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Bonilha I, Gomes ÉIL, Carmo HRP, Breder I, Barreto J, Breder J, Munhoz DB, Carvalho LSF, Quinaglia T, Kimura-Medorima ST, Gossi CM, Zimetti F, Nadruz W, Zanotti I, Sposito AC. Effect of Empagliflozin with or without the Addition of Evolocumab on HDL Subspecies in Individuals with Type 2 Diabetes Mellitus: A Post Hoc Analysis of the EXCEED-BHS3 Trial. Int J Mol Sci 2024; 25:4108. [PMID: 38612917 PMCID: PMC11012560 DOI: 10.3390/ijms25074108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
Evolocumab and empagliflozin yield a modest rise in plasma high-density lipoprotein cholesterol (HDL-C) through unknown mechanisms. This study aims to assess the effect of evolocumab plus empagliflozin vs. empagliflozin alone on HDL subspecies isolated from individuals with type 2 diabetes mellitus (T2D). This post hoc prespecified analysis of the EXCEED-BHS3 trial compared the effects of a 16-week therapy with empagliflozin (E) alone or in combination with evolocumab (EE) on the lipid profile and cholesterol content in HDL subspecies in individuals with T2D divided equally into two groups of 55 patients. Both treatments modestly increased HDL-C. The cholesterol content in HDL subspecies 2a (7.3%), 3a (7.2%) and 3c (15%) increased from baseline in the E group, while the EE group presented an increase from baseline in 3a (9.3%), 3b (16%) and 3c (25%). The increase in HDL 3b and 3c was higher in the EE group when compared to the E group (p < 0.05). No significant interactive association was observed between changes in hematocrit and HDL-C levels after treatment. Over a 16-week period, empagliflozin with or without the addition of evolocumab led to a modest but significant increase in HDL-C. The rise in smaller-sized HDL particles was heterogeneous amongst the treatment combinations.
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Affiliation(s)
- Isabella Bonilha
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Érica Ivana Lázaro Gomes
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Helison R. P. Carmo
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Ikaro Breder
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Joaquim Barreto
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Jessica Breder
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Daniel B. Munhoz
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
| | - Luiz Sergio F. Carvalho
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Thiago Quinaglia
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Sheila T. Kimura-Medorima
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Camila Moreira Gossi
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
| | - Francesca Zimetti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (I.Z.)
| | - Wilson Nadruz
- Division of Cardiology, State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil;
| | - Ilaria Zanotti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (I.Z.)
| | - Andrei C. Sposito
- Laboratory of Vascular Biology and Atherosclerosis (Aterolab), State University of Campinas (Unicamp), Sao Paulo 13083-887, Brazil; (I.B.); (É.I.L.G.); (H.R.P.C.); (I.B.); (J.B.); (J.B.); (D.B.M.); (L.S.F.C.); (T.Q.); (S.T.K.-M.); (C.M.G.)
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Kosmas CE, Bousvarou MD, Papakonstantinou EJ, Tsamoulis D, Koulopoulos A, Echavarria Uceta R, Guzman E, Rallidis LS. Novel Pharmacological Therapies for the Management of Hyperlipoproteinemia(a). Int J Mol Sci 2023; 24:13622. [PMID: 37686428 PMCID: PMC10487774 DOI: 10.3390/ijms241713622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Lipoprotein(a) [Lp(a)] is a well-established risk factor for cardiovascular disease, predisposing to major cardiovascular events, including coronary heart disease, stroke, aortic valve calcification and abdominal aortic aneurysm. Lp(a) is differentiated from other lipoprotein molecules through apolipoprotein(a), which possesses atherogenic and antithrombolytic properties attributed to its structure. Lp(a) levels are mostly genetically predetermined and influenced by the size of LPA gene variants, with smaller isoforms resulting in a greater synthesis rate of apo(a) and, ultimately, elevated Lp(a) levels. As a result, serum Lp(a) levels may highly vary from extremely low to extremely high. Hyperlipoproteinemia(a) is defined as Lp(a) levels > 30 mg/dL in the US and >50 mg/dL in Europe. Because of its association with CVD, Lp(a) levels should be measured at least once a lifetime in adults. The ultimate goal is to identify individuals with increased risk of CVD and intervene accordingly. Traditional pharmacological interventions like niacin, statins, ezetimibe, aspirin, PCSK-9 inhibitors, mipomersen, estrogens and CETP inhibitors have not yet yielded satisfactory results. The mean Lp(a) reduction, if any, is barely 50% for all agents, with statins increasing Lp(a) levels, whereas a reduction of 80-90% appears to be required to achieve a significant decrease in major cardiovascular events. Novel RNA-interfering agents that specifically target hepatocytes are aimed in this direction. Pelacarsen is an antisense oligonucleotide, while olpasiran, LY3819469 and SLN360 are small interfering RNAs, all conjugated with a N-acetylgalactosamine molecule. Their ultimate objective is to genetically silence LPA, reduce apo(a) production and lower serum Lp(a) levels. Evidence thus so far demonstrates that monthly subcutaneous administration of a single dose yields optimal results with persisting substantial reductions in Lp(a) levels, potentially enhancing CVD risk reduction. The Lp(a) reduction achieved with novel RNA agents may exceed 95%. The results of ongoing and future clinical trials are eagerly anticipated, and it is hoped that guidelines for the tailored management of Lp(a) levels with these novel agents may not be far off.
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Affiliation(s)
- Constantine E. Kosmas
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA;
- Cardiology Clinic, Cardiology Unlimited, PC, New York, NY 10033, USA;
| | - Maria D. Bousvarou
- School of Medicine, University of Crete, 710 03 Heraklion, Greece; (M.D.B.); (A.K.)
| | | | - Donatos Tsamoulis
- First Department of Internal Medicine, Thriasio General Hospital of Eleusis, 196 00 Athens, Greece;
| | - Andreas Koulopoulos
- School of Medicine, University of Crete, 710 03 Heraklion, Greece; (M.D.B.); (A.K.)
| | | | - Eliscer Guzman
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA;
- Cardiology Clinic, Cardiology Unlimited, PC, New York, NY 10033, USA;
| | - Loukianos S. Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, 124 62 Athens, Greece;
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Pharmacometabolomics for the Study of Lipid-Lowering Therapies: Opportunities and Challenges. Int J Mol Sci 2023; 24:ijms24043291. [PMID: 36834701 PMCID: PMC9960554 DOI: 10.3390/ijms24043291] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Lipid-lowering therapies are widely used to prevent the development of atherosclerotic cardiovascular disease (ASCVD) and related mortality worldwide. "Omics" technologies have been successfully applied in recent decades to investigate the mechanisms of action of these drugs, their pleiotropic effects, and their side effects, aiming to identify novel targets for future personalized medicine with an improvement of the efficacy and safety associated with the treatment. Pharmacometabolomics is a branch of metabolomics that is focused on the study of drug effects on metabolic pathways that are implicated in the variation of response to the treatment considering also the influences from a specific disease, environment, and concomitant pharmacological therapies. In this review, we summarized the most significant metabolomic studies on the effects of lipid-lowering therapies, including the most commonly used statins and fibrates to novel drugs or nutraceutical approaches. The integration of pharmacometabolomics data with the information obtained from the other "omics" approaches could help in the comprehension of the biological mechanisms underlying the use of lipid-lowering drugs in view of defining a precision medicine to improve the efficacy and reduce the side effects associated with the treatment.
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Martinez LO, Perret B, Genoux A. Update on proprotein convertase subtilisin/kexin type 9 inhibitors, lipoprotein(a) and cardiovascular risk. Curr Opin Lipidol 2021; 32:324-327. [PMID: 34472540 DOI: 10.1097/mol.0000000000000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Laurent O Martinez
- I2MC, Université de Toulouse, Inserm, Université Toulouse III - Paul Sabatier (UPS)
| | - Bertrand Perret
- I2MC, Université de Toulouse, Inserm, Université Toulouse III - Paul Sabatier (UPS)
- Service de Biochimie, Pôle de biologie, Hôpital de Purpan, CHU de Toulouse, Toulouse, France
| | - Annelise Genoux
- I2MC, Université de Toulouse, Inserm, Université Toulouse III - Paul Sabatier (UPS)
- Service de Biochimie, Pôle de biologie, Hôpital de Purpan, CHU de Toulouse, Toulouse, France
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Sascău R, Clement A, Radu R, Prisacariu C, Stătescu C. Triglyceride-Rich Lipoproteins and Their Remnants as Silent Promoters of Atherosclerotic Cardiovascular Disease and Other Metabolic Disorders: A Review. Nutrients 2021; 13:1774. [PMID: 34067469 PMCID: PMC8224751 DOI: 10.3390/nu13061774] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022] Open
Abstract
While targeting elevated serum levels of low-density lipoprotein cholesterol has been the mainstay of atherosclerosis prevention and treatment for decades, the evidence regarding the atherogenic role of hypertriglyceridemia is still controversial. Various epidemiological population-based studies on statin-treated subjects nominated triglycerides, triglyceride-rich lipoproteins (namely, chylomicrons and very-low-density lipoprotein particles), and their remnants as major determinants of the substantial residual cardiovascular risk. With the triglyceride-glucose index and triglyceride to high-density lipoprotein ratio emerging as surrogate indicators of peripheral artery disease and atherosclerotic cerebrovascular disease, one can conclude that further research addressing the intricate relationship between triglycerides and atherosclerosis is warranted. Therefore, this review aims to provide insight into the current clinical and epidemiological state of knowledge on the relationship between triglycerides and atherosclerotic cardiovascular disease. It also intends to highlight the connection between triglycerides and other metabolic disorders, including diabetes mellitus, and the potential benefits of triglyceride-lowering agents on cardiovascular outcomes and all-cause mortality.
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Affiliation(s)
- Radu Sascău
- Internal Medicine Department, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (R.S.); (R.R.); (C.P.); (C.S.)
- Cardiology Department, Institute of Cardiovascular Diseases Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
| | - Alexandra Clement
- Cardiology Department, Institute of Cardiovascular Diseases Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
| | - Rodica Radu
- Internal Medicine Department, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (R.S.); (R.R.); (C.P.); (C.S.)
- Cardiology Department, Institute of Cardiovascular Diseases Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
| | - Cristina Prisacariu
- Internal Medicine Department, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (R.S.); (R.R.); (C.P.); (C.S.)
- Cardiology Department, Institute of Cardiovascular Diseases Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (R.S.); (R.R.); (C.P.); (C.S.)
- Cardiology Department, Institute of Cardiovascular Diseases Prof. Dr. George I.M. Georgescu, 700503 Iași, Romania
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