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Colivicchi F, Arca M, Di Fusco SA, Pirillo A, Catapano AL. [STEP-RCV Project - A scientific expert panel for patients at high and very high cardiovascular risk: how to streamline lipid-lowering therapy]. G Ital Cardiol (Rome) 2024; 25:318-326. [PMID: 38639122 DOI: 10.1714/4252.42295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Over the last decade, several innovative therapeutic options have been developed and marketed for the management of hypercholesterolemia. However, the impossibility of a contextual update of international guidelines and the limits imposed by national regulatory authorities do not allow the use of these treatments in many patients, in particular in those at higher cardiovascular risk. Real-world studies show that the use of lipid-lowering therapies is inadequate even among patients at higher cardiovascular risk, with only 20% achieving recommended low-density lipoprotein cholesterol (LDL-C) levels and the use of combination therapies implemented in only 24% of patients. This review aims to highlight the benefits of an approach based on combination therapy and to propose a therapeutic algorithm that includes oral combination therapy, where necessary also in triple association (statin, ezetimibe and bempedoic acid), as an initial approach based on the most favorable cost-effectiveness ratio for patients at higher cardiovascular risk and the use of injectable anti-proprotein convertase subtilisin/kexin 9 therapies if the recommended LDL-C goal is not achieved.
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Affiliation(s)
- Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Marcello Arca
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza Università di Roma, Roma
| | - Stefania Angela Di Fusco
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri - ASL Roma 1, Roma
| | - Angela Pirillo
- Centro per lo Studio dell'Aterosclerosi, Ospedale E. Bassini, Cinisello Balsamo (MI)
| | - Alberico L Catapano
- IRCCS Multimedica, Milano - Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi, Milano
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Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00757-8. [PMID: 38642570 DOI: 10.1016/s0140-6736(24)00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/07/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. METHODS The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. FINDINGS Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021. INTERPRETATION Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. FUNDING Bill & Melinda Gates Foundation.
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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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CCD, Iyer M, Jaan A, Jacob L, Jadidi-Niaragh F, Jafari M, Jafarinia M, Jafarzadeh A, Jahankhani K, Jahanmehr N, Jahrami H, Jaiswal A, Jakovljevic M, Jamora RDG, Jana S, Javadi N, Javed S, Javeed S, Jayapal SK, Jayaram S, Jiang H, Johnson CO, Johnson WD, Jokar M, Jonas JB, Joseph A, Joseph N, Joshua CE, Jürisson M, Kabir A, Kabir Z, Kabito GG, Kadashetti V, Kafi F, Kalani R, Kalantar F, Kaliyadan F, Kamath A, Kamath S, Kanchan T, Kandel A, Kandel H, Kanmodi KK, Karajizadeh M, Karami J, Karanth SD, Karaye IM, Karch A, Karimi A, Karimi H, Karimi Behnagh A, Kasraei H, Kassebaum NJ, Kauppila JH, Kaur H, Kaur N, Kayode GA, Kazemi F, Keikavoosi-Arani L, Keller C, Keykhaei M, Khadembashiri MA, Khader YS, Khafaie MA, Khajuria H, Khalaji A, Khamesipour F, Khammarnia M, Khan M, Khan MAB, Khan YH, Khan Suheb MZ, Khanmohammadi S, Khanna T, Khatab K, Khatatbeh H, Khatatbeh MM, Khateri S, Khatib MN, Khayat Kashani HR, Khonji MS, khorashadizadeh F, Khormali M, Khubchandani J, Kian S, Kim G, Kim J, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kivimäki M, Kochhar S, Kolahi AA, Koly KN, Kompani F, Koroshetz WJ, Kosen S, Kourosh Arami M, Koyanagi A, Kravchenko MA, Krishan K, Krishnamoorthy V, Kuate Defo B, Kuddus MA, Kumar A, Kumar GA, Kumar M, Kumar N, Kumsa NB, Kundu S, Kurniasari MD, Kusuma D, Kuttikkattu A, Kyu HH, La Vecchia C, Ladan MA, Lahariya C, Laksono T, Lal DK, Lallukka T, Lám J, Lami FH, Landires I, Langguth B, Lasrado S, Latief K, Latifinaibin K, Lau KMM, Laurens MB, Lawal BK, Le LKD, Le TTT, Ledda C, Lee M, Lee SW, Lee SW, Lee WC, Lee YH, Leonardi M, Lerango TL, Li MC, Li W, Ligade VS, Lim SS, Linehan C, Liu C, Liu J, Liu W, Lo CH, Lo WD, Lobo SW, Logroscino G, Lopes G, Lopukhov PD, Lorenzovici L, Lorkowski S, Loureiro JA, Lubinda J, Lucchetti G, Lutzky Saute R, Ma ZF, Mabrok M, Machoy M, Madadizadeh F, Magdy Abd El Razek M, Maghazachi AA, Maghbouli N, Mahjoub S, Mahmoudi M, Majeed A, Malagón-Rojas JN, Malakan Rad E, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Manilal A, Mansouri V, Mansournia MA, Marasini BP, Marateb HR, Maroufi SF, Martinez-Raga J, Martini S, Martins-Melo FR, Martorell M, März W, Marzo RR, Massano J, Mathangasinghe Y, Mathews E, Maude RJ, Maugeri A, Maulik PK, Mayeli M, Mazaheri M, McAlinden C, McGrath JJ, Meena JK, Mehndiratta MM, Mendez-Lopez MAM, Mendoza W, Mendoza-Cano O, Menezes RG, Merati M, Meretoja A, Merkin A, Mersha AM, Mestrovic T, Mi T, Miazgowski T, Michalek IM, Mihretie ET, Minh LHN, Mirfakhraie R, Mirica A, Mirrakhimov EM, Mirzaei M, Misganaw A, Misra S, Mithra P, Mizana BA, Mohamadkhani A, Mohamed NS, Mohammadi E, Mohammadi H, Mohammadi S, Mohammadi S, Mohammadshahi M, Mohammed M, Mohammed S, Mohammed S, Mohan S, Mojiri-forushani H, Moka N, Mokdad AH, Molinaro S, Möller H, Monasta L, Moniruzzaman M, Montazeri F, Moradi M, Moradi Y, Moradi-Lakeh M, Moraga P, Morovatdar N, Morrison SD, Mosapour A, Mosser JF, Mossialos E, Motaghinejad M, Mousavi P, Mousavi SE, Mubarik S, Muccioli L, Mughal F, Mukoro GD, Mulita A, Mulita F, Musaigwa F, Mustafa A, Mustafa G, Muthu S, Nagarajan AJ, Naghavi P, Naik GR, Nainu F, Nair TS, Najmuldeen HHR, Nakhostin Ansari N, Nambi G, Namdar Areshtanab H, Nargus S, Nascimento BR, Naser AY, Nashwan AJJ, Nasoori H, Nasreldein A, Natto ZS, Nauman J, Nayak BP, Nazri-Panjaki A, Negaresh M, Negash H, Negoi I, Negoi RI, Negru SM, Nejadghaderi SA, Nematollahi MH, Nesbit OD, Newton CRJ, Nguyen DH, Nguyen HTH, Nguyen HQ, Nguyen NTT, Nguyen PT, Nguyen VT, Niazi RK, Nikolouzakis TK, Niranjan V, Nnyanzi LA, Noman EA, Noroozi N, Norrving B, Noubiap JJ, Nri-Ezedi CA, Ntaios G, Nuñez-Samudio V, Nurrika D, Oancea B, Odetokun IA, O'Donnell MJ, Ogunsakin RE, Oguta JO, Oh IH, Okati-Aliabad H, Okeke SR, Okekunle AP, Okonji OC, Okwute PG, Olagunju AT, Olaiya MT, Olana MD, Olatubi MI, Oliveira GMM, Olufadewa II, Olusanya BO, Omar Bali A, Ong S, Onwujekwe OE, Ordak M, Orji AU, Ortega-Altamirano DV, Osuagwu UL, Otstavnov N, Otstavnov SS, Ouyahia A, Owolabi MO, P A MP, Pacheco-Barrios K, Padubidri JR, Pal PK, Palange PN, Palladino C, Palladino R, Palma-Alvarez RF, Pan F, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandian JD, Pangaribuan HU, Pantazopoulos I, Pardhan S, Parija PP, Parikh RR, Park S, Parthasarathi A, Pashaei A, Patel J, Patil S, Patoulias D, Pawar S, Pedersini P, Pensato U, Pereira DM, Pereira J, Pereira MO, Peres MFP, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Pham HT, Phillips MR, Pinilla-Monsalve GD, Piradov MA, Plotnikov E, Poddighe D, Polat B, Poluru R, Pond CD, Poudel GR, Pouramini A, Pourbagher-Shahri AM, Pourfridoni M, Pourtaheri N, Prakash PY, Prakash S, Prakash V, Prates EJS, Pritchett N, Purnobasuki H, Qasim NH, Qattea I, Qian G, Radhakrishnan V, Raee P, Raeisi Shahraki H, Rafique I, Raggi A, Raghav PR, Rahati MM, Rahim F, Rahimi Z, Rahimifard M, Rahman MO, Rahman MHU, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmani Youshanlouei H, Rahmati M, Raj Moolambally S, Rajabpour-Sanati A, Ramadan H, Ramasamy SK, Ramasubramani P, Ramazanu S, Rancic N, Rao IR, Rao SJ, Rapaka D, Rashedi V, Rashid AM, Rashidi MM, Rashidi Alavijeh M, Rasouli-Saravani A, Rawaf S, Razo C, Redwan EMM, Rekabi Bana A, Remuzzi G, Rezaei N, Rezaei N, Rezaei N, Rezaeian M, Rhee TG, Riad A, Robinson SR, Rodrigues M, Rodriguez JAB, Roever L, Rogowski ELB, Romoli M, Ronfani L, Roy P, Roy Pramanik K, Rubagotti E, Ruiz MA, Russ TC, S Sunnerhagen K, Saad AMA, Saadatian Z, Saber K, SaberiKamarposhti M, Sacco S, Saddik B, Sadeghi E, Sadeghian S, Saeed U, Saeed U, Safdarian M, Safi SZ, Sagar R, Sagoe D, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahraian MA, Sajedi SA, Sakshaug JW, Saleh MA, Salehi Omran H, Salem MR, Salimi S, Samadi Kafil H, Samadzadeh S, Samargandy S, Samodra YL, Samuel VP, Samy AM, Sanadgol N, Sanjeev RK, Sanmarchi F, Santomauro DF, Santri IN, Santric-Milicevic MM, Saravanan A, Sarveazad A, Satpathy M, Saylan M, Sayyah M, Scarmeas N, Schlaich MP, Schuermans A, Schwarzinger M, Schwebel DC, Selvaraj S, Sendekie AK, Sengupta P, Senthilkumaran S, Serban D, Sergindo MT, Sethi Y, SeyedAlinaghi S, Seylani A, Shabani M, Shabany M, Shafie M, Shahabi S, Shahbandi A, Shahid S, Shahraki-Sanavi F, Shahsavari HR, Shahwan MJ, Shaikh MA, Shaji KS, Sham S, Shama ATT, Shamim MA, Shams-Beyranvand M, Shamsi MA, Shanawaz M, Sharath M, Sharfaei S, Sharifan A, Sharma M, Sharma R, Shashamo BB, Shayan M, Sheikhi RA, Shekhar S, Shen J, Shenoy SM, Shetty PH, Shiferaw DS, Shigematsu M, Shiri R, Shittu A, Shivakumar KM, Shokri F, Shool S, Shorofi SA, Shrestha S, Siankam Tankwanchi AB, Siddig EE, Sigfusdottir ID, Silva JP, Silva LMLR, Sinaei E, Singh BB, Singh G, Singh P, Singh S, Sirota SB, Sivakumar S, Sohag AAM, Solanki R, Soleimani H, Solikhah S, Solomon Y, Solomon Y, Song S, Song Y, Sotoudeh H, Spartalis M, Stark BA, Starnes JR, Starodubova AV, Stein DJ, Steiner TJ, Stovner LJ, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Sunkersing D, Sunny A, Susianti H, Swain CK, Szeto MD, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabai S, Tabish M, Taheri M, Tahvildari A, Tajbakhsh A, Tampa M, Tamuzi JJLL, Tan KK, Tang H, Tareke M, Tarigan IU, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Tavasol A, Tefera YM, Tehrani-Banihashemi A, Temesgen WA, Temsah MH, Teramoto M, Tesfaye AH, Tesfaye EG, Tesler R, Thakali O, Thangaraju P, Thapa R, Thapar R, Thomas NK, Thrift AG, Ticoalu JHV, Tillawi T, Toghroli R, Tonelli M, Tovani-Palone MR, Traini E, Tran NM, Tran NH, Tran PV, Tromans SJ, Truelsen TC, Truyen TTTT, Tsatsakis A, Tsegay GM, Tsermpini EE, Tualeka AR, Tufa DG, Ubah CS, Udoakang AJ, Ulhaq I, Umair M, Umakanthan S, Umapathi KK, Unim B, Unnikrishnan B, Vaithinathan AG, Vakilian A, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Vellingiri B, Venketasubramanian N, Verras GI, Vervoort D, Villafañe JH, Villani L, Vinueza Veloz AF, Viskadourou M, Vladimirov SK, Vlassov V, Volovat SR, Vu LT, Vujcic IS, Wagaye B, Waheed Y, Wahood W, Walde MT, Wang F, Wang S, Wang Y, Wang YP, Waqas M, Waris A, Weerakoon KG, Weintraub RG, Weldemariam AH, Westerman R, Whisnant JL, Wickramasinghe DP, Wickramasinghe ND, Willekens B, Wilner LB, Winkler AS, Wolfe CDA, Wu AM, Wulf Hanson S, Xu S, Xu X, Yadollahpour A, Yaghoubi S, Yahya G, Yamagishi K, Yang L, Yano Y, Yao Y, Yehualashet SS, Yeshaneh A, Yesiltepe M, Yi S, Yiğit A, Yiğit V, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Yusuf H, Zadey S, Zahedi M, Zakham F, Zaki N, Zali A, Zamagni G, Zand R, Zandieh GGZ, Zangiabadian M, Zarghami A, Zastrozhin MS, Zeariya MGM, Zegeye ZB, Zeukeng F, Zhai C, Zhang C, Zhang H, Zhang Y, Zhang ZJ, Zhao H, Zhao Y, Zheng P, Zhou H, Zhu B, Zhumagaliuly A, Zielińska M, Zikarg YT, Zoladl M, Murray CJL, Ong KL, Feigin VL, Vos T, Dua T. Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 2024; 23:344-381. [PMID: 38493795 PMCID: PMC10949203 DOI: 10.1016/s1474-4422(24)00038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378-521), affecting 3·40 billion (3·20-3·62) individuals (43·1%, 40·5-45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7-26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6-38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5-32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7-2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed. FUNDING Bill & Melinda Gates Foundation.
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Xie S, Galimberti F, Olmastroni E, Luscher TF, Carugo S, Catapano AL, Casula M. Effect of lipid-lowering therapies on C-reactive protein levels: a comprehensive meta-analysis of randomized controlled trials. Cardiovasc Res 2024; 120:333-344. [PMID: 38373008 PMCID: PMC10981526 DOI: 10.1093/cvr/cvae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/15/2023] [Accepted: 12/14/2023] [Indexed: 02/20/2024] Open
Abstract
Chronic low-degree inflammation is a hallmark of atherosclerotic cardiovascular (CV) disease. To assess the effect of lipid-lowering therapies on C-reactive protein (CRP), a biomarker of inflammation, we conducted a meta-analysis according to the PRISMA guidelines. Databases were searched from inception to July 2023. Inclusion criteria were: (i) randomized controlled trials (RCTs) in human, Phase II, III, or IV; (ii) English language; (iii) comparing the effect of lipid-lowering drugs vs. placebo; (iv) reporting the effects on CRP levels; (v) with intervention duration of more than 3 weeks; (vi) and sample size (for both intervention and control group) over than 100 subjects. The between-group (treatment-placebo) CRP absolute mean differences and 95% confidence intervals were calculated for each drug class separately. A total of 171 668 subjects from 53 RCTs were included. CRP levels (mg/L) were significantly decreased by statins [-0.65 (-0.87 to -0.43), bempedoic acid; -0.43 (-0.67 to -0.20), ezetimibe; -0.28 (-0.48 to -0.08)], and omega-3 fatty acids [omega3FAs, -0.27 (-0.52 to -0.01)]. CRP was reduced by -0.40 (-1.17 to 0.38) with fibrates, although not statistically significant. A slight increase of CRP concentration was observed for proprotein convertase subtilisin/kexin type 9 inhibitors [0.11 (0.07-0.14)] and cholesteryl-ester transfer protein inhibitors [0.10 (0.00-0.21)], the latter being not statistically significant. Meta-regression analysis did not show a significant correlation between changes in CRP and LDL cholesterol (LDL-C) or triglycerides. Statins, bempedoic acid, ezetimibe, and omega3FAs significantly reduce serum CRP concentration, independently of LDL-C reductions. The impact of this anti-inflammatory effect in terms of CV prevention needs further investigation.
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Affiliation(s)
- Sining Xie
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, via Balzaretti 9, 20033 Milan, Italy
| | - Federica Galimberti
- IRCCS MultiMedica, via Milanese 300, 20099 Sesto San Giovanni (Milan), Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, via Balzaretti 9, 20033 Milan, Italy
- IRCCS MultiMedica, via Milanese 300, 20099 Sesto San Giovanni (Milan), Italy
| | - Thomas F Luscher
- Center for Molecular Cardiology, University Zurich, Wagistrasse 12, 8952 Schlieren (Zurich), Switzerland
- Cardiac Unit, Royal Brompton and Harefield Hospitals GSTT, Imperial College and King’s College London, Sydney Street, SW3 6NP London, UK
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milan, via della Commenda 19, 20122 Milan, Italy
- Cardiology Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan, via Francesco Sforza 28, 20122 Milan, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, via Balzaretti 9, 20033 Milan, Italy
- IRCCS MultiMedica, via Milanese 300, 20099 Sesto San Giovanni (Milan), Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, via Balzaretti 9, 20033 Milan, Italy
- IRCCS MultiMedica, via Milanese 300, 20099 Sesto San Giovanni (Milan), Italy
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Cattaneo M, Baragetti A, Malovini A, Ciaglia E, Lopardo V, Olmastroni E, Casula M, Ciacci C, Catapano AL, Puca AA. Longevity-associated BPIFB4 gene counteracts the inflammatory signaling. Immun Ageing 2024; 21:19. [PMID: 38468336 PMCID: PMC10929107 DOI: 10.1186/s12979-024-00424-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Increased levels of pro-inflammatory proteins in plasma can be detected in older individuals and associate with the so called chronic low-grade inflammation, which contributes to a faster progression of aged-related cardiovascular (CV) diseases, including frailty, neurodegeneration, gastro-intestinal diseases and disorders reflected by alterations in the composition of gut microbiota. However, successful genetic programme of long-living individuals alters the trajectory of the ageing process, by promoting an efficient immune response that can counterbalance deleterious effects of inflammation and the CV complications. This is the case of BPIFB4 gene in which, homozygosity for a four single-nucleotide polymorphism (SNP) haplotype, the Longevity-Associated Variant (LAV) correlates with prolonged health span and reduced risk of CV complications and inflammation. The relation between LAV-BPIFB4 and inflammation has been proven in different experimental models, here we hypothesized that also human homozygous carriers of LAV-BPIFB4 gene may experience a lower inflammatory burden as detected by plasma proteomics that could explain their favourable CV risk trajectory over time. Moreover, we explored the therapeutic effects of LAV-BPIFB4 in inflammatory disease and monolayer model of intestinal barrier. RESULTS We used high-throughput proteomic approach to explore the profiles of circulating proteins from 591 baseline participants selected from the PLIC cohort according to the BPIFB4 genotype to identify the signatures and differences of BPIFB4 genotypes useful for health and disease management. The observational analysis identified a panel of differentially expressed circulating proteins between the homozygous LAV-BPIFB4 carriers and the other alternative BPIFB4 genotypes highlighting in the latter ones a higher grade of immune-inflammatory markers. Moreover, in vitro studies performed on intestinal epithelial organs from inflammatory bowel disease (IBD) patients and monolayer model of intestinal barrier demonstrated the benefit of LAV-BPIFB4 treatment. CONCLUSIONS Homozygosity for LAV-BPIFB4 results in the attenuation of inflammation in PLIC cohort and IBD patients providing preliminary evidences for its therapeutic use in inflammatory disorders that need to be further characterized and confirmed by independent studies.
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Affiliation(s)
| | - Andrea Baragetti
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Elena Ciaglia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Valentina Lopardo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Elena Olmastroni
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Manuela Casula
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Carolina Ciacci
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alberico L Catapano
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy
| | - Annibale A Puca
- Cardiovascular Department, IRCCS MultiMedica, Milan, Italy.
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.
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Schumacher AE, Kyu HH, Aali A, Abbafati C, Abbas J, Abbasgholizadeh R, Abbasi MA, Abbasian M, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdoun M, Abdullahi A, Abdurehman AM, Abebe M, Abedi A, Abedi A, Abegaz TM, Abeldaño Zuñiga RA, Abhilash ES, Abiodun OO, Aboagye RG, Abolhassani H, Abouzid M, Abreu LG, Abrha WA, Abrigo MRM, Abtahi D, Abu Rumeileh S, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Acuna JM, Adair T, Addo IY, Adebayo OM, Adegboye OA, Adekanmbi V, Aden B, Adepoju AV, Adetunji CO, Adeyeoluwa TE, Adeyomoye OI, Adha R, Adibi A, Adikusuma W, Adnani QES, Adra S, Afework A, Afolabi AA, Afraz A, Afyouni S, Afzal S, Agasthi P, Aghamiri S, Agodi A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmadzade M, Ahmed A, Ahmed H, Ahmed LA, Ahmed MB, Ahmed SA, Ajami M, Aji B, Ajumobi O, Akalu GT, Akara EM, Akinosoglou K, Akkala S, Akyirem S, Al Hamad H, Al Hasan SM, Al Homsi A, Al Qadire M, Ala M, Aladelusi TO, 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Salami AA, Salaroli LB, Saleh MA, Salehi S, Salem MR, Salem MZY, Salimi S, Samadi Kafil H, Samadzadeh S, Samara KA, Samargandy S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanganyado E, Sanjeev RK, Sanmarchi F, Sanna F, Santri IN, Santric-Milicevic MM, Sarasmita MA, Saravanan A, Saravi B, Sarikhani Y, Sarkar C, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sattin D, Saulam J, Sawyer SM, Saxena S, Saya GK, Sayadi Y, Sayeed A, Sayeed MA, Saylan M, Scarmeas N, Schaarschmidt BM, Schlee W, Schmidt MI, Schuermans A, Schwebel DC, Schwendicke F, Šekerija M, Selvaraj S, Semreen MH, Senapati S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Sertsu A, Sethi Y, SeyedAlinaghi S, Seyedi SA, Shafaat A, Shafaat O, Shafie M, Shafiee A, Shah NS, Shah PA, Shahabi S, Shahbandi A, Shahid I, Shahid S, Shahid W, Shahwan MJ, Shaikh MA, Shakeri A, Shakil H, Sham S, Shamim MA, Shams-Beyranvand M, Shamshad H, Shamshirgaran MA, Shamsi MA, Shanawaz M, Shankar A, Sharfaei S, Sharifan A, Shariff M, Sharifi-Rad J, Sharma M, Sharma R, Sharma S, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shehabeldine AME, Sheikh A, Sheikhi RA, Shen J, Shenoy MM, Shetty BSK, Shetty RS, Shey RA, Shiani A, Shibuya K, Shiferaw D, Shigematsu M, Shin JI, Shin MJ, Shiri R, Shirkoohi R, Shittu A, Shiue I, Shivakumar KM, Shivarov V, Shool S, Shrestha S, Shuja KH, Shuval K, Si Y, Sibhat MM, Siddig EE, Sigfusdottir ID, Silva JP, Silva LMLR, Silva S, Simões JP, Simpson CR, Singal A, Singh A, Singh A, Singh A, Singh BB, Singh B, Singh M, Singh M, Singh NP, Singh P, Singh S, Siraj MS, Sitas F, Sivakumar S, Skryabin VY, Skryabina AA, Sleet DA, Slepak ELN, Sohrabi H, Soleimani H, Soliman SSM, Solmi M, Solomon Y, Song Y, Sorensen RJD, Soriano JB, Soyiri IN, Spartalis M, Sreeramareddy CT, Starnes JR, Starodubov VI, Starodubova AV, Stefan SC, Stein DJ, Steinbeis F, Steiropoulos P, Stockfelt L, Stokes MA, Stortecky S, Stranges S, Stroumpoulis K, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Sunkersing D, Susanty S, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taborda-Barata LM, Tabuchi T, Tadesse BT, Taheri A, Taheri Abkenar Y, Taheri Soodejani M, Taherkhani A, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tamuzi JL, Tan KK, Tang H, Tang HK, Tat NY, Tat VY, Tavakoli Oliaee R, Tavangar SM, Taveira N, Tebeje TM, Tefera YM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Tesfaye SH, Thangaraju P, Thankappan KR, Thapa R, Thapar R, Thomas N, Thrift AG, Thum CCC, Tian J, Tichopad A, Ticoalu JHV, Tiruye TY, Tohidast SA, Tonelli M, Touvier M, Tovani-Palone MR, Tram KH, Tran NM, Trico D, Trihandini I, Tromans SJ, Truong VT, Truyen TTTT, Tsermpini EE, Tumurkhuu M, Tung K, Tyrovolas S, Ubah CS, Udoakang AJ, Udoh A, Ulhaq I, Ullah S, Ullah S, Umair M, Umar TP, Umeokonkwo CD, Umesh A, Unim B, Unnikrishnan B, Upadhyay E, Urso D, Vacante M, Vahdani AM, Vaithinathan AG, Valadan Tahbaz S, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Varma SA, Vart P, Varthya SB, Vasankari TJ, Veerman LJ, Venketasubramanian N, Venugopal D, Verghese NA, Verma M, Verma P, Veroux M, Verras GI, Vervoort D, Vieira RJ, Villafañe JH, Villani L, Villanueva GI, Villeneuve PJ, Violante FS, Visontay R, Vlassov V, Vo B, Vollset SE, Volovat SR, Volovici V, Vongpradith A, Vos T, Vujcic IS, Vukovic R, Wado YD, Wafa HA, Waheed Y, Wamai RG, Wang C, Wang D, Wang F, Wang S, Wang S, Wang Y, Wang YP, Ward P, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Weldemariam AH, Wells KM, Wen YF, Werdecker A, Westerman R, Wickramasinghe DP, Wickramasinghe ND, Wijeratne T, Wilson S, Wojewodzic MW, Wool EE, Woolf AD, Wu D, Wulandari RD, Xiao H, Xu B, Xu X, Yadav L, Yaghoubi S, Yang L, Yano Y, Yao Y, Ye P, Yesera GE, Yesodharan R, Yesuf SA, Yiğit A, Yiğit V, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yu C, Zadey S, Zadnik V, Zafari N, Zahedi M, Zahid MN, Zahir M, Zakham F, Zaki N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Pirillo A, Tokgözoğlu L, Catapano AL. European Lipid Guidelines and Cardiovascular Risk Estimation: Current Status and Future Challenges. Curr Atheroscler Rep 2024:10.1007/s11883-024-01194-7. [PMID: 38430340 DOI: 10.1007/s11883-024-01194-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Genetic, experimental, epidemiologic, and clinical data support the causal role of elevated levels of low-density lipoprotein cholesterol (LDL-C) in atherosclerosis and cardiovascular disease (CVD). The recommendations of the 2019 European guidelines are based on the concept of differential CV risk, which in turn defines the LDL-C goals that should be achieved. RECENT FINDINGS The 2019 ESC/EAS guidelines for dyslipidaemia use the Systematic COronary Risk Evaluation (SCORE) model to assess CV risk, which provides a 10-year risk of fatal CV event. The SCORE model has recently been updated to reflect current rates of cardiovascular disease in Europe. The new SCORE2 model provides estimates of the 10-year risk of fatal and non-fatal CVD events in people aged 40-69 years, thus improving the identification of individuals at higher risk of a CVD event. However, as in the SCORE age is the main determinant of risk, young people have a relatively low estimated 10-year risk of a CV event even with high levels of one or more causal risk factors. Individuals with familial hypercholesterolaemia, who have elevated LDL-C levels from birth and have a high risk of premature CVD, are one example. The concept of cumulative LDL exposure is thus becoming increasingly important. This is also supported by Mendelian randomisation studies showing that carrying genetic variants associated with lower LDL-C levels reduces CV risk. These observations have introduced the concept of "cholesterol-years", which takes into account both LDL-C levels and time of exposure. It is crucial that future European guidelines pay more attention to this point.
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Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Alberico L Catapano
- IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
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D'Erasmo L, Bini S, Casula M, Gazzotti M, Bertolini S, Calandra S, Tarugi P, Averna M, Iannuzzo G, Fortunato G, Catapano AL, Arca M. Contemporary lipid-lowering management and risk of cardiovascular events in homozygous familial hypercholesterolaemia: insights from the Italian LIPIGEN Registry. Eur J Prev Cardiol 2024:zwae036. [PMID: 38374534 DOI: 10.1093/eurjpc/zwae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
AIMS The availability of novel lipid-lowering therapies (LLTs) has remarkably changed the clinical management of homozygous familial hypercholesterolaemia (HoFH). The impact of these advances was evaluated in a cohort of 139 HoFH patients followed in a real-world clinical setting. METHODS AND RESULTS The clinical characteristics of 139 HoFH patients, along with information about LLTs and low-density lipoprotein cholesterol (LDL-C) levels at baseline and after a median follow-up of 5 years, were retrospectively retrieved from the records of patients enrolled in the LIPid transport disorders Italian GEnetic Network-Familial Hypercholesterolaemia (LIPIGEN-FH) Registry. The annual rates of major atherosclerotic cardiovascular events (MACE-plus) during follow-up were compared before and after baseline. Additionally, the lifelong survival free from MACE-plus was compared with that of the historical LIPIGEN HoFH cohort. At baseline, LDL-C level was 332 ± 138 mg/dL. During follow-up, the potency of LLTs was enhanced and, at the last visit, 15.8% of patients were taking quadruple therapy. Consistently, LDL-C decreased to an average value of 124 mg/dL corresponding to a 58.3% reduction (Pt < 0.001), with the lowest value (∼90 mg/dL) reached in patients receiving proprotein convertase subtilisin/kexin type 9 inhibitors and lomitapide and/or evinacumab as add-on therapies. The average annual MACE-plus rate in the 5-year follow-up was significantly lower than that observed during the 5 years before baseline visit (21.7 vs. 56.5 per 1000 patients/year; P = 0.0016). CONCLUSION Our findings indicate that the combination of novel and conventional LLTs significantly improved LDL-C control with a signal of better cardiovascular prognosis in HoFH patients. Overall, these results advocate the use of intensive, multidrug LLTs to effectively manage HoFH.
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Affiliation(s)
- Laura D'Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome 00185, Italy
| | - Simone Bini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome 00185, Italy
| | - Manuela Casula
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | | | - Stefano Bertolini
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Sebastiano Calandra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Tarugi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maurizio Averna
- Department of Health Promotion, Mother and Child Care, Internal Medicine, University of Palermo, Palermo, Italy
- Medical Specialties 'G. D'Alessandro' (PROMISE), University of Palermo, Palermo, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giuliana Fortunato
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
- CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy
| | - Alberico L Catapano
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome 00185, Italy
- Internal medicine and metabolic diseases Unit,Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy
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Packard CJ, Pirillo A, Tsimikas S, Ference BA, Catapano AL. Exploring apolipoprotein C-III: pathophysiological and pharmacological relevance. Cardiovasc Res 2024; 119:2843-2857. [PMID: 38039351 DOI: 10.1093/cvr/cvad177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 12/03/2023] Open
Abstract
The availability of pharmacological approaches able to effectively reduce circulating LDL cholesterol (LDL-C) has led to a substantial reduction in the risk of atherosclerosis-related cardiovascular disease (CVD). However, a residual cardiovascular (CV) risk persists in treated individuals with optimal levels of LDL-C. Additional risk factors beyond LDL-C are involved, and among these, elevated levels of triglycerides (TGs) and TG-rich lipoproteins are causally associated with an increased CV risk. Apolipoprotein C-III (apoC-III) is a key regulator of TG metabolism and hence circulating levels through several mechanisms including the inhibition of lipoprotein lipase activity and alterations in the affinity of apoC-III-containing lipoproteins for both the hepatic receptors involved in their removal and extracellular matrix in the arterial wall. Genetic studies have clarified the role of apoC-III in humans, establishing a causal link with CVD and showing that loss-of-function mutations in the APOC3 gene are associated with reduced TG levels and reduced risk of coronary heart disease. Currently available hypolipidaemic drugs can reduce TG levels, although to a limited extent. Substantial reductions in TG levels can be obtained with new drugs that target specifically apoC-III; these include two antisense oligonucleotides, one small interfering RNA and an antibody.
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Affiliation(s)
- Chris J Packard
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Milan, Italy
- Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy
| | - Sotirios Tsimikas
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA, USA
| | - Brian A Ference
- Centre for Naturally Randomized Trials, University of Cambridge, Cambridge, UK
| | - Alberico L Catapano
- Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, via Balzaretti 9, 20133 Milan, Italy
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Tokgozoglu L, Orringer C, Catapano AL. The year in cardiovascular medicine 2023: the top 10 papers in dyslipidaemias. Eur Heart J 2024; 45:504-506. [PMID: 38153186 DOI: 10.1093/eurheartj/ehad837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Affiliation(s)
- Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhiye, 06100 Ankara, Turkey
| | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences and I.R.C.C.S Multimedica, University of Milan, Milano, Italy
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Schiele F, Catapano AL, De Caterina R, Laufs U, Jukema JW, Zaman A, Sionis A. Quality control to improve LDL-cholesterol management in patients with acute coronary syndromes based on the ACS EuroPath IV project. Eur Heart J Acute Cardiovasc Care 2024; 13:46-54. [PMID: 37832522 PMCID: PMC10853845 DOI: 10.1093/ehjacc/zuad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/17/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023]
Abstract
AIMS We performed quality control of lipid-lowering therapy (LLT) in patients with acute coronary syndrome (ACS), with a view to proposing corrective actions. METHODS AND RESULTS Using a Define Measure Analysis Improve Control (DMAIC) approach applied to data from the ACS EuroPath IV survey, we measured attainment of two quality indicators (QIs) related to lipid-lowering treatment: (i) prescription of high-intensity statins (or equipotent treatment) before discharge, and (ii) proportion with LDL-cholesterol <55 mg/dL (1.4 mmol/L) during follow-up. A total of 530 European cardiologists responded and provided data for up to 5 patients from their centre, for acute and follow-up phases. Corrective measures are proposed to increase the rate of attainment of both QIs. Attainment of the first QI was measured in 929 acute-phase patients, 99% had LLT prescribed at discharge and 75% of patients fulfilled the first QI. Attainment of the second QI was assessed in 1721 patients with follow-up. The second QI was reached in 31% of patients. The DMAIC approach yielded 10 potential changes in prescription, 3 for the first and 7 for the second QI. The overall strategy is 'Fire to Target', i.e. early intensification of the LLT using statins, ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type-9 inhibitors, and is presented as an algorithm for routine application. CONCLUSION Quality control for LLT, based on the ACS EuroPath IV survey, detected 10 potential changes in prescription that could enhance attainment of 2 QIs. Whether the Fire to Target strategy will be adopted and effective needs to be assessed in further steps of the EuroPath Quality programme.
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Affiliation(s)
- François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, Boulevard Fleming, Besançon 25000, France
- EA3920, University of Franche-Comte, 19 rue Ambroise Pare, 25000 Besançon, France
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy
- IRCCS MultiMedica, Via Milanese 300, 20099 Sesto S. Giovanni, Milan, Italy
| | - Raffaele De Caterina
- Chair of Cardiology, University of Pisa, Via Savi 10, 56126 Pisa, Italy
- Cardiovascular Division, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
- The Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Azfar Zaman
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, NE7 7DN Newcastle-upon-Tyne, UK
| | - Alessandro Sionis
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona 08025, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid 28029, Spain
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Alieva A, Di Costanzo A, Gazzotti M, Reutova O, Usova E, Bakaleiko V, Arca M, D'Erasmo L, Pellegatta F, Galimberti F, Olmastroni E, Catapano AL, Casula M. Genetic heterogeneity of familial hypercholesterolaemia in two populations from two different countries. Eur J Intern Med 2024:S0953-6205(24)00016-5. [PMID: 38245461 DOI: 10.1016/j.ejim.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a genetically determined monogenic disorder of predominantly autosomal dominant inheritance. A number of studies on differences in the genetic profile of patients with FH have demonstrated the importance of a more substantive evaluation of genetic features. The aim of this study was to evaluate the genetic profile of patients with clinical FH among Italian and Russian patients. METHODS We included 144 Italian and 79 Russian FH patients; clinical diagnosis was based on the same criteria. Patients were divided in: positive to genetic test (one causative variant), inconclusive (only variants of uncertain clinical significance [VUS]), and negative (with likely benign/benign variants, heterozygous variants in LDLRAP1 gene, or without causative variants). RESULTS The genetic test was positive in 76.4 % of the Italian patients and in 49.4 % of the Russian patients. The presence of VUS alone was detected in 7.6 % and in 19.0 % (p < 0.001), respectively. Among patients with positive genetic diagnosis, pre-treatment LDL-C levels were higher in the Russian cohort (353.5 ± 111.3 vs. 302.7 ± 52.1 mg/dL, p = 0.009), as well as the percentage of treated patients (53.8 % vs. 14.5 %, p < 0.001) and the prevalence of premature coronary heart disease (12.8 % vs. 3.6 %, p = 0.039). Among patients carrying only VUS, mean pre-treatment LDL-C levels were similar between the cohorts (299.5 ± 68.1 vs. 295.3 ± 46.8 mg/dL, p = 0.863). Among pathogenic/likely pathogenic variants and VUS, only 5 % and 4 % was shared between the two cohorts, respectively. CONCLUSION The genetic background of patients clinically diagnosed with FH in two different countries is characterized by high variability.
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Affiliation(s)
- Asiiat Alieva
- Almazov National Medical Research Centre, Saint Petersburg, Russia.
| | - Alessia Di Costanzo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Olga Reutova
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena Usova
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura D'Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Elena Olmastroni
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences (DisFeB), University of Milan, Milan, Italy
| | - Alberico L Catapano
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences (DisFeB), University of Milan, Milan, Italy
| | - Manuela Casula
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences (DisFeB), University of Milan, Milan, Italy
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14
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Duell PB, Banach M, Catapano AL, Laufs U, Mancini GBJ, Ray KK, Broestl C, Zhang Y, Lei L, Goldberg AC. Efficacy and safety of bempedoic acid in patients with heterozygous familial hypercholesterolemia: analysis of pooled patient-level data from phase 3 clinical trials. J Clin Lipidol 2024:S1933-2874(23)00355-0. [PMID: 38341323 DOI: 10.1016/j.jacl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Patients with heterozygous familial hypercholesterolemia (HeFH) often cannot reach guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals despite multidrug therapy. OBJECTIVE To evaluate the efficacy and safety of bempedoic acid as an add-on therapy for lowering LDL-C in patients with HeFH. METHODS Pooled data from two 52-week phase 3 clinical trials of patients with atherosclerotic cardiovascular disease and/or HeFH receiving maximally tolerated statin therapy (randomized 2:1 to bempedoic acid or placebo) were analyzed by HeFH status. Endpoints included changes from baseline to week 12 (and up to week 52) in LDL-C and other lipid parameters, achievement of LDL-C goals, and safety. RESULTS A total of 217 (bempedoic acid, 146; placebo, 71) patients with HeFH and 2,792 (bempedoic acid, 1,864; placebo, 928) without HeFH were included (mean baseline LDL-C, 172.8 mg/dL and 102.6 mg/dL, respectively). Bempedoic acid significantly lowered LDL-C at week 12 vs. placebo regardless of HeFH status (with HeFH, -21.2%; without HeFH, -18.2% [both P<0.0001]). Bempedoic acid significantly reduced other lipid parameters and high-sensitivity C-reactive protein vs. placebo regardless of HeFH status (all P≤0.01). Among patients with HeFH treated with bempedoic acid, 32% and 27% achieved LDL-C <100 mg/dL at weeks 12 and 52, respectively. Overall treatment-emergent adverse event incidence was comparable across all four groups (74.7-77.5%). CONCLUSION Bempedoic acid significantly lowered LDL-C levels vs. placebo and was generally well tolerated in all patients, with no new safety findings in patients with HeFH, despite more intensive lipid-lowering therapy in patients with vs. without HeFH.
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Affiliation(s)
- P Barton Duell
- Center for Preventive Cardiology, Knight Cardiovascular Institute and Division of Endocrinology, Diabetes, and Clinical Nutrition, School of Medicine, Oregon Health & Science University, Portland, OR, USA (Dr Duell).
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Łódź (MUL), Łódź, Poland (Dr Banach)
| | | | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany (Dr Laufs)
| | - G B John Mancini
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada (Dr Mancini)
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, UK (Dr Ray)
| | - Christine Broestl
- Esperion Therapeutics, Inc., Ann Arbor, MI, USA (Drs Broestl, Zhang, Lei)
| | - Yang Zhang
- Esperion Therapeutics, Inc., Ann Arbor, MI, USA (Drs Broestl, Zhang, Lei)
| | - Lei Lei
- Esperion Therapeutics, Inc., Ann Arbor, MI, USA (Drs Broestl, Zhang, Lei)
| | - Anne C Goldberg
- Department of Medicine, Washington University, St. Louis, MO, USA (Dr Goldberg)
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15
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Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder R, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macias JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. METHODS For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. FINDINGS Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. INTERPRETATION Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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16
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Catapano AL. Emerging therapies in dyslipidaemias. Vascul Pharmacol 2023; 153:107229. [PMID: 37716371 DOI: 10.1016/j.vph.2023.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 09/18/2023]
Abstract
Several observations have shown that elevated levels of low-density lipoprotein cholesterol (LDL-C) are a cause of cardiovascular disease. Lowering LDL-C is a key strategy for reducing cardiovascular risk, with a continuous linear correlation between LDL-C reduction and cardiovascular benefit. Based on these observations, current guidelines have further lowered LDL-C goals and call for the use of more effective therapeutic interventions. In addition to statins, ezetimibe and the monoclonal antibodies targeting PCSK9, several new lipid-lowering agents are currently in phase 3 clinical trials to evaluate their clinical effects, and more are in development. The use of combination therapies targeting different pathways can increase the effectiveness of treatment.
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Affiliation(s)
- Alberico L Catapano
- IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
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17
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Pirillo A, Catapano AL. How to Handle Elevated Triglycerides: Life after PROMINENT. Curr Atheroscler Rep 2023; 25:921-929. [PMID: 38114852 DOI: 10.1007/s11883-023-01175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Hypertriglyceridaemia (HTG) is a common condition characterised by elevated levels of plasma triglycerides (TG), which are transported in the blood mainly by TG-rich lipoproteins (TRL). Elevated TG levels (150-400 mg/dL) are associated with increased cardiovascular risk. Severe HTG (>880 mg/dL) is associated with a risk of acute pancreatitis only. Randomised clinical trials investigating the clinical benefit of TG-lowering drugs in patients with elevated TG levels have provided conflicting results. RECENT FINDINGS Elevated TG levels are only one marker of altered lipid/lipoprotein metabolism and indeed reflect altered concentrations of one or more classes or subfractions of TRL, which in turn may have a different association with CV risk. Fibrates, the drugs most commonly used to treat HTG, provide cardiovascular benefits to only a specific subgroup of patients. The lack of clinical benefit from pemafibrate has emphasised the concept that lowering TG levels is not sufficient to reduce the CV risk unless it is accompanied by a reduction in the number of circulating atherogenic lipoproteins, which can be assessed by determining apolipoprotein B levels. Treatment with omega-3 fatty acids was also ineffective in reducing CV risk, with the exception of icosapent ethyl, which, however, appears to have beneficial effects beyond lipids. New drugs are currently being developed that aim to lower TG levels by targeting apolipoprotein C-III or angiopoietin-like-3, both of which are involved in the metabolism of TGs. TG reduction can be achieved by various drugs, but most of them are ineffective in reducing CV risk. The results of outcome studies on new TG-lowering drugs will clarify whether lowering apoB levels is critical to achieve clinical benefit.
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Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Alberico L Catapano
- IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
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Pirillo A, Catapano AL. Cardiovascular risk assessment: are we getting all the information we need? Eur J Prev Cardiol 2023; 30:1853-1855. [PMID: 37494724 DOI: 10.1093/eurjpc/zwad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
- IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Alberico L Catapano
- IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milano, Italy
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19
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Goldberg AC, Banach M, Catapano AL, Duell PB, Leiter LA, Hanselman JC, Lei L, Mancini GBJ. Evaluation of the efficacy and safety of bempedoic acid in women and men: Pooled analyses from phase 3 trials. Atherosclerosis 2023; 384:117192. [PMID: 37648637 DOI: 10.1016/j.atherosclerosis.2023.117192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIMS Sex-specific differences in the response to lipid-lowering therapies have been reported. Here, we assessed the effect of bempedoic acid in women and men using pooled, patient-level data from four phase 3 clinical trials of bempedoic acid. METHODS Patients were grouped into two pools: 1) atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH) "on statins" and 2) "low-dose or no statin". Percent changes from baseline to at least week 12 in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC), apolipoprotein B (Apo B), and high-sensitivity C-reactive protein (hsCRP), as well as safety, were analyzed by statin pool and sex. RESULTS Overall, 3623 patients were included (bempedoic acid, 2425; placebo, 1198). Significant reductions in lipid parameters and hsCRP were observed with bempedoic acid vs. placebo in both sexes in the ASCVD and/or HeFH on statins (n = 3009) and the low-dose or no statin (n = 614) pools (p ≤ 0.002). Compared with men, women had significantly greater placebo-corrected reductions in LDL-C (-21.2% vs. -17.4%; p = 0.044), non-HDL-C (-17.3% vs. -12.1%; p = 0.003), TC (-13.8% vs. -10.5%; p = 0.012), and Apo B (-16.0% vs. -11.3%; p = 0.004) in the ASCVD and/or HeFH on statins pool. Women had similar reductions to men in lipid parameters in the low-dose or no statin pool and hsCRP in both pools. The safety of bempedoic acid was comparable between sexes. CONCLUSIONS In this pooled analysis, women experienced significant improvements in levels of LDL-C and other lipid parameters with bempedoic acid.
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Affiliation(s)
- Anne C Goldberg
- Washington University School of Medicine, St. Louis, MO, USA.
| | - Maciej Banach
- Medical University of Łódź and Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | | | - P Barton Duell
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Lei Lei
- Esperion Therapeutics Inc., Ann Arbor, MI, USA
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Casula M, Gazzotti M, Capra ME, Olmastroni E, Galimberti F, Catapano AL, Pederiva C. Refinement of the diagnostic approach for the identification of children and adolescents affected by familial hypercholesterolemia: Evidence from the LIPIGEN study. Atherosclerosis 2023; 385:117231. [PMID: 37648636 DOI: 10.1016/j.atherosclerosis.2023.117231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIMS We aimed to describe the limitations of familiar hypercholesterolemia (FH) diagnosis in childhood based on the presence of the typical features of FH, such as physical sings of cholesterol accumulation and personal or family history of premature cardiovascular disease or hypercholesterolemia, comparing their prevalence in the adult and paediatric FH population, and to illustrate how additional information can lead to a more effective diagnosis of FH at a younger age. METHODS From the Italian LIPIGEN cohort, we selected 1188 (≥18 years) and 708 (<18 years) genetically-confirmed heterozygous FH, with no missing personal FH features. The prevalence of personal and familial FH features was compared between the two groups. For a sub-group of the paediatric cohort (N = 374), data about premature coronary heart disease (CHD) in second-degree family members were also included in the evaluation. RESULTS The lower prevalence of typical FH features in children/adolescents vs adults was confirmed: the prevalence of tendon xanthoma was 2.1% vs 13.1%, and arcus cornealis was present in 1.6% vs 11.2% of the cohorts, respectively. No children presented clinical history of premature CHD or cerebral/peripheral vascular disease compared to 8.8% and 5.6% of adults, respectively. The prevalence of premature CHD in first-degree relatives was significantly higher in adults compared to children/adolescents (38.9% vs 19.7%). In the sub-cohort analysis, a premature CHD event in parents was reported in 63 out of 374 subjects (16.8%), but the percentage increased to 54.0% extending the evaluation also to second-degree relatives. CONCLUSIONS In children, the typical FH features are clearly less informative than in adults. A more thorough data collection, adding information about second-degree relatives, could improve the diagnosis of FH at younger age.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, 20133, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, 20099, Italy.
| | - Marta Gazzotti
- Fondazione SISA (Società Italiana per lo Studio dell'Aterosclerosi), 20133, Milano, Italy
| | - Maria Elena Capra
- Centre for Paediatric Dyslipidaemias, Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121, Piacenza, Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, 20133, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, 20099, Italy
| | | | | | - Cristina Pederiva
- Clinical Service for Dyslipidaemias, Study and Prevention of Atherosclerosis in Childhood, Paediatrics Unit, ASST-Santi Paolo e Carlo, 20142, Milan, Italy
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21
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Kim MS, Hwang J, Yon DK, Lee SW, Jung SY, Park S, Johnson CO, Stark BA, Razo C, Abbasian M, Abbastabar H, Abhari AP, Aboyans V, Adane DEA, Adebayo OM, Alahdab F, Almustanyir S, Aly H, Ameyaw EK, Anderson JA, Andrei CL, Aryan Z, Aujayeb A, Bagherieh S, Baltatu OC, Banach M, Bayileyegn NS, Bearne LM, Behnoush AH, Bensenor IM, Bhaskar S, Bhat AN, Bhat V, Bikbov B, Bintoro BS, Burkart K, Cámera LA, Catapano AL, Chandrasekar EK, Charan J, Chattu VK, Chi G, Chukwu IS, Chung SC, Cirillo M, Coberly K, Costa VM, Dadras O, Dai X, Do TC, Doshi R, Ekholuenetale M, Elgendy IY, Elhadi M, Fagbamigbe AF, Feizkhah A, Fekadu G, Gill PS, Goldust M, Golechha M, Guan SY, Gupta VK, Hadei M, Hadi NR, Hammoud A, Hankey GJ, Harlianto NI, Hasaballah AI, Hassan S, Hassen MB, Heidari G, Hostiuc M, Ilesanmi OS, Iwagami M, Jokar M, Jonas JB, Joshua CE, Jozwiak JJ, Kazemian S, Keykhaei M, Khalaji A, Khan MAB, Khateri S, Kibret BG, Korzh O, Koulmane Laxminarayana SL, Krishan K, Kumar A, Kumar M, Kuttikkattu A, Laksono T, Larijani B, Le TTT, Lim SS, Liu X, Lorkowski S, Magdy Abd El Razek H, Malhotra K, Manla Y, Maugeri A, Mentis AFA, Mestrovic T, Micheletti Gomide Nogueira de Sá AC, Mirica A, Mirrakhimov EM, Misganaw A, Mishra M, Mohammad Y, Mokdad AH, Moni MA, Montasir AA, Moradi Y, Moraga P, Morovatdar N, Mousavi-Aghdas SA, Murray CJL, Naghavi M, Nair TS, Nassereldine H, Natto ZS, Nguyen DH, Nguyen HQ, Nguyen VT, Noubiap JJ, Oancea B, Oliveira GMM, Owolabi MO, Padron-Monedero A, Perico N, Petcu IR, Radfar A, Rafferty Q, Rahman M, Rahman MA, Ram P, Rashedi S, Rashid AM, Rawaf S, Remuzzi G, Renzaho AMN, Rezaee M, Roever L, Saad AMA, Saadatagah S, Sadeghi M, Sahebkar A, Saleh MA, Samy AM, Santric-Milicevic MM, Sepanlou SG, Seylani A, Sharfaei S, Shorofi SA, Singh JA, Singh P, Spartalis M, Sundström J, Tan KK, Teramoto M, Tharwat S, Tyrovolas S, Valadan Tahbaz S, Van den Eynde J, Vart P, Wang C, Wang F, Westerman R, Xia J, Xu S, Yada DY, Yamagishi K, Yonemoto N, Zahir M, Zangiabadian M, Zarrintan A, Zastrozhin MS, Zastrozhina A, Zoladl M, Hay SI, Shin JI, Roth GA. Global burden of peripheral artery disease and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health 2023; 11:e1553-e1565. [PMID: 37734799 PMCID: PMC10522777 DOI: 10.1016/s2214-109x(23)00355-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Peripheral artery disease is a growing public health problem. We aimed to estimate the global disease burden of peripheral artery disease, its risk factors, and temporospatial trends to inform policy and public measures. METHODS Data on peripheral artery disease were modelled using the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 database. Prevalence, disability-adjusted life years (DALYs), and mortality estimates of peripheral artery disease were extracted from GBD 2019. Total DALYs and age-standardised DALY rate of peripheral artery disease attributed to modifiable risk factors were also assessed. FINDINGS In 2019, the number of people aged 40 years and older with peripheral artery disease was 113 million (95% uncertainty interval [UI] 99·2-128·4), with a global prevalence of 1·52% (95% UI 1·33-1·72), of which 42·6% was in countries with low to middle Socio-demographic Index (SDI). The global prevalence of peripheral artery disease was higher in older people, (14·91% [12·41-17·87] in those aged 80-84 years), and was generally higher in females than in males. Globally, the total number of DALYs attributable to modifiable risk factors in 2019 accounted for 69·4% (64·2-74·3) of total peripheral artery disease DALYs. The prevalence of peripheral artery disease was highest in countries with high SDI and lowest in countries with low SDI, whereas DALY and mortality rates showed U-shaped curves, with the highest burden in the high and low SDI quintiles. INTERPRETATION The total number of people with peripheral artery disease has increased globally from 1990 to 2019. Despite the lower prevalence of peripheral artery disease in males and low-income countries, these groups showed similar DALY rates to females and higher-income countries, highlighting disproportionate burden in these groups. Modifiable risk factors were responsible for around 70% of the global peripheral artery disease burden. Public measures could mitigate the burden of peripheral artery disease by modifying risk factors. FUNDING Bill & Melinda Gates Foundation.
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22
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Vallejo-Vaz AJ, Bray S, Villa G, Brandts J, Kiru G, Murphy J, Banach M, De Servi S, Gaita D, Gouni-Berthold I, Kees Hovingh G, Jozwiak JJ, Jukema JW, Gabor Kiss R, Kownator S, Iversen HK, Maher V, Masana L, Parkhomenko A, Peeters A, Clifford P, Raslova K, Siostrzonek P, Romeo S, Tousoulis D, Vlachopoulos C, Vrablik M, Catapano AL, Poulter NR, Ray KK. Implications of ACC/AHA Versus ESC/EAS LDL-C Recommendations for Residual Risk Reduction in ASCVD: A Simulation Study From DA VINCI. Cardiovasc Drugs Ther 2023; 37:941-953. [PMID: 35567726 PMCID: PMC10516778 DOI: 10.1007/s10557-022-07343-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated. METHODS DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated. RESULTS Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81-115) mg/dl and 32% (25-43%), respectively. Median LDL-C reductions of 24 (12-46) and 39 (27-91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7-25%) and 22% (15-32%), respectively, and ARRs of 4% (2-7%) and 6% (4-9%), respectively. CONCLUSION In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach.
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Affiliation(s)
- Antonio J Vallejo-Vaz
- School of Public Health, Imperial College London, London, UK
- Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain
- Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC, Seville, Spain
| | - Sarah Bray
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
| | - Guillermo Villa
- Global Health Economics, Amgen Europe (GmbH), Rotkreuz, Switzerland
| | - Julia Brandts
- Imperial Centre for Cardiovascular Disease Prevention Imperial Clinical Trials Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - Gaia Kiru
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Jennifer Murphy
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Maciej Banach
- Department of Hypertension, Medical University of Łódź, Łódź, Poland
- Polish Mother's Memorial Hospital-Research Institute (PMMHRI), Łódź, Poland
- Cardiovascular Research Centre, University of Zielona Góra, Zielona Góra, Poland
| | | | - Dan Gaita
- Institutul de Boli Cardiovasculare, Fundatia Cardioprevent, Victor Babeş University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioanna Gouni-Berthold
- Centre for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jacek J Jozwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, Opole, Poland
| | | | | | | | - Helle K Iversen
- Department of Neurology, Stroke Centre Rigshospitalet, Copenhagen, Rigshospitalet, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vincent Maher
- Trinity College Dublin, Dublin, Ireland
- Advanced Lipid Management and Research Centre, Tallaght University Hospital, Dublin, Ireland
| | - Luis Masana
- Universitat Rovira I Virgili, IISPV, CIBERDEM, Saint Joan University Hospital, Reus, Spain
| | | | - André Peeters
- Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Piers Clifford
- Imperial Hospitals NHS Trust (Hammersmith Campus), London, UK
| | | | | | - Stefano Romeo
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Clinical Nutrition, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
- Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dimitrios Tousoulis
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Michal Vrablik
- 1st Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention Imperial Clinical Trials Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK.
- Imperial Clinical Trials Unit, Imperial College London, London, UK.
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23
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Pirillo A, Casula M, Catapano AL. European guidelines for the treatment of dyslipidaemias: New concepts and future challenges. Pharmacol Res 2023; 196:106936. [PMID: 37739143 DOI: 10.1016/j.phrs.2023.106936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality and morbidity worldwide. Low-density lipoprotein cholesterol (LDL-C) is one of the most important causal factors for ASCVD. Based on the evidence of the clinical benefits of lowering LDL-C, the current 2019 European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines provide guidance for optimal management of people with dyslipidaemia. These guidelines include new and revised concepts, with a general tightening of LDL-C goals to be achieved, especially for patients at high and very high cardiovascular risk, based on the results of clinical trials of the recently approved drugs for the treatment of hypercholesterolaemia. However, some issues are still open for discussion. Among others, the concept of lifetime exposure to elevated LDL-C levels will probably drive the pharmacological approach and future guidelines. In addition, other factors such as non-HDL-C, apolipoprotein B, and lipoprotein(a) are becoming increasingly important in determining cardiovascular risk. Finally, there is the question of whether combination therapy should be used as the first step to maximise the effectiveness of the pharmacological approach, avoiding the stepwise approach, which is likely to have a detrimental effect on adherence. Given the ever-changing landscape and the availability of new drugs targeting other important lipids, future guidelines will need to consider all these issues.
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Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.
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24
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Chiesa G, Zenti MG, Baragetti A, Barbagallo CM, Borghi C, Colivicchi F, Maggioni AP, Noto D, Pirro M, Rivellese AA, Sampietro T, Sbrana F, Arca M, Averna M, Catapano AL. Consensus document on Lipoprotein(a) from the Italian Society for the Study of Atherosclerosis (SISA). Nutr Metab Cardiovasc Dis 2023; 33:1866-1877. [PMID: 37586921 DOI: 10.1016/j.numecd.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
AIMS In view of the consolidating evidence on the causal role of Lp(a) in cardiovascular disease, the Italian Society for the Study of Atherosclerosis (SISA) has assembled a consensus on Lp(a) genetics and epidemiology, together with recommendations for its measurement and current and emerging therapeutic approaches to reduce its plasma levels. Data on the Italian population are also provided. DATA SYNTHESIS Lp(a) is constituted by one apo(a) molecule and a lipoprotein closely resembling to a low-density lipoprotein (LDL). Its similarity with an LDL, together with its ability to carry oxidized phospholipids are considered the two main features making Lp(a) harmful for cardiovascular health. Plasma Lp(a) concentrations vary over about 1000 folds in humans and are genetically determined, thus they are quite stable in any individual. Mendelian Randomization studies have suggested a causal role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis and observational studies indicate a linear direct correlation between cardiovascular disease and Lp(a) plasma levels. Lp(a) measurement is strongly recommended once in a patient's lifetime, particularly in FH subjects, but also as part of the initial lipid screening to assess cardiovascular risk. The apo(a) size polymorphism represents a challenge for Lp(a) measurement in plasma, but new strategies are overcoming these difficulties. A reduction of Lp(a) levels can be currently attained only by plasma apheresis and, moderately, with PCSK9 inhibitor treatment. CONCLUSIONS Awaiting the approval of selective Lp(a)-lowering drugs, an intensive management of the other risk factors for individuals with elevated Lp(a) levels is strongly recommended.
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Affiliation(s)
- Giulia Chiesa
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università Degli Studi di Milano, Milan, Italy.
| | - Maria Grazia Zenti
- Section of Diabetes and Metabolism, Pederzoli Hospital, Peschiera Del Garda, Verona, Italy.
| | - Andrea Baragetti
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università Degli Studi di Milano, Milan, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Carlo M Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Claudio Borghi
- Department of Cardiovascular Medicine, IRCCS AOU S. Orsola, Bologna, Italy
| | - Furio Colivicchi
- Division of Clinical Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Firenze, Italy
| | - Davide Noto
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine and Surgery, University of Perugia, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Tiziana Sampietro
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine (DTPM), Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Maurizio Averna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy; Institute of Biophysics, National Council of Researches, Palermo, Italy
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università Degli Studi di Milano, Milan, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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25
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Osadnik K, Osadnik T, Gierlotka M, Windak A, Tomasik T, Mastej M, Kuras A, Jóźwiak K, Penson PE, Lip GYH, Mikhailidis DP, Toth PP, Catapano AL, Ray KK, Howard G, Tomaszewski M, Charchar FJ, Sattar N, Williams B, MacDonald TM, Banach M, Jóźwiak J. Metabolic syndrome is associated with similar long-term prognosis in those living with and without obesity: an analysis of 45 615 patients from the nationwide LIPIDOGRAM 2004-2015 studies. Eur J Prev Cardiol 2023; 30:1195-1204. [PMID: 37039119 DOI: 10.1093/eurjpc/zwad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
AIMS We aimed to evaluate the association between metabolic syndrome (MetS) and long-term all-cause mortality. METHODS AND RESULTS The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006, and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III), and Joint Interim Statement (JIS) criteria. The cohort was divided into four groups: non-obese patients without MetS, obese patients without MetS, non-obese patients with MetS, and obese patients with MetS. Differences in all-cause mortality were analysed using Kaplan-Meier and Cox regression analyses. A total of 45 615 participants were enrolled (mean age 56.3, standard deviation: 11.8 years; 61.7% female). MetS was diagnosed in 14 202 (31%) by NCEP/ATP III criteria and 17 216 (37.7%) by JIS criteria. Follow-up was available for 44 620 (97.8%, median duration 15.3 years) patients. MetS was associated with increased mortality risk among the obese {hazard ratio, HR: 1.88 [95% confidence interval (CI) 1.79-1.99] and HR: 1.93 [95% CI 1.82-2.04], according to NCEP/ATP III and JIS criteria, respectively} and non-obese individuals [HR: 2.11 (95% CI 1.85-2.40) and 1.7 (95% CI 1.56-1.85) according to NCEP/ATP III and JIS criteria, respectively]. Obese patients without MetS had a higher mortality risk than non-obese patients without MetS [HR: 1.16 (95% CI 1.10-1.23) and HR: 1.22 (95% CI 1.15-1.30), respectively in subgroups with NCEP/ATP III and JIS criteria applied]. CONCLUSIONS MetS is associated with increased all-cause mortality risk in non-obese and obese patients. In patients without MetS, obesity remains significantly associated with mortality. The concept of metabolically healthy obesity should be revised.
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Affiliation(s)
- Kamila Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland, Jordana 38 st., 41-808 Zabrze, Poland
| | - Tadeusz Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland, Jordana 38 st., 41-808 Zabrze, Poland
| | - Marek Gierlotka
- Department of Cardiology, Institute of Medical Sciences, University of Opole, Al. W. Witosa 26, 45-401 Opole, Poland
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4 Street, 31-061 Krakow, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Bochenska 4 Street, 31-061 Krakow, Poland
| | - Mirosław Mastej
- Mastej Medical Center, Staszica 17A St., 38-200 Jasło, Poland
| | - Agnieszka Kuras
- Multiprofile Medical Simulation Center, University of Opole, Oleska 48 St., 45-052 Opole, Poland
| | - Kacper Jóźwiak
- Faculty of Health Sciences, Jagiellonian University Collegium Medicum, ul/street: Piotra Michałowskiego 12, 31-126 Kraków, Poland
| | - Peter E Penson
- Clinical Pharmacy & Therapeutics Research Group, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool L3 3AF, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Brownlow Hill, Liverpool L69 7TX, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, 6 West Derby St., Liverpool L7 8TX, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond St., London NW3 2QG, UK
| | - Peter P Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- CGH Medical Center, Department of Preventive Cardiology, 101 East Miller Road, Sterling, IL 61081, USA
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Via G. Balzaretti 9, 10136 Milan, Italy
- IRCCS MultiMedica, Sesto S. Giovanni, Via Milanese, 300, 20099 Milan, Italy
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, 320 St Dunstan's Road (Reynolds Building) Imperial College London, London W68RP, UK
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, 1665 University Blvd, AL 35294-0022, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, 46 Grafton St., Manchester M13 9NT, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Nelson St, Manchester M13 9NQ, UK
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University Australia, University Drive, Ballarat, Victoria 3350, Australia
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK
| | - Bryan Williams
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, 149 Tottenham Court Road, London W1T 7DN, UK
| | - Thomas M MacDonald
- MEMO Research, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Ninewells Avenue, Dundee DD1 9SY, UK
| | - Maciej Banach
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338 Lodz, Poland
- Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Rzgowska 281/289, 93-338 Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zyty 28, 65-046 Zielona Gora, Poland
| | - Jacek Jóźwiak
- Department of Family Medicine and Public Health, University of Opole, Oleska 48 Street, 45-052 Opole, Poland
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Brandts J, Bray S, Villa G, Catapano AL, Poulter NR, Vallejo-Vaz AJ, Ray KK. Optimal implementation of the 2019 ESC/EAS dyslipidaemia guidelines in patients with and without atherosclerotic cardiovascular disease across Europe: a simulation based on the DA VINCI study. Lancet Reg Health Eur 2023; 31:100665. [PMID: 37547279 PMCID: PMC10398584 DOI: 10.1016/j.lanepe.2023.100665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 08/08/2023]
Abstract
Background The impact of the stepwise implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) treatment algorithm on low-density lipoprotein cholesterol (LDL-C) goal attainment was simulated in patients from the DA VINCI study. Methods Monte Carlo simulation was used to evaluate treatment optimisation scenarios, based on a patient's risk category: statin intensification (step 1), addition of ezetimibe (step 2), and addition of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (step 3). Residual cardiovascular risk and predicted relative and absolute risk reduction (RRR and ARR) in cardiovascular events were assessed. Findings In DA VINCI, 2482 patients did not achieve their 2019 ESC/EAS LDL-C goals and were included in the simulation. In patients without atherosclerotic cardiovascular disease (ASCVD) (n = 962), 27.0% (n = 259) and 57.0% (n = 548) are likely to achieve their LDL-C goals at step 1 and step 2, respectively. Of those at very high risk without ASCVD (n = 74), 88.1% (n = 65) are likely to achieve their LDL-C goals at step 3. In patients with ASCVD (n = 1520), 12.0% (n = 183), 42.1% (n = 641) and 93.2% (n = 1416) are likely to achieve their LDL-C goals at steps 1, 2 and 3, respectively. In patients with and without ASCVD, treatment optimisation may result in mean simulated RRR of 24.0% and 17.7%, respectively, and ARR of 8.1% and 2.6%, respectively. Interpretation Most patients at high cardiovascular risk are unlikely to achieve LDL-C goals through statin optimisation and ezetimibe, and will require a PCSK9 inhibitor, leading to greater reduction in cardiovascular risk. Funding Amgen.
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Affiliation(s)
- Julia Brandts
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London, London, UK
- Department of Internal Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Sarah Bray
- Global Biostatistical Science, Amgen Ltd, Cambridge, UK
| | - Guillermo Villa
- Health Economics & Outcomes Research, Amgen (Europe) GmbH, Risch-Rotkreuz, Switzerland
| | - Alberico L. Catapano
- IRCCS MultiMedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Neil R. Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Antonio J. Vallejo-Vaz
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London, London, UK
- Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain
- Clinical Epidemiology and Vascular Risk, Institute of Biomedicine of Seville (IBiS), IBiS/Hospital Universitario Virgen del Rocío/University of Seville/CSIC, Seville, Spain
| | - Kausik K. Ray
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London, London, UK
- Imperial Clinical Trials Unit, Imperial College London, London, UK
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Sadiq F, Hegele RA, Catapano AL, Groselj U. Editorial: Rare dyslipidemias. Front Genet 2023; 14:1248435. [PMID: 37529775 PMCID: PMC10390060 DOI: 10.3389/fgene.2023.1248435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Fouzia Sadiq
- Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Alberico L. Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milano, Milan, Italy
- IRCCS Multimedica, Milano, Italy
| | - Urh Groselj
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Center, University Children’s Hospital, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
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28
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Kraaijenhof JM, Opstal TSJ, Cornel JH, Gill D, Hovingh GK, Catapano AL, Koenig W, Ridker PM, Stroes ESG, Nurmohamed NS. Effect of PCSK9 Inhibition on the Plasma Proteome: A SPIRE SubStudy. Arterioscler Thromb Vasc Biol 2023. [PMID: 37317854 PMCID: PMC10364960 DOI: 10.1161/atvbaha.123.319272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Jordan M Kraaijenhof
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (J.M.K., G.K.H., E.S.G.S., N.S.N.)
| | - Tjerk S J Opstal
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands (T.S.J.O., J.H.C.)
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands (T.S.J.O., J.H.C.)
| | - Jan H Cornel
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands (T.S.J.O., J.H.C.)
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands (T.S.J.O., J.H.C.)
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (D.G.)
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (J.M.K., G.K.H., E.S.G.S., N.S.N.)
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milano, Italy (A.L.C.)
- IRCCS Multimedica, Milano, Italy (A.L.C.)
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K.)
- German Centre for Cardiovascular Research (DZHK e.V.), partner site Munich Heart Alliance, Germany (W.K)
- Institute of Epidemiology and Medical Biometry, University of Ulm, Germany (W.K.)
| | - Paul M Ridker
- Divisions of Preventive Medicine and Cardiovascular Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.M.R.)
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (J.M.K., G.K.H., E.S.G.S., N.S.N.)
| | - Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (J.M.K., G.K.H., E.S.G.S., N.S.N.)
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands (N.S.N.)
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Toplak H, Bilitou A, Alber H, Auer J, Clodi M, Ebenbichler C, Fließer-Görzer E, Gelsinger C, Hanusch U, Ludvik B, Maca T, Schober A, Sock R, Speidl WS, Stulnig TM, Weitgasser R, Zirlik A, Koch M, Wienerroither S, Wolowacz SE, Diamand F, Catapano AL. Simulation of bempedoic acid and ezetimibe in the lipid-lowering treatment pathway in Austria using the contemporary SANTORINI cohort of high and very high risk patients. Wien Klin Wochenschr 2023:10.1007/s00508-023-02221-4. [PMID: 37286910 DOI: 10.1007/s00508-023-02221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The low-density lipoprotein cholesterol goals in the 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines necessitate greater use of combination therapies. We describe a real-world cohort of patients in Austria and simulate the addition of oral bempedoic acid and ezetimibe to estimate the proportion of patients reaching goals. METHODS Patients at high or very high cardiovascular risk on lipid-lowering treatments (excluding proprotein convertase subtilisin/kexin type 9 inhibitors) from the Austrian cohort of the observational SANTORINI study were included using specific criteria. For patients not at their risk-based goals at baseline, addition of ezetimibe (if not already received) and subsequently bempedoic acid was simulated using a Monte Carlo simulation. RESULTS A cohort of patients (N = 144) with a mean low-density lipoprotein cholesterol of 76.4 mg/dL, with 94% (n = 135) on statins and 24% (n = 35) on ezetimibe monotherapy or in combination, were used in the simulation. Only 36% of patients were at goal (n = 52). Sequential simulation of ezetimibe (where applicable) and bempedoic acid increased the proportion of patients at goal to 69% (n = 100), with a decrease in the mean low-density lipoprotein cholesterol from 76.4 mg/dL at baseline to 57.7 mg/dL overall. CONCLUSIONS The SANTORINI real-world data in Austria suggest that a proportion of high and very high-risk patients remain below the guideline-recommended low-density lipoprotein cholesterol goals. Optimising use of oral ezetimibe and bempedoic acid after statins in the lipid-lowering pathway could result in substantially more patients attaining low-density lipoprotein cholesterol goals, likely with additional health benefits.
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Affiliation(s)
- Hermann Toplak
- Department of Endocrinology and Diabetes, Clinic for Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Hannes Alber
- Department of Internal Medicine and Cardiology, KABEG Clinic Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Johann Auer
- Department of Internal Medicine I, Hospital St. Josef Braunau, Braunau, Austria
| | - Martin Clodi
- Hospital of Internal Medicine Brüder Linz, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
| | | | | | | | - Ursula Hanusch
- Centre for Clinical Studies Dr. Hanusch GmbH, Vienna, Austria
| | - Bernhard Ludvik
- Medical Department in Diabetology, Endocrinology and Nephrology and Karl Landsteiner Institute for Obesity and Metabolic Disorders, Landstraße Clinic, Vienna, Austria
| | - Thomas Maca
- Evangelical Hospital Vienna, Vienna, Austria
| | - Andreas Schober
- Department of Cardiology, Hospital North-Clinic Floridsdorf, Vienna, Austria
| | | | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas M Stulnig
- Department of Medicine III and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna, Austria
| | - Raimund Weitgasser
- Department of Internal Medicine / Diabetology, Wehrle-Diakonissen Private Hospital, Salzburg, Austria
| | - Andreas Zirlik
- Clinical Department of Cardiology, University Clinic Graz, Graz, Austria
| | - Marina Koch
- Daiichi Sankyo Austria GmbH, Vienna, Austria
| | | | | | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and Multimedica IRCCS, Milan, Italy
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30
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Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, Dweck MR, Koschinsky ML, Lambert G, Mach F, McNeal CJ, Moriarty PM, Natarajan P, Nordestgaard BG, Parhofer KG, Virani SS, von Eckardstein A, Watts GF, Stock JK, Ray KK, Tokgözoğlu LS, Catapano AL. Frequent questions and responses on the 2022 lipoprotein(a) consensus statement of the European Atherosclerosis Society. Atherosclerosis 2023; 374:107-120. [PMID: 37188555 DOI: 10.1016/j.atherosclerosis.2023.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023]
Abstract
In 2022, the European Atherosclerosis Society (EAS) published a new consensus statement on lipoprotein(a) [Lp(a)], summarizing current knowledge about its causal association with atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. One of the novelties of this statement is a new risk calculator showing how Lp(a) influences lifetime risk for ASCVD and that global risk may be underestimated substantially in individuals with high or very high Lp(a) concentration. The statement also provides practical advice on how knowledge about Lp(a) concentration can be used to modulate risk factor management, given that specific and highly effective mRNA-targeted Lp(a)-lowering therapies are still in clinical development. This advice counters the attitude: "Why should I measure Lp(a) if I can't lower it?". Subsequent to publication, questions have arisen relating to how the recommendations of this statement impact everyday clinical practice and ASCVD management. This review addresses 30 of the most frequently asked questions about Lp(a) epidemiology, its contribution to cardiovascular risk, Lp(a) measurement, risk factor management and existing therapeutic options.
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Affiliation(s)
- Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Samia Mora
- Center for Lipid Metabolomics, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian A Ference
- Centre for Naturally Randomized Trials, University of Cambridge, Cambridge, UK
| | - Benoit J Arsenault
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, and Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | - Lars Berglund
- Department of Internal Medicine, School of Medicine, University of California-Davis, Davis, CA, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Marlys L Koschinsky
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Gilles Lambert
- Inserm, UMR 1188 Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, 97400, Saint-Pierre, La Réunion, France
| | - François Mach
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Catherine J McNeal
- Division of Cardiology, Department of Internal Medicine Baylor Scott & White Health, 2301 S. 31st St., Temple, TX, 76508, USA
| | - Patrick M Moriarty
- Atherosclerosis and Lipoprotein-apheresis Clinic, University of Kansas Medical Center, Kansas City, KS, USA
| | - Pradeep Natarajan
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; and Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus G Parhofer
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians University Klinikum, Munich, Germany
| | - Salim S Virani
- The Aga Khan University, Karachi, Pakistan; Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA
| | - Arnold von Eckardstein
- Institute of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerald F Watts
- Medical School, University of Western Australia, and Department of Cardiology, Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia
| | - Jane K Stock
- European Atherosclerosis Society, Mässans Gata 10, SE-412 51, Gothenburg, Sweden
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Lale S Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, and IRCCS MultiMedica, Milan, Italy
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31
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Ray KK, Haq I, Bilitou A, Manu MC, Burden A, Aguiar C, Arca M, Connolly DL, Eriksson M, Ferrières J, Laufs U, Mostaza JM, Nanchen D, Rietzschel E, Strandberg T, Toplak H, Visseren FL, Catapano AL. Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI study. Lancet Reg Health Eur 2023; 29:100624. [PMID: 37090089 PMCID: PMC10119631 DOI: 10.1016/j.lanepe.2023.100624] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Background European data pre-2019 suggest statin monotherapy is the most common approach to lipid management for preventing cardiovascular (CV) events, resulting in only one-fifth of high- and very high-risk patients achieving the 2019 ESC/EAS recommended low-density lipoprotein cholesterol (LDL-C) goals. Whether the treatment landscape has evolved, or gaps persist remains of interest. Methods Baseline data are presented from SANTORINI, an observational, prospective study that documents the use of lipid-lowering therapies (LLTs) in patients ≥18 years at high or very high CV risk between 2020 and 2021 across primary and secondary care settings in 14 European countries. Findings Of 9602 enrolled patients, 9044 with complete data were included (mean age: 65.3 ± 10.9 years; 72.6% male). Physicians reported using 2019 ESC/EAS guidelines as a basis for CV risk classification in 52.0% (4706/9044) of patients (overall: high risk 29.2%; very high risk 70.8%). However, centrally re-assessed CV risk based on 2019 ESC/EAS guidelines suggested 6.5% (308/4706) and 91.0% (4284/4706) were high- and very high-risk patients, respectively. Overall, 21.8% of patients had no documented LLTs, 54.2% were receiving monotherapy and 24.0% combination LLT. Median (interquartile range [IQR]) LDL-C was 2.1 (1.6, 3.0) mmol/L (82 [60, 117] mg/dL), with 20.1% of patients achieving risk-based LDL-C goals as per the 2019 ESC/EAS guidelines. Interpretation At the time of study enrolment, 80% of high- and very high-risk patients failed to achieve 2019 ESC/EAS guidelines LDL-C goals. Contributory factors may include CV risk underestimation and underutilization of combination therapies. Further efforts are needed to achieve current guideline-recommended LDL-C goals. Trial registration ClinicalTrials.gov Identifier: NCT04271280. Funding This study is funded by Daiichi Sankyo Europe GmbH, Munich, Germany.
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Affiliation(s)
- Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention, ICTU-Global, Imperial College London, London, UK
- Corresponding author. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London SW7 2AZ, UK.
| | - Inaam Haq
- Medical Affairs, Daiichi Sankyo Europe, Munich, Germany
| | - Aikaterini Bilitou
- Health Economics and Outcomes Research, Daiichi Sankyo Europe, Munich, Germany
| | | | - Annie Burden
- Biostatistics and Data Management, Daiichi Sankyo Europe, Munich, Germany
| | - Carlos Aguiar
- Advanced Heart Failure and Heart Transplantation Unit, Heart Institute, Carnaxide, Portugal
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza Università di Roma, Rome, Italy
| | - Derek L. Connolly
- Sandwell and West Birmingham NHS Trust, Birmingham City Hospital, Institute of Cardiovascular Sciences, University of Birmingham, and Aston Medical School, Birmingham, UK
| | - Mats Eriksson
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jean Ferrières
- Department of Cardiology and INSERM UMR 1295, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Jose M. Mostaza
- Department of Internal Medicine, La Paz-Carlos III Hospital, Madrid, Spain
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Ernst Rietzschel
- Department of Internal Medicine and Pediatrics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Timo Strandberg
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Hermann Toplak
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Frank L.J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alberico L. Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Multimedica IRCCS, Milan, Italy
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Olmastroni E, Gazzotti M, Averna M, Arca M, Tarugi P, Calandra S, Bertolini S, Catapano AL, Casula M. Lipoprotein(a) Genotype Influences the Clinical Diagnosis of Familial Hypercholesterolemia. J Am Heart Assoc 2023; 12:e029223. [PMID: 37183858 DOI: 10.1161/jaha.122.029223] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Background Evidence suggests that LPA risk genotypes are a possible contributor to the clinical diagnosis of familial hypercholesterolemia (FH). This study aimed at determining the prevalence of LPA risk variants in adult individuals with FH enrolled in the Italian LIPIGEN (Lipid Transport Disorders Italian Genetic Network) study, with (FH/M+) or without (FH/M-) a causative genetic variant. Methods and Results An lp(a) [lipoprotein(a)] genetic score was calculated by summing the number risk-increasing alleles inherited at rs3798220 and rs10455872 variants. Overall, in the 4.6% of 1695 patients with clinically diagnosed FH, the phenotype was not explained by a monogenic or polygenic cause but by genotype associated with high lp(a) levels. Among 765 subjects with FH/M- and 930 subjects with FH/M+, 133 (17.4%) and 95 (10.2%) were characterized by 1 copy of either rs10455872 or rs3798220 or 2 copies of either rs10455872 or rs3798220 (lp(a) score ≥1). Subjects with FH/M- also had lower mean levels of pretreatment low-density lipoprotein cholesterol than individuals with FH/M+ (t test for difference in means between FH/M- and FH/M+ groups <0.0001); however, subjects with FH/M- and lp(a) score ≥1 had higher mean (SD) pretreatment low-density lipoprotein cholesterol levels (223.47 [50.40] mg/dL) compared with subjects with FH/M- and lp(a) score=0 (219.38 [54.54] mg/dL for), although not statistically significant. The adjustment of low-density lipoprotein cholesterol levels based on lp(a) concentration reduced from 68% to 42% the proportion of subjects with low-density lipoprotein cholesterol level ≥190 mg/dL (or from 68% to 50%, considering a more conservative formula). Conclusions Our study supports the importance of measuring lp(a) to perform the diagnosis of FH appropriately and to exclude that the observed phenotype is driven by elevated levels of lp(a) before performing the genetic test for FH.
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Affiliation(s)
- Elena Olmastroni
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP) University of Milan Italy
| | | | - Maurizio Averna
- Department ProMISE (Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties) University of Palermo Italy
| | - Marcello Arca
- Department of Translational and Precision Medicine Sapienza University of Rome Italy
| | - Patrizia Tarugi
- Department of Life Sciences University of Modena and Reggio Emilia Italy
| | - Sebastiano Calandra
- Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio Emilia Italy
| | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP) University of Milan Italy
- IRCCS MultiMedica Sesto San Giovanni (MI) Italy
| | - Manuela Casula
- Department of Pharmacological and Biomolecular Sciences, Epidemiology and Preventive Pharmacology Service (SEFAP) University of Milan Italy
- IRCCS MultiMedica Sesto San Giovanni (MI) Italy
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Cuchel M, Raal FJ, Hegele RA, Al-Rasadi K, Arca M, Averna M, Bruckert E, Freiberger T, Gaudet D, Harada-Shiba M, Hudgins LC, Kayikcioglu M, Masana L, Parhofer KG, Roeters van Lennep JE, Santos RD, Stroes ESG, Watts GF, Wiegman A, Stock JK, Tokgözoğlu LS, Catapano AL, Ray KK. 2023 Update on European Atherosclerosis Society Consensus Statement on Homozygous Familial Hypercholesterolaemia: new treatments and clinical guidance. Eur Heart J 2023:7148157. [PMID: 37130090 DOI: 10.1093/eurheartj/ehad197] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/22/2022] [Accepted: 03/16/2023] [Indexed: 05/03/2023] Open
Abstract
This 2023 statement updates clinical guidance for homozygous familial hypercholesterolaemia (HoFH), explains the genetic complexity, and provides pragmatic recommendations to address inequities in HoFH care worldwide. Key strengths include updated criteria for the clinical diagnosis of HoFH and the recommendation to prioritize phenotypic features over genotype. Thus, a low-density lipoprotein cholesterol (LDL-C) >10 mmol/L (>400 mg/dL) is suggestive of HoFH and warrants further evaluation. The statement also provides state-of-the art discussion and guidance to clinicians for interpreting the results of genetic testing and for family planning and pregnancy. Therapeutic decisions are based on the LDL-C level. Combination LDL-C-lowering therapy-both pharmacologic intervention and lipoprotein apheresis (LA)-is foundational. Addition of novel, efficacious therapies (i.e. inhibitors of proprotein convertase subtilisin/kexin type 9, followed by evinacumab and/or lomitapide) offers potential to attain LDL-C goal or reduce the need for LA. To improve HoFH care around the world, the statement recommends the creation of national screening programmes, education to improve awareness, and management guidelines that account for the local realities of care, including access to specialist centres, treatments, and cost. This updated statement provides guidance that is crucial to early diagnosis, better care, and improved cardiovascular health for patients with HoFH worldwide.
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Affiliation(s)
- Marina Cuchel
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 9017 Maloney Building, 3600 Spruce Street, Philadelphia, PA 19104, USA
| | - Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand Parktown, Johannesburg, South Africa
| | - Robert A Hegele
- Department of Medicine and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Khalid Al-Rasadi
- Department of Biochemistry, College of Medicine & Health Sciences, Medical Research Center, Sultan Qaboos University, Muscat, Oman
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maurizio Averna
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy
- Istituto di Biofisica, Consiglio Nazionale delle Ricerche, Genova, Italy
| | - Eric Bruckert
- Pitié-Salpêtrière Hospital and Sorbonne University, Cardio metabolic Institute, Paris, France
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Daniel Gaudet
- Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Center, Department of Medicine, Université de Montréal, ECOGENE, Clinical and Translational Research Center, and Lipid Clinic, Chicoutimi Hospital, Chicoutimi, Québec, Canada
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Lisa C Hudgins
- Rogosin Institute, Weill Cornell Medical College, New York, NY, USA
| | - Meral Kayikcioglu
- Department of Cardiology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Luis Masana
- Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV CIBERDEM, Reus, Spain
| | - Klaus G Parhofer
- Medizinische Klinik und Poliklinik IV, Ludwigs-Maximilians University Klinikum, Munich, Germany
| | | | - Raul D Santos
- Lipid Clinic, Heart Institute (InCor), University of São Paulo Medical School Hospital, São Paulo, Brazil
- Academic Research Organization Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerald F Watts
- Medical School, University of Western Australia, and Department of Cardiology, Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia
| | - Albert Wiegman
- Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jane K Stock
- European Atherosclerosis Society, Gothenburg, Sweden
| | - Lale S Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alberico L Catapano
- IRCCS MultiMedica, and Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Mattavelli E, Olmastroni E, Casula M, Grigore L, Pellegatta F, Baragetti A, Magni P, Catapano AL. Adherence to Mediterranean Diet: A Population-Based Longitudinal Cohort Study. Nutrients 2023; 15:nu15081844. [PMID: 37111063 PMCID: PMC10145158 DOI: 10.3390/nu15081844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Adherence to the Mediterranean diet (MedDiet) is recommended for cardiovascular disease prevention. However, recent epidemiological studies report a shift toward lower adherence to MedDiet. We have conducted a prospective cohort study to evaluate changes in individual determinants of MedDiet adherence over time. Clinical information and MedDiet adherence score (MEDAS) were collected in 711 subjects (mean age 68 ± 10 years; 42% males), enrolled in the PLIC study (Progression of Intimal Atherosclerotic Lesions in Carotid arteries), during two visits conducted, on average, 4.5 years apart. MEDAS score worsening and improvements (absolute change, ΔMEDAS) and the variation in the proportion of subjects reporting to meet each MEDAS criteria were assessed. Overall, 34% of the subjects improved their MedDiet adherence (ΔMEDAS: +1.87 ± 1.13), by consuming more olive oil, legumes and fish and use of dishes seasoned with sofrito and 48% subjects worsened their MedDiet adherence (ΔMEDAS: -2.02 ± 1.14) by consuming less fruit, legumes, fish and nuts, with higher rates of worsening in women and subjects aged 50-65 years. Subjects who improved the score were more obese, had higher plasma glucose levels, and metabolic syndrome at the basal visit. In summary, we report an overall decrease in MedDiet adherence, evaluated during a timeframe heavily affected by the COVID-19 pandemic, underlining the need for better dietary interventions.
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Affiliation(s)
- Elisa Mattavelli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milan, Italy
- MultiMedica IRCCS, Sesto S. Giovanni, 20099 Milan, Italy
| | - Elena Olmastroni
- MultiMedica IRCCS, Sesto S. Giovanni, 20099 Milan, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milan, Italy
| | - Manuela Casula
- MultiMedica IRCCS, Sesto S. Giovanni, 20099 Milan, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milan, Italy
| | | | | | - Andrea Baragetti
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milan, Italy
- MultiMedica IRCCS, Sesto S. Giovanni, 20099 Milan, Italy
| | - Paolo Magni
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20133 Milan, Italy
- MultiMedica IRCCS, Sesto S. Giovanni, 20099 Milan, Italy
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Pirillo A, Catapano AL. Remnant cholesterol: A reliable prognostic marker? Eur J Prev Cardiol 2023:7112088. [PMID: 37037665 DOI: 10.1093/eurjpc/zwad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
- IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
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Stroes ESG, Bays HE, Banach M, Catapano AL, Duell PB, Laufs U, Mancini GBJ, Ray KK, Sasiela WJ, Zhang Y, Gotto AM. Bempedoic acid lowers high-sensitivity C-reactive protein and low-density lipoprotein cholesterol: Analysis of pooled data from four phase 3 clinical trials. Atherosclerosis 2023; 373:1-9. [PMID: 37075696 DOI: 10.1016/j.atherosclerosis.2023.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND AND AIMS High-sensitivity C-reactive protein (hsCRP), a marker for atherosclerotic cardiovascular disease risk, is reduced by bempedoic acid. We assessed the relationship between changes in low-density lipoprotein cholesterol (LDL-C) and hsCRP in relation to baseline statin use. METHODS Pooled data from four phase 3 trials (patients on maximally tolerated statins [Pool 1] and patients receiving no or low-dose statins [Pool 2]) were used to determine the proportion of patients with baseline hsCRP ≥2 mg/L who achieved hsCRP <2 mg/L at week 12. The percentage of patients who achieved hsCRP <2 mg/L and guideline-recommended LDL-C (Pool 1, <70 mg/dL; Pool 2, <100 mg/dL) was determined for patients on statins in Pool 1 and those not on statins in Pool 2, as was the correlation between percent changes in hsCRP and LDL-C. RESULTS Overall, 38.7% in Pool 1 and 40.7% in Pool 2 with baseline hsCRP ≥2 mg/L achieved hsCRP <2 mg/L with bempedoic acid, with little effect from background statin. Among patients taking a statin in Pool 1 or not taking a statin in Pool 2, 68.6% and 62.4% achieved hsCRP <2 mg/L. Both hsCRP <2 mg/L and United States guideline-recommended LDL-C were achieved more often with bempedoic acid vs. placebo (20.8% vs. 4.3%, respectively, in Pool 1 and 32.0% vs. 5.3%, in Pool 2). Changes in hsCRP and LDL-C were only weakly correlated (Pool 1, r = 0.112; Pool 2, r = 0.173). CONCLUSIONS Bempedoic acid significantly reduced hsCRP irrespective of background statin therapy; the effect was largely independent of LDL-C lowering.
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Affiliation(s)
- Erik S G Stroes
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
| | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Łódź and Polish Mother's Memorial Hospital Research Institute (PMMHRI), Łódź, Poland
| | | | - P Barton Duell
- Knight Cardiovascular Institute, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - G B John Mancini
- Division of Cardiology, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Yang Zhang
- Esperion Therapeutics, Inc, Ann Arbor, MI, USA
| | - Antonio M Gotto
- Houston Methodist Research Institute, Houston, TX, USA; Weill Cornell Medicine, New York, NY, USA
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AlRahimi J, AlSaif S, Alasnag M, Awan Z, Almutairi F, Al Mudaiheem H, Gencer B, Catapano AL, Mach F, Tash A. 2022 Saudi Guidelines for the Management of Dyslipidemia. Heart Views 2023; 24:67-92. [PMID: 37305331 PMCID: PMC10249637 DOI: 10.4103/heartviews.heartviews_102_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/16/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Jamilah AlRahimi
- Department of Cardiology, King Faisal Cardiac Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Dammam, Saudi Arabia
| | - Shukri AlSaif
- Department of Cardiology, Saud AlBabtain Cardiac Center, Dammam, Saudi Arabia
| | - Mirvat Alasnag
- Department of Cardiology, Catheterization Laboratory, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Zuhier Awan
- Medicine, Biochemistry and Molecular Genetics, Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fawaz Almutairi
- Department of Cardiology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hajer Al Mudaiheem
- Therapeutic Affairs Department, Ministry of Health, Riyadh, Saudi Arabia
| | - Baris Gencer
- Department of Cardiology, Geneva University Hospital, Geneva
- Institute of Primary Healthcare (BIHAM), Bern University, Bern, Switzerland
| | - Alberico L. Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - François Mach
- Department of Cardiology, Geneva University Hospital, Geneva
| | - Adel Tash
- Cardiac Services Development, Ministry of Health, Riyadh, Saudi Arabia
- National Heart Center, Saudi Health Council, Riyadh, Saudi Arabia
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Catapano AL, Tokgözoğlu L, Banach M, Gazzotti M, Olmastroni E, Casula M, Ray KK. Evaluation of lipoprotein(a) in the prevention and management of atherosclerotic cardiovascular disease: A survey among the Lipid Clinics Network. Atherosclerosis 2023; 370:5-11. [PMID: 36894469 DOI: 10.1016/j.atherosclerosis.2023.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND AIMS The European Atherosclerosis Society (EAS) Lipid Clinics Network promoted a survey in order to identify and understand how and when lipoprotein(a) [Lp(a)] is tested and clinically evaluated in lipid clinics throughout Europe, and the challenges that may prevent evaluation from being carried out. METHODS This survey was divided into three areas of inquiry: background and clinical setting information of clinicians, questions for doctors who claimed not to measure Lp(a), in order to understand what were the reasons for not ordering the test, and questions for doctors who measure Lp(a), to investigate the use of this value in the management of patients. RESULTS A total of 151 centres clinicians filled in the survey, out of 226 invited. The proportion of clinicians who declare to routinely measure Lp(a) in clinical practice was 75.5%. The most common reasons for not ordering the Lp(a) test were the lack of reimbursement or of treatment options, the non-availability of Lp(a) test, and the high cost of performing the laboratory test. The availability of therapies targeting this lipoprotein would result in a greater propensity of clinicians to start testing Lp(a). Among those who declared to routinely measure Lp(a), the Lp(a) measurement is mostly requested to further stratify patients' cardiovascular risk, and half of them recognized 50 mg/dL (approx. 110 nmol/L) as the threshold for increased cardiovascular risk due. CONCLUSIONS These results warrant for a great deal of effort from scientific societies to address the barriers that limit the routine use of the measurement of Lp(a) concentration and to recognise the importance of Lp(a) as a risk factor.
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Affiliation(s)
- Alberico L Catapano
- IRCCS MultiMedica, Sesto San Giovanni, MI, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Gora, Poland
| | | | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Manuela Casula
- IRCCS MultiMedica, Sesto San Giovanni, MI, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK
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Nurmohamed NS, Kraaijenhof JM, Mayr M, Nicholls SJ, Koenig W, Catapano AL, Stroes ESG. Proteomics and lipidomics in atherosclerotic cardiovascular disease risk prediction. Eur Heart J 2023; 44:1594-1607. [PMID: 36988179 PMCID: PMC10163980 DOI: 10.1093/eurheartj/ehad161] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/04/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
Given the limited accuracy of clinically used risk scores such as the Systematic COronary Risk Evaluation 2 system and the Second Manifestations of ARTerial disease 2 risk scores, novel risk algorithms determining an individual's susceptibility of future incident or recurrent atherosclerotic cardiovascular disease (ASCVD) risk are urgently needed. Due to major improvements in assay techniques, multimarker proteomic and lipidomic panels hold the promise to be reliably assessed in a high-throughput routine. Novel machine learning-based approaches have facilitated the use of this high-dimensional data resulting from these analyses for ASCVD risk prediction. More than a dozen of large-scale retrospective studies using different sets of biomarkers and different statistical methods have consistently demonstrated the additive prognostic value of these panels over traditionally used clinical risk scores. Prospective studies are needed to determine the clinical utility of a biomarker panel in clinical ASCVD risk stratification. When combined with the genetic predisposition captured with polygenic risk scores and the actual ASCVD phenotype observed with coronary artery imaging, proteomics and lipidomics can advance understanding of the complex multifactorial causes underlying an individual's ASCVD risk.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jordan M Kraaijenhof
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Manuel Mayr
- School of Cardiovascular and Metabolic Medicine & Science, King's College London, Strand, London WC2R 2LS, UK
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel, 18-201090 Vienna, Austria
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, 631 Blackburn Rd, Clayton, VIC 3168, Australia
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstraße 36, 80636 München, Germany
- German Centre for Cardiovascular Research (DZHK e.V.), partner site Munich Heart Alliance, Pettenkoferstr. 8a & 9, 80336 Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy
- IRCCS Multimedica, Via Milanese, 300, 20099 Sesto San Giovanni (MI), Italy
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Olmastroni E, Galimberti F, Tragni E, Catapano AL, Casula M. Impact of COVID-19 Pandemic on Adherence to Chronic Therapies: A Systematic Review. Int J Environ Res Public Health 2023; 20:3825. [PMID: 36900831 PMCID: PMC10001666 DOI: 10.3390/ijerph20053825] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
The spread of the coronavirus disease 2019 (COVID-19) pandemic caused a sudden and significant disruption in healthcare services, especially for patients suffering from chronic diseases. We aimed at evaluating the impact of the pandemic on adherence to chronic therapies through a systematic review of available studies. PubMed, EMBASE, and Web of Science were searched since inception to June 2022. Inclusion criteria were: (1) observational studies or surveys; (2) studies on patients with chronic diseases; (3) reporting the effects of COVID-19 pandemic on adherence to chronic pharmacological treatment, as a comparison of adherence during the pandemic period vs. pre-pandemic period (primary outcome) or as rate of treatment discontinuation/delay specifically due to factors linked to COVID-19 (secondary outcome). Findings from 12 (primary outcome) and 24 (secondary outcome) studies showed that many chronic treatments were interrupted or affected by a reduced adherence in the pandemic period, and that fear of infection, difficulty in reaching physicians or healthcare facilities, and unavailability of medication were often reported as reasons for discontinuation or modification of chronic therapies. For other therapies where the patient was not required to attend the clinic, continuity of treatment was sometimes ensured through the use of telemedicine, and the adherence was guaranteed with drug stockpiling. While the effects of the possible worsening of chronic disease management need to be monitored over time, positive strategies should be acknowledged, such as the implementation of e-health tools and the expanded role of community pharmacists, and may play an important role in preserving continuity of care for people with chronic diseases.
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Affiliation(s)
- Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | | | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Alberico L. Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
- IRCCS MultiMedica, 20099 Sesto San Giovanni (MI), Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
- IRCCS MultiMedica, 20099 Sesto San Giovanni (MI), Italy
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Catapano AL, De Caterina R, Jukema JW, Klempfner R, Landmesser U, Schiele F, Sionis A. Addressing current challenges in optimization of lipid management following an ACS event: Outcomes of the ACS EuroPath III initiative. Clin Cardiol 2023; 46:407-415. [PMID: 36799113 PMCID: PMC10106658 DOI: 10.1002/clc.23988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Low-density lipoprotein cholesterol (LDL-C) lowering is key to reduce atherosclerotic disease progression and recurrent events for patients after acute coronary syndrome (ACS). However, LDL-C management for post-ACS patients remains challenging in clinical practice. HYPOTHESIS The ACS EuroPath III project was designed to optimize LDL-C management in post-ACS patients by promoting guideline implementation and translating existing evidence into effective actions. METHODS Three surveys targeting cardiologists (n = 555), general practitioners (GPs; n = 445), and patients (n = 662) were conducted in Europe, with the aim of capturing information on patient characteristics and treatment during acute phase, discharge and follow-up. GPs' and patients' opinions on key treatment aspects were also collected. Based on survey results, international experts and clinicians identified areas of improvement and generated prototype solutions. Participants voted to select the most feasible and replicable proposals for co-development and implementation. RESULTS Five key areas of improvement were identified: (1) inappropriate treatment prescribed at discharge; (2) lack of lipid guidance in the discharge letter; (3) inadequate lipid-lowering therapy (LLT) optimization; (4) gaps in guideline knowledge and lack of referral practices for GPs; (5) patients' concerns about lipid management. Proposed solutions for these focus areas included development of a treatment algorithm for the acute phase, a standardized GP discharge letter, an assessment tool for LLT efficacy at follow-up, an education plan for GPs/patients and a patient engagement discharge kit. The standardized GP discharge letter and treatment algorithm have been selected as the highest priority solutions for development. CONCLUSION These initiatives have the potential to improve adherence to guidelines and patient management after ACS.
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Affiliation(s)
- Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Raffaele De Caterina
- Division of Cardiovascular, Department of Cardiothoracic and Vascular, Pisa University Hospital, University of Pisa, Pisa, Azienda Ospedaliero-Universitaria Pisana, Pisa, and Fondazione Villaserena per la Ricerca, Città Sant'Angelo, Pescara, Italy
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Robert Klempfner
- Cardiac Rehabilitation Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - François Schiele
- Department of Cardiology, University of Burgundy Franche-Comte, University Hospital Jean Minjoz, Besançon, France
| | - Alessandro Sionis
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Poli A, Catapano AL, Corsini A, Manzato E, Werba JP, Catena G, Cetin I, Cicero AFG, Cignarella A, Colivicchi F, Consoli A, Landi F, Lucarelli M, Manfellotto D, Marrocco W, Parretti D, Perrone Filardi P, Pirillo A, Sesti G, Volpe M, Marangoni F. LDL-cholesterol control in the primary prevention of cardiovascular diseases: An expert opinion for clinicians and health professionals. Nutr Metab Cardiovasc Dis 2023; 33:245-257. [PMID: 36566123 DOI: 10.1016/j.numecd.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS Although adequate clinical management of patients with hypercholesterolemia without a history of known cardiovascular disease is essential for prevention, these subjects are often disregarded. Furthermore, the scientific literature on primary cardiovascular prevention is not as rich as that on secondary prevention; finally, physicians often lack adequate tools for the effective management of subjects in primary prevention and have to face some unsolved relevant issues. This document aims to discuss and review the evidence available on this topic and provide practical guidance. DATA SYNTHESIS Available algorithms and risk charts represent the main tool for the assessment of cardiovascular risk in patients in primary prevention. The accuracy of such an estimate can be substantially improved considering the potential contribution of some additional risk factors (C-reactive protein, lipoprotein(a), family history of cardiovascular disease) and conditions (environmental pollution, sleep quality, socioeconomic status, educational level) whose impact on the cardiovascular risk has been better understood in recent years. The availability of non-invasive procedures to evaluate subclinical atherosclerosis may help to identify subjects needing an earlier intervention. Unveiling the presence of these conditions will improve cardiovascular risk estimation, granting a more appropriate intervention. CONCLUSIONS The accurate assessment of cardiovascular risk in subjects in primary prevention with the use of algorithms and risk charts together with the evaluation of additional factors will allow physicians to approach each patient with personalized strategies, which should translate into an increased adherence to therapy and, as a consequence, a reduced cardiovascular risk.
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Affiliation(s)
- Andrea Poli
- NFI - Nutrition Foundation of Italy, Milan, Italy.
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Enzo Manzato
- Department of Medicine, University of Padova, Padova, Italy; SISA - Italian Society for the Study of Atherosclerosis, Italy
| | - José Pablo Werba
- Unit of Atherosclerosis Prevention, Monzino Cardiology Center, IRCCS, Milan, Italy
| | | | - Irene Cetin
- Department of Woman, Mother and Neonate Hospital Buzzi, Milan, University of Milan, Italy; SIGO - Italian Society of Gynecology and Obstetrics, Italy
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, IRCCS AOU di Bologna, Bologna, Italy; SINut - Italian Nutraceutical Society, Italy
| | - Andrea Cignarella
- Department of Medicine, University of Padova, Padova, Italy; Italian Research Center for Gender Health and Medicine, Italy
| | - Furio Colivicchi
- Division of Clinical Cardiology, San Filippo Neri Hospital, Rome, Italy; ANMCO - Italian National Association of Hospital Cardiologists, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti, Italy; SID - Italian Society of Diabetology, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy; SIGG - Italian Society of Gerontology and Geriatrics, Italy
| | - Maurizio Lucarelli
- SNaMID - National Society of Medical Education in General Practice, Italy
| | - Dario Manfellotto
- Department of Internal Medicine, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; FADOI - Federation of Associations of Hospital Internists, Italy
| | - Walter Marrocco
- SIMPeSV and FIMMG - Italian Society of Preventive and Lifestyle Medicine and Italian Federation of General Practitioners, Italy
| | | | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; SIC - Italian Society of Cardiology, Italy
| | - Angela Pirillo
- Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy; Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy; SIMI - Italian Society of Internal Medicine, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy; SIPREC - Italian Society for Cardiovascular Prevention, Italy
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Arca M, Solini A, Calabrò P, Gambacurta R, Jarkko S, Ray KK, Catapano AL. 981 CARDIOVASCULAR RISK PROFILE ASSESSMENT AS REPORTED BY INVESTIGATORS AND BY ESC/EAS CRITERIA: EVIDENCE FROM SANTORINI STUDY (THE ITALIAN REALITY)). Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
The SANTORINI study is an observational study that enrolled 9606 adult patients at high or very high cardiovascular (CV) risk from 14 European countries, aiming at providing information on the management of hypercholesterolemia, in light of the new European guidelines published in 2019. The scope of the present analysis was to assess the cardiovascular risk in patients and to investigate whether the 2019 ESC/EAS guidelines for the management of dyslipidaemia are being implemented in clinical practice.
Italy participated in the study with 1977 patients, of which, according to the investigators, 1531 (77.4%) were classified as very high CV risk and 446 (22.6%) as high CV risk. In 72.8% of the cases, the cardiovascular risk classification according to the most recent European ESC/EAS guidelines was applied, in 22.81% it was based on clinical experience alone, and in the remaining 4.4% on national, regional or local guidelines. Following the investigator's risk classification according to guidelines, 1144 (79.5%) patients fell into the very high cardiovascular risk and 295 (20.5%) into the high cardiovascular risk. Considering all available data, the cardiovascular risk was re-evaluated according to ESC/EAS guidelines, with 1288 (89.51%) patients being allocated to the very high-risk class and 119 (8.3%) into the high-risk class; for 32 patients (2.2%) there was no evidence to support very high-risk classification. The discrepancy shown after reassessment of patients’ risk classes highlights an underestimation of patients’ cardiovascular risk in Italian clinical practice. In fact, reclassifying the risk of the enrolled population according to guidelines shows that the percent of patients who were originally classified as very high risk rose from 79.5% to 89.5%, and those at high risk decreased from 20.5% to 8.3%. It is therefore concluded that although the investigating clinician in most cases follows the guidelines for the management of dyslipidaemia, these are not correctly applied, underestimating the cardiovascular risk of patients, especially when they belong to the highest risk classes. Considering the therapeutic goals recommended by the most recent European guidelines (LDL-C <55 mg/dL or <70 mg/dL respectively in very high or high-risk patients), only 20.33% of the overall study population achieved such goals (19.92% of very high-risk patients and 21.75% of high-risk patients). Regarding the use of hypolipidemic therapies, although most patients are at very high CV risk, overall, only 33% received combination therapy, 32.6% have no documented hypolipidemic therapy and 34.4% monotherapy. Three years after the 2019 update of the dyslipidemia guidelines, underestimation of cardiovascular risk and low utilisation of hypolipidemic combination therapies, even in patients at very high cardiovascular risk, remain important barriers to guideline implementation. This means that about 80% of patients are far from the recommended therapeutic goals for their risk category and additional measures are requested to improve the goals achievement.
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Affiliation(s)
- Marcello Arca
- Department Of Translational And Precision Medicine, ’Sapienza’, University Of Rome_Rome_Italy
| | - Anna Solini
- University Of Pisa School Of Medicine_Pisa_Italy
| | - Paolo Calabrò
- Division Of Cardiology Of Sant’anna And San Sebastiano Hospital, University Of Campania ’Luigi Vanvitelli’_Caserta_Italy
| | | | | | - Kausik K Ray
- Imperial College London, Imperial Centre For Cardiovascular Disease Prevention_London_United Kingdomof Great Bretain & Northern Ireland
| | - Alberico L Catapano
- University Of Milan, Department Of Pharmacological And Biomolecular Sciences_Milan_Italy
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Cesaro A, Calabrò P, Arca M, Solini A, Gambacurta R, Soronen J, Diamand F, Catapano AL. 1075 USE OF LIPID-LOWERING COMBINATION THERAPIES IN SANTORINI STUDY: EVIDENCE FROM ITALIAN COHORT. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
The SANTORINI registry is an observational study that aims to evaluate the management of patients with high and very high cardiovascular (CV) risk in clinical practice, collecting data at enrolment and after 12 months. Italy participated in this study with 1531 patients at very high risk and 446 at high risk. The scope of the present analysis was to investigate low-density lipoprotein cholesterol (LDL-C) goal attainment in patients who do not qualify for PCSK9 inhibitors (PCSK9i) (according to Italian reimbursement regulations) in Italian cohort, with focus on patients in secondary prevention. The current indications for PCKS9i charged to the National Health System in Italy in secondary prevention, are for patients aged ≤ 80 years with LDL-c levels ≥ 70 mg/dl in at least three detections despite therapy for at least 6 months with high intensity statin at the highest tolerated dose and ezetimibe or after a single LDL-C detection for recent myocardial infarction or multiple cardiovascular events or with demonstrated intolerance to statins and/or ezetimibe. At enrolment, a total of 509 (33.2%) of 1531 patients at very-high risk had an LDL-C level of less than 70 mg/dl. Of them, about half do not reach the LDL-C target. In particular, 34.4% takes statin monotherapy, and 50.3% of them do not reach the target. Even patients taking high-intensity statins as monotherapy reach the target in only 47.9% of cases, leaving more than half of patients with LDL-C levels between 55 and 70 mg/dl. Regarding combination therapy, statin and ezetimibe, patients taking this combination account for 26.9%, of these those taking the combination of moderate-intensity statin and ezetimibe reach the target in 56.7% of cases while those taking high-intensity statins and ezetimibe reach the target in 51.4% of cases. Our findings show that there is a proportion of patients with LDL-C below 70 mg/dl who do not qualify for PCSK9i who are not at target for LDL-C levels despite maximal therapy with statins and ezetimibe.
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Affiliation(s)
- Arturo Cesaro
- Division Of Cardiology Sant’anna And San Sebastiano Hospital, University Of Campania ’Luigi Vanvitelli’_Caserta_Italy
| | - Paolo Calabrò
- Division Of Cardiology Sant’anna And San Sebastiano Hospital, University Of Campania ’Luigi Vanvitelli’_Caserta_Italy
| | - Marcello Arca
- Department Of Translational And Precision Medicine, ’Sapienza’, University Of Rome_Rome_Italy
| | - Anna Solini
- University Of Pisa School Of Medicine_Pisa_Italy
| | | | | | - Francoise Diamand
- Daiichi Sankyo Europe , Biostatistics And Data Management_Munich_Germany
| | - Alberico L Catapano
- Univeristy Of Milan, Department Of Pharmacological And Biomolecular Sciences_Milan_Italy
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Olmastroni E, Galimberti F, Catapano AL, Tragni E, Casula M. Beta-blockers in post-acute myocardial infarction patients: Drug prescription patterns from 2018 to Italy's first wave of the COVID-19 pandemic. Front Pharmacol 2022; 13:1040710. [PMID: 36569305 PMCID: PMC9768333 DOI: 10.3389/fphar.2022.1040710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Major guidelines recommend the initiation of a beta-blocker therapy after an acute myocardial infarction (AMI). We aimed to map the treatment pathway of beta-blockers for AMI survivors during the first wave of COVID-19 pandemic in Italy and to investigate predictors for treatment non-initiation. Methods: Healthcare utilization databases of Lombardy Region were investigated. Subjects aged ≥18 years who were hospitalised with AMI in the period February-March-April of 2018, 2019, and 2020 were included, and followed for 30 days from the discharge date, to investigate whether they presented a first prescription of beta-blockers. A multivariate logistic model was performed to evaluate the effect of several covariates on the probability of not receiving a post-AMI beta-blocker therapy. Results: The cohorts comprised 2259, 2383, and 1932 individuals who were hospitalised with AMI in the 3-month period in 2018, 2019, and 2020, respectively. Overall in 2020, about 58-60% of individuals with AMI received a prescription of beta-blockers within 1 month after the discharge. A continuous decreasing trend over time was observed. Men were 30% more likely to start the treatment than women, increasing age was associated with significant increasing probability of not receiving a post-infarction beta-blocker therapy, while having received an antihypertensive or lipid-lowering treatment, or having been hospitalized for heart failure prior to the AMI hospitalization reduced the likelihood of not being treated with beta-blockers. Conclusion: The initiation of beta-blocker treatment after AMI remains an under-prescribed practice, that does not seem to have been further affected by the first wave of the COVID-19 pandemic.
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Affiliation(s)
- Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy,*Correspondence: Elena Olmastroni,
| | | | - Alberico L. Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy,IRCCS MultiMedica, Sesto S. Giovanni, MI, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy,IRCCS MultiMedica, Sesto S. Giovanni, MI, Italy
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Farnier M, Santos RD, Cosin-Sales J, Ezhov MV, Liu J, Granados D, Santoni S, Khan I, Catapano AL. Projected impact of treatment intensification with statin, ezetimibe, and statin plus ezetimibe fixed-dose combination on MACE across six countries. Eur J Prev Cardiol 2022; 29:2264-2271. [PMID: 36134461 DOI: 10.1093/eurjpc/zwac214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/08/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
AIMS The 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) dyslipidaemia guidelines recommend achievement of low-density lipoprotein cholestrol (LDL-C) goals based on an individual's risk. We aimed to evaluate the impact of guideline adoption with statin, ezetimibe, and statin plus ezetimibe fixed-dose combination (FDC) on LDL-C goal achievement and incidence of major adverse cardiovascular events (MACE) across six countries. METHODS AND RESULTS A simulation model with a five-year horizon (2020-2024) was developed based on Institute for Health Metrics and Evaluation Global Burden of Disease Study database with a business-as-usual (BAU) scenario representing status quo, intervention scenario-1 representing treatment with statin and ezetimibe as separate agents, and intervention scenario-2 representing treatment with statin or statin plus ezetimibe FDC. MACE was defined as the composite of myocardial infarction, ischaemic stroke, and cardiovascular death. The mean population LDL-C was reduced from 4.25 mmol/L in the BAU scenario, to 3.65 mmol/L and 3.59 mmol/L in intervention scenarios-1 and -2, respectively. Compared with BAU, intervention scenarios-1 and-2 resulted in relative reduction of MACE by 5.4% and 6.4% representing ∼3.7 and 4.4 million MACE averted, respectively, across six countries over 5 years. The absolute benefit in terms of MACE averted was highest for China, whereas France had highest relative reduction in MACE with both intervention scenarios compared with BAU. CONCLUSION The 2019 ESC/EAS guideline-based treatment intensification with strategies based on statin, ezetimibe, and statin plus ezetimibe FDC is estimated to result in a substantial population-level benefit in terms of MACE averted compared with BAU.
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Affiliation(s)
- Michel Farnier
- Equipe PEC2, EA 7460, Service de Cardiologie, CHU Dijon Bourgogne, Université de Bourgogne Franche-Comté, 21000 Dijon, France
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of São Paulo Medical School Hospital, Av. Dr Enéas C. Aguiar 44, 05403-900 São Paulo, Brazil.,Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 05652- 900, São Paulo, Brazil
| | - Juan Cosin-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Calle San Clemente 12, 46015 Valencia, Spain.,Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU-Cardenal Herrena, 46113 Moncada, Valencia, Spain
| | - Marat V Ezhov
- Laboratory of Lipid Disorders, Department of Atherosclerosis, A.L. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, 11 Xizhimen South Street, 100044 Beijing, China
| | - Denis Granados
- Epidemiology and Benefit-Risk, Research and Development, Sanofi, 1, Avenue Pierre Brossolette, 91380 Chilly-Mazarin, France
| | - Serena Santoni
- Institute for Health Metrics and Evaluation, Population Health Building/Hans Rosling Center, 3980 15th Ave. NE, Seattle, WA 98195, USA
| | - Irfan Khan
- Medical Evidence Generation, General Medicines, Sanofi, Bridgewater, NJ 08807, USA
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and IRCCS Multimedica, Via Balzaretti 9, 20133, Milan, Italy
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Magnoni M, Andreini D, Pirillo A, Uboldi P, Latini R, Catapano AL, Maggioni AP, Norata GD. Predictive value of HDL function in patients with coronary artery disease: relationship with coronary plaque characteristics and clinical events. Ann Med 2022; 54:1036-1046. [PMID: 35438019 PMCID: PMC9090377 DOI: 10.1080/07853890.2022.2063374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND HDL is endowed with several metabolic, vascular, and immunoinflammatory protective functions. Among them, a key property is to promote reverse cholesterol transport from cells back to the liver. The aim of this study was to estimate the association of scavenger receptor class B type I (SR-BI)- and ATP binding cassette transporter A1 (ABCA1)-mediated cholesterol efflux (the two major routes for cholesterol efflux to HDL) with the presence, extent, and severity of coronary artery disease (CAD), vascular wall remodelling processes, coronary plaque characteristics, and the incidence of myocardial infarction in the different subgroups of patients from the CAPIRE study. METHODS Patients (n = 525) from the CAPIRE study were divided into two groups: low-risk factors (RF), with 0-1 RF (n = 263), and multiple-RF, with ≥2 RFs; within each group, subjects were classified as no-CAD or CAD based on the segment involvement score (SIS) evaluated by coronary computed tomography angiography (SIS = 0 and SIS > 5, respectively). SR-BI- and ABCA1-mediated cholesterol efflux were measured using the plasma of all patients. RESULTS SR-BI-mediated cholesterol efflux was significantly reduced in patients with CAD in both the low-RF and multiple-RF groups, whereas ABCA1-mediated cholesterol efflux was similar among all groups. In CAD patients, multivariable analysis showed that SR-BI-mediated cholesterol efflux <25th percentile predicted cardiovascular outcome (odds ratio 4.1; 95% CI: 1.3-13.7; p = .019), whereas ABCA-1-mediated cholesterol efflux and HDL-C levels significantly did not. Despite this finding, reduced SR-BI-mediated cholesterol efflux was not associated with changes in high-risk plaque features or changes in the prevalence of elevated total, non-calcified, and low-attenuation plaque volume. CONCLUSION SR-BI-mediated cholesterol efflux capacity is lower in patients with diffuse coronary atherosclerosis. In addition, a lower SR-BI-mediated cholesterol efflux capacity is associated with the worst clinical outcomes in patients with CAD, independently of atherosclerotic plaque features. Key MessagesIncreased cholesterol efflux capacity, an estimate of HDL function, is associated with a reduced CVD risk, regardless of HDL-C levels.HDL-C levels are significantly lower in patients with CAD.Lower SR-BI-mediated cholesterol efflux capacity is observed in patients with diffuse coronary atherosclerosis and is associated with the worst clinical outcomes in patients with CAD, independently of atherosclerotic plaque features.
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Affiliation(s)
| | - Daniele Andreini
- IRCCS, Centro Cardiologico Monzino, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Angela Pirillo
- Centro SISA per lo Studio dell'Aterosclerosi, Ospedale Bassini, Balsamo, Italy.,IRCSS Multimedica, Milan, Italy
| | - Patrizia Uboldi
- Department of Excellence of Pharmacological and Biomolecular Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Medicine, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Alberico L Catapano
- IRCSS Multimedica, Milan, Italy.,Department of Excellence of Pharmacological and Biomolecular Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Aldo P Maggioni
- Heart Care Foundation ANMCO Research Center, Florence, Italy
| | - Giuseppe D Norata
- Centro SISA per lo Studio dell'Aterosclerosi, Ospedale Bassini, Balsamo, Italy.,Department of Excellence of Pharmacological and Biomolecular Sciences, Università Degli Studi di Milano, Milan, Italy
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48
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von Eckardstein A, Nordestgaard BG, Remaley AT, Catapano AL. High-density lipoprotein revisited: biological functions and clinical relevance. Eur Heart J 2022; 44:1394-1407. [PMID: 36337032 PMCID: PMC10119031 DOI: 10.1093/eurheartj/ehac605] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Previous interest in high-density lipoproteins (HDLs) focused on their possible protective role in atherosclerotic cardiovascular disease (ASCVD). Evidence from genetic studies and randomized trials, however, questioned that the inverse association of HDL-cholesterol (HDL-C) is causal. This review aims to provide an update on the role of HDL in health and disease, also beyond ASCVD. Through evolution from invertebrates, HDLs are the principal lipoproteins, while apolipoprotein B-containing lipoproteins first developed in vertebrates. HDLs transport cholesterol and other lipids between different cells like a reusable ferry, but serve many other functions including communication with cells and the inactivation of biohazards like bacterial lipopolysaccharides. These functions are exerted by entire HDL particles or distinct proteins or lipids carried by HDL rather than by its cholesterol cargo measured as HDL-C. Neither does HDL-C measurement reflect the efficiency of reverse cholesterol transport. Recent studies indicate that functional measures of HDL, notably cholesterol efflux capacity, numbers of HDL particles, or distinct HDL proteins are better predictors of ASCVD events than HDL-C. Low HDL-C levels are related observationally, but also genetically, to increased risks of infectious diseases, death during sepsis, diabetes mellitus, and chronic kidney disease. Additional, but only observational, data indicate associations of low HDL-C with various autoimmune diseases, and cancers, as well as all-cause mortality. Conversely, extremely high HDL-C levels are associated with an increased risk of age-related macular degeneration (also genetically), infectious disease, and all-cause mortality. HDL encompasses dynamic multimolecular and multifunctional lipoproteins that likely emerged during evolution to serve several physiological roles and prevent or heal pathologies beyond ASCVD. For any clinical exploitation of HDL, the indirect marker HDL-C must be replaced by direct biomarkers reflecting the causal role of HDL in the respective disease.
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Affiliation(s)
- Arnold von Eckardstein
- Institute of Clinical Chemistry, University Hospital Zurich and University of Zurich , Zurich , Switzerland
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital , Herlev , Denmark
- The Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte Hospital , Herlev , Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health , Bethesda, MD , USA
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan , Milan , Italy
- IRCCS MultiMedica, Sesto S. Giovanni , Milan , Italy
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49
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Evans PC, Davidson SM, Wojta J, Bäck M, Bollini S, Brittan M, Catapano AL, Chaudhry B, Cluitmans M, Gnecchi M, Guzik TJ, Hoefer I, Madonna R, Monteiro JP, Morawietz H, Osto E, Padró T, Sluimer JC, Tocchetti CG, Van der Heiden K, Vilahur G, Waltenberger J, Weber C. From novel discovery tools and biomarkers to precision medicine-basic cardiovascular science highlights of 2021/22. Cardiovasc Res 2022; 118:2754-2767. [PMID: 35899362 PMCID: PMC9384606 DOI: 10.1093/cvr/cvac114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Here, we review the highlights of cardiovascular basic science published in 2021 and early 2022 on behalf of the European Society of Cardiology Council for Basic Cardiovascular Science. We begin with non-coding RNAs which have emerged as central regulators cardiovascular biology, and then discuss how technological developments in single-cell 'omics are providing new insights into cardiovascular development, inflammation, and disease. We also review recent discoveries on the biology of extracellular vesicles in driving either protective or pathogenic responses. The Nobel Prize in Physiology or Medicine 2021 recognized the importance of the molecular basis of mechanosensing and here we review breakthroughs in cardiovascular sensing of mechanical force. We also summarize discoveries in the field of atherosclerosis including the role of clonal haematopoiesis of indeterminate potential, and new mechanisms of crosstalk between hyperglycaemia, lipid mediators, and inflammation. The past 12 months also witnessed major advances in the field of cardiac arrhythmia including new mechanisms of fibrillation. We also focus on inducible pluripotent stem cell technology which has demonstrated disease causality for several genetic polymorphisms in long-QT syndrome and aortic valve disease, paving the way for personalized medicine approaches. Finally, the cardiovascular community has continued to better understand COVID-19 with significant advancement in our knowledge of cardiovascular tropism, molecular markers, the mechanism of vaccine-induced thrombotic complications and new anti-viral therapies that protect the cardiovascular system.
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Affiliation(s)
| | | | | | | | - Sveva Bollini
- Department of Experimental Medicine (DIMES), University of Genova, L.go R. Benzi 10, 16132 Genova, Italy
| | - Mairi Brittan
- Queens Medical Research Institute, BHF Centre for Cardiovascular Sciences, University of Edinburgh, Scotland
| | | | - Bill Chaudhry
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Matthijs Cluitmans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Philips Research, Eindhoven, Netherlands
| | - Massimiliano Gnecchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia Division of Cardiology, Unit of Translational Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Medicine, University of Cape Town, South Africa
| | - Tomasz J Guzik
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Imo Hoefer
- Central Diagnostic Laboratory, UMC Utrecht, the Netherlands
| | - Rosalinda Madonna
- Institute of Cardiology, Department of Surgical, Medical, Molecular and Critical Care Area, University of Pisa, Pisa, 56124 Italy
- Department of Internal Medicine, Cardiology Division, University of Texas Medical School, Houston, TX, USA
| | - João P Monteiro
- Queens Medical Research Institute, BHF Centre for Cardiovascular Sciences, University of Edinburgh, Scotland
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Elena Osto
- Institute of Clinical Chemistry and Department of Cardiology, Heart Center, University Hospital & University of Zurich, Switzerland
| | - Teresa Padró
- Cardiovascular Program-ICCC, IR-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, and CIBERCV-Instituto de Salud Carlos III, Barcelona, Spain
| | - Judith C Sluimer
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherland
- University/BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, 80131 Napoli, Italy
| | - Kim Van der Heiden
- Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gemma Vilahur
- Cardiovascular Program-ICCC, IR-Hospital Santa Creu i Sant Pau, IIB-Sant Pau, and CIBERCV-Instituto de Salud Carlos III, Barcelona, Spain
| | - Johannes Waltenberger
- Cardiovascular Medicine, Medical Faculty, University of Muenster, Muenster, Germany
- Diagnostic and Therapeutic Heart Center, Zurich, Switzerland
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50
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Catapano AL, Manu MC, Burden A, Ray KK. LDL-C goal achievement and lipid-lowering therapy in patients by atherosclerotic cardiovascular disease subtype: the SANTORINI study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In the 2019 ESC/EAS guidelines, documented ASCVD is a criterion for patients being categorised as at very high cardiovascular (CV) risk, and stringent low-density lipoprotein cholesterol (LDL-C) reductions of ≥50% plus a goal of <1.4 mmol/L are recommended. Intensive lipid lowering therapy (LLT) is therefore key to reducing the risk of future CV events.
Purpose
To describe patient characteristics, approaches to lipid management and LDL-C goal attainment at baseline in the subgroup of secondary prevention patients with a history of ASCVD enrolled in the SANTORINI study.
Methods
SANTORINI is a multinational observational study (NCT-04271280) evaluating the real-world use of LLT in adult patients with high- and very-high CV risk enrolled from primary and secondary care sites across Europe between March 2020 and February 2021. The ASCVD status of patients was defined based on medical records as either coronary (myocardial infarction; unstable angina; angina pectoris; coronary artery bypass graft surgery; percutaneous transluminal coronary angioplasty; coronary artery disease [CAD]; CAD unequivocal on imaging), cerebral (stroke; transient ischaemic attack; cerebrovascular disease; cerebrovascular disease unequivocal on imaging; carotid artery disease), peripheral/other (peripheral arterial disease [PAD]; lower extremity artery disease; PAD unequivocal on imaging; retinal vascular disease; abdominal aortic aneurysm; renovascular disease) or polyvascular (≥1 ASCVD).
Results
Of the 9044 patients included in the analysis 6954 (76.9%) had a history of ASCVD. Baseline demographics and patient characteristics by type of ASCVD are shown in Table 1. The majority of patients were male (76.9%) and mean (SD) age was 66.1 (10.4) years. Mean (SD) LDL-C level was 2.29 (1.13) mmol/L and a total of 20.7% of patients achieved CV risk-based LDL-C goals. Fewer patients with cerebral ASCVD attained LDL-C goals (15.0%). Despite being at very-high CV risk, 21.4% of all patients had no documented LLT (up to 28.5% for the cerebral ASCVD group). The majority of patients (49.2%) received statin monotherapy, particularly moderate (21.8%) and high-intensity statins (24.9%). The peripheral/other ASCVD and cerebral ASCVD groups recorded the highest use of monotherapy across subgroups (≥57.8%), whereas any other LLT alone was consistently low, including ezetimibe (≤2.5%) and PCSK9i (≤2.0%). Overall, only 25.6% of patients received combination therapy (17.5% statin + ezetimibe; 4.7% PCSK9i + statin and/or ezetimibe; 3.4% other).
Conclusion
The SANTORINI baseline analysis shows that the majority of patients with ASCVD do not achieve their LDL-C goals. The underutilisation of combination therapy in this very high CV risk population highlights the need to move beyond high-intensity statin monotherapy and rather focus on combination therapies which achieve more intensive LDL-C reductions, thus improving LDL-C goal attainment.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Europe GmbH, Munich, Germany
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Affiliation(s)
- A L Catapano
- University of Milan, Department of Pharmacological and Biomolecular Sciences , Milan , Italy
| | - M C Manu
- Daiichi Sankyo Europe, Medical Affairs , Munich , Germany
| | - A Burden
- Daiichi Sankyo Europe, Biostatistics and Data Management , Munich , Germany
| | - K K Ray
- Imperial College London, Imperial Centre for Cardiovascular Disease Prevention, ICTU-Global , London , United Kingdom
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