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Beneficial effects of sodium glucose co-transporter 2 inhibitors (SGLT2i) on heart failure and cardiovascular death in patients with type 2 diabetes might be due to their off-target effects on cardiac metabolism 葡萄糖共转运蛋白2抑制剂钠(SGLT2i)对2型糖尿病患者心力衰竭和心血管死亡的有益作用可能是由于其对心脏代谢的脱靶作用
Q Medicine Pub Date : 2016-09-12 DOI: 10.1080/17584299.2016.1230316
V. Athyros, K. Imprialos, M. Doumas, A. Karagiannis
Sodium/glucose co-transporter 2 inhibitors (SGLT2i) lower blood glucose by inhibiting the reabsorption of glucose in the proximal renal tubules.[1] There are several licensed SGLT2i. One of them, empagliflozin, was evaluated in the EMPA-REG OUTCOME trial.[2] This prospective, randomised, double-blind, placebo-controlled, survival study included 7020 patients with type 2 diabetes mellitus (T2DM) and followed them for a median period of 3.1 years.[2] The EMPAREG OUTCOME trial showed that the use of either 10 or 25 mg/d of empagliflozin (cumulative results presentation because there were no significant differences between the two doses) on top of standard therapy produced relative risk reductions in the primary endpoint [cumulative incidence of death from cardiovascular disease (CVD), nonfatal myocardial infarction (MI) or nonfatal stroke] by 14%, total mortality by 32%, of CVD mortality by 38% and hospitalisation for heart failure (HF) by 35% compared with placebo; all reductions were highly statistically significant.[2] The main side effect was an increased rate of genital infection.[2] Following a review of a few cases, the European Medical Agency recommended an update of all SGLT2i Summary of Product Characteristics to include diabetic ketoacidosis as a rare of (1/1000 patients) adverse reaction (http:// www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/SGLT2_inhibitors/humanreferral_ prac000052.jsp&mid=WC0b01ac05805c516f ). The EMPA-REG OUTCOME trial results were a surprise; the Evaluation of Cardiovascular Outcome Results (LEADER) trial with liraglutide, a human glucagon like peptide 1 receptors agonist (GLP1 RA), that showed similar clinical benefits in terms of improved survival, except for the reduction in hospitalisation for HF, were presented a few months later.[3] The mechanisms driving the effects of empagliflozin on HF and CVD death are not clear.[4] Potential mechanisms include osmotic diuresis, modulation of the cardiorenal axis that reduced plasma volume and less sodium retention, reduction in arterial stiffness, reduced left ventricular afterload, fall in body weight and blood pressure (BP), without increases in sympathetic nervous activity, delay in renal function impairment, reduction in hyperglycaemia with linked reduction in insulin levels and reductions in serum uric acid (SUA) levels.[4,5] However, even all those collectively may not be enough to explain the substantial clinical benefits of empagliflozin manifested early (within the first 3 months of the study) in the EMPA-REG trial.[2] Recently, two papers tried to explain the possible mechanism of empagliflozin clinical benefits focusing on its effect on heart metabolism or “energetics”; this hypothesis, together with all the off-target effects mentioned above, might be an explanation for the beneficial outcomes of empagliflozin in the EMPA-REG trial.[6,7] Several years ago, it was suggested that people with T2DM or insulin resistance have an impaired myo
钠/葡萄糖共转运蛋白2抑制剂(SGLT2i)通过抑制近端肾小管中葡萄糖的重吸收来降低血糖[1]。有几种许可的SGLT2i。其中之一的恩帕列净在EMPA-REG OUTCOME试验中进行了评估。[2]这项前瞻性、随机、双盲、安慰剂对照的生存研究纳入了7020例2型糖尿病(T2DM)患者,随访时间中位数为3.1年。[2]EMPAREG OUTCOME试验显示,在标准治疗的基础上,使用10或25mg /d的恩帕列净(累积结果显示,因为两种剂量之间没有显著差异)可使主要终点(心血管疾病(CVD)、非致死性心肌梗死(MI)或非致死性卒中的累积死亡发生率)的相对风险降低14%,总死亡率降低32%。与安慰剂相比,心血管疾病死亡率降低38%,心力衰竭住院率降低35%;所有的减少在统计上都非常显著。[2]主要的副作用是生殖器感染率的增加。[2]在对少数病例进行审查后,欧洲医疗机构建议更新所有sgltii产品特性摘要,将糖尿病酮症酸中毒作为一种罕见的(1/1000患者)不良反应(http:// www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/SGLT2_inhibitors/humanreferral_ prac000052.jsp&mid=WC0b01ac05805c516f)。EMPA-REG OUTCOME试验结果令人惊讶;几个月后,利拉鲁肽(一种人胰高血糖素样肽1受体激动剂(GLP1 RA))的心血管结局结果评估(LEADER)试验显示,除了减少心力衰竭住院率外,在提高生存率方面也显示出类似的临床益处。[3]恩格列净对心衰和心血管疾病死亡影响的机制尚不清楚。[4]潜在的机制包括渗透性利尿、心肾轴调节减少血浆容量和钠潴留、动脉僵硬度降低、左心室后负荷减少、体重和血压(BP)下降、交感神经活动不增加、肾功能损害延迟、高血糖降低、胰岛素水平降低和血清尿酸(SUA)水平降低。[4,5]然而,即使所有这些都不足以解释EMPA-REG试验中早期(研究的前3个月内)表现出的恩帕列净的实质性临床益处。[2]最近,两篇论文试图解释恩格列净临床获益的可能机制,重点是其对心脏代谢或“能量学”的影响;这一假设,连同上述所有的脱靶效应,可能是EMPA-REG试验中恩格列净有益结果的解释。[6,7]几年前,有人认为T2DM或胰岛素抵抗患者心肌代谢受损,葡萄糖利用率下降,心肌游离脂肪酸(FFA)摄取和氧化增加,导致血液/代谢物供应与心脏代谢需求不匹配[8]。也有人提出,如果心肌功能障碍不再被视为简单的氧/代谢物需求/供应失衡,而是作为一种能量紊乱,这将激励针对这种特定代谢紊乱的药物的开发,而不仅仅是治疗缺血性和/或糖尿病心脏衰竭的危险因素和症状。[9]有人建议,一种旨在改善心脏代谢的治疗方法是通过
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引用次数: 3
Clinical Lipidology: I shall return* 临床血脂学:我将返回*
Q Medicine Pub Date : 2016-08-23 DOI: 10.1080/17584299.2016.1219154
D. Mikhailidis, D. Nair
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引用次数: 0
Considering gender in prescribing statins: what do physicians need to know? 在开他汀类药物时考虑性别:医生需要知道什么?
Q Medicine Pub Date : 2015-12-01 DOI: 10.2217/clp.15.39
C. Pavanello, Giuliana Mombelli
Abstract Numerous clinical studies with objectives such as mortality and morbidity of cardiovascular (CV) have reported the benefit of treatment for dyslipidemia with lipid-lowering therapy, in particular using the statins. But the trials conducted in past years did not consider the gender differences of statin effect, because women were poorly represented. All the results in terms of response, efficacy, reduction of LDL cholesterol and CV risk in primary and secondary prevention refer to men. In these recent years, it emerges the need to consider the different lipoprotein profile during lifetime and CV risk between men and women. Furthermore it is necessary to consider that, in patients with coronary artery disease, the lipid goal achieved is different between the two genders. Finally, we have to evaluate the side effects mostly present in women. In conclusion, there is a different prescription of these treatments in particular in the dosage used, that it is insufficient in women with cardiovascular disease. More recently it has emerged the exigency to use new guidelines that clearly indicate how should be the medical care, therefore, the specific way to treat men and women.
许多以心血管死亡率和发病率为目标的临床研究已经报道了使用降脂疗法治疗血脂异常的益处,特别是使用他汀类药物。但是,过去几年进行的试验并没有考虑他汀类药物效果的性别差异,因为女性的代表性很低。在一级和二级预防中,所有关于反应、疗效、降低LDL胆固醇和心血管风险的结果都是指男性。近年来,有必要考虑男性和女性一生中不同的脂蛋白特征和CV风险。此外,需要考虑的是,在冠状动脉疾病患者中,两性达到的脂质目标是不同的。最后,我们要评估主要出现在女性身上的副作用。总之,这些治疗的处方不同,特别是在使用的剂量上,对于患有心血管疾病的妇女来说是不够的。最近,迫切需要使用新的指导方针,明确指出医疗护理应该如何,因此,是治疗男性和女性的具体方式。
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引用次数: 12
The association between hypovitaminosis D and metabolic syndrome: current understanding 维生素D缺乏症与代谢综合征之间的关系:目前的认识
Q Medicine Pub Date : 2015-12-01 DOI: 10.2217/clp.15.38
I. Miñambres, J. L. Sánchez-Quesada, Antonio Pérez
Abstract The metabolic syndrome and its components have been associated with hypovitaminosis D in many observational trials. Several mechanisms have been proposed to explain this relationship and include most conditions that are present in patients with the metabolic syndrome. A causal relationship of the association between the metabolic syndrome and hypovitaminosis D, however, has not been demonstrated, and the cardiovascular and metabolic benefits of vitamin D supplementation have not been confirmed. For the time being therefore, supplementation with vitamin D should only be recommended to maintain bone health and to avoid falls.
在许多观察性试验中,代谢综合征及其组成部分与维生素D缺乏症有关。已经提出了几种机制来解释这种关系,包括代谢综合征患者中存在的大多数情况。然而,代谢综合征和维生素D缺乏症之间的因果关系尚未得到证实,补充维生素D对心血管和代谢的益处也尚未得到证实。因此,就目前而言,补充维生素D应该只推荐用于保持骨骼健康和避免跌倒。
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引用次数: 7
Effects of Armolipid Plus on small dense LDL particles in a sample of patients affected by familial combined hyperlipidemia. 阿莫脂增强剂对家族性联合高脂血症患者样本中低密度脂蛋白小颗粒的影响。
Q Medicine Pub Date : 2015-12-01 Epub Date: 2015-11-23 DOI: 10.2217/clp.15.37
Marco Gentile, Ilenia Calcaterra, Alfonso Strazzullo, Carmen Pagano, Delia Pacioni, Enza Speranza, Paolo Rubba, Gennaro Marotta

Aim: The aim of this study was to test small dense LDL changes with Armolipid Plus treatment in patients with familial combined hyperlipidemia (FCHL).

Methods: After 4 weeks, 30 patients with FCHL were included in an 8-week, randomized, double-blind study and were taking, in addition to the standard diet, either placebo or Armolipid Plus.

Results: The placebo group showed no statistically significant differences in the studied parameters; instead, in the Armolipid Plus group, statistically significant reduction differences were detected in BMI (p = 0.010), LDL score (p = 0.035) and an increase in mean LDL particle diameter (p = 0.040).

Conclusion: The combination of a standard diet with Armolipid Plus is able to reduce LDL score and increase LDL particle diameter in a group of FCHL after 8 weeks of treatment.

目的:本研究的目的是测试家族性联合高脂血症(FCHL)患者接受阿莫脂强化剂治疗后小密度低密度脂蛋白的变化:4周后,30名家族性联合高脂血症患者被纳入一项为期8周的随机双盲研究,除标准饮食外,他们还服用安慰剂或阿莫脂增强剂:结果:安慰剂组在研究参数上没有统计学意义上的显著差异;相反,在阿莫脂强化剂组中,BMI(p = 0.010)、低密度脂蛋白评分(p = 0.035)和低密度脂蛋白颗粒平均直径增加(p = 0.040)在统计学意义上有显著降低差异:结论:经过8周的治疗,标准饮食与阿莫脂增强剂的结合能够降低一组FCHL患者的低密度脂蛋白评分,增加低密度脂蛋白颗粒直径。
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引用次数: 0
The past, present and future of lipidlowering therapy 降脂疗法的过去、现在和未来
Q Medicine Pub Date : 2015-12-01 DOI: 10.2217/clp.15.40
Osman Najam, G. Lambert, K. Ray
Abstract Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. Dyslipidemia is a major risk factor, with elevated plasma lipids having a well-established relationship with CVD. While lifestyle modification and statins have played an important role in reducing risk, many patients develop CVD despite best care. Statins remain the most prescribed lipid-lowering therapy, yet many patients may require additional therapies. Fibrates, ezetimibe and bile acid sequestrants have been extensively investigated thus far, with mixed results. Newer classes of lipid modifying therapy include monoclonal antibodies to PCSK9, lomitapide and cholesterol ester transfer protein inhibitors. In this review, we revisit the history of lipid-lowering therapy, the pharmacotherapies currently used and future direction of research.
心血管疾病(CVD)仍然是世界范围内发病率和死亡率的主要原因。血脂异常是一个主要的危险因素,血浆脂质升高与心血管疾病有明确的关系。虽然生活方式的改变和他汀类药物在降低风险方面发挥了重要作用,但许多患者尽管得到了最好的治疗,还是患上了心血管疾病。他汀类药物仍然是最常用的降脂药物,但许多患者可能需要额外的治疗。迄今为止,贝特类、依折麦布和胆汁酸螯合剂已被广泛研究,结果好坏参半。较新的脂质修饰疗法包括PCSK9单克隆抗体、洛米他胺和胆固醇酯转移蛋白抑制剂。本文就降脂治疗的历史、目前使用的药物治疗方法及未来的研究方向作一综述。
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引用次数: 5
The value of apoA-I in predicting heart disease and myocardial infarction apoa - 1在预测心脏病和心肌梗死中的价值
Q Medicine Pub Date : 2015-12-01 DOI: 10.2217/clp.15.36
C. Schmidt, G. Bergström, A. Sniderman
Abstract Ischemic heart disease is the leading cause of death worldwide, accounting for approximately 11% of all deaths in 2011. Numerous studies have shown that cardiovascular risk correlates positively and powerfully with total or LDL-cholesterol (LDL-C) and correlates inversely with HDl-cholesterol (HDL-C). Much effort has spent comparing proatherogenic cholesterol markers LDL-C, non-HDL-C, apoB and LDL particle number, while little effort has been spent comparing the markers of the antiatherogenic marker apoA-I and HDL-C. Therefore, this review focused on comparing apoA-I and HDL-C in the prediction of heart disease and myocardial infarction. We identified 28 studies of which 12 indicated that the HDL-C was likely to be a superior marker of risk for heart disease and myocardial infarction compared with eight studies that identified apoA-I to be a superior marker of risk.
缺血性心脏病是全球死亡的主要原因,2011年约占所有死亡人数的11%。大量研究表明,心血管风险与总胆固醇或低密度脂蛋白胆固醇(LDL-C)呈正相关,与高密度脂蛋白胆固醇(HDL-C)呈负相关。人们在比较致动脉粥样硬化胆固醇标志物LDL- c、非HDL-C、apoB和LDL颗粒数方面花费了大量的精力,而在比较抗动脉粥样硬化标志物apoA-I和HDL-C方面花费的精力很少。因此,本文就apoA-I与HDL-C在心脏病和心肌梗死预测中的比较进行综述。我们确定了28项研究,其中12项表明HDL-C可能是心脏病和心肌梗死风险的优越标志,而8项研究确定apoa - 1是风险的优越标志。
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引用次数: 1
Apolipoprotein A-I mimetic peptides in dyslipidemia and atherosclerosis: an investigational timeline 载脂蛋白A-I模拟肽在血脂异常和动脉粥样硬化中的作用:一个研究时间轴
Q Medicine Pub Date : 2015-11-23 DOI: 10.2217/clp.15.35
G. Wool
Abstract “the ability of the apoA-I mimetic peptides (as demonstrated by 6F) to modulate formation or block activity of unsaturated lysophosphatidic acid in the gut appears to the relevant mechanism of action for atheroprevention.” Submitted: 5 August 2015; Accepted: 14 August 2015; Online: 23 November 2015
摘要:apoa - 1模拟肽(如6F所示)调节肠道中不饱和溶血磷脂酸的形成或阻断其活性的能力似乎是预防动脉粥样硬化的相关作用机制。提交日期:2015年8月5日;录用日期:2015年8月14日;发布日期:2015年11月23日
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引用次数: 0
The past, present and future of molecular genetic diagnosis in familial hypercholesterolemia 家族性高胆固醇血症分子遗传学诊断的过去、现在和未来
Q Medicine Pub Date : 2015-10-01 DOI: 10.2217/clp.15.29
E. Thomas
Abstract Familial hypercholesterolemia (FH) is the most common single gene disorder of lipid metabolism. Identifying the genetic cause of FH affects the management of the patient and their family members. Traditional genetic testing methods have been limited by throughput and cost, and therefore the majority of patients have not received a molecular diagnosis. Genetic testing technology has made huge advances in recent years, and these advances are now being translated to improve clinical diagnostic testing for many genetic disorders including FH. This review describes these advances in genetic testing, and considers their implications for the diagnosis and treatment of FH.
家族性高胆固醇血症(FH)是最常见的单基因脂质代谢疾病。确定FH的遗传原因影响患者及其家庭成员的管理。传统的基因检测方法受到吞吐量和成本的限制,因此大多数患者没有接受分子诊断。基因检测技术近年来取得了巨大进步,这些进步现在正在转化为改善包括FH在内的许多遗传疾病的临床诊断检测。这篇综述描述了基因检测的这些进展,并考虑了它们对FH诊断和治疗的意义。
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引用次数: 0
Cardiolipin alterations and mitochondrial dysfunction in heart ischemia/reperfusion injury 心脏缺血/再灌注损伤中心磷脂改变和线粒体功能障碍
Q Medicine Pub Date : 2015-10-01 DOI: 10.2217/clp.15.31
G. Paradies, V. Paradies, F. M. Ruggiero, G. Petrosillo
Abstract Mitochondrial dysfunction is centrally involved in heart ischemia/reperfusion (I/R) injury. Increased reactive oxygen species production, impaired respiratory chain complexes activity and opening of the mitochondrial permeability transition pore have been suggested as possible factors responsible for mitochondrial dysfunction in heart I/R injury. Cardiolipin (CL), a phospholipid of the inner mitochondrial membrane, plays an important role in mitochondrial bioenergetics. CL alterations have been shown to play a causative role in mitochondrial dysfunction in a variety of pathological conditions, as well as in cell death. The role of CL alterations in mitochondrial dysfunction in heart I/R injury is here reviewed. Several cardioprotective strategies to prevent myocardial injury during I/R targeting mitochondrial CL are also examined.
线粒体功能障碍是心脏缺血/再灌注(I/R)损伤的核心机制。活性氧产生增加、呼吸链复合物活性受损和线粒体通透性过渡孔开放被认为是导致心脏I/R损伤中线粒体功能障碍的可能因素。心磷脂(Cardiolipin, CL)是线粒体内膜磷脂,在线粒体生物能量学中起着重要作用。CL改变已被证明在各种病理条件下的线粒体功能障碍以及细胞死亡中起致病作用。本文综述了心肌I/R损伤中CL改变在线粒体功能障碍中的作用。几种心脏保护策略,以防止心肌损伤在I/R针对线粒体CL也进行了研究。
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引用次数: 16
期刊
Clinical Lipidology
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