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Risk stratification and lipid evaluation in mexican patients, evidence of lipid and cardiovascular analysis in REMECAR. The mexican registry of cardiovascular diseases (REMECAR group) 墨西哥患者的风险分层和血脂评估,REMECAR中血脂和心血管分析的证据。墨西哥心血管疾病登记处(REMECAR组)
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-12-01 DOI: 10.1016/j.athplu.2022.08.002
Manuel Odín De los Ríos-Ibarra , José Luis Leiva-Pons , Humberto Rodríguez-Reyes , Marco Antonio Alcocer-Gamba , Jorge Cortés-Lawrenz , Frida María Vizcaíno-Rios , Jaime Barragán-Luna , Julio Iván Farjat-Ruiz , Luis R. Virgen-Carrillo , Francisco Padilla-Padilla , Abel Pavia-López , Enrique C. Morales-Villegas , Natalie C. Ward , Leslie Marisol Lugo-Gavidia

Background and aims

Dyslipidaemia is a significant risk factor for cardiovascular disease in the Mexican population. This analysis aimed to describe the baseline LDL-c levels of patients presenting to cardiovascular clinics and evaluate the proportion who achieved their risk-based LDL-c goals as recommended by 2021 ESC prevention guidelines.

Methods

The REMECAR registry is an observational study of patients attending a specialized cardiovascular clinic for their first visit. The cardiovascular risk was retrospectively determined using the 2021 ESC guideline stratification and the SCORE2 and SCORE-OP.

Results

A total of 5443 patients were included in the analysis. Within this population, 55.96% presented as very high, 39.98% as high and 4.06% as moderate to low risk. 63% of the participants were not on any lipid-lowering treatment at entry, while 12.4% were receiving high-intensity statin therapy. Patients presenting with established atherosclerotic cardiovascular disease had a mean LDL-c of 90.9 ± 40.7 mg/dL. Of these, 14.1% were achieving LDL-c levels of 70–55 mg/dL and 19.3% were achieving LDL-c levels <55 mg/dL. In diabetic patients at very high risk, only 25.7% achieved their LDL-c goal. Finally, in patients without another risk factor and very high-risk evaluated by SCORE2 & SCORE-OP, only 14% of patients achieved their LDL-c goals.

Conclusions

An important number of patients were not receiving any lipid-lowering therapy. Furthermore, in those who were, a significant portion did not achieve LDL-c recommended thresholds. Our results underline the urgent need to improve the prescription and optimization of lipid-lowering therapy as the current management appears to be insufficient for achieving optimal recommended goals. Identifying key barriers in lipid management is fundamental to establishing better strategies and health system policies to reduce cardiovascular risk.

背景和目的在墨西哥人群中,血脂异常是心血管疾病的重要危险因素。该分析旨在描述到心血管诊所就诊的患者的基线LDL-c水平,并评估达到2021年ESC预防指南推荐的基于风险的LDL-c目标的比例。方法REMECAR登记是一项观察性研究,研究对象是首次到心血管专科诊所就诊的患者。采用2021年ESC指南分层和SCORE2和SCORE-OP回顾性确定心血管风险。结果共纳入5443例患者。在该人群中,55.96%为极高风险,39.98%为高风险,4.06%为中至低风险。63%的参与者在入组时没有接受任何降脂治疗,而12.4%的参与者接受了高强度他汀类药物治疗。确诊为动脉粥样硬化性心血管疾病的患者的平均LDL-c为90.9±40.7 mg/dL。其中,14.1%的患者LDL-c水平达到70-55 mg/dL, 19.3%的患者LDL-c水平达到55 mg/dL。在高危糖尿病患者中,只有25.7%达到了LDL-c目标。最后,在没有其他危险因素且经SCORE2评估为高危的患者中;SCORE-OP,只有14%的患者达到了他们的LDL-c目标。结论有相当一部分患者未接受任何降脂治疗。此外,在那些没有达到LDL-c推荐阈值的人中,有很大一部分没有达到推荐阈值。我们的结果强调迫切需要改进处方和优化降脂治疗,因为目前的管理似乎不足以实现最佳推荐目标。确定脂质管理中的关键障碍对于制定更好的战略和卫生系统政策以降低心血管风险至关重要。
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引用次数: 0
Subclinical atherosclerosis determined by coronary artery calcium deposition in patients with clinical familial hypercholesterolemia 临床家族性高胆固醇血症患者冠状动脉钙沉积测定亚临床动脉粥样硬化
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-12-01 DOI: 10.1016/j.athplu.2022.10.002
Sanna á Borg , Christian Sørensen Bork , Michael René Skjelbo Nielsen , Jan Jóanesarson , Tomas Zaremba , Ihab Bishara Yousef Lolas , Søren Lundbye-Christensen , Peter Søgaard , Erik Berg Schmidt , Albert Marni Joensen

Background and aims

Limited knowledge exists regarding the association between coronary artery calcium (CAC) deposition in patients with clinical familial hypercholesterolemia (FH) and FH subtypes such as polygenic causes. We studied CAC score in patients with clinical FH and subtypes including polygenic causes of FH compared to healthy controls.

Methods

In a case-control study, we identified potential clinical FH cases registered with an LDL-C >6.7 mmol/l within a nationwide clinical laboratory database on the Faroe Islands and invited them for diagnostic evaluation according to clinical FH scoring systems. Controls were identified in the background population. All subjects were aged 18–75 years and without a history of cardiovascular disease. FH mutation testing and genotypes of twelve LDL-C associated single nucleotide polymorphisms were determined using conventional methods in selected individuals. CAC scores were assessed by cardiac CT. Odds ratios obtained using multivariate logistic regression were used as measures of association.

Results

A total of 120 clinical FH patients and 117 age- and sex-matched controls were recruited. We found a very low frequency of monogenic FH (3%), but a high level of polygenic FH (60%) in those genetically tested (54%). There was a statistically significant association between the CAC score and a diagnosis of clinical FH with the highest observed odds ratio of 5.59 (95% CI 1.65; 18.94, p = 0.006) in those with a CAC score ≥300 compared to those with a CAC of zero. In supplemental analyses, there was a strong association between CAC scores and clinical FH of a polygenic cause.

Conclusion

We found a statistically significant association between CAC levels and clinical FH with the highest observed risk estimates among clinical FH cases of a presumed polygenic cause.

背景和目的关于临床家族性高胆固醇血症(FH)患者冠状动脉钙(CAC)沉积与FH亚型(如多基因原因)之间的关系,目前的知识有限。我们研究了临床FH患者和FH亚型(包括多基因病因)与健康对照的CAC评分。方法在一项病例对照研究中,我们在法罗群岛的全国临床实验室数据库中发现LDL-C为6.7 mmol/l的潜在临床FH病例,并邀请他们根据临床FH评分系统进行诊断评估。对照是在背景人群中确定的。所有受试者年龄在18-75岁之间,无心血管疾病史。在选定的个体中,采用常规方法测定了12种LDL-C相关单核苷酸多态性的FH突变检测和基因型。通过心脏CT评估CAC评分。使用多变量逻辑回归获得的优势比作为关联的度量。结果共纳入120例临床FH患者和117例年龄和性别匹配的对照组。我们发现单基因FH的发生率很低(3%),但多基因FH的发生率很高(60%)(54%)。CAC评分与临床FH诊断之间有统计学意义的关联,观察到的最高比值比为5.59 (95% CI 1.65;(18.94, p = 0.006), CAC评分≥300的患者与CAC评分为0的患者相比有显著性差异。在补充分析中,CAC评分与多基因原因的临床FH有很强的相关性。结论:我们发现CAC水平与临床FH之间存在统计学意义上的关联,在假定的多基因原因的临床FH病例中,观察到的风险估计最高。
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引用次数: 0
Low-density lipoprotein cholesterol goal attainment in Germany: Results from the DA VINCI study 低密度脂蛋白胆固醇在德国的目标实现:来自DA VINCI研究的结果
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-12-01 DOI: 10.1016/j.athplu.2022.07.024
Ioanna Gouni-Berthold , Frank Schaper , Ulrike Schatz , Anja Tabbert-Zitzler , Uwe Fraass , Sarah Sauer , Kausik K. Ray

Background and aims

Cardiovascular mortality is high in Germany. For patients with high or very high cardiovascular risk, the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend intensive lipid lowering therapy (LLT). This study aimed to assess dyslipidaemia management and achievement of the ESC/EAS guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals.

Methods

This European 18-country, cross-sectional, observational DA VINCI study (EUPAS22075) collected data during a single visit between June 2017 and November 2018 and included LLT in the preceding 12 months and the patients' most recent LDL-C measurement. Achievement of the risk-based 2016 and 2019 ESC/EAS LDL-C goals while receiving stabilized LLT was assessed. Data from the German cohort are presented here.

Results

Seven German sites enrolled a total of 421 primary and secondary prevention patients, 327 were receiving stabilized LLT at the time of LDL-C measurement, i.e. statin monotherapy of high (16%; n = 53), moderate (49%; n = 160) or low (7%; n = 24) intensity, ezetimibe combination (18%; n = 58), proprotein convertase subtilisin/kexin type 9 antibody combination (3%; n = 9), and other LLT (7%; n = 23). The 2016 and 2019 risk-based LDL-C goals were attained by 46% (n = 149) and 28% (n = 92) of patients, respectively.

Conclusions

There is a large gap between ESC/EAS recommendations and LDL-C goal achievement in routine clinical practice in high and very high-risk patients in Germany. Low-to-moderate-intensity statin monotherapy was the most frequently used LLT; use of high-intensity statins and combination therapy was limited. In addition to optimizing statin intensity, combination with non-statin LLT may be needed in most of these patients.

背景和目的德国的心血管疾病死亡率很高。对于心血管风险高或非常高的患者,欧洲心脏病学会(ESC)/欧洲动脉粥样硬化学会(EAS)指南推荐强化降脂治疗(LLT)。本研究旨在评估血脂异常的管理和ESC/EAS指南推荐的低密度脂蛋白胆固醇(LDL-C)目标的实现情况。这项欧洲18个国家的横断面观察性DA VINCI研究(EUPAS22075)在2017年6月至2018年11月的单次访问中收集数据,包括前12个月的LLT和患者最近的LDL-C测量。在接受稳定LLT的同时,评估基于风险的2016年和2019年ESC/EAS LDL-C目标的实现情况。来自德国队列的数据如下所示。结果7个德国试验点共纳入421例一级和二级预防患者,其中327例在LDL-C测量时接受稳定LLT治疗,即他汀类药物单药治疗高(16%;N = 53),中度(49%;N = 160)或低(7%;N = 24),依折麦布联合用药(18%;N = 58),蛋白转化酶subtilisin/kexin 9型抗体联合(3%;n = 9),其他LLT (7%;n = 23)。2016年和2019年,分别有46% (n = 149)和28% (n = 92)的患者达到了基于风险的LDL-C目标。结论在德国,ESC/EAS推荐值与高、高危患者的LDL-C目标实现水平存在较大差距。低至中等强度的他汀类药物单药治疗是最常用的LLT;使用高强度他汀类药物和联合治疗是有限的。除了优化他汀类药物强度外,大多数患者可能需要联合非他汀类药物LLT。
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引用次数: 6
The circulating furin-cleaved/mature PCSK9 ratio has a potential prognostic significance in statin-naïve patients with acute ST elevation myocardial infarction 急性ST段抬高型心肌梗死statin-naïve患者循环中游离/成熟PCSK9比值具有潜在的预后意义
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-12-01 DOI: 10.1016/j.athplu.2022.09.002
Jun Sawaguchi , Yasuhiko Saeki , Minako Oda , Taka-aki Takamura , Kosuke Fujibayashi , Minoru Wakasa , Hironobu Akao , Michihiko Kitayama , Yasuyuki Kawai , Kouji Kajinami

Background and aims

Proprotein convertase subtilisin/kexin type 9 (PCSK9) circulates as mature and furin-cleaved forms, but their biological functions are uncertain. We investigated whether their levels associate with prognosis in patients with acute ST elevation myocardial infarction (STEMI).

Methods

We enrolled 160 statin-naïve patients with acute STEMI and followed for 3 years. PCSK9 subtype levels were determined by an enzyme-linked immunosorbent assay before and at five timepoints up to 48 h after emergent coronary intervention. The occurrence of coronary and cardiac events was compared between subjects stratified by the PCSK9 level.

Results

One hundred and twenty-six patients completed 3 years of follow-up. In the acute phase, both PCSK9 subtype levels decreased, and thereafter increased from 6 to 48 h (mature: from 198 ± 67 to 334 ± 116 ng/mL, furin-cleaved: from 20 ± 7 to 39 ± 16 ng/mL, both p < 0.01). Major cardiac events occurred in 46 patients. The furin-cleaved/mature PCSK9 ratio at 48 h after coronary intervention predicted the likelihood of experiencing of events; patients in the third tertile had lower event-free survival than those in the first and second tetiles in Kaplan–Meier analysis (p = 0.004). Multivariate Cox regression analysis revealed that this ratio had a greater impact (HR: 1.92; 95% CI: 1.06–3.45, p = 0.03) on events than other known atherosclerosis risk factors.

Conclusions

The furin-cleaved/mature PCSK9 ratio was associated with 3-year cardiovascular events in statin-naïve patients with acute STEMI, suggesting a potential link between furin cleavage process of PCSK9 and its effect on prognosis. (249 words)

背景与目的枯草素/酶解蛋白9型(PCSK9)蛋白转化酶以成熟的和卵磷脂裂解的形式存在,但其生物学功能尚不清楚。我们研究了它们的水平是否与急性ST段抬高型心肌梗死(STEMI)患者的预后相关。方法选取160例statin-naïve急性STEMI患者,随访3年。在紧急冠状动脉介入治疗前和48小时后的5个时间点,通过酶联免疫吸附试验检测PCSK9亚型水平。比较按PCSK9水平分层的受试者之间冠状动脉和心脏事件的发生情况。结果126例患者完成3年随访。在急性期,两种PCSK9亚型水平均下降,随后从6 - 48 h升高(成熟期:从198±67到334±116 ng/mL,氟裂解期:从20±7到39±16 ng/mL, p和lt;0.01)。46例患者发生重大心脏事件。冠状动脉介入治疗后48 h糠蛋白裂解/成熟PCSK9比值预测事件发生的可能性;Kaplan-Meier分析显示,第三组患者的无事件生存率低于第一组和第二组患者(p = 0.004)。多因素Cox回归分析显示,该比值有较大的影响(HR: 1.92;95% CI: 1.06-3.45, p = 0.03)。结论氟化蛋白裂解/成熟PCSK9比值与statin-naïve急性STEMI患者3年心血管事件相关,提示PCSK9的氟化蛋白裂解过程与其对预后的影响存在潜在联系。(249字)
{"title":"The circulating furin-cleaved/mature PCSK9 ratio has a potential prognostic significance in statin-naïve patients with acute ST elevation myocardial infarction","authors":"Jun Sawaguchi ,&nbsp;Yasuhiko Saeki ,&nbsp;Minako Oda ,&nbsp;Taka-aki Takamura ,&nbsp;Kosuke Fujibayashi ,&nbsp;Minoru Wakasa ,&nbsp;Hironobu Akao ,&nbsp;Michihiko Kitayama ,&nbsp;Yasuyuki Kawai ,&nbsp;Kouji Kajinami","doi":"10.1016/j.athplu.2022.09.002","DOIUrl":"10.1016/j.athplu.2022.09.002","url":null,"abstract":"<div><h3>Background and aims</h3><p>Proprotein convertase subtilisin/kexin type 9 (PCSK9) circulates as mature and furin-cleaved forms, but their biological functions are uncertain. We investigated whether their levels associate with prognosis in patients with acute ST elevation myocardial infarction (STEMI).</p></div><div><h3>Methods</h3><p>We enrolled 160 statin-naïve patients with acute STEMI and followed for 3 years. PCSK9 subtype levels were determined by an enzyme-linked immunosorbent assay before and at five timepoints up to 48 h after emergent coronary intervention. The occurrence of coronary and cardiac events was compared between subjects stratified by the PCSK9 level.</p></div><div><h3>Results</h3><p>One hundred and twenty-six patients completed 3 years of follow-up. In the acute phase, both PCSK9 subtype levels decreased, and thereafter increased from 6 to 48 h (mature: from 198 ± 67 to 334 ± 116 ng/mL, furin-cleaved: from 20 ± 7 to 39 ± 16 ng/mL, both <em>p</em> &lt; 0.01). Major cardiac events occurred in 46 patients. The furin-cleaved/mature PCSK9 ratio at 48 h after coronary intervention predicted the likelihood of experiencing of events; patients in the third tertile had lower event-free survival than those in the first and second tetiles in Kaplan–Meier analysis (<em>p</em> = 0.004). Multivariate Cox regression analysis revealed that this ratio had a greater impact (HR: 1.92; 95% CI: 1.06–3.45, <em>p</em> = 0.03) on events than other known atherosclerosis risk factors.</p></div><div><h3>Conclusions</h3><p>The furin-cleaved/mature PCSK9 ratio was associated with 3-year cardiovascular events in statin-naïve patients with acute STEMI, suggesting a potential link between furin cleavage process of PCSK9 and its effect on prognosis. (249 words)</p></div>","PeriodicalId":72324,"journal":{"name":"Atherosclerosis plus","volume":"50 ","pages":"Pages 50-56"},"PeriodicalIF":1.6,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/02/main.PMC9833232.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10540449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Burden of cardiovascular disease in a large contemporary cohort of patients with heterozygous familial hypercholesterolemia 杂合子家族性高胆固醇血症患者的心血管疾病负担
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-12-01 DOI: 10.1016/j.athplu.2022.08.001
Jean Ferrières , Michel Farnier , Eric Bruckert , Alexandre Vimont , Vincent Durlach , Emile Ferrari , Antonio Gallo , Franck Boccara , Dorota Ferrières , Sophie Béliard

Background and aims

Heterozygous familial hypercholesterolemia (HeFH) is increasingly better diagnosed and treatments can improve the cardiovascular prognosis. We evaluated the long-term cardiovascular risk of HeFH using the French REgistry of Familial hypERCHOLesterolemia (REFERCHOL).

Methods

We studied HeFH patients diagnosed genetically and clinically by the Dutch Lipid Clinic Network (DLCN) criteria in all lipid clinics across the country and their 5-year risk of cardiovascular events (all fatal and non-fatal acute coronary, cerebral and peripheral arterial disease events, aortic valve replacement surgery) using the French national health data system.

Results

The database comprised 3202 individuals, 2010 (62.8%) with genetically verified HeFH and 1192 (37.2%) a DLCN score ≥6. Of these individuals, 2485 (77.6%) were in primary prevention and 717 (22.4%) in secondary prevention. The incidence of cardiovascular events was 24.58 per 1000 person-years for the overall sample, 19.15 in primary prevention and 43.40 in secondary prevention. The incidence of myocardial infarction, cerebral infarction and death was 16.32 per 1000 person-years for the overall sample, 12.93 in primary prevention and 28.08 in secondary prevention. The incidence of aortic valve replacement was 1.78 per 1000 person-years. In the overall sample, at inclusion, 41% were not treated for LDL cholesterol, 48% of these in primary prevention and 20% in secondary prevention and high-dose statins were used by only 24% of individuals, 15% of these in primary prevention and 45% in secondary prevention.

Conclusions

The incidence of cardiovascular events in HeFH is high and lipid-lowering treatment is far from optimal. The cardiovascular risk of HeFH is underestimated and patients are inadequately treated.

背景与目的杂合子家族性高胆固醇血症(HeFH)的诊断和治疗越来越好,可以改善心血管预后。我们使用法国家族性高胆固醇血症登记处(REFERCHOL)评估了HeFH的长期心血管风险。方法:采用法国国家健康数据系统,研究根据荷兰脂质临床网络(DLCN)标准进行遗传和临床诊断的HeFH患者及其5年心血管事件(所有致死性和非致死性急性冠状动脉、脑和外周动脉疾病事件、主动脉瓣置换术)的风险。结果该数据库包括3202例HeFH患者,其中2010例(62.8%)经基因验证为HeFH, 1192例(37.2%)DLCN评分≥6。其中一级预防2485人(77.6%),二级预防717人(22.4%)。总体样本的心血管事件发生率为每1000人年24.58例,一级预防为19.15例,二级预防为43.40例。心肌梗死、脑梗死和死亡的发生率为每1000人年16.32例,一级预防组为12.93例,二级预防组为28.08例。主动脉瓣置换术的发生率为1.78 / 1000人年。在整个样本中,纳入时,41%未接受低密度脂蛋白胆固醇治疗,其中48%接受一级预防治疗,20%接受二级预防治疗,只有24%的人使用高剂量他汀类药物,其中15%接受一级预防治疗,45%接受二级预防治疗。结论HeFH患者心血管事件发生率高,降脂治疗效果尚不理想。HeFH的心血管风险被低估,患者得不到充分治疗。
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引用次数: 1
I used to dream that my cholesterol could be in single figures, and now it is!!! 我曾经梦想我的胆固醇可以是个位数,现在是了!!!
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-10-01 DOI: 10.1016/j.athplu.2022.07.019
A. Pottle, T. Gondo, C. Huggett, L. Jones, T. Khan, S. Mower, E. Neves, J. Senior, J. Wagg, M. Barbir
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引用次数: 0
A primary Care based Familial Hypercholesterolaemia screening service in Guernsey, from concept to delivery 根西岛基于初级保健的家族性高胆固醇血症筛查服务,从概念到交付
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-10-01 DOI: 10.1016/j.athplu.2022.07.016
M. Dorrian
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引用次数: 0
Familial Hypercholesterolaemia – a targeted Next Generation Sequencing panel and retrospective analysis of patients with no previously identified pathogenic variant 家族性高胆固醇血症——针对未发现致病变异的患者的新一代测序面板和回顾性分析
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-10-01 DOI: 10.1016/j.athplu.2022.07.011
E. Willis , M. Wood , N. Hamling , L. Lazarou , S. Morgan , S. Corrin , R. Harris , I. McDowell , K. Haralambos , D. Datta
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引用次数: 0
Cardiovascular disease morbidity is associated with social deprivation in subjects with familial hypercholesterolaemia (FH): a study comparing FH individuals in UK primary care and the UK Simon Broome register linked with secondary care records 心血管疾病发病率与家族性高胆固醇血症(FH)患者的社会剥夺相关:一项比较英国初级保健和英国西蒙·布鲁姆登记中与二级保健记录相关的FH患者的研究
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-10-01 DOI: 10.1016/j.athplu.2022.07.009
B. Iyen , N. Qureshi , P. Roderick , N. Capps , P.N. Durrington , I.F.W. McDowell , J. Cegla , H. Soran , J. Schofield , H.A.W. Neil , J. Kai , S. Weng , S.E. Humphries , the Simon Broome Familial Hyperlipidaemia Register Group
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引用次数: 1
An outreaching lipid clinic model supporting PCSK9i uptake and lipid optimisation in secondary prevention across primary/secondary care interface 一个支持PCSK9i摄取和脂质优化的外展脂质临床模型,用于一级/二级护理界面的二级预防
IF 1.6 Q3 PERIPHERAL VASCULAR DISEASE Pub Date : 2022-10-01 DOI: 10.1016/j.athplu.2022.07.022
C. Tucker, S. Barrett, S. Pattman
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引用次数: 0
期刊
Atherosclerosis plus
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