1
|
Lyons ARM, Stevens CAT, Dharmayat KI, Vallejo-Vaz DAJ, Ray KK. Overview of a collaborative global effort to address the burden of familial hypercholesterolaemia. Indian Heart J 2024; 76 Suppl 1:S113-S116. [PMID: 37981086 PMCID: PMC11019322 DOI: 10.1016/j.ihj.2023.11.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
This is an overview of the EAS Familial Hypercholesterolaemia (FH) Studies Collaboration (FHSC) global consortium and registry (established 2015), which broadly addresses the global burden of FH. Eighty-seven National Lead Investigators from 74 countries form this expanding global consortium, and this global registry currently includes pooled data on 70,000 participants from participating countries to facilitate FH surveillance. Published first results from this global registry concluded that FH is diagnosed late, and management of LDL-cholesterol falls below guideline recommendations, and therefore earlier detection of FH and wider use of combination therapy is required. Further FHSC studies will follow on updated data including new countries, participants and variables, and non-DNA genetic information, and on the remaining cohorts in the registry. FHSC cross-sectional collaborative global studies are expected to promote FH detection earlier in life to subsequently initiate early lipid lowering therapy to reduce lifelong exposure to cumulative LDL-cholesterol thus reducing cardiovascular disease risk.
Collapse
Affiliation(s)
- Alexander R M Lyons
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
| | - Christophe A T Stevens
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Kanika I Dharmayat
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Dr Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom; 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
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Kim NH, Kim JY, Choi J, Kim SG. Associations of omega-3 fatty acids vs. fenofibrate with adverse cardiovascular outcomes in people with metabolic syndrome: propensity matched cohort study. Eur Heart J Cardiovasc Pharmacother 2024; 10:118-127. [PMID: 38017618 DOI: 10.1093/ehjcvp/pvad090] [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: 08/14/2023] [Revised: 11/01/2023] [Accepted: 11/26/2023] [Indexed: 11/30/2023]
Abstract
AIMS Omega-3 fatty acids and fenofibrates have shown some beneficial cardiovascular effects; however, their efficacy has not been compared. This study aimed to compare the effectiveness of currently available omega-3 fatty acids and fenofibrate for reducing major adverse cardiovascular events (MACE). METHODS AND RESULTS From a nationwide population-based cohort in South Korea (2008-2019), individuals with metabolic syndrome (≥30 years) who received statin with omega-3 fatty acids and those receiving statin with fenofibrate were matched by propensity score (n = 39 165 in both groups). The primary outcome was MACE, including ischaemic heart disease (IHD), ischaemic stroke (IS), and death from cardiovascular causes. The risk of MACE was lower [hazard ratio (HR), 0.79; 95% confidence interval (CI), 0.74-0.83] in the fenofibrate group than in the omega-3 fatty acid group. Fenofibrate was associated with a lower incidence of IHD (HR, 0.72; 95% CI, 0.67-0.77) and hospitalization for heart failure (HR, 0.90; 95% CI, 0.82-0.97), but not IS (HR, 0.90; 95% CI, 0.81-1.00) nor death from cardiovascular causes (HR, 1.07; 95% CI, 0.97-1.17). The beneficial effect of fenofibrate compared to omega-3 fatty acids was prominent in patients with preexisting atherosclerotic cardiovascular disease and those receiving lower doses of omega-3 fatty acids (≤2 g per day). CONCLUSION In a real-world setting, fenofibrate use was associated with a lower risk of MACE compared with low-dose omega-3 fatty acids when added to statins in people with metabolic syndrome.
Collapse
Affiliation(s)
- Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Ji Yoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| |
Collapse
|
3
|
Siddiqui S, Harun SN, Ghadzi SMS, Wahid NA, Hassan AB, Zainal H. Patterns of dyslipidemia and its associated factors among prediabetic subjects. A cross-sectional study at a primary care clinic. Malays Fam Physician 2023; 18:73. [PMID: 38213389 PMCID: PMC10781612 DOI: 10.51866/oa.125] [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] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Introduction Diabetes is closely linked to cardiovascular diseases, with diabetic dyslipidaemia serving as an established marker of the acceleration of complications, contributing to an increased cardiovascular risk among patients. Timely detection and early characterization of lipid abnormalities can help clinicians in implementing effective preventive measures. This study aimed to determine the patterns and associated factors of dyslipidaemia among Malaysian subjects with borderline diabetes. Methods A retrospective study was conducted among subjects with borderline diabetes aged ≥18 years who visited a primary healthcare centre at Universiti Sains Malaysia from January 2017 to December 2018. Sociodemographic, clinical and laboratory data were obtained from electronic medical records. Data were analysed using SPSS version 25. Results A total of 250 participants with borderline diabetes were included in the analysis. Of them, 93.6% (n=234) had lipid abnormalities. Isolated dyslipidaemia characterised by a high low-density lipoprotein cholesterol (LDL-C) level (38.8%, n=97) was the most common pattern found, followed by combined dyslipidaemia of high LDL-C and triglyceride (TG) levels (22.8%, n=57). The male sex was found to be significantly associated with hypertriglyceridemia (adjusted odds ratio [AOR] = 1.86, 95% confidence interval [CI] =1.09-3.1)(P=0.02). Diastolic blood pressure ≥90mmHg was significantly associated with a low HDL-C level (A0R=2.09, 95% CI=1.0-4.1) (P=0.03). Conclusion The majority of subjects with borderline diabetes have lipid abnormalities. Specifically, isolated dyslipidaemia characterised by a high LDL-C level is alarmingly prevalent. Further large-scale robust studies are needed to confirm the present findings.
Collapse
Affiliation(s)
- Sania Siddiqui
- MSc (Clinical Pharmacy), PharmD, School of Pharmaceutical Science, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Sabariah Noor Harun
- MSc (Clinical Pharmacy), PharmD, School of Pharmaceutical Science, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Siti Maisharah Sheikh Ghadzi
- BPharm (Hons), MPharm (Clinical Pharmacy), PhD, School of Pharmaceutical Science, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | | | - Azima Binti Hassan
- BScN, Pusat Sejahtera, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Hadzliana Zainal
- BPharm (Hons), MPharm (Clinical Pharmancy), PhD, School of Pharmaceutical Science, Universiti Sains Malaysia, Pulau Pinang, Malaysia.
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
Lan NSR, Hong RSY, Ryan C, Jenkins AJ, Fegan PG. Patient perceptions of cardiovascular risk, lipid management and statins in type 1 diabetes. Prim Care Diabetes 2023; 17:526-528. [PMID: 37532667 DOI: 10.1016/j.pcd.2023.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023]
Abstract
Lipid-lowering reduces cardiovascular risk in type 1 diabetes (T1D), but dyslipidaemia remains under-recognised and under-treated. Through patient surveys, barriers to lipid management in T1D were identified, including lack of awareness of cardiovascular risk and cholesterol levels, preference for managing glycaemia over lipids, preference for lifestyle modification over pharmacotherapy, and statin side-effect concerns.
Collapse
Affiliation(s)
- Nick S R Lan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Australia; Department of Cardiology, Fiona Stanley Hospital, Australia; Medical School, University of Western Australia, Australia.
| | - Regina S Y Hong
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Australia
| | | | | | - P Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Australia; Medical School, Curtin University, Australia
| |
Collapse
|
6
|
Park JI, Lee SJ, Hong BK, Cho YH, Shin WY, Lim SW, Kang WC, Park Y, Lee SY, Lee YJ, Hong SJ, Ahn CM, Kim BK, Ko YG, Choi D, Hong MK, Jang Y, Kim JS. Efficacy and safety of moderate-intensity statin with ezetimibe combination therapy in patients after percutaneous coronary intervention: a post-hoc analysis of the RACING trial. EClinicalMedicine 2023; 58:101933. [PMID: 37090440 PMCID: PMC10119495 DOI: 10.1016/j.eclinm.2023.101933] [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: 12/28/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
Background Moderate-intensity statin role with ezetimibe combination therapy following percutaneous coronary intervention (PCI) has not been thoroughly investigated, particularly compared to high-intensity statin monotherapy. We aimed to investigate the effect of ezetimibe combination with moderate-intensity statin in patients with atherosclerotic cardiovascular disease following PCI. Methods This was a post-hoc analysis of a subset of patients who underwent PCI in the RACING trial. At 26 centres in South Korea, patients with atherosclerotic cardiovascular disease (ASCVD) were randomly assigned to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The prespecified endpoints of the RACING trial were used. The primary endpoint was the 3-year composite of cardiovascular death, major cardiovascular events, and nonfatal stroke. Event rates between the two groups were compared using log-rank tests, and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox regression analysis. Consistent with the RACING trial, the primary and secondary efficacy endpoints were evaluated using an intention-to-treatment approach, and the safety endpoints were assessed in the safety population. The RACING trial was registered at ClinicalTrials.gov (NCT03044665). Findings Between Feb 14, 2017, and Dec 18, 2018, 3780 participants were enrolled in the RACING trial. Prior history of PCI was found in 2497 patients (67%, median 64 years, 79% male), and was associated with higher rates of the primary endpoint (hazard ratio [HR], 1.34; 95% confidence interval [CI], 1.06-1.69; p = 0.014). Among patients with prior PCI, moderate-intensity statin therapy with ezetimibe combination versus high-intensity statin therapy did not increase the risk of the primary endpoint (HR, 0.95; 95% CI, 0.74-1.24; p = 0.781). The proportion of patients with low-density lipoprotein cholesterol (LDL-C) <70 mg/dL at 1, 2, and 3 years was 74%, 76%, and 73%, respectively, in the combination therapy group, and was significantly higher than that in the high-intensity statin monotherapy group (57%, 62%, and 59%, respectively, all p < 0.001). Discontinuation of lipid-lowering drugs occurred less frequently in the combination group (4.2% vs. 7.6%, p = 0.001). Interpretation The effects of ezetimibe combination therapy observed in the RACING trial were consistently preserved among patients with ASCVD following PCI. Ezetimibe combination could be considered as a suitable therapeutic strategy to achieve strict control of LDL-C and reduce drug intolerance in patients who underwent PCI. Funding Hanmi Pharmaceutical, Seoul, South Korea.
Collapse
Affiliation(s)
- Jong-Il Park
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Yeungnam University College of Medicine, Daegu, South Korea
| | - Seung-Jun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Bum-Kee Hong
- Gangnam Severance Hospital, Seoul, South Korea
- Corresponding author. Division of Cardiology, Heart Centre, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-Ro, Gangnam-Gu, Seoul, 06273, South Korea.
| | - Yun-Hyeong Cho
- Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Won-Yong Shin
- Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Sang-Wook Lim
- CHA University College of Medicine, Seongnam, South Korea
| | | | - Yongwhi Park
- Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Sung-Yoon Lee
- Inje University Ilsan Paik Hospital, Ilsan, South Korea
| | - Yong-Joon Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Jin Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul-Min Ahn
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byeong-Keuk Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Ki Hong
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Jung-Sun Kim
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Corresponding author. Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea.
| | | |
Collapse
|
7
|
Holzbach LC, Silveira AGZ, Franco LP, Horst MA, Cominetti C. Polymorphism PLIN1 11482 G>A interacts with dietary intake to modulate anthropometric measures and lipid profile in adults with normal-weight obesity syndrome. Br J Nutr 2022; 128:1004-12. [PMID: 34725012 DOI: 10.1017/S0007114521004396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Evidence shows that genetic polymorphisms in perilipin 1 gene (PLIN1) are associated with excessive accumulation of body fat and disturbances in cardiometabolic markers. Therefore, the aim of this study was to verify whether the SNP PLIN1 11482 G>A (rs894160) interacts with nutrient intake, anthropometric, body composition and cardiometabolic markers in adults with normal-weight obesity (NWO) syndrome. A cross-sectional study was carried out with 116 individuals aged 20-59 years, with normal BMI and high percentage of body fat. Anthropometric and body composition measures, glycaemic control and serum lipid markers, SNP PLIN1 11482 G>A and nutrient intake were evaluated. Interactions between nutrient intake and the SNP were determined by regression models and adjusted for potential confounders. The SNP frequency was 56·0 % GG, 38·8 % GA and 5·2 % AA. Anthropometric measures and biochemical markers were not different according to genotype, except for total cholesterol (TC), LDL-cholesterol and non-HDL-cholesterol concentrations. However, important interactions between the SNP and dietary intake were observed. Carbohydrate intake interacted with the SNP PLIN1 11482 G>A to modulate waist circumference (WC) and the homeostatic model assessment of insulin resistance index. Interaction of lipid intake and the SNP modulated TC and LDL-cholesterol concentrations, and the interaction between protein intake and the SNP tended to modulate weight, WC and BMI. The SNP PLIN1 11482 G>A seems to modulate responses in anthropometric and lipid profile biomarkers of subjects with NWO depending on the dietary macronutrient composition, which may have long-term impact on cardiometabolic markers.
Collapse
|
8
|
Raheem J, Sliz E, Shin J, Holmes MV, Pike GB, Richer L, Gaudet D, Paus T, Pausova Z. Visceral adiposity is associated with metabolic profiles predictive of type 2 diabetes and myocardial infarction. Commun Med (Lond) 2022; 2:81. [PMID: 35789567 DOI: 10.1038/s43856-022-00140-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background Visceral fat (VF) increases risk for cardiometabolic disease (CMD), the leading cause of morbidity and mortality. Variations in the circulating metabolome predict the risk for CMD but whether or not this is related to VF is unknown. Further, CMD is now also present in adolescents, and the relationships between VF, circulating metabolome, and CMD may vary between adolescents and adults. Methods With an aim to add understanding to the metabolic variations in visceral obesity, we tested associations between VF, measured directly with magnetic resonance imaging, and 228 fasting serum metabolomic measures, quantified with nuclear magnetic resonance spectroscopy, in 507 adults (36–65 years) and 938 adolescents (12–18 years). We further utilized data from published studies to estimate similarities between VF and CMD-associated metabolic profiles. Results Here we show that VF, independently of body mass index (BMI) or subcutaneous fat, is associated with triglyceride-rich lipoproteins, fatty acids, and inflammation in both adults and adolescents, whereas the associations with amino acids, glucose, and intermediary metabolites are significant in adults only. BMI-adjusted metabolomic profile of VF resembles those predicting type 2 diabetes in adults (R2 = 0.88) and adolescents (R2 = 0.70), and myocardial infarction in adults (R2 = 0.59) and adolescents (R2 = 0.40); this is not the case for ischemic stroke (adults: R2 = 0.05, adolescents: R2 = 0.08). Conclusions Visceral adiposity is associated with metabolomic profiles predictive of type 2 diabetes and myocardial infarction even in normal-weight individuals and already in adolescence. Targeting factors contributing to the emergence and maintenance of these profiles might ameliorate their cumulative effects on cardiometabolic health. Obesity increases risk for multiple diseases, likely due to changes in how the body breaks down carbohydrates and fats and due to the molecules that circulate in the blood as a result. In obesity, the accumulation of fat around the internal organs of the abdomen (visceral fat) may be more detrimental than fat accumulation elsewhere in the body. Here, we show that visceral fat is associated with variations in the levels of various molecules in the blood, and these variations are similar to those that can predict type 2 diabetes and heart disease, not only in adults but also in adolescents. This suggests that visceral fat accumulation may be closely related to development of these diseases from a young age. Raheem, Sliz et al. study the serum metabolome and an imaging-based measure of visceral fat in adults and adolescents. The authors find that, independently of BMI, visceral fat quantity is associated with a metabolomic profile similar to those predictive of type 2 diabetes and myocardial infarction.
Collapse
|
9
|
Talic S, Marquina C, Ofori-Asenso R, Petrova M, Liew D, Owen AJ, Lybrand S, Thomson D, Ilomaki J, Zomer E, Ademi Z. Switching, Persistence and Adherence to Statin Therapy: a Retrospective Cohort Study Using the Australian National Pharmacy Data. Cardiovasc Drugs Ther 2021. [PMID: 34097194 DOI: 10.1007/s10557-021-07199-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Statins are widely prescribed for the primary and secondary prevention of cardiovascular disease (CVD), but their effectiveness is dependent on the level of adherence and persistence. OBJECTIVES This study aimed to explore the patterns of switching, adherence and persistence among the Australian general population with newly dispensed statins. METHODS A retrospective cohort study was conducted using a random sample of data from the Australian national prescription claims data. Switching, adherence to and persistence with statins were assessed for people starting statins from 1 January 2015 to 31 December 2019. Switching was defined as either switching to another intensity of statin, to another statin or to a non-statin agent. Non-persistence to treatment was defined as discontinuation (i.e. ≥90 days with no statin) of coverage. Adherence was measured using proportion of days covered (PDC), and patients with PDC < 0.80 were considered non-adherent. Cox proportional hazard models were used to compare discontinuation, switching and reinitiation between different statins. RESULTS A cohort of 141,062 people dispensed statins and followed over a median duration of 2.5 years were included. Of the cohort, 29.3% switched statin intensity, 28.4% switched statin type, 3.7% switched to ezetimibe and in 2.7%, ezetimibe was added as combination therapy during the study period. Overall, 58.8% discontinued statins based on the 90-day gap criteria, of whom 55.2% restarted. The proportion of people non-adherent was 24.0% at 6 months to 49.0% at 5 years. People on low and moderate intensity statins were more likely to discontinue compared to those on high-intensity statins (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09-1.31), (HR 1.28, 95%CI 1.14-1.42), respectively. Compared to maintaining same statin type and intensity, switching statins, which includes up-titration (HR 0.77, 95%CI 0.70 to 0.86) was associated with less likelihood of discontinuation after reinitiation. CONCLUSIONS Long-term persistence and adherence to statins remains generally poor among Australians, which limits the effectiveness of these medicines and the consequent health impact they may provide for individuals (and by extension, the population impact when poor persistence and adherence is considered in the statin-taking population). Switching between statins is prevalent in one third of statin users, although any clinical benefit of the observed switching trend is unknown. This, combined with the high volume of statin prescriptions, highlights the need for better strategies to address poor persistence and adherence.
Collapse
|
10
|
Hitchen SA, Lan NSR, Ali US, Hort AL, Larbalestier R, Yeap BB, Fegan PG. Investigating the effect of an education program on diabetes and lipid lowering medication usage following coronary artery bypass graft surgery. Intern Med J 2021; 52:1354-1365. [PMID: 34033208 DOI: 10.1111/imj.15393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/26/2020] [Revised: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Guidelines advocate multifactorial cardiovascular risk management in patients with diabetes and atherosclerotic cardiovascular disease. In hospitalised patients with diabetes following coronary artery bypass graft (CABG) we evaluated the impacts of decision-support algorithms for optimising glycaemia and lipid-lowering. We also assessed the safety of initiating sodium-glucose cotransporter 2 (SGLT2) inhibitors near time of hospital discharge. METHODS This was a single-site, pre- and post-intervention analysis of glucose and lipid management in consecutive hospitalised patients with diabetes undergoing CABG surgery. The intervention involved education and decision-support algorithms designed by a multidisciplinary committee to guide cardiac surgery unit clinicians. RESULTS A total of 200 patients were included in the study. The pre- and post-intervention groups had similar baseline characteristics (HbA1c 7.9 ± 1.9% versus 8.1 ± 1.8%). Of 4092 blood glucose measurements the incidence of levels between 5 to 10 mmol/L was not different post-intervention (55.5% versus 57.0%, p = 0.441). Fewer endocrinology consultations occurred (59.0% versus 45.0%, p = 0.048) and rates of hypoglycaemia remained low. High-intensity statin was prescribed in >90% pre- and post-intervention although non-statin lipid-lowering agents remained <10% despite patients not achieving LDL-C targets. No 30-day readmissions for diabetic ketoacidosis occurred in patients prescribed SGLT2 inhibitors. CONCLUSION The intervention did not improve inpatient glycaemia or increase non-statin lipid-lowering prescriptions in patients with diabetes following CABG surgery but did reduce reliance on specialty input. Initiation of SGLT2 inhibitor therapy near time of hospital discharge was not associated with safety concerns. Alternative interventions or strategies are required to optimise glycaemia and non-statin lipid-lowering therapy prescribing in this setting. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Sarah A Hitchen
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia.,Department of Pharmacy, Fiona Stanley Hospital, Western Australia, Australia
| | - Nick S R Lan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia.,Department of Cardiology, Fiona Stanley Hospital, Western Australia.,Medical School, The University of Western Australia, Western Australia, Australia
| | - Umar S Ali
- Medical School, The University of Western Australia, Western Australia, Australia.,Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Western Australia, Australia
| | - Adam L Hort
- Department of Pharmacy, Fiona Stanley Hospital, Western Australia, Australia
| | - R Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Western Australia, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia.,Medical School, The University of Western Australia, Western Australia, Australia
| | - P Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia.,Medical School, Curtin University, Western Australia, Australia
| |
Collapse
|
11
|
Frederiksen TC, Mortensen MB, Kanstrup HL. Seventeen years of misdiagnosis in rare dyslipidaemia: a case report of sitosterolaemia in a young female. Eur Heart J Case Rep 2021; 5:ytab188. [PMID: 34268478 PMCID: PMC8276620 DOI: 10.1093/ehjcr/ytab188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 04/16/2021] [Indexed: 01/21/2023]
Abstract
Background Sitosterolaemia is a rare, autosomal recessive dyslipidaemia with increased absorption
of dietary plant sterol and often presents with hypercholesterolaemia, xanthomas, and
haematologic manifestations. If left untreated, sitosterolaemia can lead to high
symptomatic burden and coronary artery disease (CAD). Case summary We describe a case of a young female who initially presented at 4 years of age with
classic manifestations of sitosterolaemia. She was misdiagnosed and treated for both
juvenile arthritis and later familial hypercholesterolaemia until adulthood, when venous
blood samples showed significantly elevated concentrations of plant sterols. DNA
analyses showed that the patient was homozygous for a mutation in the ABCG5 gene,
[c.1336C>T, p.(Arg446*)], which is known to be associated with sitosterolaemia. Discussion Sitosterolaemia presents with multiple manifestations, which can initially be
misinterpreted leading to prolonged misdiagnosis. Early diagnosis is key in order to
relieve symptoms and prevent CAD.
Collapse
Affiliation(s)
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Helle Lynge Kanstrup
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| |
Collapse
|
12
|
|
13
|
Akyea RK, Qureshi N, Kai J, Weng SF. Performance and clinical utility of supervised machine-learning approaches in detecting familial hypercholesterolaemia in primary care. NPJ Digit Med 2020; 3:142. [PMID: 33145438 PMCID: PMC7603302 DOI: 10.1038/s41746-020-00349-5] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/24/2020] [Indexed: 12/17/2022] Open
Abstract
Familial hypercholesterolaemia (FH) is a common inherited disorder, causing lifelong elevated low-density lipoprotein cholesterol (LDL-C). Most individuals with FH remain undiagnosed, precluding opportunities to prevent premature heart disease and death. Some machine-learning approaches improve detection of FH in electronic health records, though clinical impact is under-explored. We assessed performance of an array of machine-learning approaches for enhancing detection of FH, and their clinical utility, within a large primary care population. A retrospective cohort study was done using routine primary care clinical records of 4,027,775 individuals from the United Kingdom with total cholesterol measured from 1 January 1999 to 25 June 2019. Predictive accuracy of five common machine-learning algorithms (logistic regression, random forest, gradient boosting machines, neural networks and ensemble learning) were assessed for detecting FH. Predictive accuracy was assessed by area under the receiver operating curves (AUC) and expected vs observed calibration slope; with clinical utility assessed by expected case-review workload and likelihood ratios. There were 7928 incident diagnoses of FH. In addition to known clinical features of FH (raised total cholesterol or LDL-C and family history of premature coronary heart disease), machine-learning (ML) algorithms identified features such as raised triglycerides which reduced the likelihood of FH. Apart from logistic regression (AUC, 0.81), all four other ML approaches had similarly high predictive accuracy (AUC > 0.89). Calibration slope ranged from 0.997 for gradient boosting machines to 1.857 for logistic regression. Among those screened, high probability cases requiring clinical review varied from 0.73% using ensemble learning to 10.16% using deep learning, but with positive predictive values of 15.5% and 2.8% respectively. Ensemble learning exhibited a dominant positive likelihood ratio (45.5) compared to all other ML models (7.0-14.4). Machine-learning models show similar high accuracy in detecting FH, offering opportunities to increase diagnosis. However, the clinical case-finding workload required for yield of cases will differ substantially between models.
Collapse
Affiliation(s)
- Ralph K. Akyea
- Primary Care Stratified Medicine, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Nadeem Qureshi
- Primary Care Stratified Medicine, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Primary Care Stratified Medicine, Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Stephen F. Weng
- Primary Care Stratified Medicine, Division of Primary Care, University of Nottingham, Nottingham, UK
| |
Collapse
|
14
|
Hashimoto N, Dateki S, Suzuki E, Tsuchihashi T, Isobe A, Banno S, Kageyama T, Maeda N, Hatabu N, Sato R, Miharu M, Fujita H, Komiyama O, Shimizu H, Hasegawa T, Yamazawa K. Compound heterozygous variants in the ABCG8 gene in a Japanese girl with sitosterolemia. Hum Genome Var 2020; 7:25. [PMID: 33014402 PMCID: PMC7490419 DOI: 10.1038/s41439-020-00112-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/03/2020] [Accepted: 08/15/2020] [Indexed: 11/09/2022] Open
Abstract
Sitosterolemia is an autosomal recessive disorder that affects lipid metabolism and is characterized by elevated serum plant sterol levels, xanthomas, and accelerated atherosclerosis. In this study, we report a novel nonsense single-nucleotide variant, c.225G > A (p.Trp75*), and an East Asian population-specific missense multiple-nucleotide variant, c.1256_1257delTCinsAA (p.Ile419Lys), in the ABCG8 gene in a compound heterozygous state observed in a Japanese girl with sitosterolemia.
Collapse
Affiliation(s)
- Nobuhiro Hashimoto
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Sumito Dateki
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Eri Suzuki
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takatoshi Tsuchihashi
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.,Department of Pediatrics, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Aiko Isobe
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Sari Banno
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Tomoka Kageyama
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naonori Maeda
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naomi Hatabu
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Rieko Sato
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masashi Miharu
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hisayo Fujita
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Osamu Komiyama
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hitomi Shimizu
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Yamazawa
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.,Medical Genetics Center, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| |
Collapse
|
15
|
Pirillo A, Svecla M, Catapano AL, Holleboom AG, Norata GD. Impact of protein glycosylation on lipoprotein metabolism and atherosclerosis. Cardiovasc Res 2020; 117:1033-1045. [PMID: 32886765 DOI: 10.1093/cvr/cvaa252] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 05/26/2020] [Revised: 07/23/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
Protein glycosylation is a post-translational modification consisting in the enzymatic attachment of carbohydrate chains to specific residues of the protein sequence. Several types of glycosylation have been described, with N-glycosylation and O-glycosylation being the most common types impacting on crucial biological processes, such as protein synthesis, trafficking, localization, and function. Genetic defects in genes involved in protein glycosylation may result in altered production and activity of several proteins, with a broad range of clinical manifestations, including dyslipidaemia and atherosclerosis. A large number of apolipoproteins, lipoprotein receptors, and other proteins involved in lipoprotein metabolism are glycosylated, and alterations in their glycosylation profile are associated with changes in their expression and/or function. Rare genetic diseases and population genetics have provided additional information linking protein glycosylation to the regulation of lipoprotein metabolism.
Collapse
Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, via M. Gorki 50, 20092 Cinisello Balsamo, Milan, Italy.,IRCCS MultiMedica, via Milanese 300, 20099 Sesto S. Giovanni, Milan, Italy
| | - Monika Svecla
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, Milan 20133, Italy
| | - Alberico Luigi Catapano
- IRCCS MultiMedica, via Milanese 300, 20099 Sesto S. Giovanni, Milan, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, Milan 20133, Italy
| | - Adriaan G Holleboom
- Department of Vascular Medicine, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Giuseppe Danilo Norata
- Center for the Study of Atherosclerosis, E. Bassini Hospital, via M. Gorki 50, 20092 Cinisello Balsamo, Milan, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, Milan 20133, Italy
| |
Collapse
|
16
|
Brito ADM, Hermsdorff HHM, Filgueiras MS, Vieira-Ribeiro SA, Franceschini SDCC, Novaes JF. TAG-glucose (TyG) index in childhood: an estimate of cut-off points and the relation to cardiometabolic risk in 4- to 9-year-old children. Public Health Nutr 2021; 24:2603-10. [PMID: 32624056 DOI: 10.1017/S1368980020000944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To propose cut-off points for the TAG-glucose (TyG) index in Brazilian children and evaluate the link to cardiometabolic risk. DESIGN A cross-sectional study with children from a municipality in Minas Gerais, Brazil. Anthropometric (weight, height, waist circumference and waist:height ratio), biochemical (lipid and glucose profile) and blood pressure (BP) tests were performed. Using the receiver operating characteristic curve, cut-off points for the TyG index were proposed according to sex using homoeostasis model of assessment - insulin resistance (IR) as the reference method. SETTING Viçosa, MG, Brazil. PARTICIPANTS Children aged 4-9 years (n 515). RESULTS The TyG index cut-off points to identify the risk of IR were 7·9 and 8·1 for boys and girls, respectively. We observed that 48·7 % of the children had an increased TyG index. The increased TyG index was associated with overweight, total body and central fat, increased BP and altered lipid profile. Children with an increased TyG index had a higher accumulation of cardiometabolic risk factors. CONCLUSIONS According to the cut-off points proposed by the current study, children at risk of IR estimated by the TyG index presented a higher cardiometabolic risk, including isolated risk factors, as to the higher accumulation of these.
Collapse
|
17
|
Oni-Orisan A, Haldar T, Ranatunga DK, Medina MW, Schaefer C, Krauss RM, Iribarren C, Risch N, Hoffmann TJ. The impact of adjusting for baseline in pharmacogenomic genome-wide association studies of quantitative change. NPJ Genom Med 2020; 5:1. [PMID: 31969989 DOI: 10.1038/s41525-019-0109-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022] Open
Abstract
In pharmacogenomic studies of quantitative change, any association between genetic variants and the pretreatment (baseline) measurement can bias the estimate of effect between those variants and drug response. A putative solution is to adjust for baseline. We conducted a series of genome-wide association studies (GWASs) for low-density lipoprotein cholesterol (LDL-C) response to statin therapy in 34,874 participants of the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort as a case study to investigate the impact of baseline adjustment on results generated from pharmacogenomic studies of quantitative change. Across phenotypes of statin-induced LDL-C change, baseline adjustment identified variants from six loci meeting genome-wide significance (SORT/CELSR2/PSRC1, LPA, SLCO1B1, APOE, APOB, and SMARCA4/LDLR). In contrast, baseline-unadjusted analyses yielded variants from three loci meeting the criteria for genome-wide significance (LPA, APOE, and SLCO1B1). A genome-wide heterogeneity test of baseline versus statin on-treatment LDL-C levels was performed as the definitive test for the true effect of genetic variants on statin-induced LDL-C change. These findings were generally consistent with the models not adjusting for baseline signifying that genome-wide significant hits generated only from baseline-adjusted analyses (SORT/CELSR2/PSRC1, APOB, SMARCA4/LDLR) were likely biased. We then comprehensively reviewed published GWASs of drug-induced quantitative change and discovered that more than half (59%) inappropriately adjusted for baseline. Altogether, we demonstrate that (1) baseline adjustment introduces bias in pharmacogenomic studies of quantitative change and (2) this erroneous methodology is highly prevalent. We conclude that it is critical to avoid this common statistical approach in future pharmacogenomic studies of quantitative change.
Collapse
|
18
|
Stillman MD, Williams S. Guideline for the identification and management of cardiometabolic risk after spinal cord injury: a case of unsubstantiated recommendations. Spinal Cord Ser Cases 2019; 5:97. [PMID: 31798972 PMCID: PMC6881404 DOI: 10.1038/s41394-019-0240-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/18/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
The 2018 Guideline for the Identification and Management of Cardiometabolic Risk after Spinal Cord Injury (SCI) represented the first concerted effort to address a cluster of derangements and diseases that are claiming the lives of individuals living with injuries. Its contributors and authors scoured the literature, weighed the validity, importance, and clinical relevance of what data they found, and collaborated in an effort to meaningfully improve the health and lives of people with SCI. However, we are concerned that several of the guideline's central recommendations-particularly around screening for and detection of glycemic dysregulation and dyslipidemia-have been offered prematurely. In several instances, the authors cite data from studies of people without SCI and, in our opinion, inappropriately apply those findings to support their SCI-specific suggestions. In other instances, they recommend that we employ tests whose usefulness and clinical relevance have yet to be demonstrated among people living with injuries. In short, we fear that the authors have developed clinical guidelines that are inadequately supported by data. This guideline is an extraordinary show of collaboration, and is an important first step toward understanding and treating a number of secondary cardiometabolic effects of SCI. The lack of data underpinning several of its central recommendations-making them, in our opinion, unadoptable-underscores the inadequacy of research in this area and provides a roadmap for future investigative efforts.
Collapse
Affiliation(s)
- Michael D. Stillman
- Internal Medicine and Rehabilitation Medicine, Sydney Kimmel Medical College of Thomas Jefferson University, 1100 Walnut Street, Suite 601, Philadelphia, PA 19107 USA
| | - Steve Williams
- Rehabilitation Medicine, Sydney Kimmel Medical College, Philadelphia, PA USA
| |
Collapse
|
19
|
Carrillo-Larco RM, Albitres-Flores L, Barengo NC, Bernabe-Ortiz A. The association between serum lipids and risk of premature mortality in Latin America: a systematic review of population-based prospective cohort studies. PeerJ 2019; 7:e7856. [PMID: 31592360 PMCID: PMC6779113 DOI: 10.7717/peerj.7856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022] Open
Abstract
Objective To synthetize the scientific evidence on the association between serum lipids and premature mortality in Latin America (LA). Methods Five data bases were searched from inception without language restrictions: Embase, Medline, Global Health, Scopus and LILACS. Population-based studies following random sampling methods were identified. The exposure variable was lipid biomarkers (e.g., total, LDL- or HDL- cholesterol). The outcome was all-cause and cause-specific mortality. The risk of bias was assessed following the Newcastle-Ottawa criteria. Results were summarized qualitatively. Results The initial search resulted in 264 abstracts, five (N = 27,903) were included for the synthesis. Three papers reported on the same study from Puerto Rico (baseline in 1965), one was from Brazil (1996) and one from Peru (2007). All reports analysed different exposure variables and used different risk estimates (relative risks, hazard ratios or odds ratios). None of the reviewed reports showed strong association between individual lipid biomarkers and all-cause or cardiovascular mortality. Conclusion The available evidence is outdated, inconsistently reported on several lipid biomarker definitions and used different methods to study the long-term mortality risk. These findings strongly support the need to better ascertain the mortality risk associated with lipid biomarkers in LA.
Collapse
Affiliation(s)
- Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.,CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Centro de Estudios de Población, Universidad Católica los Ángeles de Chimbote (ULADECH-Católica), Chimbote, Peru
| | - Leonardo Albitres-Flores
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Peru.,Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo-SOCEMUNT, Trujillo, Peru
| | - Noël C Barengo
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, United States of America.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Faculty of Medicine, Rı¯ga Stradiņš University (RSU), Riga, Latvia
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Universidad Científica del Sur, Lima, Peru
| |
Collapse
|
20
|
Ren NN, Chen HJ, Li Y, Mcgowan GW, Lin YG. [A clinical study on the effect of nattokinase on carotid artery atherosclerosis and hyperlipidaemia]. Zhonghua Yi Xue Za Zhi 2017; 97:2038-42. [PMID: 28763875 DOI: 10.3760/cma.j.issn.0376-2491.2017.26.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the efficacy of oral nattokinase (NK) in the reduction of common carotid artery intimal medial thickness (CCA-IMT) and carotid artery plaque size and in lowering blood lipids, and to explore the underlying mechanism of actions of NK and its potential clinical use. Methods: All enrolled patients were from the Out-Patient Clinic of the Department of TCM at the 3(rd) Affiliated Hospital of Sun Yat-sen University. Using randomised picking method, all patients were randomly assigned to one of two groups, NK and Statin (ST) group. NK Group-patients were given NK at a daily dose of 6 000 FU and ST Group-patients were treated with statin (simvastatin 20 mg) daily. The treatment course was 26 weeks. CCA-IMT, carotid plaque size and blood lipid profile of the patients were measured before and after treatment. Results: A total of 82 patients were enrolled in the study and 76 patients (NK 39, ST 37) completed the study. Following the treatments for 26 weeks, there was a significant reduction in CCA-IMT and carotid plaque size in both groups compared with the baseline before treatment. The carotid plaque size and CCA-IMT reduced from(0.25±0.12)cm(2) to (0.16±0.10)cm(2) and from (1.13±0.12)mm to (1.01±0.11)mm, repectively. The reduction in the NK group was significantly profound (P<0.01, 36.6% reduction in plaque size in NK group versus 11.5% change in ST group). Both treatments reduced total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG). While the reduction in both groups was shown to be statistically significant (P<0.01), the reduction of TC, LDL-C and TG in ST group was significantly greater (P<0.05). In addition, NK significantly increased the level of high-density lipoprotein cholesterol (HDL-C) (P<0.05), in contrast, HDL-C in the ST group did not change. The lipid lowering effect observed in the NK group was not correlated to the reduction of CCA-IMT and carotid artery plaque size (r=0.35, P=0.09). Conclusions: Our findings from this pioneer clinical study suggests that daily NK supplementation is an effective way to manage the progression of atherosclerosis and potentially may be a better alternative to statins which are commonly used to reduce atherosclerosis and further to prevent cardiovascular attack and stroke in patients. The mechanism underlying the reduction of carotid atherosclerosis by NK may be independent from its lipid-lowering effect, which is different from that of statins.
Collapse
|
21
|
Ju J, Li J, Lin Q, Xu H. Efficacy and safety of berberine for dyslipidaemias: A systematic review and meta-analysis of randomized clinical trials. Phytomedicine 2018; 50:25-34. [PMID: 30466986 DOI: 10.1016/j.phymed.2018.09.212] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND In recent years, berberine has become widely used as an effective alternative to treat dyslipidaemias; much clinical evidence has emerged. It is important to systematically and critically evaluate the existing evidence. PURPOSE This study aims to evaluate the efficacy and safety of berberine in patients with dyslipidaemias. STUDY DESIGN A systematic review and meta-analysis of randomized clinical trials. METHODS Five electronic databases were searched up to Apr 15, 2018 to identify randomized controlled trials (RCTs) of berberine in treatment of dyslipidaemias. The outcomes were lipid profile parameters and adverse events. Study selection, data collection, risk of bias assessment, data analyses and interpretations were conducted according to the Cochrane handbook. RESULTS Sixteen trials with total of 2147 participants were judged to be eligible and were included in the meta-analysis. The included trials were assessed to be of high clinical heterogeneity. The methodological quality of the majority of the trials was generally low in terms of random sequence generation, allocation concealment, blinding and incomplete outcome data. Thus, selection bias, performance bias, detection bias, attrition bias and confounding bias might exist. Meta-analysis showed that berberine significantly reduced levels of total cholesterol (TC) (MD = -0.47 mmol/l 95% CI [-0.64, -0.31], p < 0.00001), low-density lipoprotein cholesterol (LDL-C) (MD =-0.38 mmol/l 95% CI [-0.53, -0.22], p < 0.00001) and triglycerides (TG) (MD = -0.28 mmol/l 95% CI [-0.46, -0.10], p = 0.002). Berberine also increased the level of high-density lipoprotein cholesterol (HDL-C) when used alone (MD = 0.08 mmol/l 95% CI [0.03, 0.12], p = 0.001). No significant differences were found between groups in terms of incidence of adverse events (RR = 0.64 95% CI [0.31, 1.30], p = 0.22). No severe adverse effects were reported in either group. CONCLUSION Berberine improves lipid profiles in dyslipidaemias with satisfactory safety. Nevertheless, these findings should be interpreted with caution because of the high clinical heterogeneity and high risk of bias in the included trials. Rigorous clinical trials should be carried out to provide more reliable evidence.
Collapse
Affiliation(s)
- Jianqing Ju
- Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Jingen Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Qian Lin
- Graduate School, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hao Xu
- Cardiovascular Diseases Center, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China..
| |
Collapse
|
22
|
Daghestani M, Daghestani M, Daghistani M, Eldali A, Hassan ZK, Elamin MH, Warsy A. ADRB3 polymorphism rs4994 (Trp64Arg) associates significantly with bodyweight elevation and dyslipidaemias in Saudis but not rs1801253 (Arg389Gly) polymorphism in ARDB1. Lipids Health Dis 2018; 17:58. [PMID: 29587766 PMCID: PMC5870215 DOI: 10.1186/s12944-018-0679-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/19/2018] [Indexed: 11/25/2022] Open
Abstract
Background In some populations, obesity and body weight related disorders show a correlation with polymorphisms in three subtypes of beta-adrenoceptor (β1, β2, and β3) [ADRB1, ADRB2 and ADRB3] genes. We scanned for the polymorphism of Arg389Gly (rs1801253) in ADRB1 and Trp64Arg (rs4994) in ADRB3 genes in Saudi population to determine association, if any, of these polymorphisms with obesity and related disorders. Methods We studied 329 non-related adults (33.1% men and 66.9% women), aged 18–36 years. Anthropometric measurements were recorded, and Body mass index (BMI) and waist/hip ratio were calculated; leptin, insulin, lipidogram, and glucose concentrations were determined. ADRB1 and ADRB3 polymorphisms (Arg389Gly and Trp64Arg, respectively) were screened by DNA sequencing. The subjects were divided into three groups according to BMI: normal weight (BMI < 25 kg/m2), overweight (BMI ≥25.1–29.9 kg/m2) subjects, and obese (≥30 kg/m2). Results In the age-matched groups of the normal weight, overweight and obese male and female subjects, all anthropometric parameters were found to be significantly higher, and in the obese group, all biochemical parameters were significantly elevated compared to the normal weight controls. The allelic frequency of Gly389 ADRB1 did not differ amongst the three groups, whereas the frequency of Arg64 of ADRB3 gene was significantly higher in the overweight and obese subjects, compared with the normal weight subjects. In addition, subjects carrying Arg64 allele regardless of their BMI had a greater waist and hip circumference, W/H ratio, plasma cholesterol, triglyceride, LDL, leptin, insulin, and glucose level compared to those with the wild-type Trp allele. Conclusion The results of this study have shown a significant association between the Trp64Arg polymorphism in ADRB3 gene and the development of overweight and obesity in Saudi populations. It also has an influence on the levels of lipid, insulin, leptin, and glucose, whereas, Arg389Gly polymorphism in ADRB1 is not associated with overweight, obesity or dyslipidaemias in Saudis.
Collapse
Affiliation(s)
- Maha Daghestani
- Department of Zoology, Center for Scientific and Medical Female Colleges, King Saud University, P.O. Box 22455, Riyadh, 11495, Saudi Arabia
| | - Mazin Daghestani
- Department of Obstetrics and Gynecology, Umm-Al-Qura University, P.O.Box 424, Makkah, 21955, Saudi Arabia
| | - Mamoon Daghistani
- Department of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, P.O.Box, Jeddah, 9515, Saudi Arabia
| | - Abdelmoneim Eldali
- Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, P.O. Box3354, Riyadh, 11211, Saudi Arabia
| | - Zeinab K Hassan
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute Cairo University, Cairo, Egypt
| | - Maha H Elamin
- Department of Zoology, Faculty of Sciences, King Saud University, P.O. Box 22452, Riyadh, 11495, Saudi Arabia
| | - Arjumand Warsy
- Senior Scientist, Central Laboratory, Center for Scientific and Medical Female Colleges, King Saud University, P.O. Box 22455, Riyadh, 11495, Saudi Arabia.
| |
Collapse
|
23
|
Reis SA, Conceição LL, Rosa DD, Siqueira NP, Peluzio MCG. Mechanisms responsible for the hypocholesterolaemic effect of regular consumption of probiotics. Nutr Res Rev 2017; 30:36-49. [PMID: 27995830 DOI: 10.1017/S0954422416000226] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CVD affect a large proportion of the world's population, with dyslipidaemia as the major risk factor. The regular consumption of both probiotic bacteria and yeast has been associated with improvement in the serum lipid profile. Thus, the present review aims to describe and discuss the potential mechanisms responsible for the hypocholesterolaemic effect of regular consumption of probiotic bacteria and yeast. Regarding the hypocholesterolaemic effect of probiotic bacteria, the potential mechanisms responsible include: deconjugation of bile salts; modulation of lipid metabolism; and decreased absorption of intestinal cholesterol through co-precipitation of intestinal cholesterol with the deconjugated bile salts, incorporation and assimilation of cholesterol in the cell membrane of the probiotics, intestinal conversion of cholesterol in coprostanol, and inhibition of the expression of the intestinal cholesterol transporter Niemann-Pick C1 like 1 (NPC1L1) in the enterocytes. The potential mechanisms responsible for the hypocholesterolaemic effect of probiotic yeasts include: deconjugation of bile salts; co-precipitation of intestinal cholesterol with the deconjugated bile salts; incorporation and assimilation of cholesterol in the cell membrane; and inhibition of hepatic cholesterol synthesis. The regular consumption of probiotic bacteria and yeast, as a non-pharmaceutical approach to help manage cardiovascular risk, holds promise, according to the beneficial hypocholesterolaemic effects described herein. However, the hypocholesterolaemic effects vary according to the strains used, the physiological state of the host, and the type of diet to which the probiotics are added. Further studies are necessary to fill the gaps with regard to the knowledge related to this topic.
Collapse
|