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Efficacy and safety of statins, ezetimibe and statins-ezetimibe therapies for children and adolescents with heterozygous familial hypercholesterolaemia: Systematic review, pairwise and network meta-analyses of randomised controlled trials. 他汀类药物、依折麦布和他汀类药物-依折麦布疗法对杂合性家族性高胆固醇血症儿童和青少年的疗效和安全性:随机对照试验的系统综述、配对分析和网络荟萃分析。
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-28 DOI: 10.1016/j.atherosclerosis.2024.118598
Alexis Llewellyn, Mark Simmonds, David Marshall, Melissa Harden, Beth Woods, Steve E Humphries, Uma Ramaswami, Lorraine Priestley-Barnham, Mark Fisher, Laila J Tata, Nadeem Qureshi

Background and aims: Statins, ezetimibe and statins-ezetimibe combination therapy are recommended lipid-lowering therapies (LLTs) in children with heterozygous familial hypercholesterolaemia (HeFH). However, their relative effectiveness is not well understood. We aimed to compare the safety and efficacy of these therapies using direct and indirect comparisons.

Methods: We conducted systematic review, pairwise and network meta-analyses (NMAs) of randomised-controlled trials (RCTs) of statins, ezetimibe and statins-ezetimibe combination therapy in people <18 years with HeFH. Comprehensive bibliographic searches were conducted in December 2022, and a Medline update in January 2024. NMA models accounted for drug class, statin type and dosage.

Results: Thirteen RCTs were included (n = 1649, median age 13 years, follow-up 6 weeks-2 years). All LLTs reduced low-density lipoprotein cholesterol (LDL-C) and total cholesterol; statins led to increases in high-density lipoprotein cholesterol and reductions in triglycerides. Statins reduced LDL-C by 33.61 % against placebo (95 % CI 27.58 to 39.63, I2 = 83 %). Adding ezetimibe to statins reduced LDL-C by an additional 15.85 % (95 % CI 11.91 to 19.79). NMAs showed intermediate-dose statins reduced LDL-C by an additional 4.77 % compared with lower-doses statins (95 % CrI -11.22 to 1.05); higher-dose statins and intermediate-dose statins + ezetimibe may be similarly effective and are probably superior to ezetimibe, intermediate-and lower-dose statins. There was no evidence of differences in maturation, safety or tolerability between LLTs and placebo.

Conclusions: Statins, ezetimibe and statins-ezetimibe are all effective treatments for children with HeFH, but the magnitude of LDL-C reductions varies and may depend on treatment dosage and combination. No safety or tolerability issues were found. Longer-term safety and effectiveness are uncertain.

背景和目的:他汀类药物、依折麦布和他汀类药物-依折麦布联合疗法是杂合子家族性高胆固醇血症(HeFH)患儿的推荐降脂疗法(LLTs)。然而,人们对它们的相对有效性还不甚了解。我们旨在通过直接和间接比较来比较这些疗法的安全性和有效性:我们对他汀类药物、依折麦布和他汀类药物-依折麦布联合疗法的随机对照试验(RCT)进行了系统回顾、配对分析和网络荟萃分析(NMAs):共纳入 13 项随机对照试验(n = 1649,中位年龄 13 岁,随访 6 周-2 年)。所有低密度脂蛋白胆固醇疗法都能降低低密度脂蛋白胆固醇(LDL-C)和总胆固醇;他汀类药物能增加高密度脂蛋白胆固醇并降低甘油三酯。与安慰剂相比,他汀类药物可使低密度脂蛋白胆固醇降低 33.61%(95 % CI 27.58 至 39.63,I2 = 83 %)。在他汀类药物基础上添加依折麦布可使低密度脂蛋白胆固醇再降低 15.85 %(95 % CI 11.91 至 19.79)。NMA显示,与低剂量他汀类药物相比,中等剂量他汀类药物可额外降低4.77%的LDL-C(95 % CrI -11.22至1.05);高剂量他汀类药物和中等剂量他汀类药物+依折麦布可能具有类似的效果,并且可能优于依折麦布、中等剂量和低剂量他汀类药物。没有证据表明LLTs与安慰剂在成熟度、安全性或耐受性方面存在差异:他汀类药物、依折麦布和他汀类药物-依折麦布都是治疗 HeFH 儿童的有效药物,但低密度脂蛋白胆固醇的降低幅度各不相同,可能取决于治疗剂量和组合。未发现安全性或耐受性问题。长期安全性和有效性尚不确定。
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引用次数: 0
Relationship of proteins and subclinical cardiovascular traits in the population-based LIFE-Adult study 基于人群的 LIFE-成人研究中蛋白质与亚临床心血管特征的关系
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-21 DOI: 10.1016/j.atherosclerosis.2024.118613
Tarcyane Garcia , Agnese Petrera , Stefanie M. Hauck , Ronny Baber , Kerstin Wirkner , Holger Kirsten , Janne Pott , Anke Tönjes , Sylvia Henger , Markus Loeffler , Annette Peters , Markus Scholz

Background and aims

Understanding molecular processes of the early phase of atherosclerotic cardiovascular disease conditions is of utmost importance for early prediction and intervention measures.

Methods

We measured 92 cardiovascular-disease-related proteins (Olink, Cardiovascular III) in 2024 elderly participants of the population-based LIFE-Adult study. We analysed the impact of 27 covariables on these proteins including blood counts, cardiovascular risk factors and life-style-related parameters. We also analysed protein associations with 13 subclinical cardiovascular traits comprising carotid intima media thickness, plaque burden, three modes of Vicorder-based pulse-wave velocities, ankle-brachial index and ECLIA-based N-terminal prohormone of brain natriuretic peptide (NT-proBNP).

Results

Estimated glomerular filtration rate, triglycerides and sex where the most relevant covariables explaining more than 1 % variance of 49, 22 and 20 proteins, respectively. A total of 43 proteins were significantly associated with at least one of the analysed subclinical cardiovascular traits. NT-pro-BNP, brachial-ankle pulse-wave velocity (baPWV) and parameters of carotid plaque burden accounted for the largest number of associations. Association overlaps were relatively sparse. Only growth/differentiation factor 15, low density lipoprotein receptor and interleukin-1 receptor type 2 are associated with these three different cardiovascular traits. We confirmed several literature findings and found yet unreported associations for carotid plaque presence (von-Willebrand factor, galectin 4), carotid intima-media thickness (carboxypeptidase A1 andB1), baPWV (cathepsin D) and NT-proBNP (cathepsin Z, low density lipoprotein receptor, neurogenic locus homolog protein 3, trem-like transcript 2). Sex-interaction effects were observed, e.g. for spondin-1 and growth/differentiation factor 15 likely regulated by androgen response elements.

Conclusions

We extend the catalogue of proteome biomarkers possibly involved in early stages of cardiovascular disease pathologies providing targets for early risk prediction or intervention strategies.
背景和目的了解动脉粥样硬化性心血管疾病早期阶段的分子过程对于早期预测和干预措施至关重要。方法我们测量了基于人群的 LIFE-Adult 研究中 2024 名老年参与者的 92 种心血管疾病相关蛋白(Olink,心血管 III)。我们分析了 27 个协变量对这些蛋白质的影响,包括血细胞计数、心血管风险因素和生活方式相关参数。我们还分析了蛋白质与 13 种亚临床心血管特征的关系,包括颈动脉内膜厚度、斑块负荷、基于 Vicorder 的三种模式脉搏波速度、踝肱指数和基于 ECLIA 的脑钠肽 N 端前体(NT-proBNP)。共有 43 种蛋白质与所分析的亚临床心血管特征中的至少一种显著相关。NT-pro-BNP、肱踝脉搏波速度(baPWV)和颈动脉斑块负荷参数的相关性最大。关联重叠相对较少。只有生长/分化因子 15、低密度脂蛋白受体和白细胞介素-1 受体 2 型与这三种不同的心血管特征相关。我们证实了一些文献的研究结果,并发现颈动脉斑块的存在(von-Willebrand因子、galectin 4)、颈动脉内膜厚度(羧肽酶A1和B1)、baPWV(cathepsin D)和NT-proBNP(cathepsin Z、低密度脂蛋白受体、神经源性基因座同源蛋白3、trem-like转录本2)与之相关,但尚未报道。结论我们扩展了可能参与心血管疾病病理早期阶段的蛋白质组生物标志物目录,为早期风险预测或干预策略提供了目标。
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引用次数: 0
Lipids, lipoproteins, and apolipoproteins: Associations with cognition and dementia 血脂、脂蛋白和脂蛋白:与认知能力和痴呆症的关系
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-21 DOI: 10.1016/j.atherosclerosis.2024.118614
Ida Juul Rasmussen , Jiao Luo , Ruth Frikke-Schmidt
Due to increasing lifespan and aging populations globally there has been a steep rise in late-life dementia, which is now the second most common cause of death in high-income countries. In general, dementia can be divided into two major groups: Alzheimer's disease (AD) and vascular-related dementia (VD). AD is pathologically characterised by senile plaques containing amyloid-β and neurofibrillary tangles composed of hyperphosphorylated tau, whereas VD is dominated by vascular pathology such as cerebral small vessel disease, major strokes, and white matter lesions. Recently, the importance of vascular components in AD is increasingly recognized and it is estimated that up to 45 % of all dementia cases can be prevented by preventing or treating midlife cardiovascular risk factors such as physical inactivity, diabetes, and hypertension. Even though the brain contains approximately 25 % of the total body cholesterol pool, and several genetic variants related to the lipid metabolism have been identified in genome-wide associations studies of AD, the role of lipids, lipoproteins, and apolipoproteins in dementia risk is less well-known.
In this review, we go through the current literature on lipids, lipoproteins, and apolipoproteins and risk of dementia. We conclude that the evidence is primarily insufficient or conflicting, possibly due to nonoptimal study designs. The future calls for large, prospective studies of midlife measurements of lipids, lipoproteins, and apolipoproteins and one-sample, individual level data Mendelian randomization studies to overcome survival bias. However, the current literature suggests that it is safe to say that what is good for the heart is good for the brain.
由于全球寿命延长和人口老龄化,晚年痴呆症的发病率急剧上升,目前已成为高收入国家的第二大常见死因。一般来说,痴呆症可分为两大类:阿尔茨海默病(AD)和血管相关性痴呆(VD)。阿尔茨海默病的病理特征是含有淀粉样蛋白-β的老年斑和由高磷酸化 tau 组成的神经纤维缠结,而血管性痴呆则以血管病变为主,如脑小血管疾病、重大中风和白质病变。最近,血管病变在老年痴呆症中的重要性日益得到认可,据估计,通过预防或治疗中年期心血管风险因素(如缺乏运动、糖尿病和高血压),可预防高达 45% 的痴呆症病例。尽管大脑中的胆固醇约占人体胆固醇总量的 25%,而且在注意力缺失症的全基因组关联研究中发现了一些与脂质代谢有关的基因变异,但脂质、脂蛋白和载脂蛋白在痴呆症风险中的作用却鲜为人知。我们得出的结论是,证据主要不足或相互矛盾,这可能是由于非最佳研究设计造成的。未来需要对血脂、脂蛋白和脂蛋白的中年测量进行大型前瞻性研究,并进行单样本、个体水平数据的孟德尔随机研究,以克服生存偏倚。不过,目前的文献表明,可以肯定地说,对心脏有益的东西就是对大脑有益的东西。
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引用次数: 0
The German Lipoprotein Apheresis Registry-Summary of the eleventh annual report 德国脂蛋白分离登记处--第十一次年度报告摘要
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-19 DOI: 10.1016/j.atherosclerosis.2024.118601
V.J.J. Schettler , N. Selke , S. Jenke , T. Zimmermann , G. Schlieper , W. Bernhardt , F. Heigl , P. Grützmacher , I. Löhlein , R. Klingel , B. Hohenstein , W. Ramlow , A. Vogt , U. Julius , Scientific Board of GLAR for the German Apheresis Working Group

Background

In 2012, the German Lipoprotein Apheresis Registry (GLAR) was launched. Real-world data on lipoprotein apheresis (LA) treatment are now available for a time period of 11 years. All patients received the maximally tolerated lipid-lowering therapy, which included statins, ezetimibe, bempedoic acid, and either proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies or antisense therapy.

Methods and Results

During the time period from 2012 to 2022, 92 German apheresis centers collected retrospective and prospective observational data of a total of 2,301 patients undergoing regular lipoprotein apheresis (LA) treatment of hypercholesterolemia or/and Lp(a)-hyperlipoproteinemia suffering from progressive atherosclerotic cardiovascular disease (ASCVD), with complete data sets of 1.125 patients, who were the subject of this analysis. More than 61,500 LA sessions are documented in the database. In 2022, all patients treated with LA demonstrated a significant immediate median reduction rate of LDL-C (68.8 %) and Lp(a) (72.9 %). Patient data were analyzed for the incidence rate of major coronary events (MACE) 1 and 2 years before the beginning of LA treatment (y-2 and y-1) and prospectively up to eleven years on LA treatment (y+1 to y+11). During the first two years of LA treatment (y+1 and y+2), a MACE reduction of 73 % was observed and continued to be low during y+3 to y+11, when all LA patients were analyzed. LA patients with only increased Lp(a) levels (Lp(a) ≥ 60 mg/dl (≥120 nmol/l) and an LDL-C < 100 mg/dl (<2.6 mmol/l)) had a higher MACE reduction (85 %; n = 443) in the first two years of LA treatment compared to LA patients with only increased LDL-C-levels (LDL-C ≥ 100 mg/dl (≥2.6 mmol/l); Lp(a) < 60 mg/dl (<120 nmol/l)) (53 %; n = 171). Adverse events of LA remained low (about 5 %) over the eleven years and mainly represented puncture problems (1.0 %). No side effects resulted in termination of LA therapy.

Conclusions

The current analysis of GLAR data indicates that regular LA leads to very low incidence rates of cardiovascular events in patients with high LDL-C and/or high Lp(a) levels, progressive ASCVD, and maximally tolerated lipid-lowering medication, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition. Additionally, LA was safe with a low rate of adverse effects over an 11-year period. The number of enrolled patients and the duration of observation establish GLAR as the largest LA registry worldwide.
背景2012年,德国脂蛋白分离注册中心(GLAR)成立。目前已有11年来的脂蛋白分离(LA)治疗的真实数据。所有患者都接受了最大耐受性降脂治疗,包括他汀类药物、依折麦布、贝美多酸和9型丙蛋白转换酶亚基酶/kexin(PCSK9)抗体或反义疗法。方法和结果在2012年至2022年期间,德国的92个无细胞疗法中心共收集了2301名接受常规脂蛋白无细胞疗法(LA)治疗的高胆固醇血症或/和Lp(a)-高脂蛋白血症的进展性动脉粥样硬化性心血管疾病(ASCVD)患者的回顾性和前瞻性观察数据,其中有1125名患者的完整数据集是本次分析的对象。数据库中记录了 61,500 多次 LA 治疗。2022 年,所有接受 LA 治疗的患者的低密度脂蛋白胆固醇(LDL-C)(68.8%)和脂蛋白(a)(72.9%)的即时中位数下降率都非常显著。对患者数据进行了分析,以了解LA治疗开始前1年和2年(y-2和y-1)以及LA治疗11年(y+1至y+11)的主要冠状动脉事件(MACE)发生率。在 LA 治疗的前两年(y+1 和 y+2),观察到 MACE 减少了 73%,在 y+3 至 y+11 期间,对所有 LA 患者进行分析时,MACE 减少率仍然很低。仅 Lp(a) 水平升高(Lp(a) ≥ 60 mg/dl (≥120 nmol/l)和 LDL-C < 100 mg/dl (< 2.6毫摩尔/升))的LA患者相比,LDL-C水平仅升高(LDL-C ≥ 100 mg/dl (≥2.6 mmol/l);Lp(a) < 60 mg/dl (<120 nmol/l))的LA患者在LA治疗的头两年中MACE减少率更高(85%;n = 443)(53%;n = 171)。十一年来,LA 的不良反应仍然很少(约 5%),主要是穿刺问题(1.0%)。结论目前对 GLAR 数据的分析表明,对于低密度脂蛋白胆固醇(LDL-C)和/或脂蛋白(a)水平较高、有进行性 ASCVD 和最大耐受性降脂药物(包括 9 型丙蛋白转换酶亚基酶/kexin (PCSK9) 抑制剂)的患者,定期服用 LA 可降低心血管事件的发生率。此外,在长达11年的时间里,LA安全性高,不良反应发生率低。GLAR登记的患者人数和观察时间使其成为全球最大的LA登记机构。
{"title":"The German Lipoprotein Apheresis Registry-Summary of the eleventh annual report","authors":"V.J.J. Schettler ,&nbsp;N. Selke ,&nbsp;S. Jenke ,&nbsp;T. Zimmermann ,&nbsp;G. Schlieper ,&nbsp;W. Bernhardt ,&nbsp;F. Heigl ,&nbsp;P. Grützmacher ,&nbsp;I. Löhlein ,&nbsp;R. Klingel ,&nbsp;B. Hohenstein ,&nbsp;W. Ramlow ,&nbsp;A. Vogt ,&nbsp;U. Julius ,&nbsp;Scientific Board of GLAR for the German Apheresis Working Group","doi":"10.1016/j.atherosclerosis.2024.118601","DOIUrl":"10.1016/j.atherosclerosis.2024.118601","url":null,"abstract":"<div><h3>Background</h3><div>In 2012, the German Lipoprotein Apheresis Registry (GLAR) was launched. Real-world data on lipoprotein apheresis (LA) treatment are now available for a time period of 11 years. All patients received the maximally tolerated lipid-lowering therapy, which included statins, ezetimibe, bempedoic acid, and either proprotein convertase subtilisin/kexin type 9 (PCSK9) antibodies or antisense therapy.</div></div><div><h3>Methods and Results</h3><div>During the time period from 2012 to 2022, 92 German apheresis centers collected retrospective and prospective observational data of a total of 2,301 patients undergoing regular lipoprotein apheresis (LA) treatment of hypercholesterolemia or/and Lp(a)-hyperlipoproteinemia suffering from progressive atherosclerotic cardiovascular disease (ASCVD), with complete data sets of 1.125 patients, who were the subject of this analysis. More than 61,500 LA sessions are documented in the database. In 2022, all patients treated with LA demonstrated a significant immediate median reduction rate of LDL-C (68.8 %) and Lp(a) (72.9 %). Patient data were analyzed for the incidence rate of major coronary events (MACE) 1 and 2 years before the beginning of LA treatment (y-2 and y-1) and prospectively up to eleven years on LA treatment (y+1 to y+11). During the first two years of LA treatment (y+1 and y+2), a MACE reduction of 73 % was observed and continued to be low during y+3 to y+11, when all LA patients were analyzed. LA patients with only increased Lp(a) levels (Lp(a) ≥ 60 mg/dl (≥120 nmol/l) and an LDL-C &lt; 100 mg/dl (&lt;2.6 mmol/l)) had a higher MACE reduction (85 %; n = 443) in the first two years of LA treatment compared to LA patients with only increased LDL-C-levels (LDL-C ≥ 100 mg/dl (≥2.6 mmol/l); Lp(a) &lt; 60 mg/dl (&lt;120 nmol/l)) (53 %; n = 171). Adverse events of LA remained low (about 5 %) over the eleven years and mainly represented puncture problems (1.0 %). No side effects resulted in termination of LA therapy.</div></div><div><h3>Conclusions</h3><div>The current analysis of GLAR data indicates that regular LA leads to very low incidence rates of cardiovascular events in patients with high LDL-C and/or high Lp(a) levels, progressive ASCVD, and maximally tolerated lipid-lowering medication, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition. Additionally, LA was safe with a low rate of adverse effects over an 11-year period. The number of enrolled patients and the duration of observation establish GLAR as the largest LA registry worldwide.</div></div>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":"398 ","pages":"Article 118601"},"PeriodicalIF":4.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The singular French PCSK9-p.Ser127Arg gain-of-function variant: A significant player in cholesterol levels from a 775-year-old common ancestor 独特的法国 PCSK9-p.Ser127Arg 功能增益变体:775年前共同祖先胆固醇水平的重要影响因素
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1016/j.atherosclerosis.2024.118596
Yara Azar , Thomas E. Ludwig , Hugo Le Bon , Thea Bismo Strøm , Olivier Bluteau , Mathilde Di-Filippo , Alain Carrié , Hedi Chtioui , Sophie Béliard , Oriane Marmontel , Annie Fonteille , Maite Gebhart , Noël Peretti , Philippe Moulin , Jean Ferrières , Alain Pradignac , Michel Farnier , Antonio Gallo , Cécile Yelnik , Dirk Blom , Mathilde Varret

Background and aims

PCSK9 is a key regulator of LDL-cholesterol levels. PCSK9 gain of function variants (GOFVs) cause autosomal dominant hypercholesterolemia (ADH). The first described PCSK9-GOFV, p.Ser127Arg, almost exclusively reported in France, represents 67 % of the PCSK9 French GOFVs due to a founder effect. Few other carriers are reported in South Africa and Norway. This study aims to estimate when the common ancestor lived and to describe a cohort of p.Ser127Arg carriers.

Methods

Eight families and 14 p.Ser127Arg carriers were genotyped and phenotyped. Haplotypes were constructed using 11 microsatellites around PCSK9 and 6 intragenic single nucleotide polymorphisms (SNPs). To add to the biological analysis, eight additional p.Ser127Arg carriers, 12 carriers of other PCSK9-GOFVs, 93 LDLR loss of function variant (LOFV) carriers and 49 non-carriers subjects were phenotyped.

Results

The most common ancestor of p.Ser127Arg was estimated to have lived 775 years ago [95 % CI: 575-1075]. French Protestants exiled after the revocation of the Edict of Nantes in 1685 AD likely brought the variant to South Africa and Norway. As expected for ADH subjects, carriers of LDLR-LOFV, the p.Ser127Arg, or other PCSK9-GOFVs showed significantly higher LDL-C levels than that of the non-carriers. Interestingly, LDL-C levels are higher for LDLR-LOFVs and for the reduced secreted p.Ser127Arg than for secreted PCSK9-GOFVs, suggesting a greater effect of the p.Ser127Arg. Conversely, HDL-C was significantly lower for LDLR-LOFV and p.Ser127Arg carriers.

Conclusions

This first report from a large cohort of PCSK9-p.Ser127Arg carriers provides observations suggesting a stronger hypercholesterolemic potential of the mutated pro-PCSK9 compared with the secreted mature protein. This work also provides additional data to support the association between PCSK9 and HDL metabolism, and molecular evidence that this variant appeared in France around 1248 AD (Graphical Abstract = Fig. 1).
背景和目的PCSK9是低密度脂蛋白胆固醇水平的关键调节因子。PCSK9 功能增益变异(GOFV)会导致常染色体显性高胆固醇血症(ADH)。第一个描述的 PCSK9-GOFV 是 p.Ser127Arg,几乎只在法国有报道,由于创始人效应,它占 PCSK9 法国 GOFV 的 67%。南非和挪威很少有其他携带者的报道。本研究旨在估计共同祖先的生活时间,并描述 p.Ser127Arg 携带者的队列。方法对 8 个家庭和 14 个 p.Ser127Arg 携带者进行了基因分型和表型分析。利用 PCSK9 周围的 11 个微卫星和 6 个基因内单核苷酸多态性 (SNP) 构建了单倍型。为了补充生物学分析,还对另外 8 名 p.Ser127Arg 携带者、12 名其他 PCSK9-GOFVs 携带者、93 名 LDLR 功能缺失变异体 (LOFV) 携带者和 49 名非携带者进行了表型分析。结果p.Ser127Arg 的最常见祖先估计生活在 775 年前[95 % CI:575-1075]。公元1685年南特敕令废除后流亡的法国新教徒很可能将该变异体带到了南非和挪威。正如 ADH 受试者所预期的那样,LDLR-LOFV、p.Ser127Arg 或其他 PCSK9-GOFV 携带者的低密度脂蛋白胆固醇水平明显高于非携带者。有趣的是,与分泌型 PCSK9-GOFV 相比,LDLR-LOFV 和分泌减少的 p.Ser127Arg 的 LDL-C 水平更高,这表明 p.Ser127Arg 的作用更大。结论这是对一大群 PCSK9-p.Ser127Arg 携带者的首次报道,观察结果表明,与分泌型成熟蛋白相比,突变的原 PCSK9 具有更强的高胆固醇血症潜力。这项研究还提供了更多数据,支持 PCSK9 与高密度脂蛋白代谢之间的联系,并提供了分子证据,证明该变异体在公元 1248 年左右出现在法国(图解摘要 = 图 1)。
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引用次数: 0
In Memoriam: Akira Endo (1933-2024) 悼念:远藤明(1933-2024)
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-13 DOI: 10.1016/j.atherosclerosis.2024.118545
Alberico L. Catapano
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引用次数: 0
The association between trimethylamine N-oxide levels and coronary microvascular dysfunction and prognosis in patients with ST-elevation myocardial infarction 三甲胺 N-氧化物水平与 ST 段抬高型心肌梗死患者冠状动脉微血管功能障碍和预后之间的关系
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-12 DOI: 10.1016/j.atherosclerosis.2024.118597
Ali Aldujeli , Tsung-Ying Tsai , Ayman Haq , Vacis Tatarunas , Scot Garg , Diarmaid Hughes , Ieva Ciapiene , Ramunas Unikas , Faisal Sharif , Vaiva Lesauskaite , Yoshinobu Onuma , Patrick W. Serruys

Background and aims

Coronary microvascular dysfunction (CMD) is common after ST-elevation myocardial infarction (STEMI), leading to adverse clinical outcomes. However, its diagnosis remains difficult, and mechanisms elusive. This study explores the role of Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, as a potential biomarker for diagnosing CMD in STEMI patients.

Methods

This prospective, observational study enrolled 210 STEMI patients with multivessel coronary artery disease who underwent primary percutaneous coronary intervention (PCI). TMAO levels were measured at baseline, 3 months, and 12 months post-PCI, whilst coronary physiology was assessed at 3 months. The primary endpoint was the incidence of CMD at 3 months, with the secondary endpoint being major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months. An additional 59 consecutive patients were enrolled for validation.

Results

TMAO levels varied from baseline to 3 months, then stabilised. The areas under the ROC curve for baseline TMAO and TMAO at 3-month were 0.55 (95 % CI 0.46–0.64; p = 0.426), and 0.80 (95 % CI 0.73–0.87; p < 0.001), respectively. The optimal cut-off for TMAO at 3-month to diagnose CMD was 3.91, with similar sensitivity and specificity in the derivation and validation cohort. The incidence of MACCE was higher in patients with TMAO≥3.91 (41.4 % vs 10.7 %; p < 0.001). The addition of 3-month TMAO improved the diagnostic performance of traditional risk factors.

Conclusion

TMAO is a robust biomarker for CMD and is significantly associated with the incidence of MACCE. TMAO has the potential in guiding clinical decision-making and suggests an interplay between gut microbiota and CMD.
背景和目的冠状动脉微血管功能障碍(CMD)是ST段抬高型心肌梗死(STEMI)后的常见病,会导致不良的临床结局。然而,其诊断仍很困难,其机制也难以捉摸。本研究探讨了肠道微生物群代谢物三甲胺N-氧化物(TMAO)作为诊断STEMI患者CMD的潜在生物标记物的作用。方法这项前瞻性观察性研究共纳入了210名接受初级经皮冠状动脉介入治疗(PCI)的STEMI多支血管冠状动脉疾病患者。在PCI术后基线、3个月和12个月时测量TMAO水平,在3个月时评估冠状动脉生理功能。主要终点是3个月时的CMD发生率,次要终点是12个月时的主要不良心脑血管事件(MACCE)。结果TMAO水平从基线到3个月期间有所变化,随后趋于稳定。基线 TMAO 和 3 个月时 TMAO 的 ROC 曲线下面积分别为 0.55 (95 % CI 0.46-0.64; p = 0.426) 和 0.80 (95 % CI 0.73-0.87; p < 0.001)。3个月时TMAO诊断CMD的最佳临界值为3.91,在推导队列和验证队列中具有相似的敏感性和特异性。TMAO≥3.91的患者MACCE发生率更高(41.4% vs 10.7%;p < 0.001)。结论TMAO是一种可靠的CMD生物标记物,与MACCE的发病率显著相关。TMAO具有指导临床决策的潜力,并表明肠道微生物群与CMD之间存在相互作用。
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引用次数: 0
Arterial inflammation on [18F]FDG PET/CT in melanoma patients treated with and without immune checkpoint inhibitors: CHECK-FLAME I 接受和未接受免疫检查点抑制剂治疗的黑色素瘤患者[18F]FDG PET/CT 上的动脉炎症:CHECK-FLAME I
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-07 DOI: 10.1016/j.atherosclerosis.2024.118595
Elissa A.S. Polomski , Ellen W. Kapiteijn , Julius C. Heemelaar , Anne V. van der Kolk , Timo M. Kalisvaart , Alina van de Burgt , Petra Dibbets-Schneider , Floris H.P. van Velden , Tom T.P. Seijkens , J. Lauran Stöger , J. Wouter Jukema , Lioe-Fee de Geus-Oei , M. Louisa Antoni

Background and aims

Immune checkpoint inhibitors (ICIs) revolutionized cancer treatment. However, ICIs may increase the immune response to non-tumor cells, possibly resulting in increased arterial inflammation, raising the risk of atherosclerotic events. Nevertheless, malignancies may induce a pro-inflammatory state and the association between ICIs and arterial inflammation remains to be clarified. This study aims to assess differences in increase in arterial inflammation between patients with advanced melanoma treated with ICIs compared to a control group without ICIs.

Methods

Patients with advanced melanoma who underwent [18F]FDG PET/CT scans at baseline, 6 months (T1) and 18 months (T2) were included in this retrospective observational study. Arterial inflammation was evaluated in eight segments by calculating the target-to-background ratio (TBR). The primary study outcome was the difference in increase in mean TBRmax between patients treated with and without ICIs.

Results

We included 132 patients of whom 72.7 % were treated with ICIs. After exclusion for the use of anti-inflammatory medication, patients treated with ICIs showed a significant increase in mean TBRmax between baseline and T1 from 1.29 ± 0.12 to 1.33 ± 0.13 (p = 0.017), while in the control group, no change in mean TBRmax (1.30 ± 0.12 to 1.28 ± 0.10, p = 0.22) was observed (p = 0.027). During longer follow-up, mean TBRmax remained stable in both groups. Arterial inflammation increased significantly after ICI therapy in patients without active inflammation (p < 0.001) and in patients without calcifications (p = 0.013).

Conclusions

A significant increase in arterial inflammation as measured on [18F]FDG PET/CT was observed in patients with advanced melanoma treated with ICIs only in the first six months after initiation of therapy, whereas no changes were observed in the control group. Moreover, arterial inflammation was mainly increased in patients without pre-existing inflammatory activity and with non-calcified lesions.

背景和目的免疫检查点抑制剂(ICIs)彻底改变了癌症治疗。然而,免疫检查点抑制剂可能会增加对非肿瘤细胞的免疫反应,从而可能导致动脉炎症加剧,增加动脉粥样硬化事件的风险。然而,恶性肿瘤可能会诱发促炎症状态,而 ICIs 与动脉炎症之间的关联仍有待明确。本研究旨在评估接受 ICIs 治疗的晚期黑色素瘤患者与未接受 ICIs 治疗的对照组患者之间动脉炎症增加的差异。方法这项回顾性观察研究纳入了在基线、6 个月(T1)和 18 个月(T2)接受 [18F]FDG PET/CT 扫描的晚期黑色素瘤患者。通过计算目标与背景比值(TBR)对八个节段的动脉炎症进行了评估。主要研究结果是接受和未接受 ICIs 治疗的患者平均 TBRmax 的增加差异。在排除使用抗炎药物的情况后,接受 ICIs 治疗的患者的平均 TBRmax 在基线和 T1 之间有显著增加,从 1.29 ± 0.12 增加到 1.33 ± 0.13(p = 0.017),而对照组的平均 TBRmax 没有变化(从 1.30 ± 0.12 增加到 1.28 ± 0.10,p = 0.22)(p = 0.027)。在较长时间的随访中,两组的平均 TBRmax 均保持稳定。结论 在接受 ICIs 治疗的晚期黑色素瘤患者中,仅在开始治疗后的前 6 个月内,[18F]FDG PET/CT 检测到动脉炎症显著增加,而对照组未观察到任何变化。此外,动脉炎症主要在无炎症活动和无钙化病灶的患者中增加。
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引用次数: 0
Is colchicine on its way to a place in the polypill for cardiovascular prevention? 秋水仙碱是否即将成为预防心血管疾病的多用途药物?
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-05 DOI: 10.1016/j.atherosclerosis.2024.118594
Fernando Botto, Sebastián Garcia-Zamora
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引用次数: 0
Silencing ARL11 relieved atherosclerotic inflammation and lipid deposition via retraining JAK2/STAT1 pathway 沉默ARL11可通过重新训练JAK2/STAT1通路缓解动脉粥样硬化炎症和脂质沉积。
IF 4.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-05 DOI: 10.1016/j.atherosclerosis.2024.118564
Yanhua Zhen , Jiaqi Yang , Ji Song , Zeyu Xing , Jiahe Zheng

Background and aims

Atherosclerosis (AS), an arterial vasculature disease, is characterized by abnormal lipid accumulation and inflammatory response. ADP ribosylation factor like GTPase 11 (ARL11) is linked to multifarious processes in cells. This study aims to clarify the underlying mechanism of ARL11 in AS.

Methods

ApoE−/− mice fed with high-fat diet were used as mouse model of AS. Gene expression in AS was determined by mRNA-sequencing. ARL11 expression was detected by real-time PCR, Western blot and immunofluorescence. M1 polarization of macrophages was indicated by TNF-α and IL-6 levels as detected with ELISA, and iNOS expression determined by real-time PCR and Western blot. The role of ARL11 during AS was explored through loss-of-function analysis.

Results

There were 1301 upregulated and 1110 downregulated genes during AS. These differentially expressed genes (DEGs) were mainly enriched in pathways and terms which are involved in inflammation. Moreover, Arl11 was highly expressed in AS models. Downregulation of Arl11 decreased lipid deposition and atherosclerotic plaques in the aortas of AS mice, and declined inflammatory cytokines and M1 polarization of macrophages induced by IFN-γ. Furthermore, ARL11 interacted with JAK2 and p-JAK2 and modulated their degradation, thus inhibiting the activation of JAK2/STAT1 pathway.

Conclusions

ARL11 promoted the development of AS via interacting with JAK2 and activating JAK2/STAT1 pathway. Thus, silencing ARL11 may prevent the process of AS and be a novel way to treat AS.
背景和目的:动脉粥样硬化(AS)是一种动脉血管疾病,以脂质异常积累和炎症反应为特征。ADP 核糖基化因子类 GTPase 11(ARL11)与细胞中的多种过程有关。本研究旨在阐明ARL11在强直性脊柱炎中的潜在机制:方法:以高脂饮食喂养的载脂蛋白E-/-小鼠作为强直性脊柱炎小鼠模型。通过 mRNA 序列测定 AS 中的基因表达。通过实时 PCR、Western 印迹和免疫荧光检测 ARL11 的表达。巨噬细胞的M1极化通过ELISA检测的TNF-α和IL-6水平以及实时PCR和Western印迹检测的iNOS表达来显示。通过功能缺失分析探讨了ARL11在强直性脊柱炎中的作用:结果:强直性脊柱炎期间有1301个基因上调,1110个基因下调。这些差异表达基因(DEGs)主要富集在与炎症有关的通路和术语中。此外,Arl11在强直性脊柱炎模型中高度表达。下调Arl11可减少AS小鼠主动脉中的脂质沉积和动脉粥样硬化斑块,并降低炎性细胞因子和IFN-γ诱导的巨噬细胞M1极化。此外,ARL11与JAK2和p-JAK2相互作用并调节其降解,从而抑制了JAK2/STAT1通路的激活:结论:ARL11通过与JAK2相互作用并激活JAK2/STAT1通路,促进了强直性脊柱炎的发展。结论:ARL11通过与JAK2相互作用并激活JAK2/STAT1通路,促进了强直性脊柱炎的发展。
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引用次数: 0
期刊
Atherosclerosis
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