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Chen T, Shi Z, Qian C. Influence of Metabolic Syndrome on the Long-Term Prognosis of Patients with Myocardial Infarction: A Meta-Analysis. Horm Metab Res 2024; 56:435-444. [PMID: 38056496 DOI: 10.1055/a-2196-3764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The influence of metabolic syndrome (MetS) on long-term prognosis of patients with myocardial infarction (MI), the most severe type of coronary artery disease, remains not fully determined. This systematic review and meta-analysis were conducted to investigate the association between MetS and long-term clinical outcomes of patients with MI. A systematic search of Medline, Web of Science, and Embase databases from inception to June 25, 2023, was conducted to obtain eligible studies. Only studies with follow-up duration for at least one year were considered. A random-effects model was utilized to pool the results, accounting for heterogeneity. Ten observational studies were included, which included 33 197 patients with MI. Among them, 17 244 (51.9%) were with MetS at baseline. During a follow-up duration of 12 to 48 months (mean: 22.5 months), patients with MetS were associated with higher incidence of major adverse cardiovascular events [risk ratio (RR): 1.35. 95% confidence interval (CI): 1.19 to 1.54, p<0.001; I2=64%] and all-cause deaths (RR: 1.34, 95% CI: 1.18 to 1.52, p<0.001; I2=23%), as compared to those without MetS at baseline. Subgroup analyses showed that the results were not significantly affected by study characteristics such as study country, design, type of MI, mean age of the patients, treatment with percutaneous coronary intervention, follow-up durations, or study quality scores (p for subgroup difference all>0.05). In patients with MI, MetS may be a risk factor of poor long-term prognosis.
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Affiliation(s)
- Tianfeng Chen
- Department of Cardiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, China
| | - Zhewei Shi
- Department of Cardiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, China
| | - Caizhen Qian
- Department of Cardiology, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, China
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Lee YJ, Lee SH, You SC, Lee YH, Lee SJ, Hong SJ, Ahn CM, Kim BK, Ko YG, Choi D, Hong MK, Jang Y, Kim JS. Moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome and atherosclerotic cardiovascular disease: A post-hoc analysis of the RACING trial. Diabetes Obes Metab 2024; 26:829-839. [PMID: 37994242 DOI: 10.1111/dom.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/28/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
AIM This study evaluated the safety and efficacy of a moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome (MetS) and atherosclerotic cardiovascular disease. MATERIALS AND METHODS In this post-hoc subgroup analysis of the RACING trial, patients were analysed based on the presence of MetS. MetS was defined as meeting at least three of the five following criteria: (a) elevated waist circumference; (b) elevated triglycerides; (c) reduced high-density lipoprotein cholesterol; (d) elevated blood pressure; and (e) elevated fasting glucose. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. RESULTS Of the 3780 patients enrolled in the RACING trial, 1703 (45.1%) had MetS at baseline. The primary outcome rate was 10.1% and 10.3% in patients with MetS receiving ezetimibe combination therapy versus high-intensity statin monotherapy (hazard ratio = 0.97; 95% confidence interval = 0.72-1.32; p = .868). Lower rates of intolerance-related drug discontinuation or dose reduction (3.9% vs. 8.0%; p < .001) and lower low-density lipoprotein cholesterol levels (57 vs. 65 mg/dl; p < .001) were observed with ezetimibe combination therapy versus high-intensity statin monotherapy. Furthermore, the rate of new-onset diabetes was 18.5% and 19.1% in each group (p = .822). There were no significant interactions between MetS and therapy regarding study outcomes in the total population. CONCLUSIONS In patients with MetS and atherosclerotic cardiovascular disease, a moderate-intensity statin with ezetimibe combination therapy had comparable cardiovascular benefits with those of high-intensity statin monotherapy. Meanwhile, ezetimibe combination therapy was associated with lower drug intolerance and low-density lipoprotein cholesterol levels, but there was no apparent between-group difference in new-onset diabetes.
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Affiliation(s)
- Yong-Joon Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Hyup Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Ho Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Jun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Jin Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul-Min Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byeong-Keuk Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Ki Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- CHA University College of Medicine, Seongnam, South Korea
| | - Jung-Sun Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Zeng P, Jiang C, Liu A, Yang X, Lin F, Cheng L. Association of systemic immunity-inflammation index with metabolic syndrome in U.S. adult: a cross-sectional study. BMC Geriatr 2024; 24:61. [PMID: 38225566 PMCID: PMC10788994 DOI: 10.1186/s12877-023-04635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/24/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a pathological condition characterized by the abnormal clustering of several metabolic components and has become a major public health concern. We aim to investigate the potential link of Systemic immunity-inflammation index (SII) on MetS and its components. METHODS AND RESULT Weighted multivariable logistic regression was conducted to assess the relationship between SII and MetS and its components. Restricted cubic spline (RCS) model and threshold effect analysis were also performed. A total of 6,999 U.S. adults were enrolled. Multivariate model found that SII were positively associated with MetS (OR = 1.18;95CI%:1.07-1.30) and hypertension (OR = 1.22; 95CI%:1.12-1.34) in a dose-dependent manner. When SII was converted into a categorical variable, the risk of MetS increased by 36% and the risk of hypertension increased by 53% in the highest quantile of SIIs. The RCS model confirmed linear associations between SII and MetS, as well as a non-linear association between SII and certain components of MetS, including hypertension, hyperglycemia, low HDL, and hyperlipidemia. Meanwhile, the relationship between SII and hypertension presents a J-shaped curve with a threshold of 8.27, above which the risk of hypertension increases. Furthermore, in MetS and hypertension, age, sex, body mass index (BMI), and race were not significantly associated with this positive association based on subgroup analyses and interaction tests(p for interaction > 0.05). CONCLUSIONS The present study indicated that there was a higher SII association with an increased risk of MetS and hypertension in adults. However, further prospective cohort studies are required to establish a causal relationship between SII and MetS, as well as its components.
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Affiliation(s)
- Peng Zeng
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, 518000, China
| | - Cheng Jiang
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, 518000, China
| | - Anbang Liu
- Shandong First Medical University, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250000, China
| | - Xinyuan Yang
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, 518000, China
| | - Feng Lin
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, 518000, China.
| | - Lingli Cheng
- The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, 511518, Guangdong, China.
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Wadström BN, Wulff AB, Pedersen KM, Nordestgaard BG. Do Triglyceride-Rich Lipoproteins Equal Low-Density Lipoproteins in Risk of ASCVD? Curr Atheroscler Rep 2023; 25:795-803. [PMID: 37768410 DOI: 10.1007/s11883-023-01153-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE OF REVIEW Recent large clinical trials have failed to show that triglyceride-rich lipoprotein-lowering therapies decrease the risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we reconcile these findings with evidence showing that elevated levels of triglyceride-rich lipoproteins and the cholesterol they contain, remnant cholesterol, cause ASCVD alongside low-density lipoprotein (LDL) cholesterol. RECENT FINDINGS Results from observational epidemiology, genetic epidemiology, and randomized controlled trials indicate that lowering of remnant cholesterol and LDL cholesterol decrease ASCVD risk by a similar magnitude per 1 mmol/L (39 mg/dL) lower non-high-density lipoprotein cholesterol (remnant cholesterol+LDL cholesterol). Indeed, recent guidelines for ASCVD prevention recommend the use of non-high-density lipoprotein cholesterol instead of LDL cholesterol. Current consensus is moving towards recognizing remnant cholesterol and LDL cholesterols as equals per 1 mmol/L (39 mg/dL) higher levels in the risk assessment of ASCVD; hence, triglyceride-rich lipoprotein-lowering therapies should also lower levels of non-HDL cholesterol to reduce ASCVD risk.
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Affiliation(s)
- Benjamin N Wadström
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, N5, DK-2730, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, M3, DK-2730, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3b 33.5, DK-2200, Copenhagen, Denmark
| | - Anders B Wulff
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, N5, DK-2730, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, M3, DK-2730, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3b 33.5, DK-2200, Copenhagen, Denmark
| | - Kasper M Pedersen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, N5, DK-2730, Herlev, Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, M3, DK-2730, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3b 33.5, DK-2200, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, N5, DK-2730, Herlev, Denmark.
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Borgmester Ib Juuls Vej 73, entrance 7, 4th floor, M3, DK-2730, Herlev, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3b 33.5, DK-2200, Copenhagen, Denmark.
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Miller M, Bhatt DL, Brinton EA, Jacobson TA, Steg PG, Pineda AL, Ketchum SB, Doyle RT, Tardif JC, Ballantyne CM. Effectiveness of icosapent ethyl on first and total cardiovascular events in patients with metabolic syndrome, but without diabetes: REDUCE-IT MetSyn. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead114. [PMID: 38035037 PMCID: PMC10684296 DOI: 10.1093/ehjopen/oead114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023]
Abstract
Aims Metabolic syndrome (MetSyn) is associated with high risk of cardiovascular (CV) events, irrespective of statin therapy. In the overall REDUCE-IT study of statin-treated patients, icosapent ethyl (IPE) reduced the risk of the primary composite endpoint (CV death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, or unstable angina requiring hospitalization) and the key secondary composite endpoint (CV death, non-fatal myocardial infarction, or non-fatal stroke). Methods and results REDUCE-IT was an international, double-blind trial that randomized 8179 high CV risk statin-treated patients with controlled LDL cholesterol and elevated triglycerides, to IPE 4 g/day or placebo. The current study evaluated the pre-specified patient subgroup with a history of MetSyn, but without diabetes at baseline. Among patients with MetSyn but without diabetes at baseline (n = 2866), the majority (99.8%) of this subgroup was secondary prevention patients. Icosapent ethyl use was associated with a 29% relative risk reduction for the first occurrence of the primary composite endpoint [hazard ratio: 0.71; 95% confidence interval (CI): 0.59-0.84; P < 0.0001, absolute risk reduction (ARR) = 5.9%; number needed to treat = 17] and a 41% reduction in total (first plus subsequent) events [rate ratio: 0.59; (95% CI: 0.48-0.72); P < 0.0001] compared with placebo. The risk for the key secondary composite endpoint was reduced by 20% (P = 0.05) and a 27% reduction in fatal/non-fatal MI (P = 0.03), 47% reduction in urgent/emergent revascularization (P < 0.0001), and 58% reduction in hospitalization for unstable angina (P < 0.0001). Non-statistically significant reductions were observed in cardiac arrest (44%) and sudden cardiac death (34%). Conclusion In statin-treated patients with a history of MetSyn, IPE significantly reduced the risk of first and total CV events in REDUCE-IT. The large relative and ARRs observed supports IPE as a potential therapeutic consideration for patients with MetSyn at high CV risk. Registration REDUCE-IT ClinicalTrials.gov number: NCT01492361.
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Affiliation(s)
- Michael Miller
- Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center and Hospital of the University of Pennsylvania, 3900 Woodland Avenue, Philadelphia, PA 19104-4551, USA
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Terry A Jacobson
- Lipid Clinic and Cardiovascular Risk Reduction Program, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Philippe Gabriel Steg
- Université de Paris, FACT (French Alliance for Cardiovascular Trials), Assistance Publique–Hôpitaux de Paris, Hôpital Bichat, INSERM Unité 1148, Paris, France
| | | | | | | | | | - Christie M Ballantyne
- Department of Medicine, Baylor College of Medicine, Texas Heart Institute, Houston, TX, USA
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Paquette M, Bernard S, Cariou B, Hegele RA, Genest J, Trinder M, Brunham LR, Béliard S, Baass A. Metabolic syndrome predicts cardiovascular risk and mortality in familial hypercholesterolemia. J Clin Lipidol 2023; 17:376-383. [PMID: 37003850 DOI: 10.1016/j.jacl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The association between familial hypercholesterolemia (FH) and premature atherosclerotic cardiovascular disease (ASCVD) is well established. Several risk factors other than the cumulative low-density lipoprotein cholesterol (LDL-C) have been shown to modulate the severity of the phenotype in these patients. However, the effect of the metabolic syndrome (MetS) on ASCVD risk in FH remains to be determined. OBJECTIVES The objective was to study the association between the presence of MetS and the incidence of different ASCVD endpoints and all-cause mortality. METHODS This prospective follow up study used data from 5 independent FH cohorts from Europe and North America. We analysed data of 2401 adult heterozygous FH without history of a prior ASCVD event (21,139 person-years of follow-up). Multivariate Cox proportional hazards regression was used to estimate the association between MetS and the incidence of the different endpoints. RESULTS The prevalence of MetS was 14% in the study population. The presence of MetS was a significant predictor of incident 10-year ASCVD after adjustment for traditional cardiovascular risk factors (HR 2.07, 95% CI 1.34-3.19), as well as of 10-year major adverse cardiovascular event (MACE) (HR 4.59, 95% CI 2.27-9.30), 10-year myocardial infarction (MI) (HR 4.29, 95% CI 1.91-9.63), and 30-year all-cause mortality (HR 4.87, 95% CI 1.99-11.89). CONCLUSION Our findings suggests that FH patients with MetS, have an increased cardiovascular risk that is independent from LDL-C and other traditional risk factors. Future studies are required to determine the most appropriate strategy to reduce the cardiovascular burden associated with MetS in this population.
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Affiliation(s)
- Martine Paquette
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec H2W 1R7, Canada (Drs Paquette, Bernard, and Baass)
| | - Sophie Bernard
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec H2W 1R7, Canada (Drs Paquette, Bernard, and Baass); Department of Medicine, Division of Endocrinology, Université de Montreal, Montreal, Québec H3T 1J4, Canada (Dr Bernard); Research Centre of the Centre Hospitalier Universitaire de Montréal (CRCHUM), Montreal, Québec H2 × 0A9, Canada (Dr Bernard)
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes F-44000, France (Dr Cariou)
| | - Robert A Hegele
- Departments of Medicine and Biochemistry, and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario N6A 5C1 and N6A 5K8, Canada (Dr Hegele)
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Montreal, Québec H4A 3J1, Canada (Dr Genest)
| | - Mark Trinder
- Faculty of Medicine, University of British Columbia, Centre for Heart and Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia V6Z 1Y6, Canada (Drs Trinder, and Brunham)
| | - Liam R Brunham
- Faculty of Medicine, University of British Columbia, Centre for Heart and Lung Innovation, Department of Medicine, University of British Columbia, Vancouver, British Columbia V6Z 1Y6, Canada (Drs Trinder, and Brunham)
| | - Sophie Béliard
- Aix Marseille University, INSERM, INRAE, C2VN, Department of Nutrition, Metabolic Diseases, Endocrinology, La Conception Hospital, Marseille, 13005, France (Dr Béliard)
| | - Alexis Baass
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Montreal, Québec H2W 1R7, Canada (Drs Paquette, Bernard, and Baass); Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Montreal, Québec H3G 2M1, Canada (Dr Baass).
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Wang B, Liu X, Hao W, Fan J, Que B, Ai H, Wang X, Nie S. Comorbid obstructive sleep apnea is associated with adverse cardiovascular outcomes in female patients with acute coronary syndrome complicating metabolic syndrome. Clin Cardiol 2023. [PMID: 37060185 DOI: 10.1002/clc.24020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and metabolic syndrome (MetS) are each increasingly common in patients with acute coronary syndrome (ACS). Whether OSA increases cardiovascular consequences in ACS patients with MetS has not been investigated. HYPOTHESIS OSA increases cardiovascular risk in ACS patients with MetS. We aimed to examine the association between OSA and cardiovascular consequences in ACS patients with MetS. METHODS In this prospective cohort study, we consecutive recruited 2160 ACS patients who underwent portable sleep breathing monitoring. OSA is defined as an apnea-hypopnea index (AHI) ≥ 15 events/h. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. RESULTS A total of 1927 patients with ACS were enrolled. Among them, 1486 (77.1%) had MetS and 1014 (52.6%) had OSA. During 2.9 years of follow-up, the cumulative incidence of MACCE was similar between OSA and non-OSA groups in patients with MetS (21.9% vs. 17.9%, adjusted hazard ratio [HR] = 1.29 95% confidence interval [CI]: 0.99-1.67, p = .06) and patients without MetS (24.4% vs. 17.3%, adjusted HR = 1.21 95% CI: 0.73-2.03, p = .46). Patients with MetS and OSA had a significantly higher risk of MACCE than patients with MetS and without OSA in women (27.8% vs. 18.1%, adjusted HR = 1.70, 95% CI: 1.01-3.09, p = .04) but not in men (21.0% vs. 17.9%, adjusted HR = 1.19, 95% CI: 0.91-1.59, p = .21). CONCLUSIONS In hospitalized ACS patients with MetS, comorbid OSA was associated with increased risk of cardiovascular consequences among women.
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Affiliation(s)
- Bin Wang
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiaogang Liu
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, China
| | - Wen Hao
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jingyao Fan
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Bin Que
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hui Ai
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xiao Wang
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Shaoping Nie
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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PCSK9 Inhibitors in Cancer Patients Treated with Immune-Checkpoint Inhibitors to Reduce Cardiovascular Events: New Frontiers in Cardioncology. Cancers (Basel) 2023; 15:cancers15051397. [PMID: 36900189 PMCID: PMC10000232 DOI: 10.3390/cancers15051397] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Cancer patients treated with immune checkpoint inhibitors (ICIs) are exposed to a high risk of atherosclerosis and cardiometabolic diseases due to systemic inflammatory conditions and immune-related atheroma destabilization. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key protein involved in metabolism of low-density lipoprotein (LDL) cholesterol. PCSK9 blocking agents are clinically available and involve monoclonal antibodies, and SiRNA reduces LDL levels in high-risk patients and atherosclerotic cardiovascular disease events in multiple patient cohorts. Moreover, PCSK9 induces peripheral immune tolerance (inhibition of cancer cell- immune recognition), reduces cardiac mitochondrial metabolism, and enhances cancer cell survival. The present review summarizes the potential benefits of PCSK9 inhibition through selective blocking antibodies and siRNA in patients with cancer, especially in those treated with ICIs therapies, in order to reduce atherosclerotic cardiovascular events and potentially improve ICIs-related anticancer functions.
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Atherogenic Dyslipidemias: Unmet Needs and the Therapeutic Potential of Emerging and Novel Approaches and Drugs. Pharmaceuticals (Basel) 2023. [DOI: 10.3390/ph16020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Innovative lipid-modifying agents are valuable resources to improve the control of atherogenic dyslipidemias and reduce the lipid-related residual cardiovascular risk of patients with intolerance or who are not fully responsive to a consolidated standard of care (statins plus ezetimibe). Moreover, some of the upcoming compounds potently affect lipid targets that are thus far considered “unmodifiable”. The present paper is a viewpoint aimed at presenting the incremental metabolic and cardiovascular benefits of the emerging lipid-modulating agents and real-life barriers, hindering their prescription by physicians and their assumption by patients, which need to be worked out for a more diffuse and appropriate drug utilization.
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Banach M, Surma S, Reiner Z, Katsiki N, Penson PE, Fras Z, Sahebkar A, Paneni F, Rizzo M, Kastelein J. Personalized management of dyslipidemias in patients with diabetes-it is time for a new approach (2022). Cardiovasc Diabetol 2022; 21:263. [PMID: 36443827 PMCID: PMC9706947 DOI: 10.1186/s12933-022-01684-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 11/29/2022] Open
Abstract
Dyslipidemia in patients with type 2 diabetes (DMT2) is one of the worst controlled worldwide, with only about 1/4 of patients being on the low-density lipoprotein cholesterol (LDL-C) target. There are many reasons of this, including physicians' inertia, including diabetologists and cardiologists, therapy nonadherence, but also underusage and underdosing of lipid lowering drugs due to unsuitable cardiovascular (CV) risk stratification. In the last several years there is a big debate on the risk stratification of DMT2 patients, with the strong indications that all patients with diabetes should be at least at high cardiovascular disease (CVD) risk. Moreover, we have finally lipid lowering drugs, that not only allow for the effective reduction of LDL-C and do not increase the risk of new onset diabetes (NOD), and/or glucose impairment; in the opposite, some of them might effectively improve glucose control. One of the most interesting is pitavastatin, which is now available in Europe, with the best metabolic profile within statins (no risk of NOD, improvement of fasting blood glucose, HOMA-IR, HbA1c), bempedoic acid (with the potential for the reduction of NOD risk), innovative therapies-PCSK9 inhibitors and inclisiran with no DMT2 risk increase, and new forthcoming therapies, including apabetalone and obicetrapib-for the latter one with the possibility of even decreasing the number of patients diagnosed with prediabetes and DMT2. Altogether, nowadays we have possibility to individualize lipid lowering therapy in DMT2 patients and increase the number of patients on LDL-C goal without any risk of new onset diabetes and/or diabetes control worsening, and in consequence to reduce the risk of CVD complications due to progression of atherosclerosis in this patients' group.
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Affiliation(s)
- Maciej Banach
- grid.8267.b0000 0001 2165 3025Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland ,grid.415071.60000 0004 0575 4012Department of Cardiology and Congenital Heart Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland ,grid.28048.360000 0001 0711 4236Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Stanisław Surma
- grid.411728.90000 0001 2198 0923Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland ,Club of Young Hypertensiologists, Polish Society of Hypertension, Gdansk, Poland
| | - Zeljko Reiner
- grid.4808.40000 0001 0657 4636Department of Internal Diseases, University Hospital Center Zagreb School of Medicine, Zagreb University, Zagreb, Croatia
| | - Niki Katsiki
- grid.449057.b0000 0004 0416 1485Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece ,grid.440838.30000 0001 0642 7601School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Peter E. Penson
- grid.4425.70000 0004 0368 0654Clinical Pharmacy and Therapeutics Research Group, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK ,grid.10025.360000 0004 1936 8470Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Zlatko Fras
- grid.29524.380000 0004 0571 7705Department of Vascular Disease, University Medical Center Ljubljana, Ljubljana, Slovenia ,grid.8954.00000 0001 0721 6013Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Amirhossein Sahebkar
- grid.411583.a0000 0001 2198 6209Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Francesco Paneni
- grid.412004.30000 0004 0478 9977University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland ,grid.412004.30000 0004 0478 9977Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Manfredi Rizzo
- grid.10776.370000 0004 1762 5517Promise Department, School of Medicine, University of Palermo, Palermo, Italy ,grid.510259.a0000 0004 5950 6858College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - John Kastelein
- grid.7177.60000000084992262Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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11
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Chen Y, Wu J, Tang Y, Li Z, Wen Q, Sun X, Yuan H, Lu Y, Cai J. Multimorbidity and combined interventions for patients with coronary heart disease in Chinese population: Latent class analysis of a multi-center study. Int J Cardiol 2022; 368:17-26. [PMID: 35963444 DOI: 10.1016/j.ijcard.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS This study aimed to explore the profile of multimorbidity phenotype clusters and their discrepancy in mortality and the efficiency of combined interventions on blood pressure, glucose and lipid in each cluster. METHODS Fine and Gray competing risk regression models and Kaplan-Meier curves were used to assess the association between multimorbidity and mortality and rehospitalization. Fine and Gray competing risk regression models and subgroup analyses were used to estimate the relations between combined interventions and mortality. RESULTS Three distinct multimorbidity clusters were observed: Class 1 named severe class, Class 2 termed moderate class, and Class 3 named mild class. Competing risk regression models revealed that patients in Class 1 have the greatest burden of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.43 (95% CI 1.30-1.56, P < 0.001) and 2.97 (95% CI 2.74-3.21, P < 0.001), respectively. The patients in Class 2 have moderate risk of mortality and rehospitalization compared to Class 3 after confounder adjustment, with HRs 1.41 (95% CI 1.30-1.52, P < 0.001) and 2.39 (95% CI 2.23-2.56, P < 0.001), respectively. Furthermore, we found that combined interventions on blood pressure, glucose and lipid simultaneously could further benefit on survival compared to each individual intervention or two in combine. CONCLUSIONS This study found that multimorbidity among patients with CHD was common and increased the risks of death and rehospitalization. Three multimorbidity clusters that were significantly associated with death and rehospitalization were identified. Simultaneous intervention on blood pressure, glucose and lipid level may further benefit CHD patient in survival.
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Affiliation(s)
- Yuanyuan Chen
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Junru Wu
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Yan Tang
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Zhengxin Li
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Qing Wen
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Xuejing Sun
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Hong Yuan
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China; The Center of Clinical Pharmacology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China
| | - Yao Lu
- The Center of Clinical Pharmacology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China.
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China; The Center of Clinical Pharmacology, The Third Xiangtan Hospital, Central South University, Changsha 410013, China.
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12
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Abstract
Purpose of Review Since the discovery of PCSK9 in 2003, this proprotein convertase was shown to target specific receptors for degradation in endosomes/lysosomes, including LDLR and other family members and hence to enhance the levels of circulating LDL-cholesterol (LDLc). Accordingly, inhibitors of PCSK9, including monoclonal antibodies blocking its circulating activity and siRNA silencers of its hepatic expression, are now used in clinics worldwide to treat hypercholesterolemia patients effectively and safely in combination with statins and/or ezetimibe. These powerful treatments reduce the incidence of atherosclerosis by at least 20%. Since 2008, novel targets of PCSK9 began to be defined, thereby expanding its roles beyond LDLc regulation into the realm of inflammation, pathogen infections and cellular proliferation in various cancers and associated metastases. Recent Findings Some pathogens such as dengue virus exploit the ability of PCSK9 to target the LDLR for degradation to enhance their ability to infect cells. Aside from increasing the degradation of the LDLR and its family members VLDLR, ApoER2 and LRP1, circulating PCSK9 also reduces the levels of other receptors such as CD36 (implicated in fatty acid uptake), oxidized LDLR receptor (that clears oxidized LDLc) as well as major histocompatibility class-I (MHC-I) receptors (implicated in the immune response to antigens). Thus, these novel targets provided links between PCSK9 and inflammation/atherosclerosis, viral infections and cancer/metastasis. The functional activities of PCSK9, accelerated the development of novel therapies to inhibit PCSK9 functions, including small molecular inhibitors, long-term vaccines, and possibly CRISPR-based silencing of hepatic expression of PCSK9. Summary The future of inhibitors/silencers of PCSK9 function or expression looks bright, as these are expected to provide a modern armamentarium to treat various pathologies beyond hypercholesterolemia and its effects on atherosclerosis.
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13
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Turner TA, Stein EA. Targeting PCSK9 inhibitors to those who will benefit most. Lancet Diabetes Endocrinol 2022; 10:301-303. [PMID: 35378071 DOI: 10.1016/s2213-8587(22)00086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/07/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Traci A Turner
- Metabolic and Atherosclerosis Research Center, Cincinnati, OH 45227, USA
| | - Evan A Stein
- Metabolic and Atherosclerosis Research Center, Cincinnati, OH 45227, USA.
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14
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Carugo S, Sirtori CR, Corsini A, Tokgozoglu L, Ruscica M. PCSK9 Inhibition and Risk of Diabetes: Should We Worry? Curr Atheroscler Rep 2022; 24:995-1004. [PMID: 36383291 PMCID: PMC9750910 DOI: 10.1007/s11883-022-01074-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE OF REVIEW Since the clinical benefit of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors occurs in a setting of reducing low-density lipoprotein-cholesterol (LDL-C) to unprecedentedly low levels, it becomes of interest to investigate possible adverse effects pertaining to the risk of new-onset diabetes (NOD). RECENT FINDINGS While safety results reported in either meta-analyses or cardiovascular outcome trials FOURIER (with evolocumab) and ODYSSEY (with alirocumab) did not rise the incidence of NOD, Mendelian randomization analyses were almost concordant in showing an increased risk of NOD. This evidence was in line with post-marketing safety reports highlighting that evolocumab and alirocumab were primarily related to mild hyperglycaemia rather than diabetes, with most of the hyperglycaemic events occurring during the first 6 months of treatment. Considering the different nature of genetic studies and of randomized controlled trials, with careful monitoring of patients, particularly in the earlier phases of treatment, and the identification of those more susceptible to develop NOD, treatment with PCSK9 inhibitors should be of minimal concern.
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Affiliation(s)
- Stefano Carugo
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy ,Fondazione Ospedale Maggiore IRCCS Policlinico Di Milano, Milan, Italy
| | - Cesare R. Sirtori
- grid.4708.b0000 0004 1757 2822Department of Pharmacological and Biomolecular Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Alberto Corsini
- grid.4708.b0000 0004 1757 2822Department of Pharmacological and Biomolecular Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Lale Tokgozoglu
- grid.14442.370000 0001 2342 7339Hacettepe University, Ankara, Turkey
| | - Massimiliano Ruscica
- grid.4708.b0000 0004 1757 2822Department of Pharmacological and Biomolecular Sciences, Università Degli Studi Di Milano, Milan, Italy
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