic indices. The strongest associations were observed for DA with sedentary lifestyle (OR: 9.15; 95% CI: 8.08-10.23) and poor diet quality (OR: 5.23; 95% CI: 4.39-6.07). Notably, 17-22% of normal-weight workers showed abnormal lipid ratios suggestive of increased cardiometabolic risk.</p><p><strong>Conclusions: </strong>Normal BMI does not guarantee cardiometabolic health. A considerable proportion of normal-weight individuals exhibit lipid profiles consistent with atherogenic dyslipidemia, largely driven by modifiable lifestyle factors. Lipid-based indices are valuable tools for early risk identification in occupational settings and should complement traditional anthropometric screening.</p>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":" ","pages":"500871"},"PeriodicalIF":1.9,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-18DOI: 10.1016/j.arteri.2025.500870
Rosa Fernández-Olmo, Jesús Lara Mariscal, Ana García Ruano, Alberto Cordero, Juan Manuel Castillo Casas, Diego Franco
Lp(a) is a cardiovascular risk factor influenced by the LPA gene and apo(a) isoforms. Their relationship is not always linear and there are discordant phenotypes, for this reason in our work we evaluated the association between apo(a) isoforms and Lp(a) levels in patients with acute coronary syndrome (ACS). To this end, 43 patients with ACS and Lp(a) >50mg/dL were studied. The isoforms were characterized in 12bands by Western blotting. The association between bands and Lp(a) concentrations was evaluated by statistical analysis. It was observed that the intermediate molecular weight bands (b5-b8) were the most frequent, with band 8 predominating. No significant association was found between isoform size and Lp(a) levels (P>.05). We conclude that in this cohort no correlation was observed between apo(a) and Lp(a) isoforms. Other genetic or regulatory mechanisms could explain the observed variability, supporting the need for larger studies.
{"title":"Relationship between apolipoprotein(a) isoforms and lipoprotein(a) levels in patients with acute coronary syndrome.","authors":"Rosa Fernández-Olmo, Jesús Lara Mariscal, Ana García Ruano, Alberto Cordero, Juan Manuel Castillo Casas, Diego Franco","doi":"10.1016/j.arteri.2025.500870","DOIUrl":"https://doi.org/10.1016/j.arteri.2025.500870","url":null,"abstract":"<p><p>Lp(a) is a cardiovascular risk factor influenced by the LPA gene and apo(a) isoforms. Their relationship is not always linear and there are discordant phenotypes, for this reason in our work we evaluated the association between apo(a) isoforms and Lp(a) levels in patients with acute coronary syndrome (ACS). To this end, 43 patients with ACS and Lp(a) >50mg/dL were studied. The isoforms were characterized in 12bands by Western blotting. The association between bands and Lp(a) concentrations was evaluated by statistical analysis. It was observed that the intermediate molecular weight bands (b5-b8) were the most frequent, with band 8 predominating. No significant association was found between isoform size and Lp(a) levels (P>.05). We conclude that in this cohort no correlation was observed between apo(a) and Lp(a) isoforms. Other genetic or regulatory mechanisms could explain the observed variability, supporting the need for larger studies.</p>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":" ","pages":"500870"},"PeriodicalIF":1.9,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.arteri.2025.500830
Jose María Mostaza, Miquel Camafort Babkowksi, Soraya Sotto Rodriguez, Cristina Vehi Gasol, Juan Carlos Yáñez Wonenburguer, Miguel Chopo Alcubilla, Carlos Escobar, Maria Luisa Fernández Bujia, Fernando Gallo Trébol, Mar Gracia, Marta Martín Millán, Guillermo Pinillos, Juan Pedro Justel Pérez
Background: Arterial hypertension and dyslipidemia are two of the most relevant modifiable cardiovascular risk factors (CVRFs), and they often coexist. No recent studies specifically evaluating the achievement of LDL-C and blood pressure (BP) targets in hypertensive patients with dyslipidemia are available in Spain.
Methods: The SNAPSHOT study was a multicenter, cross-sectional observational study conducted in cardiology and internal medicine (IM) departments/clinics and primary care (PC) centers in Spain. The study enrolled consecutive adult patients (≥18 years of age) diagnosed with both hypertension and dyslipidemia. The primary endpoint was the percentage of patients achieving both the LDL-C goals recommended by the 2021 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines and the BP targets established in the 2018 ESC/European Society of Hypertension (ESH) guidelines. Cardiovascular (CV) risk (very high, high, low-to-moderate) was centrally assessed according to the updated Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Older Person (OP) algorithms recommended in the 2021 ESC guidelines.
Results: Between December 2021 and April 2022, a total of 443 evaluable patients were enrolled (males: 54%; ≥65 years of age: 66.1%; obesity: 37.4%; diabetes mellitus: 37.3%; coronary artery disease [CAD]: 25.7%). Out of the 388 patients in whom CV risk could be assessed, 34.3% and 56.4% were considered as having high and very high risk, respectively. Overall, 24% of the patients had achieved their risk-based LDL-C goals (21.8% of the patients at high-CV risk and 25.1% of those at very high risk), and 30.3% of the patients had reached the recommended BP targets (27.1% of the patients at high risk and 36.1% of those at very high risk). A total of 8.8% of the patients had achieved both the LDL-C and BP targets. Overall, 51.4% of the patients with concurrent diabetes had achieved glycemic control (HbA1c <7%), while only 9.4% of the diabetic patients had reached simultaneous control of LDL-C, BP and HbA1C targets (7.8% of the patients at high risk and 10.4% of those at very high risk).
Conclusion: The attainment of LDL-C and BP goals is still suboptimal in patients with dyslipidemia and hypertension in the real-world setting in Spain, with approximately 75% of the patients at very high risk of cardiovascular disease failing to reach their risk-based LDL-C and BP targets. Additionally, the rate corresponding to simultaneous control of LDL-C, BP and HbA1c is likewise very low. The present study thus highlights the current challenge of controlling multiple CVRFs that significantly contribute to atherosclerotic cardiovascular disease events and mortality and emphasizes the need for more effective management of CVRFs in the real-world setting.
{"title":"Real-world characterization of clinical management and achievement of the recommended risk-based low-density lipoprotein cholesterol and blood pressure goals in patients with arterial hypertension and dyslipidemia. The SNAPSHOT study.","authors":"Jose María Mostaza, Miquel Camafort Babkowksi, Soraya Sotto Rodriguez, Cristina Vehi Gasol, Juan Carlos Yáñez Wonenburguer, Miguel Chopo Alcubilla, Carlos Escobar, Maria Luisa Fernández Bujia, Fernando Gallo Trébol, Mar Gracia, Marta Martín Millán, Guillermo Pinillos, Juan Pedro Justel Pérez","doi":"10.1016/j.arteri.2025.500830","DOIUrl":"https://doi.org/10.1016/j.arteri.2025.500830","url":null,"abstract":"<p><strong>Background: </strong>Arterial hypertension and dyslipidemia are two of the most relevant modifiable cardiovascular risk factors (CVRFs), and they often coexist. No recent studies specifically evaluating the achievement of LDL-C and blood pressure (BP) targets in hypertensive patients with dyslipidemia are available in Spain.</p><p><strong>Methods: </strong>The SNAPSHOT study was a multicenter, cross-sectional observational study conducted in cardiology and internal medicine (IM) departments/clinics and primary care (PC) centers in Spain. The study enrolled consecutive adult patients (≥18 years of age) diagnosed with both hypertension and dyslipidemia. The primary endpoint was the percentage of patients achieving both the LDL-C goals recommended by the 2021 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines and the BP targets established in the 2018 ESC/European Society of Hypertension (ESH) guidelines. Cardiovascular (CV) risk (very high, high, low-to-moderate) was centrally assessed according to the updated Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Older Person (OP) algorithms recommended in the 2021 ESC guidelines.</p><p><strong>Results: </strong>Between December 2021 and April 2022, a total of 443 evaluable patients were enrolled (males: 54%; ≥65 years of age: 66.1%; obesity: 37.4%; diabetes mellitus: 37.3%; coronary artery disease [CAD]: 25.7%). Out of the 388 patients in whom CV risk could be assessed, 34.3% and 56.4% were considered as having high and very high risk, respectively. Overall, 24% of the patients had achieved their risk-based LDL-C goals (21.8% of the patients at high-CV risk and 25.1% of those at very high risk), and 30.3% of the patients had reached the recommended BP targets (27.1% of the patients at high risk and 36.1% of those at very high risk). A total of 8.8% of the patients had achieved both the LDL-C and BP targets. Overall, 51.4% of the patients with concurrent diabetes had achieved glycemic control (HbA1c <7%), while only 9.4% of the diabetic patients had reached simultaneous control of LDL-C, BP and HbA1C targets (7.8% of the patients at high risk and 10.4% of those at very high risk).</p><p><strong>Conclusion: </strong>The attainment of LDL-C and BP goals is still suboptimal in patients with dyslipidemia and hypertension in the real-world setting in Spain, with approximately 75% of the patients at very high risk of cardiovascular disease failing to reach their risk-based LDL-C and BP targets. Additionally, the rate corresponding to simultaneous control of LDL-C, BP and HbA1c is likewise very low. The present study thus highlights the current challenge of controlling multiple CVRFs that significantly contribute to atherosclerotic cardiovascular disease events and mortality and emphasizes the need for more effective management of CVRFs in the real-world setting.</p>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":" ","pages":"500830"},"PeriodicalIF":1.9,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.arteri.2025.500856
Lídia Puertas-Umbert, Judith Alonso, Laia Blanco-Casoliva, Roger Bentanachs, Lluis Asmarats, Gemma Arderiu, José Martínez-González, Cristina Rodríguez
Background: Inflammation, oxidative stress, and vascular remodeling play a key role in the pathophysiology of abdominal aortic aneurysm (AAA), a severe vascular disease. Previously, we had demonstrated an increase in the phosphorylated form of ATP citrate lyase (p-ACLY) in AAA and that bempedoic acid (BemA), a specific inhibitor of this enzyme, attenuates aneurysm formation in an experimental model. In this study, we further investigated the mechanisms mediating the beneficial effect of BemA.
Methods: AAA was induced by angiotensin II (AngII) infusion in ApoE-/- mice, and aneurysm formation was assessed by ultrasonography. Histological analyses (hematoxylin-eosin, orcein staining) and immunohistochemistry were performed. T cell subpopulations in the spleen were characterized by flow cytometry, and superoxide anion production in the vascular wall was evaluated by dihydroethidium (DHE) staining. The expression of enzymes involved in the control of oxidative stress was analyzed by real-time RT-PCR.
Results: Endpoint ultrasonography analyses in AngII-infused ApoE-/- mice confirmed that BemA limits aneurysm formation. Indeed, BemA administration in AngII-infused mice significantly increased both the percentage of animals that did not develop aneurysms and those free of aortic rupture, without altering the pressor effect of AngII. Histologically, BemA preserved the integrity of the aortic wall and reduced the proportion of animals presenting intramural thrombi, with a decrease in hematoma area. Immunohistochemical analyses showed increased levels of p-ACLY in the inflammatory infiltrate of human and murine aneurysmal lesions, as well as BemA's capacity to attenuate the AngII-induced increase in CD3+ T lymphocyte content in the vascular wall. Additionally, analysis of splenic CD8+ T cell subpopulations revealed no significant changes in either AngII-infused animals or those treated with BemA. Finally, ACLY activity inhibition decreased reactive oxygen species production without modifying the expression of key isoforms of the NADPH oxidase (Nox2, Nox4) or superoxide dismutase (Sod1, Sod2) families.
Conclusions: Taken together, these findings position ACLY as a relevant therapeutic target in AAA and BemA as a drug with potential protective effects against the development and progression of this vascular disease.
{"title":"Bempedoic acid attenuates vascular inflammation and oxidative stress in a preclinical model of abdominal aortic aneurysm.","authors":"Lídia Puertas-Umbert, Judith Alonso, Laia Blanco-Casoliva, Roger Bentanachs, Lluis Asmarats, Gemma Arderiu, José Martínez-González, Cristina Rodríguez","doi":"10.1016/j.arteri.2025.500856","DOIUrl":"https://doi.org/10.1016/j.arteri.2025.500856","url":null,"abstract":"<p><strong>Background: </strong>Inflammation, oxidative stress, and vascular remodeling play a key role in the pathophysiology of abdominal aortic aneurysm (AAA), a severe vascular disease. Previously, we had demonstrated an increase in the phosphorylated form of ATP citrate lyase (p-ACLY) in AAA and that bempedoic acid (BemA), a specific inhibitor of this enzyme, attenuates aneurysm formation in an experimental model. In this study, we further investigated the mechanisms mediating the beneficial effect of BemA.</p><p><strong>Methods: </strong>AAA was induced by angiotensin II (AngII) infusion in ApoE<sup>-/-</sup> mice, and aneurysm formation was assessed by ultrasonography. Histological analyses (hematoxylin-eosin, orcein staining) and immunohistochemistry were performed. T cell subpopulations in the spleen were characterized by flow cytometry, and superoxide anion production in the vascular wall was evaluated by dihydroethidium (DHE) staining. The expression of enzymes involved in the control of oxidative stress was analyzed by real-time RT-PCR.</p><p><strong>Results: </strong>Endpoint ultrasonography analyses in AngII-infused ApoE<sup>-/-</sup> mice confirmed that BemA limits aneurysm formation. Indeed, BemA administration in AngII-infused mice significantly increased both the percentage of animals that did not develop aneurysms and those free of aortic rupture, without altering the pressor effect of AngII. Histologically, BemA preserved the integrity of the aortic wall and reduced the proportion of animals presenting intramural thrombi, with a decrease in hematoma area. Immunohistochemical analyses showed increased levels of p-ACLY in the inflammatory infiltrate of human and murine aneurysmal lesions, as well as BemA's capacity to attenuate the AngII-induced increase in CD3<sup>+</sup> T lymphocyte content in the vascular wall. Additionally, analysis of splenic CD8<sup>+</sup> T cell subpopulations revealed no significant changes in either AngII-infused animals or those treated with BemA. Finally, ACLY activity inhibition decreased reactive oxygen species production without modifying the expression of key isoforms of the NADPH oxidase (Nox2, Nox4) or superoxide dismutase (Sod1, Sod2) families.</p><p><strong>Conclusions: </strong>Taken together, these findings position ACLY as a relevant therapeutic target in AAA and BemA as a drug with potential protective effects against the development and progression of this vascular disease.</p>","PeriodicalId":45230,"journal":{"name":"Clinica e Investigacion en Arteriosclerosis","volume":" ","pages":"500856"},"PeriodicalIF":1.9,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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