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Lan NSR, Bajaj A, Watts GF, Cuchel M. Recent advances in the management and implementation of care for familial hypercholesterolaemia. Pharmacol Res 2023; 194:106857. [PMID: 37460004 DOI: 10.1016/j.phrs.2023.106857] [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: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
Familial hypercholesterolaemia (FH) is a common autosomal semi-dominant and highly penetrant disorder of the low-density lipoprotein (LDL) receptor pathway, characterised by lifelong elevated levels of low-density lipoprotein cholesterol (LDL-C) and increased risk of atherosclerotic cardiovascular disease (ASCVD). However, many patients with FH are not diagnosed and do not attain recommended LDL-C goals despite maximally tolerated doses of potent statin and ezetimibe. Over the past decade, several cholesterol-lowering therapies such as those targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) or angiopoietin-like 3 (ANGPTL3) with monoclonal antibody or ribonucleic acid (RNA) approaches have been developed that promise to close the treatment gap. The availability of new therapies with complementary modes of action of lipid metabolism has enabled many patients with FH to attain guideline-recommended LDL-C goals. Emerging therapies for FH include liver-directed gene transfer of the LDLR, vaccines targeting key proteins involved in cholesterol metabolism, and CRISPR-based gene editing of PCSK9 and ANGPTL3, but further clinical trials are required. In this review, current and emerging treatment strategies for lowering LDL-C, and ASCVD risk-stratification, as well as implementation strategies for the care of patients with FH are reviewed.
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Affiliation(s)
- Nick S R Lan
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia; School of Medicine, The University of Western Australia, Perth, Australia.
| | - Archna Bajaj
- Division of Translational Medicine & Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gerald F Watts
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia; School of Medicine, The University of Western Australia, Perth, Australia
| | - Marina Cuchel
- Division of Translational Medicine & Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Moroi M, Nagayama D, Hara F, Saiki A, Shimizu K, Takahashi M, Sato N, Shiba T, Sugimoto H, Fujioka T, Chiba T, Nishizawa K, Usui S, Iwasaki Y, Tatsuno I, Sugi K, Yamasaki J, Yamamura S, Shirai K. Outcome of pitavastatin versus atorvastatin therapy in patients with hypercholesterolemia at high risk for atherosclerotic cardiovascular disease. Int J Cardiol 2020; 305:139-146. [PMID: 31987664 DOI: 10.1016/j.ijcard.2020.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 08/09/2019] [Revised: 12/24/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND There has been no report about outcome of pitavastatin versus atorvastatin therapy in high-risk patients with hypercholesterolemia. METHODS Hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases (n = 664, age = 65, male = 54%, diabetes = 76%, primary prevention = 74%) were randomized to receive pitavastatin 2 mg/day (n = 332) or atorvastatin 10 mg/day (n = 332). Follow-up period was 240 weeks. The primary end point was a composite of cardiovascular death, sudden death of unknown origin, nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, or heart failure requiring hospitalization. The secondary end point was a composite of the primary end point plus clinically indicated coronary revascularization for stable angina. RESULTS The mean low-density lipoprotein cholesterol (LDL-C) level at baseline was 149 mg/dL. The mean LDL-C levels at 1 year were 95 mg/dL in the pitavastatin group and 94 mg/dL in the atorvastatin group. There were no differences in LDL-C levels between both groups, however, pitavastatin significantly reduced the risk of the primary end point, compared to atorvastatin (pitavastatin = 2.9% and atorvastatin = 8.1%, HR, 0.366; 95% CI 0.170-0.787; P = 0.01 by multivariate Cox regression) as well as the risk of the secondary end point (pitavastatin = 4.5% and atorvastatin = 12.9%, HR = 0.350; 95%CI = 0.189-0.645, P = 0.001). The results for the primary and secondary end points were consistent across several prespecified subgroups. There were no differences in incidence of adverse events between the statins. CONCLUSION Pitavastatin therapy compared with atorvastatin more may prevent cardiovascular events in hypercholesterolemic patients with one or more risk factors for atherosclerotic diseases despite similar effects on LDL-C levels.
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Affiliation(s)
- Masao Moroi
- Division of Cardiovascular Medicine (Ohashi), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
| | | | - Fumihiko Hara
- Division of Cardiovascular Medicine (Omori), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Atsuhito Saiki
- Division of Diabetes, Endocrinology and Metabolism (Sakura), Department of Internal Medicine, Faculty of Medicine, Toho University, Chiba, Japan
| | - Kazuhiro Shimizu
- Division of Cardiovascular Medicine (Sakura), Department of Internal Medicine, Faculty of Medicine, Toho University, Chiba, Japan
| | - Mao Takahashi
- Division of Cardiovascular Medicine (Sakura), Department of Internal Medicine, Faculty of Medicine, Toho University, Chiba, Japan
| | - Naoko Sato
- Pharmaceutical Unit, Toho University Sakura Medical Center, Chiba, Japan
| | - Teruo Shiba
- Division of Diabetes and Metabolism (Ohashi), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hideki Sugimoto
- Division of Neurology (Ohashi), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Toshiki Fujioka
- Division of Neurology (Ohashi), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Tatsuo Chiba
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan
| | - Kosuke Nishizawa
- Department of Pharmacy, Toho University Omori Medical Center, Tokyo, Japan
| | - Shuki Usui
- Division of Diabetes, Endocrinology and Metabolism (Omori), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yasuo Iwasaki
- Division of Neurology (Omori), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Ichiro Tatsuno
- Division of Diabetes, Endocrinology and Metabolism (Sakura), Department of Internal Medicine, Faculty of Medicine, Toho University, Chiba, Japan
| | - Kaoru Sugi
- Division of Cardiovascular Medicine (Ohashi), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Junichi Yamasaki
- Division of Cardiovascular Medicine (Omori), Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Shigeo Yamamura
- Faculty of Pharmaceutical Sciences, Josai International University, Chiba, Japan
| | - Kohji Shirai
- Division of Diabetes, Endocrinology and Metabolism (Sakura), Department of Internal Medicine, Faculty of Medicine, Toho University, Chiba, Japan
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Semova I, Levenson AE, Krawczyk J, Bullock K, Williams KA, Wadwa RP, Shah AS, Khoury PR, Kimball TR, Urbina EM, de Ferranti SD, Bishop FK, Maahs DM, Dolan LM, Clish CB, Biddinger SB. Type 1 diabetes is associated with an increase in cholesterol absorption markers but a decrease in cholesterol synthesis markers in a young adult population. J Clin Lipidol 2019; 13:940-946. [PMID: 31706902 PMCID: PMC6980756 DOI: 10.1016/j.jacl.2019.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND To optimize treatment and prevent cardiovascular disease in subjects with type 1 diabetes, it is important to determine how cholesterol metabolism changes with type 1 diabetes. OBJECTIVE The objective of the study was to compare plasma levels of campesterol and β-sitosterol, markers of cholesterol absorption, as well as lathosterol, a marker of cholesterol synthesis, in youth with and without type 1 diabetes. METHODS Serum samples were obtained from adolescent subjects with type 1 diabetes (n = 175, mean age 15.2 years, mean duration of diabetes 8.2 years) and without diabetes (n = 74, mean age 15.4 years). Campesterol, β-sitosterol, and lathosterol, were measured using targeted liquid chromatography tandem mass spectrometry, compared between groups, and correlated with the available cardiometabolic variables. RESULTS Campesterol and β-sitosterol levels were 30% higher in subjects with type 1 diabetes and positively correlated with hemoglobin A1c levels. In contrast, lathosterol levels were 20% lower in subjects with type 1 diabetes and positively correlated with triglycerides, body mass index, and systolic blood pressure. CONCLUSION Plasma markers suggest that cholesterol absorption is increased, whereas cholesterol synthesis is decreased in adolescent subjects with type 1 diabetes. Further studies to address the impact of these changes on the relative efficacy of cholesterol absorption and synthesis inhibitors in subjects with type 1 diabetes are urgently needed.
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Affiliation(s)
- Ivana Semova
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy E Levenson
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joanna Krawczyk
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Bullock
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kathryn A Williams
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Biostatistics and Research Design Center, Boston Children's Hospital, Boston, MA, USA
| | - R Paul Wadwa
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy S Shah
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Philip R Khoury
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Thomas R Kimball
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Elaine M Urbina
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Franziska K Bishop
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lawrence M Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sudha B Biddinger
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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