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Souter V, Becraft E, Brummitt S, Gall BJ, Prigmore B, Wang Y, Benn P. Reproductive Carrier Screening: Identifying Families at Risk for Familial Hypercholesterolemia in the United States. Circ Genom Precis Med 2024; 17:e004457. [PMID: 38506081 PMCID: PMC11019987 DOI: 10.1161/circgen.123.004457] [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] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Familial hypercholesterolemia is a treatable genetic condition but remains underdiagnosed. We reviewed the frequency of pathogenic or likely pathogenic (P/LP) variants in the LDLR gene in female individuals receiving reproductive carrier screening. METHODS This retrospective observational study included samples from female patients (aged 18-55 years) receiving a 274-gene carrier screening panel from January 2020 to September 2022. LDLR exons and their 10 base pair flanking regions were sequenced. Carrier frequency for P/LP variants was calculated for the entire population and by race/ethnicity. The most common variants and their likely functional effects were evaluated. RESULTS A total of 91 637 tests were performed on women with race/ethnicity reported as Asian (8.8%), Black (6.1%), Hispanic (8.5%), White (29.0%), multiple or other (15.0%), and missing (33.0%). Median age was 32.8 years with 83 728 (91%) <40 years. P/LP LDLR variants were identified in 283 samples (1 in 324). No patients were identified with >1 P/LP variant. LDLR carrier frequency was higher in Asian (1 in 191 [95% CI, 1 in 142-258]) compared with White (1 in 417 [95% CI, 1 in 326-533]; P<0.001) or Black groups (1 in 508 [95% CI, 1 in 284-910]; P=0.004). The most common variants differed between populations. Of all variants, at least 25.0% were predicted as null variants. CONCLUSIONS P/LP variants in LDLR are common. Expanding the use of reproductive carrier screening to include genes associated with FH presents another opportunity to identify people predisposed to cardiovascular disease.
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Affiliation(s)
- Vivienne Souter
- Natera, Inc, Austin, TX (V.S., E.B., S.B., B.J.G., B.P., Y.W.)
| | - Emily Becraft
- Natera, Inc, Austin, TX (V.S., E.B., S.B., B.J.G., B.P., Y.W.)
| | | | - Bryan J. Gall
- Natera, Inc, Austin, TX (V.S., E.B., S.B., B.J.G., B.P., Y.W.)
| | | | - Yang Wang
- Natera, Inc, Austin, TX (V.S., E.B., S.B., B.J.G., B.P., Y.W.)
| | - Peter Benn
- University of Connecticut Health Center, Farmington, CT (P.B.)
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Ma X, Wang Q, Hu X, Wang X, Zhao Y, Liu X, Li J, Du Y, Wang M, Qiu C, Sun Q. Association of sdLDL-C With Incident Carotid Plaques With Stable and Vulnerable Morphology: A Prospective Cohort Study. Stroke 2024; 55:576-585. [PMID: 38214156 DOI: 10.1161/strokeaha.123.045601] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Small dense low-density lipoprotein cholesterol (sdLDL-C) particles are more atherogenic than large and intermediate low-density lipoprotein cholesterol (LDL-C) subfractions. We sought to investigate the association of sdLDL-C and the sdLDL-C/LDL-C ratio with incident carotid plaques with stable and vulnerable morphology in rural China. METHODS This community-based cohort study used data from the RICAS study (Rose Asymptomatic Intracranial Artery Stenosis), which enrolled 887 participants (aged ≥40 years) who were living in Kongcun Town, Pingyin County, Shandong, and free of carotid plaques and had no history of clinical stroke or transient ischemic attack at baseline (2017). Incident carotid plaques and their vulnerability were detected by carotid ultrasound at follow-up (2021). Multivariable logistic regression models were used to explore the association of sdLDL-C or sdLDL-C/LDL-C ratio with incident carotid plaques while adjusting for demographic factors, vascular risk factors, and follow-up time. RESULTS Of the 887 participants (mean age [SD], 53.89 [8.67%] years; 54.34% women), 179 (20.18%) were detected with incident carotid plaques during an average follow-up of 3.94 years (SD=0.14). Higher sdLDL-C or sdLDL-C/LDL-C ratio, but not LDL-C, was significantly associated with an increased risk of incident carotid plaques. The upper tertile of sdLDL-C (versus lower tertile) was associated with the multivariate-adjusted odds ratio of 2.48 (95% CI, 1.00-6.15; P=0.049; P for linear trend=0.046) for carotid plaques with vulnerable morphology (n=41), and the association remained significant in participants with normal LDL-C (<130 mg/dL; n=693; upper versus lower tertile: odds ratio, 3.38 [95% CI, 1.15-9.90]; P=0.027; P for linear trend=0.025). Moreover, the sdLDL-C/LDL-C ratio was associated with a higher odds ratio of incident carotid plaques in participants without diabetes (P for interaction=0.014). CONCLUSIONS Higher sdLDL-C was associated with an increased risk of incident carotid plaques, especially carotid plaques with vulnerable morphology, even in participants with normal LDL-C. This suggests the potential of sdLDL-C as a therapeutic target for stroke prevention. REGISTRATION URL: https://www.chictr.org.cn; Unique identifier: ChiCTR1800017197.
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Affiliation(s)
- Xiaotong Ma
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Qiuting Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China (Q.W., Y.D., C.Q., Q.S.)
| | - Xinyan Hu
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Xiang Wang
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yuanyuan Zhao
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Xiaohui Liu
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Jifeng Li
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yifeng Du
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China (Q.W., Y.D., C.Q., Q.S.)
| | - Mo Wang
- Department of Vascular Surgery (M.W.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Chengxuan Qiu
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China (Q.W., Y.D., C.Q., Q.S.)
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden (C.Q.)
| | - Qinjian Sun
- Key Laboratory of Endocrine Glucose and Lipids Metabolism and Brain Aging, Ministry of Education, Department of Neurology (X.M., X.H., X.W., Y.Z., X.L., J.L., Y.D., Q.S.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, People's Republic of China (Q.W., Y.D., C.Q., Q.S.)
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Paquette M, Cariou B, Bernard S, Hegele RA, Gallo A, Genest J, Trinder M, Brunham LR, Béliard S, Baass A. Increased FH-Risk-Score and Diabetes Are Cardiovascular Risk Equivalents in Heterozygous Familial Hypercholesterolemia. Arterioscler Thromb Vasc Biol 2024; 44:505-512. [PMID: 38031840 DOI: 10.1161/atvbaha.123.319957] [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: 08/02/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a genetic condition causing premature atherosclerotic cardiovascular disease (ASCVD). It is well established that patients with FH should be treated with statin therapy. However, there exists discordance concerning low-density lipoprotein cholesterol-lowering goals in the management of these patients between different guidelines worldwide. The objective was to compare the 10-year ASCVD risk of different subgroups of patients with and without FH including those with diabetes or a history of ASCVD and patients with FH within different FH-Risk-Score categories. METHODS This multinational observational study used data from 3 different prospective cohorts. A total of 3383 FH and 6917 non-FH controls matched for age and sex were included (104 363 person-years of follow-up). The 10-year incident ASCVD risk was assessed using Kaplan-Meier estimates, whereas the relative risk was estimated using Cox proportional hazards regression models. RESULTS FH patients with a high (score >20%) FH-Risk-Score (hazard ratio, 8.45 [95% CI, 6.69-10.67]; P<0.0001), FH patients with diabetes (hazard ratio, 7.67 [95% CI, 4.82-12.21]; P<0.0001), and non-FH patients with ASCVD (hazard ratio, 6.78 [95% CI, 5.45-8.42]; P<0.0001) had a significantly higher incident ASCVD risk over 10 years than the reference group (non-FH without ASCVD or diabetes). The observed 10-year risks in these groups were 32.1%, 30.8%, 30.0%, and 5.1%, respectively. The 10-year ASCVD risk associated with both FH and ASCVD was extremely high (observed risk of 50.7%; hazard ratio, 14.53 [95% CI, 12.14-17.38]; P<0.0001). CONCLUSIONS This study strongly suggests that the observed risk of FH patients with diabetes, history of ASCVD, and FH-Risk-Score >20% is as high or higher than non-FH individuals with a history of ASCVD. More aggressive management should be recommended for these patients.
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Affiliation(s)
- Martine Paquette
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Québec, Canada (M.P., S. Bernard, A.B.)
| | - Bertrand Cariou
- Nantes Université, CHU (Centre hospitalier universitaire) Nantes, CNRS (Centre national de la recherche scientifique), INSERM (L'Institut national de la santé et de la recherche médicale), L'institut Du Thorax, France (B.C.)
| | - Sophie Bernard
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Québec, Canada (M.P., S. Bernard, A.B.)
- Department of Medicine, Division of Endocrinology, Université de Montreal, Québec, Canada (S. Bernard)
- Research Centre of the Centre Hospitalier Universitaire de Montréal, Québec, Canada (S. Bernard)
| | - Robert A Hegele
- Department of Medicine (R.A.H.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Biochemistry (R.A.H.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Robarts Research Institute (R.A.H.), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Antonio Gallo
- Sorbonne Université, INSERM UMR1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, AP-HP (L'Assistance publique - hôpitaux de Paris), Hôpital Pitié-Salpètriêre, Paris, France (A.G.)
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada (J.G.)
| | - Mark Trinder
- Faculty of Medicine, Centre for Heart and Lung Innovation (M.T., L.R.B.)
- Department of Medicine (M.T., L.R.B.), University of British Columbia, Vancouver, Canada
| | - Liam R Brunham
- Faculty of Medicine, Centre for Heart and Lung Innovation (M.T., L.R.B.)
- Department of Medicine (M.T., L.R.B.), University of British Columbia, Vancouver, Canada
| | - Sophie Béliard
- Aix Marseille University, INSERM, INRAE (l'Institut national de recherche pour l'agriculture, l'alimentation et l'environnement), C2VN (Centre de recherche en CardioVasculaire et Nutrition), Department of Nutrition, Metabolic Diseases, Endocrinology, La Conception Hospital, France (S. Béliard)
| | - Alexis Baass
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, Québec, Canada (M.P., S. Bernard, A.B.)
- Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, Montreal, Québec, Canada (A.B.)
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Varughese MG, Ballantyne CM. The 2022 American College of Cardiology Expert Consensus on the Role of Nonstatin Therapies: An Expert-Guided Tour. Tex Heart Inst J 2023; 50:238233. [PMID: 38013588 PMCID: PMC10751478 DOI: 10.14503/thij-23-8233] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Affiliation(s)
- Mini G. Varughese
- Center for Cardiometabolic Disease Prevention, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Christie M. Ballantyne
- Center for Cardiometabolic Disease Prevention, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
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Tarar BI, Knox A, Dean CA, Brown EC. Resistance training responses across race and ethnicity: a narrative review. Ethn Health 2023; 28:1221-1237. [PMID: 37183720 DOI: 10.1080/13557858.2023.2212147] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES Although the physiological mechanisms are not fully understood, race/ethnicity differences vary across cardiometabolic disease risk factors. Resistance training (RT) is an effective therapy for improving these risk factors in addition to body composition and physical performance. Thus, the purpose of this study was to determine the effects of RT over time on different racial and ethnic populations across cardiometabolic, body composition, and physical performance outcomes. DESIGN Electronic databases Scopus and PubMed were searched for studies that compared different racial/ethnic responses to RT across cardiometabolic, body composition, and physical performance parameters. Inclusion criteria for the studies were as follows: (1) published in the English language; (2) compared races or ethnicities across cardiometabolic risk factors, body composition, or physical performance variables following a RT intervention; (3) included adults 18 years or older, and (4) included an isolated RT intervention group. RESULTS Nine studies were found that met the inclusion criteria. The identified studies involved cohorts of White American (WA), South Asian, European Chilean, Mapuche Chilean, White Scottish, and African American (AA) males and females. Race/ethnicity differences following a RT intervention were found for fat-free mass preservation and changes in blood pressure, endothelial function, brachial artery stiffness, cardiac autonomic function, inflammatory and oxidative stress markers, insulin sensitivity, body mass index, waist circumference, % body fat, and muscular strength. With the exception of changes in systolic blood pressure and brachial artery stiffness, AAs consistently showed more beneficial adaptations compared to WAs to RT across studies. CONCLUSION Race and ethnicity play a role in how adults adapt to chronic RT. These data may aid in better understanding the social, biological, and environmental factors that likely influenced these racial/ethnic differences in response to RT, assist in creating tailored exercise prescriptions for various racial/ethnic populations, and inform policies for determining resource allocations to address health inequities.
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Affiliation(s)
- Bilal Ihsan Tarar
- Department of Interdisciplinary Health Sciences, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Allan Knox
- Department of Exercise Science, College of Arts and Sciences, California Lutheran University, Thousand Oaks, CA, USA
| | - Caress Alithia Dean
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Elise Catherine Brown
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
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Harb T, Ziogos E, Schär M, Brown TT, Lai S, Gerstenblith G, Hays AG, Leucker TM. Rapid Improvement of Coronary Endothelial Function With PCSK9 Inhibition in People With HIV Is Associated With Reduced Lipoprotein (a) and Not LDL-cholesterol. Circ Cardiovasc Imaging 2023; 16:e015693. [PMID: 37772401 PMCID: PMC10591943 DOI: 10.1161/circimaging.123.015693] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Tarek Harb
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Efthymios Ziogos
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Schär
- Division of Magnetic Resonance Research, Department of Radiology (M.S.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Todd T Brown
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine (T.T.B.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shenghan Lai
- Department of Epidemiology and Public Health, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD (S.L.)
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison G Hays
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thorsten M Leucker
- Division of Cardiology, Department of Medicine (T.H., E.Z., G.G., A.G.H., T.M.L.), Johns Hopkins University School of Medicine, Baltimore, MD
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Goldstein LB, Toth PP, Dearborn-Tomazos JL, Giugliano RP, Hirsh BJ, Peña JM, Selim MH, Woo D. Aggressive LDL-C Lowering and the Brain: Impact on Risk for Dementia and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol 2023; 43:e404-e442. [PMID: 37706297 DOI: 10.1161/atv.0000000000000164] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The objective of this scientific statement is to evaluate contemporary evidence that either supports or refutes the conclusion that aggressive low-density lipoprotein cholesterol lowering or lipid lowering exerts toxic effects on the brain, leading to cognitive impairment or dementia or hemorrhagic stroke. The writing group used literature reviews, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion to summarize existing evidence and to identify gaps in current knowledge. Although some retrospective, case control, and prospective longitudinal studies suggest that statins and low-density lipoprotein cholesterol lowering are associated with cognitive impairment or dementia, the preponderance of observational studies and data from randomized trials do not support this conclusion. The risk of a hemorrhagic stroke associated with statin therapy in patients without a history of cerebrovascular disease is nonsignificant, and achieving very low levels of low-density lipoprotein cholesterol does not increase that risk. Data reflecting the risk of hemorrhagic stroke with lipid-lowering treatment among patients with a history of hemorrhagic stroke are not robust and require additional focused study.
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Gratton J, Humphries SE, Futema M. Prevalence of FH-Causing Variants and Impact on LDL-C Concentration in European, South Asian, and African Ancestry Groups of the UK Biobank-Brief Report. Arterioscler Thromb Vasc Biol 2023; 43:1737-1742. [PMID: 37409534 PMCID: PMC10443626 DOI: 10.1161/atvbaha.123.319438] [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: 04/13/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a monogenic disease that causes high low-density lipoprotein cholesterol (LDL-C) and higher risk of premature coronary heart disease. The prevalence of FH-causing variants and their association with LDL-C in non-European populations remains largely unknown. Using DNA diagnosis in a population-based cohort, we aimed to estimate the prevalence of FH across 3 major ancestry groups in the United Kingdom. METHODS Principal component analysis was used to distinguish genetic ancestry in UK Biobank participants. Whole exome sequencing data were analyzed to provide a genetic diagnosis of FH. LDL-C concentrations were adjusted for statin use. RESULTS Principal component analysis distinguished 140 439 European, 4067 South Asian, and 3906 African participants with lipid and whole exome sequencing data. There were significant differences between the 3 groups, including total and LDL-C concentrations, and prevalence and incidence of coronary heart disease. We identified 488, 18, and 15 participants of European, South Asian, and African ancestry carrying a likely pathogenic or pathogenic FH-variant. No statistical difference in the prevalence of an FH-causing variant was observed: 1 out of 288 (95% CI, 1/316-1/264) in European, 1 out of 260 (95% CI, 1/526-1/173) in African, and 1 out of 226 (95% CI, 1/419-1/155) in South Asian. Carriers of an FH-causing variant had significantly higher LDL-C concentration than noncarriers in every ancestry group. There was no difference in median (statin-use adjusted) LDL-C concentration in FH-variant carriers depending on their ancestry background. Self-reported statin use was nonsignificantly highest in FH-variant carriers of South Asian ancestry (55.6%), followed by African (40.0%) and European (33.8%; P=0.15). CONCLUSIONS The prevalence of FH-causing variants in the UK Biobank is similar across the ancestry groups analyzed. Despite overall differences in lipid concentrations, FH-variant carriers across the 3 ancestry groups had similar LDL-C levels. In all ancestry groups, the proportion of FH-variant carriers treated with lipid-lowering therapy should be improved to reduce future risk of premature coronary heart disease.
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Affiliation(s)
- Jasmine Gratton
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (J.G., S.E.H., M.F.)
| | - Steve E. Humphries
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (J.G., S.E.H., M.F.)
| | - Marta Futema
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (J.G., S.E.H., M.F.)
- Cardiology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (M.F.)
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Ozawa K, Packwood W, Varlamov O, Muller M, Xie A, Wu MD, Abraham-Fan RJ, López JA, Lindner JR. Elevated LDL (Low-Density Lipoprotein) Cholesterol Increases Microvascular Endothelial VWF (von Willebrand Factor) and Thromboinflammation After Myocardial Infarction. Arterioscler Thromb Vasc Biol 2023; 43:1041-1053. [PMID: 37128919 DOI: 10.1161/atvbaha.122.318884] [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] [Indexed: 05/03/2023]
Abstract
BACKGROUND In reperfused myocardial infarction, VWF (von Willebrand factor)-mediated platelet adhesion contributes to impaired microvascular reflow and possibly also to postmyocardial infarction inflammation. We hypothesized that postischemic thromboinflammatory processes are worsened by elevated LDL (low-density lipoprotein) cholesterol. METHODS Myocardial ischemia-reperfusion or sham procedure was performed in wild-type mice and hyperlipidemic mice deficient for the LDL receptor and Apobec-1 (apolipoprotein-B mRNA editing enzyme catalytic polypeptide-1; DKO [double knockout]). DKO subgroups were treated with N-acetylcysteine, which inhibits pro-adhesive VWF multimers or with recombinant ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin motifs-13), which enzymatically cleaves endothelial surface-associated VWF. Myocardial contrast echocardiography perfusion imaging and molecular imaging for VWF, platelet GP Ibα, and leukocyte CD18 were performed 30 minutes post-reperfusion. Histology, infarct sizing, and echocardiography were performed at 1.5 or 72 hours; late echocardiography was performed at day 21. RESULTS After ischemia-reperfusion, DKO compared with wild-type mice had ≈2-fold higher (P<0.05) risk area signal for microvascular platelet adhesion, VWF, and CD18; greater impairment in microvascular reflow, and 2-fold larger infarct size. Treatment of DKO mice with N-acetylcysteine and ADAMTS13 reduced molecular imaging signal for microvascular platelet adhesion, VWF, and CD18; improved early microvascular reflow; and reduced eventual infarct size. ADAMTS13 suppressed the postmyocardial infarction neutrophil and monocyte infiltration, enhanced the time-dependent recovery of left ventricular systolic function, and prevented late left ventricular remodeling. CONCLUSIONS In reperfused myocardial infarction, elevated LDL cholesterol promotes thromboinflammation through excess microvascular endothelial VWF and platelet adhesion, resulting in less microvascular reflow and larger infarct size. In the presence of elevated LDL cholesterol, therapies that suppress endothelial-associated VWF can promote recovery of left ventricular function and protect against remodeling.
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Affiliation(s)
- Koya Ozawa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland. (K.O., W.P., M.M.)
- University of Sydney, New South Wales, Australia (K.O.)
| | - William Packwood
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland. (K.O., W.P., M.M.)
| | - Oleg Varlamov
- Oregon National Primate Research Center, Oregon Health & Science University, Portland. (O.V.)
| | - Matthew Muller
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland. (K.O., W.P., M.M.)
| | - Aris Xie
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Institute, University of Virginia, Charlottesville (A.X., R.-J.A.-F., J.R.L.)
| | - Melinda D Wu
- Department of Pediatrics, Oregon Health & Science University, Portland. (M.D.W.)
| | - Rue-Jen Abraham-Fan
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Institute, University of Virginia, Charlottesville (A.X., R.-J.A.-F., J.R.L.)
| | - José A López
- Bloodworks Research Institute, Seattle, WA (J.A.L.)
| | - Jonathan R Lindner
- Division of Cardiovascular Medicine and Robert M. Berne Cardiovascular Research Institute, University of Virginia, Charlottesville (A.X., R.-J.A.-F., J.R.L.)
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Shapiro MD. Prolonged and Pronounced Low-Density Lipoprotein Cholesterol Lowering: The Gift That Keeps Giving. Circulation 2022; 146:1120-1122. [PMID: 36031845 DOI: 10.1161/circulationaha.122.061727] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Michael D Shapiro
- Wake Forest University School of Medicine, Center for Prevention of Cardiovascular Disease, Winston-Salem, NC
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11
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O'Donoghue ML, Giugliano RP, Wiviott SD, Atar D, Keech A, Kuder JF, Im K, Murphy SA, Flores-Arredondo JH, López JAG, Elliott-Davey M, Wang B, Monsalvo ML, Abbasi S, Sabatine MS. Long-Term Evolocumab in Patients With Established Atherosclerotic Cardiovascular Disease. Circulation 2022; 146:1109-1119. [PMID: 36031810 DOI: 10.1161/circulationaha.122.061620] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [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: 01/24/2023]
Abstract
BACKGROUND In FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk), the proprotein convertase subtilisin-kexin type 9 inhibitor evolocumab reduced low-density lipoprotein cholesterol (LDL-C) and risk of cardiovascular events and was safe and well tolerated over a median of 2.2 years of follow-up. However, large-scale, long-term data are lacking. METHODS The parent FOURIER trial randomized 27 564 patients with atherosclerotic cardiovascular disease and LDL-C ≥70 mg/dL on statin to evolocumab versus placebo. Patients completing FOURIER at participating sites were eligible to receive evolocumab in 2 open-label extension studies (FOURIER-OLE [FOURIER Open-Label Extension]) in the United States and Europe; primary analyses were pooled across studies. The primary end point was the incidence of adverse events. Lipid values and major adverse cardiovascular events were prospectively collected. RESULTS A total of 6635 patients were enrolled in FOURIER-OLE (3355 randomized to evolocumab and 3280 to placebo in the parent study). Median follow-up in FOURIER-OLE was 5.0 years; maximum exposure to evolocumab in parent plus FOURIER-OLE was 8.4 years. At 12 weeks in FOURIER-OLE, median LDL-C was 30 mg/dL, and 63.2% of patients achieved LDL-C <40 mg/dL on evolocumab. Incidences of serious adverse events, muscle-related events, new-onset diabetes, hemorrhagic stroke, and neurocognitive events with evolocumab long term did not exceed those for placebo-treated patients during the parent study and did not increase over time. During the FOURIER-OLE follow-up period, patients originally randomized in the parent trial to evolocumab versus placebo had a 15% lower risk of cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina or coronary revascularization (hazard ratio, 0.85 [95% CI, 0.75-0.96]; P=0.008); a 20% lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80 [95% CI, 0.68-0.93]; P=0.003); and a 23% lower risk of cardiovascular death (hazard ratio, 0.77 [95% CI, 0.60-0.99]; P=0.04). CONCLUSIONS Long-term LDL-C lowering with evolocumab was associated with persistently low rates of adverse events for >8 years that did not exceed those observed in the original placebo arm during the parent study and led to further reductions in cardiovascular events compared with delayed treatment initiation. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT02867813 and NCT03080935.
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Affiliation(s)
- Michelle L O'Donoghue
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Stephen D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, Norway (D.A.)
- Institute of Clinical Medicine, University of Oslo, Norway (D.A.)
| | - Anthony Keech
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Julia F Kuder
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - KyungAh Im
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | - Sabina A Murphy
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
| | | | - J Antonio G López
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | | | - Bei Wang
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | - Maria Laura Monsalvo
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | - Siddique Abbasi
- Global Development, Amgen, Thousand Oaks, CA (J.H.F.-A., J.A.G.L., B.W., M.L.M., S.A.)
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (M.L.O., R.P.G., S.D.W., J.F.K., K.I., S.A.M., M.S.S.)
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12
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Dijk W, Di Filippo M, Kooijman S, van Eenige R, Rimbert A, Caillaud A, Thedrez A, Arnaud L, Pronk A, Garçon D, Sotin T, Lindenbaum P, Ozcariz Garcia E, Pais de Barros JP, Duvillard L, Si-Tayeb K, Amigo N, Le Questel JY, Rensen PC, Le May C, Moulin P, Cariou B. Identification of a Gain-of-Function LIPC Variant as a Novel Cause of Familial Combined Hypocholesterolemia. Circulation 2022; 146:724-739. [PMID: 35899625 PMCID: PMC9439636 DOI: 10.1161/circulationaha.121.057978] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/23/2023]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is the main cause of mortality worldwide and is strongly influenced by circulating low-density lipoprotein (LDL) cholesterol levels. Only a few genes causally related to plasma LDL cholesterol levels have been identified so far, and only 1 gene, ANGPTL3, has been causally related to combined hypocholesterolemia. Here, our aim was to elucidate the genetic origin of an unexplained combined hypocholesterolemia inherited in 4 generations of a French family. METHODS Using next-generation sequencing, we identified a novel dominant rare variant in the LIPC gene, encoding for hepatic lipase, which cosegregates with the phenotype. We characterized the impact of this LIPC-E97G variant on circulating lipid and lipoprotein levels in family members using nuclear magnetic resonance-based lipoprotein profiling and lipidomics. To uncover the mechanisms underlying the combined hypocholesterolemia, we used protein homology modeling, measured triglyceride lipase and phospholipase activities in cell culture, and studied the phenotype of APOE*3.Leiden.CETP mice after LIPC-E97G overexpression. RESULTS Family members carrying the LIPC-E97G variant had very low circulating levels of LDL cholesterol and high-density lipoprotein cholesterol, LDL particle numbers, and phospholipids. The lysophospholipids/phospholipids ratio was increased in plasma of LIPC-E97G carriers, suggestive of an increased lipolytic activity on phospholipids. In vitro and in vivo studies confirmed that the LIPC-E97G variant specifically increases the phospholipase activity of hepatic lipase through modification of an evolutionarily conserved motif that determines substrate access to the hepatic lipase catalytic site. Mice overexpressing human LIPC-E97G recapitulated the combined hypocholesterolemic phenotype of the family and demonstrated that the increased phospholipase activity promotes catabolism of triglyceride-rich lipoproteins by different extrahepatic tissues but not the liver. CONCLUSIONS We identified and characterized a novel rare variant in the LIPC gene in a family who presents with dominant familial combined hypocholesterolemia. This gain-of-function variant makes LIPC the second identified gene, after ANGPTL3, causally involved in familial combined hypocholesterolemia. Our mechanistic data highlight the critical role of hepatic lipase phospholipase activity in LDL cholesterol homeostasis and suggest a new LDL clearance mechanism.
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Affiliation(s)
- Wieneke Dijk
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Mathilde Di Filippo
- UF Dyslipidémies, Service de Biochimie et de Biologie Moléculaire, Laboratoire de Biologie Médicale MultiStites, Hospices Civils de Lyon, Bron, France (M.D.F.).,CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France (M.D.F., P.M.)
| | - Sander Kooijman
- Department of Medicine, Division of Endocrinology and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands (S.K., R.v.E., A.P., P.C.N.R.)
| | - Robin van Eenige
- Department of Medicine, Division of Endocrinology and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands (S.K., R.v.E., A.P., P.C.N.R.)
| | - Antoine Rimbert
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Amandine Caillaud
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Aurélie Thedrez
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Lucie Arnaud
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Amanda Pronk
- Department of Medicine, Division of Endocrinology and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands (S.K., R.v.E., A.P., P.C.N.R.)
| | - Damien Garçon
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Thibaud Sotin
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Pierre Lindenbaum
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | | | - Jean-Paul Pais de Barros
- Lipidomic Platform, INSERM UMR1231, Université de Bourgogne Franche-Comté, Dijon, France (J.-P.P.d.B.)
| | - Laurence Duvillard
- University of Burgundy, INSERM LNC UMR1231, Dijon, France (L.D.).,CHU Dijon, Department of Biochemistry, Dijon, France (L.D.)
| | - Karim Si-Tayeb
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Nuria Amigo
- Biosfer Teslab, Reus, Spain (E.O.G., N.A.).,Department of Basic Medical Sciences, Rovira I Virgili University, IISPV, CIBERDEM, Reus, Spain (N.A.)
| | | | - Patrick C.N. Rensen
- Department of Medicine, Division of Endocrinology and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, the Netherlands (S.K., R.v.E., A.P., P.C.N.R.)
| | - Cédric Le May
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
| | - Philippe Moulin
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France (M.D.F., P.M.).,Fédération d’endocrinologie, maladies métaboliques, diabète et nutrition, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France (P.M.)
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, INSERM, l’institut du thorax, France (W.D., A.R., A.C., A.T., L.A., D.G., T.S., P.L., K.S.-T., C.L.M., B.C.)
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13
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Stankov S, Vitali C, Rader DJ. Gain-of-Function Variants in Lipid Genes Enhance Biological Insight and Point Toward Therapeutic Opportunities. Circulation 2022; 146:740-742. [PMID: 36067277 PMCID: PMC10122829 DOI: 10.1161/circulationaha.122.061233] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Sylvia Stankov
- Division of Translational Medicine and Therapeutics, Department of Medicine (S.S., C.V., D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cecilia Vitali
- Division of Translational Medicine and Therapeutics, Department of Medicine (S.S., C.V., D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel J Rader
- Division of Translational Medicine and Therapeutics, Department of Medicine (S.S., C.V., D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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14
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Hagström E, Steg PG, Szarek M, Bhatt DL, Bittner VA, Danchin N, Diaz R, Goodman SG, Harrington RA, Jukema JW, Liberopoulos E, Marx N, McGinniss J, Manvelian G, Pordy R, Scemama M, White HD, Zeiher AM, Schwartz GG. Apolipoprotein B, Residual Cardiovascular Risk After Acute Coronary Syndrome, and Effects of Alirocumab. Circulation 2022; 146:657-672. [PMID: 35770629 PMCID: PMC9422774 DOI: 10.1161/circulationaha.121.057807] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 01/23/2023]
Abstract
BACKGROUND Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipoprotein cholesterol is uncertain. METHODS The ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) compared the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins despite optimized statin therapy. Primary outcome was major adverse cardiovascular events (MACE; coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, hospitalization for unstable angina). Associations between baseline apoB or apoB at 4 months and MACE were assessed in adjusted Cox proportional hazards and propensity score-matched models. RESULTS Median follow-up was 2.8 years. In proportional hazards analysis in the placebo group, MACE incidence increased across increasing baseline apoB strata (3.2 [95% CI, 2.9-3.6], 4.0 [95% CI, 3.6-4.5], and 5.5 [95% CI, 5.0-6.1] events per 100 patient-years in strata <75, 75-<90, ≥90 mg/dL, respectively; Ptrend<0.0001) and after adjustment for low-density lipoprotein cholesterol (Ptrend=0.035). Higher baseline apoB stratum was associated with greater relative (Ptrend<0.0001) and absolute reduction in MACE with alirocumab versus placebo. In the alirocumab group, the incidence of MACE after month 4 decreased monotonically across decreasing achieved apoB strata (4.26 [95% CI, 3.78-4.79], 3.09 [95% CI, 2.69-3.54], and 2.41 [95% CI, 2.11-2.76] events per 100 patient-years in strata ≥50, >35-<50, and ≤35 mg/dL, respectively). Compared with propensity score-matched patients from the placebo group, treatment hazard ratios for alirocumab also decreased monotonically across achieved apoB strata. Achieved apoB was predictive of MACE after adjustment for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol but not vice versa. CONCLUSIONS In patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, MACE increased across baseline apoB strata. Alirocumab reduced MACE across all strata of baseline apoB, with larger absolute reductions in patients with higher baseline levels. Lower achieved apoB was associated with lower risk of MACE, even after accounting for achieved low-density lipoprotein cholesterol or non-high-density lipoprotein cholesterol, indicating that apoB provides incremental information. Achievement of apoB levels as low as ≤35 mg/dL may reduce lipoprotein-attributable residual risk after acute coronary syndrome. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01663402.
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Affiliation(s)
- Emil Hagström
- Uppsala University, Department of Medical Sciences, and Uppsala Clinical Research Center, Sweden (E.H.)
| | - P. Gabriel Steg
- Department of Cardiology, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), and INSERM U1148, France (P.G.S.).,Imperial College, Royal Brompton Hospital, London, UK (P.G.S.)
| | - Michael Szarek
- CPC Clinical Research (M. Szarek), University of Colorado School of Medicine, Aurora.,Division of Cardiology (M. Szarek, G.G.S.), University of Colorado School of Medicine, Aurora.,State University of New York, Downstate Health Sciences University, Brooklyn (M. Szarek)
| | - Deepak L. Bhatt
- Department of Medicine, Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Vera A. Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham (V.A.B.)
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France (N.D.).,Université Paris Descartes, France (N.D.)
| | - Rafael Diaz
- Estudios Cardiológicos Latino América, Instituto Cardiovascular de Rosario, Argentina (R.D.)
| | - Shaun G. Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (S.G.G.).,St. Michael’s Hospital, University of Toronto, Ontario, Canada (S.G.G.)
| | - Robert A. Harrington
- Stanford Center for Clinical Research, Department of Medicine, Stanford University, CA (R.A.H.)
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.W.J.).,Netherlands Heart Institute, Utrecht (J.W.J.)
| | | | - Nikolaus Marx
- University Hospital, RWTH Aachen University, Germany (N.M.)
| | | | - Garen Manvelian
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (J.M., G.M., R.P.)
| | - Robert Pordy
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (J.M., G.M., R.P.)
| | | | - Harvey D. White
- Green Lane Cardiovascular Services, Auckland City Hospital and Auckland University, New Zealand (H.D.W.)
| | - Andreas M. Zeiher
- Department of Medicine III, Goethe University, Frankfurt am Main, Germany (A.M.Z.)
| | - Gregory G. Schwartz
- Division of Cardiology (M. Szarek, G.G.S.), University of Colorado School of Medicine, Aurora
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15
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Elshazly MB, Quispe R. The Lower the ApoB, the Better: Now, How Does ApoB Fit in the Upcoming Era of Targeted Therapeutics? Circulation 2022; 146:673-675. [PMID: 36037269 DOI: 10.1161/circulationaha.122.061188] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Mohamed B Elshazly
- Division of Cardiology, Medical University of South Carolina, Charleston (M.B.E.).,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease; Baltimore, MD (M.B.E., R.Q.)
| | - Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease; Baltimore, MD (M.B.E., R.Q.)
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16
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Cho KH, Kim MC, Choo EH, Choi IJ, Lee SN, Park MW, Park CS, Kim HY, Kim CJ, Sim DS, Kim JH, Hong YJ, Jeong MH, Chang K, Ahn Y. Impact of Low Baseline Low-Density Lipoprotein Cholesterol on Long-Term Postdischarge Cardiovascular Outcomes in Patients With Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e025958. [PMID: 36000434 PMCID: PMC9496430 DOI: 10.1161/jaha.122.025958] [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: 11/16/2022]
Abstract
Background Real‐world data on low baseline low‐density lipoprotein cholesterol (LDL‐C) levels and long‐term postdischarge cardiovascular outcomes in patients with acute coronary syndrome are limited. Methods and Results Of the 10 719 patients enrolled in the Korean registry of acute myocardial infarction between January 2004 and August 2014, we identified 5532 patients who were event free from death, recurrent myocardial infarction, or stroke during the in‐hospital period after successful percutaneous coronary intervention. The co–primary outcomes were 3‐point major adverse cardiovascular events (a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and cardiovascular death at 5 years. Of 5532 patients with acute myocardial infarction (mean age, 62.1±12.8 years; 75.0% men), 446 cardiovascular deaths (8.1%) and 695 three‐point major adverse cardiovascular events (12.6%) occurred at 5 years. In the continuous analysis of LDL‐C, the risk of cardiovascular events increased steeply as LDL‐C levels decreased from 100 mg/dL. For categorical analysis of LDL‐C (<70, 70–99, and ≥100 mg/dL), as LDL‐C levels decreased, clinical outcomes worsened (237/3759 [6.3%] in LDL‐C ≥100 mg/dL versus 123/1291 [9.5%] in LDL‐C 70–99 mg/dL versus 86/482 [17.8%] in LDL‐C <70 mg/dL for cardiovascular death; P‐trend<0.001; and 417/3759 [11.1%] in LDL‐C ≥100 mg/dL versus 172/1291 [13.3%] in LDL‐C 70–99 mg/dL versus 106/482 [22.2%] in LDL‐C <70 mg/dL for 3‐point major adverse cardiovascular event; P‐trend<0.001). In a Cox time‐to‐event multivariable model with LDL‐C levels ≥100 mg/dL as the reference, the baseline LDL‐C level <70 mg/dL was independently associated with an increased incidence of cardiovascular death (adjusted hazard ratio, 1.68 [95% CI, 1.30–2.17]) and 3‐point major adverse cardiovascular event (adjusted hazard ratio, 1.37 [95% CI, 1.10–1.71]). Conclusions In this Korean acute myocardial infarction registry, the baseline LDL‐C level <70 mg/dL was significantly associated with an increased incidence of long‐term cardiovascular events after discharge. (COREA [Cardiovascular Risk and Identification of Potential High‐Risk Population]‐Acute Myocardial Infarction Registry; NCT02806102). Registration URL: https://www.clinicaltrials.gov/; Unique identifier: NCT02806102.
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Affiliation(s)
- Kyung Hoon Cho
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea
| | - Min Chul Kim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Eun Ho Choo
- Department of Cardiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Ik Jun Choi
- Department of Cardiology Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Incheon Republic of Korea
| | - Su Nam Lee
- Department of Cardiology St Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of Korea
| | - Mahn-Won Park
- Department of Cardiology Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Daejeon Republic of Korea
| | - Chul Soo Park
- Department of Cardiology Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Hee-Yeol Kim
- Department of Cardiology Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea Bucheon Republic of Korea
| | - Chan Joon Kim
- Department of Cardiology Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Doo Sun Sim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Ju Han Kim
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Young Joon Hong
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
| | - Kiyuk Chang
- Department of Cardiology Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea Seoul Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology Chonnam National University Hospital Gwangju Republic of Korea.,Department of Cardiology Chonnam National University Medical School Hwasun-gun Republic of Korea
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17
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Amarenco P, Kim JS, Labreuche J, Charles H, Giroud M, Lavallée PC, Lee BC, Mahagne MH, Meseguer E, Nighoghossian N, Steg PG, Vicaut É, Bruckert E. Intracranial Hemorrhage in the TST Trial. Stroke 2021; 53:457-462. [PMID: 34963300 DOI: 10.1161/strokeaha.121.035846] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although statins are effective in secondary prevention of ischemic stroke, they are also associated with an increase risk of intracranial hemorrhage (ICH) in certain conditions. In the TST trial (Treat Stroke to Target), we prespecified an exploration of the predictors of incident ICH. METHODS Patients with ischemic stroke in the previous 3 months or transient ischemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis were randomly assigned in a 1:1 ratio to a target LDL (low-density lipoprotein) cholesterol of <70 mg/dL or 100±10 mg/dL, using statin or ezetimibe. RESULTS Among 2860 patients enrolled, 31 incident ICH occurred over a median follow-up of 3 years (18 and 13 in the lower and higher target group, 3.21/1000 patient-years [95% CI, 2.38-4.04] and 2.32/1000 patient-years [95% CI, 1.61-3.03], respectively). While there were no baseline predictors of ICH, uncontrolled hypertension (HR, 2.51 [95% CI, 1.01-6.31], P=0.041) and being on anticoagulant (HR, 2.36 [95% CI, 1.00-5.62], P=0.047)] during the trial were significant predictors. On-treatment low LDL cholesterol was not a predictor of ICH. CONCLUSIONS Targeting an LDL cholesterol of <70 mg/dL compared with 100±10 mg/dL in patients with atherosclerotic ischemic stroke nonsignificantly increased the risk of ICH. Incident ICHs were not associated with low LDL cholesterol. Uncontrolled hypertension and anticoagulant therapy were associated with ICH which has important clinical implications. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT01252875; EUDRACT identifier: 2009-A01280-57.
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Affiliation(s)
- Pierre Amarenco
- APHP, Department of Neurology and Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris, France (P.A., H.C., P.C.L., E.M.)
| | - Jong S Kim
- Asan Medical Center, Seoul, South Korea (J.S.K.)
| | - Julien Labreuche
- Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, F59000-Lille, France (J.L.)
| | - Hugo Charles
- APHP, Department of Neurology and Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris, France (P.A., H.C., P.C.L., E.M.)
| | - Maurice Giroud
- Department of Neurology, University Hospital of Dijon, Dijon Stroke Registry, EA 7460, University of Burgundy, UBFC, Dijon-France (M.G.)
| | - Philippa C Lavallée
- APHP, Department of Neurology and Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris, France (P.A., H.C., P.C.L., E.M.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L.)
| | | | - Elena Meseguer
- APHP, Department of Neurology and Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris, France (P.A., H.C., P.C.L., E.M.)
| | - Norbert Nighoghossian
- Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, France (N.N.)
| | - Philippe Gabriel Steg
- Université de Paris, INSERM LVTS-U1148, F-75018, France. AP-HP, Hôpital Bichat, F-75018 Paris, France (P.G.S.)
| | - Éric Vicaut
- APHP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal hospital, France (É.V.)
| | - Eric Bruckert
- APHP, Department of Endocrinology, Pitié-Salpêtrière hospital, Sorbonne University, Paris, France (E.B.)
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18
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Qian S, You S, Sun Y, Wu Q, Wang X, Tang W, Dong X, Liu CF, Xu T, Cao Y, Zhong C. Remnant Cholesterol and Common Carotid Artery Intima-Media Thickness in Patients With Ischemic Stroke. Circ Cardiovasc Imaging 2021; 14:e010953. [PMID: 33832329 DOI: 10.1161/circimaging.120.010953] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 01/05/2023]
Abstract
BACKGROUND Remnant cholesterol makes great contribution to residual risk of cardiovascular disease, but population-based evidence on the relationship between remnant cholesterol and atherosclerosis is rare. Common carotid artery intima-media thickness (cIMT) is an imaging marker of subclinical atherosclerosis. We aimed to explore the association between remnant cholesterol levels and cIMT in patients with ischemic stroke. METHODS One thousand four hundred ninety-six ischemic stroke patients with baseline serum lipids and carotid artery imaging data were included in this analysis. Fasting remnant cholesterol was calculated as total cholesterol minus HDL (high-density lipoprotein) cholesterol minus LDL (low-density lipoprotein) cholesterol. Abnormal cIMT was defined as mean cIMT and maximum cIMT value ≥1 mm. Logistic regression and restricted cubic spline models were used to assess the relationships between remnant cholesterol levels and abnormal cIMT. RESULTS The multivariable-adjusted odds ratios (95% CIs) for the highest versus lowest quartile of remnant cholesterol were 2.06 (1.46-2.91) for abnormal mean cIMT and 1.70 (1.23-2.35) for abnormal maximum cIMT. There were linear associations between remnant cholesterol levels and both abnormal mean cIMT (P for linearity, <0.001) and abnormal maximum cIMT (P for linearity, 0.003). Moreover, the remnant cholesterol-cIMT association remained significant in the subsample of patients with optimal LDL cholesterol levels (n=179). CONCLUSIONS Elevated fasting remnant cholesterol levels were positively associated with mean cIMT and maximum cIMT in patients with ischemic stroke, even in patients with optimal LDL cholesterol levels. Future prospective studies are needed to verify our findings and to assess the effect of remnant cholesterol-lowering interventions in patients with ischemic stroke.
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Affiliation(s)
- Sifan Qian
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (S.Q., T.X., C.Z.)
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y., C.L., Y.C.)
| | - Yaming Sun
- Department of Neurology, Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Suzhou, China (Y.S.)
| | - Qiuyi Wu
- Department of Neurology, Zhangjiagang First People's Hospital, Suzhou, China (Q.W.)
| | - Xianhui Wang
- Department of Neurology, Taicang First People's Hospital, Suzhou, China (X.W.)
| | - Weiting Tang
- Department of Neurology, Changshu Second People's Hospital, Suzhou, China (W.T.)
| | - Xiaofeng Dong
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, China (X.D.)
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y., C.L., Y.C.)
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (S.Q., T.X., C.Z.)
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y., C.L., Y.C.)
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (S.Q., T.X., C.Z.)
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19
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Reeskamp LF, Millar JS, Wu L, Jansen H, van Harskamp D, Schierbeek H, Gipe DA, Rader DJ, Dallinga-Thie GM, Hovingh GK, Cuchel M. ANGPTL3 Inhibition With Evinacumab Results in Faster Clearance of IDL and LDL apoB in Patients With Homozygous Familial Hypercholesterolemia-Brief Report. Arterioscler Thromb Vasc Biol 2021; 41:1753-1759. [PMID: 33691480 PMCID: PMC8057526 DOI: 10.1161/atvbaha.120.315204] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. Objective: The mechanism by which evinacumab, a fully human monoclonal antibody directed against ANGPTL3 (angiopoietin-like 3 protein) lowers plasma LDL (low-density lipoprotein) cholesterol levels in patients with homozygous familial hypercholesterolemia is unknown. We investigated apoB (apolipoprotein B) containing lipoprotein kinetic parameters in patients with homozygous familial hypercholesterolemia, before and after treatment with evinacumab. Approach and Results: Four patients with homozygous familial hypercholesterolemia underwent apoB kinetic analyses in 2 centers as part of a substudy of a trial evaluating the efficacy and safety of evinacumab in patients with homozygous familial hypercholesterolemia. The enrichment of apoB with the stable isotope (5,5,5-2H3)-Leucine was measured in VLDL (very LDL), IDL (intermediate-density lipoprotein), and LDL at different time points before and after intravenous administration of 15 mg/kg evinacumab. Evinacumab lowered LDL-cholesterol by 59±2% and increased IDL apoB and LDL apoB fractional catabolic rate in all 4 homozygous familial hypercholesterolemia subjects, by 616±504% and 113±14%, respectively. VLDL-apoB production rate decreased in 2 of the 4 subjects. Conclusions: In this small study, ANGPTL3 inhibition with evinacumab is associated with an increase in the fractional catabolic rate of IDL apoB and LDL apoB, suggesting that evinacumab lowers LDL-cholesterol predominantly by increasing apoB-containing lipoprotein clearance from the circulation. Additional studies are needed to unravel which factors are determinants in this biological pathway. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04722068.
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Affiliation(s)
- Laurens F Reeskamp
- Department of Vascular Medicine (L.F.R., G.K.H.), Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands
| | - John S Millar
- Institute for Diabetes, Obesity, and Metabolism (J.S.M.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of Translational Medicine and Human Genetics, Department of Medicine (J.S.M., L.W., D.J.R., M.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Liya Wu
- Division of Translational Medicine and Human Genetics, Department of Medicine (J.S.M., L.W., D.J.R., M.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hans Jansen
- Department of Experimental Vascular Medicine (H.J.), Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands
| | - Dewi van Harskamp
- Stable Isotope Research Laboratory, Endocrinology, Vrije Universiteit (D.v.H., H.S.), Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands
| | - Henk Schierbeek
- Stable Isotope Research Laboratory, Endocrinology, Vrije Universiteit (D.v.H., H.S.), Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands
| | - Daniel A Gipe
- Regeneron Pharmaceuticals, Inc, Tarrytown, NY (D.A.G.)
| | - Daniel J Rader
- Division of Translational Medicine and Human Genetics, Department of Medicine (J.S.M., L.W., D.J.R., M.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - G Kees Hovingh
- Department of Vascular Medicine (L.F.R., G.K.H.), Amsterdam UMC, location AMC, University of Amsterdam, The Netherlands
| | - Marina Cuchel
- Division of Translational Medicine and Human Genetics, Department of Medicine (J.S.M., L.W., D.J.R., M.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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20
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Ikeda J, Scipione CA, Hyduk SJ, Althagafi MG, Atif J, Dick SA, Rajora M, Jang E, Emoto T, Murakami J, Ikeda N, Ibrahim HM, Polenz CK, Gao X, Tai K, Jongstra-Bilen J, Nakashima R, Epelman S, Robbins CS, Zheng G, Lee WL, MacParland SA, Cybulsky MI. Radiation Impacts Early Atherosclerosis by Suppressing Intimal LDL Accumulation. Circ Res 2021; 128:530-543. [PMID: 33397122 DOI: 10.1161/circresaha.119.316539] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
RATIONALE Bone marrow transplantation (BMT) is used frequently to study the role of hematopoietic cells in atherosclerosis, but aortic arch lesions are smaller in mice after BMT. OBJECTIVE To identify the earliest stage of atherosclerosis inhibited by BMT and elucidate potential mechanisms. METHODS AND RESULTS Ldlr-/- mice underwent total body γ-irradiation, bone marrow reconstitution, and 6-week recovery. Atherosclerosis was studied in the ascending aortic arch and compared with mice without BMT. In BMT mice, neutral lipid and myeloid cell topography were lower in lesions after feeding a cholesterol-rich diet for 3, 6, and 12 weeks. Lesion coalescence and height were suppressed dramatically in mice post-BMT, whereas lateral growth was inhibited minimally. Targeted radiation to the upper thorax alone reproduced the BMT phenotype. Classical monocyte recruitment, intimal myeloid cell proliferation, and apoptosis did not account for the post-BMT phenotype. Neutral lipid accumulation was reduced in 5-day lesions, thus we developed quantitative assays for LDL (low-density lipoprotein) accumulation and paracellular leakage using DiI-labeled human LDL and rhodamine B-labeled 70 kD dextran. LDL accumulation was dramatically higher in the intima of Ldlr-/- relative to Ldlr+/+ mice, and was inhibited by injection of HDL mimics, suggesting a regulated process. LDL, but not dextran, accumulation was lower in mice post-BMT both at baseline and in 5-day lesions. Since the transcript abundance of molecules implicated in LDL transcytosis was not significantly different in the post-BMT intima, transcriptomics from whole aortic arch intima, and at single-cell resolution, was performed to give insights into pathways modulated by BMT. CONCLUSIONS Radiation exposure inhibits LDL entry into the aortic intima at baseline and the earliest stages of atherosclerosis. Single-cell transcriptomic analysis suggests that LDL uptake by endothelial cells is diverted to lysosomal degradation and reverse cholesterol transport pathways. This reduces intimal accumulation of lipid and impacts lesion initiation and growth.
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Affiliation(s)
- Jiro Ikeda
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto
| | - Corey A Scipione
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto
| | - Sharon J Hyduk
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada
| | - Marwan G Althagafi
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto
| | - Jawairia Atif
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Ajmera Family Transplant Centre, Toronto General Hospital Research Institute (J.A., S.A.M.), University Health Network, Toronto, Canada.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto
| | - Sarah A Dick
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Ajmera Family Transplant Centre, Toronto General Hospital Research Institute (J.A., S.A.M.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto.,Ted Rogers Centre for Heart Research, Translational Biology and Engineering Program (S.A.D., S.E.)
| | - Maneesha Rajora
- Princess Margaret Cancer Centre (M.R., R.N., G.Z.), University Health Network, Toronto, Canada
| | - Erika Jang
- Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Keenan Research Centre, Unity Health (E.J., W.L.L.)
| | - Takuo Emoto
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada
| | - Junichi Murakami
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Latner Thoracic Surgery Research Laboratories (J.M.), University Health Network, Toronto, Canada
| | - Noriko Ikeda
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada
| | - Hisham M Ibrahim
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto
| | - Chanele K Polenz
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto
| | - Xiaotang Gao
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada
| | - Kelly Tai
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto
| | - Jenny Jongstra-Bilen
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto
| | - Ryota Nakashima
- Princess Margaret Cancer Centre (M.R., R.N., G.Z.), University Health Network, Toronto, Canada
| | - Slava Epelman
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Peter Munk Cardiac Centre (S.E., C.S.R., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto.,Ted Rogers Centre for Heart Research, Translational Biology and Engineering Program (S.A.D., S.E.)
| | - Clinton S Robbins
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Peter Munk Cardiac Centre (S.E., C.S.R., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto
| | - Gang Zheng
- Princess Margaret Cancer Centre (M.R., R.N., G.Z.), University Health Network, Toronto, Canada
| | - Warren L Lee
- Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Medicine (W.L.L.), University of Toronto.,Keenan Research Centre, Unity Health (E.J., W.L.L.)
| | - Sonya A MacParland
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto
| | - Myron I Cybulsky
- Toronto General Hospital Research Institute (J.I., C.A.S., S.J.H., M.G.A., J.A., S.A.D., T.E., J.M., N.I., H.M.I., C.K.P., X.G., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University Health Network, Toronto, Canada.,Peter Munk Cardiac Centre (S.E., C.S.R., M.I.C.), University Health Network, Toronto, Canada.,Laboratory Medicine and Pathobiology (J.I., C.A.S., M.G.A., E.J., H.M.I., C.K.P., J.J.-B., S.E., C.S.R., W.L.L., S.A.M., M.I.C.), University of Toronto.,Immunology (C.A.S., J.A., S.A.D., K.T., J.J.-B., S.E., C.S.R., S.A.M., M.I.C.), University of Toronto
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Leucker TM, Blaha MJ, Jones SR, Vavuranakis MA, Williams MS, Lai H, Schindler TH, Latina J, Schulman SP, Gerstenblith G. Effect of Evolocumab on Atherogenic Lipoproteins During the Peri- and Early Postinfarction Period: A Placebo-Controlled, Randomized Trial. Circulation 2020; 142:419-421. [PMID: 32718248 DOI: 10.1161/circulationaha.120.046320] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Thorsten M Leucker
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Michael J Blaha
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Steven R Jones
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Michael A Vavuranakis
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Marlene S Williams
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Hong Lai
- Department of Radiology, Johns Hopkins University School of Medicine (H.L.), Baltimore, Maryland
| | - Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University School of Medicine, Washington University in St. Louis, MO (T.H.S.)
| | - Jacqueline Latina
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Steven P Schulman
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
| | - Gary Gerstenblith
- Division of Cardiology, Department of Medicine (T.M.L., M.J.B., S.R.J., M.A.V., M.S.W., J.L., S.P.S., G.G.), Baltimore, Maryland
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22
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Affiliation(s)
- Amit V Khera
- Center for Genomic Medicine and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (A.V.K.).,Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (A.V.K.).,Department of Medicine, Harvard Medical School, Boston, MA (A.V.K.)
| | - Robert A Hegele
- Departments of Medicine and Biochemistry and Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Canada (R.A.H.)
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23
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Marston NA, Gurmu Y, Melloni GEM, Bonaca M, Gencer B, Sever PS, Pedersen TR, Keech AC, Roselli C, Lubitz SA, Ellinor PT, O'Donoghue ML, Giugliano RP, Ruff CT, Sabatine MS. The Effect of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibition on the Risk of Venous Thromboembolism. Circulation 2020; 141:1600-1607. [PMID: 32223429 PMCID: PMC7469753 DOI: 10.1161/circulationaha.120.046397] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND The relationship between cholesterol levels and risk of venous thromboembolism (VTE) is uncertain. We set out to determine the effect of PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition on the risk of VTE, explore potential mechanisms, and examine the efficacy in subgroups with clinically and genetically defined risk. METHODS We performed a post hoc analysis of the FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) testing whether evolocumab reduces the risk of VTE events (deep venous thrombosis or pulmonary embolism). Data from FOURIER and ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment with Alirocumab) were then combined in a meta-analysis to assess the class effect of PCSK9 inhibition on the risk of VTE. We also analyzed baseline lipids in FOURIER to investigate potential mechanisms explaining the reduction in VTE with evolocumab. Last, an exploratory genetic analysis was performed in FOURIER to determine whether a VTE polygenic risk score could identify high-risk patients who would derive the greatest VTE reduction from evolocumab. RESULTS In FOURIER, the hazard ratio (HR) for VTE with evolocumab was 0.71 (95% CI, 0.50-1.00; P=0.05), with no effect in the 1st year (HR, 0.96 [95% CI, 0.57-1.62]) but a 46% reduction (HR, 0.54 [95% CI, 0.33-0.88]; P=0.014) beyond 1 year. A meta-analysis of FOURIER and ODYSSEY OUTCOMES demonstrated a 31% relative risk reduction in VTE with PCSK9 inhibition (HR, 0.69 [95% CI, 0.53-0.90]; P=0.007). There was no relation between baseline low-density lipoprotein cholesterol levels and magnitude of VTE risk reduction. In contrast, in patients with higher baseline lipoprotein(a) (Lp[a]) levels, evolocumab reduced Lp(a) by 33 nmol/L and risk of VTE by 48% (HR, 0.52 [95% CI, 0.30-0.89]; P=0.017), whereas, in patients with lower baseline Lp(a) levels, evolocumab reduced Lp(a) by only 7 nmol/L and had no effect on VTE risk (Pinteraction 0.087 for HR; Pheterogeneity 0.037 for absolute risk reduction). Modeled as a continuous variable, there was a significant interaction between baseline Lp(a) concentration and magnitude of VTE risk reduction (Pinteraction=0.04). A polygenic risk score identified patients who were at >2-fold increased risk for VTE and who derived greater relative (Pinteraction=0.04) and absolute VTE reduction (Pheterogeneity=0.009) in comparison with those without high genetic risk. CONCLUSIONS PCSK9 inhibition significantly reduces the risk of VTE. Lp(a) reduction may be an important mediator of this effect, a finding of particular interest given the ongoing development of potent Lp(a) inhibitors.
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Affiliation(s)
- Nicholas A Marston
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
| | - Yared Gurmu
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
| | - Giorgio E M Melloni
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
| | - Marc Bonaca
- CPC Clinical Research, Department of Medicine, Cardiovascular Division, University of Colorado School of Medicine, Aurora (M.B.)
| | - Baris Gencer
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
| | - Peter S Sever
- National Heart and Lung Institute, Imperial College London, United Kingdom (P.S.S.)
| | - Terje R Pedersen
- Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.)
| | - Anthony C Keech
- Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.)
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (C.R., S.A.L, P.T.E.)
- University Medical Center Groningen, University of Groningen, The Netherlands (C.R.)
| | - Steven A Lubitz
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (C.R., S.A.L, P.T.E.)
- Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (C.R., S.A.L, P.T.E.)
- Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., P.T.E.)
| | - Michelle L O'Donoghue
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
| | - Christian T Ruff
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.A.M., Y.G., G.E.M.M., B.G., M.L.O., R.P.G., C.T.R., M.S.S.)
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24
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Amarenco P, Kim JS, Labreuche J, Charles H, Giroud M, Lee BC, Mahagne MH, Nighoghossian N, Gabriel Steg P, Vicaut É, Bruckert E. Benefit of Targeting a LDL (Low-Density Lipoprotein) Cholesterol <70 mg/dL During 5 Years After Ischemic Stroke. Stroke 2020; 51:1231-1239. [PMID: 32078484 DOI: 10.1161/strokeaha.119.028718] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The TST trial (Treat Stroke to Target) evaluated the benefit of targeting a LDL (low-density lipoprotein) cholesterol of <70 mg/dL to reduce the risk of cardiovascular events in 2860 patients with ischemic stroke with atherosclerotic stenosis of cerebral vasculature or aortic arch plaque >4 mm, in a French and Korean population. The follow-up lasted a median of 5.3 years in French patients (similar to the median follow-up time in the SPARCL trial [Stroke Prevention by Aggressive Reduction in Cholesterol Level]) and 2.0 years in Korean patients. Exposure duration to statin is a well-known driver for cardiovascular risk reduction. We report here the TST results in the French cohort. Methods- One thousand seventy-three French patients were assigned to <70 mg/dL (1.8 mmol/L) and 1075 to 100±10 mg/dL (90-110 mg/dL, 2.3-2.8 mmol/L). To achieve these goals, investigators used the statin and dosage of their choice and added ezetimibe on top if needed. The primary outcome was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization and vascular death. Results- After a median follow-up of 5.3 years, the achieved LDL cholesterol was 66 (1.69 mmol/L) and 96 mg/dL (2.46 mmol/L) on average, respectively. The primary end point occurred in 9.6% and 12.9% of patients, respectively (HR, 0.74 [95% CI, 0.57-0.94]; P=0.019). Cerebral infarction or urgent carotid revascularization following transient ischemic attack was reduced by 27% (P=0.046). Cerebral infarction or intracranial hemorrhage was reduced by 28% (P=0.023). The primary outcome or intracranial hemorrhage was reduced by 25% (P=0.021). Intracranial hemorrhages occurred in 13 and 11 patients, respectively (HR, 1.17 [95% CI, 0.53-2.62]; P=0.70). Conclusions- After an ischemic stroke of documented atherosclerotic origin, targeting a LDL cholesterol of <70 mg/dL during 5.3 years avoided 1 subsequent major vascular event in 4 (number needed to treat of 30) and no increase in intracranial hemorrhage. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT01252875.
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Affiliation(s)
- Pierre Amarenco
- From the APHP, Department of Neurology and Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris, France (P.A., J.L., H.C.)
| | - Jong S Kim
- Asan Medical Center, Seoul, South Korea (J.S.K.)
| | - Julien Labreuche
- From the APHP, Department of Neurology and Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris, France (P.A., J.L., H.C.)
| | - Hugo Charles
- From the APHP, Department of Neurology and Stroke center, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris, France (P.A., J.L., H.C.)
| | - Maurice Giroud
- Department of Neurology, University Hospital of Dijon, University of Burgundy, France (M.G.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L.)
| | | | - Norbert Nighoghossian
- Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, France (N.N.)
| | - Philippe Gabriel Steg
- APHP, Department of cardiology, INSERM LVTS-U1148, DHU FIRE, University of Paris, Hôpital Bichat, France (P.G.S.)
| | - Éric Vicaut
- NHLI Imperial College, ICMS Royal Brompton Hospital London, United Kingdom (P.G.S.).,APHP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal hospital, France (É.V.)
| | - Eric Bruckert
- APHP, Department of Endocrinology, Pitié-Salpêtrière hospital, Sorbonne University, Paris, France (E.B.)
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Abstract
Supplemental Digital Content is available in the text. Background: To optimize preventive strategies for coronary heart disease (CHD), it is essential to understand and appropriately quantify the contribution of its key risk factors. Our objective was to compare the associations of key modifiable CHD risk factors—specifically lipids, systolic blood pressure (SBP), diabetes mellitus, and smoking—with incident CHD events based on their prognostic performance, attributable risk fractions, and treatment benefits, overall and by age. Methods: Pooled participant-level data from 4 observational cohort studies sponsored by the National Heart, Lung, and Blood Institute were used to create a cohort of 22 626 individuals aged 45 to 84 years who were initially free of cardiovascular disease. Individuals were followed for 10 years from baseline evaluation for incident CHD. Proportional hazards regression was used to estimate metrics of prognostic model performance (likelihood ratio, C index, net reclassification, discrimination slope), hazard ratios, and population attributable fractions for SBP, non–high-density lipoprotein cholesterol (non–HDL-C), diabetes mellitus, and smoking. Expected absolute risk reductions for antihypertensive and lipid-lowering treatment were assessed. Results: Age, sex, and race capture 63% to 80% of the prognostic performance of cardiovascular risk models. In contrast, adding either SBP, non–HDL-C, diabetes mellitus, or smoking to a model with other risk factors increases the C index by only 0.004 to 0.013. However, primordial prevention could have a substantial effect as demonstrated by population attributable fractions of 28% for SBP≥130 mm Hg and 17% for non–HDL-C≥130 mg/dL. Similarly, lowering the SBP of all individuals to <130 mm Hg or lowering low-density lipoprotein cholesterol by 30% would be expected to lower a baseline 10-year CHD risk of 10.7% to 7.0 and 8.0, respectively (absolute risk reductions: 3.7% and 2.7%, respectively). Prognostic performance decreases with age (C indices for age groups 45–54, 55–64, 65–74, 75–84 are 0.75, 0.72, 0.66, and 0.62, respectively), whereas absolute risk reductions increase (SBP: 1.1%, 2.3%, 5.4%, 10.3%, respectively; non–HDL-C: 1.1%, 2.0%, 3.7%, 5.9%, respectively). Conclusions: Although individual modifiable CHD risk factors contribute only modestly to prognostic performance, our models indicate that eliminating or controlling these individual factors would lead to substantial reductions in total population CHD events. Metrics used to judge importance of risk factors should be tailored to the research objectives.
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Affiliation(s)
- Michael J Pencina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | - Ann Marie Navar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | | | - Irfan Khan
- Real-World Evidence and Clinical Outcomes, Sanofi, Bridgewater, NJ (I.K.)
| | - Joseph Elassal
- Regeneron Pharmaceuticals Inc, Tarrytown, NY (R.J.S., J.E.)
| | - Ralph B D'Agostino
- Department of Mathematics and Statistics, Boston University, MA (R.B.D.).,Baim Institute for Clinical Research, Boston, MA (R.B.D.)
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.J.P., A.M.N., D.W., E.D.P.)
| | - Allan D Sniderman
- Mike Rosenbloom Laboratory for Cardiovascular Research, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada (A.D.S.)
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26
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Reeskamp LF, Hartgers ML, Peter J, Dallinga-Thie GM, Zuurbier L, Defesche JC, Grefhorst A, Hovingh GK. A Deep Intronic Variant in LDLR in Familial Hypercholesterolemia. Circ Genom Precis Med 2019; 11:e002385. [PMID: 30562117 DOI: 10.1161/circgen.118.002385] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is an inherited disorder characterized by high plasma LDL-C (low-density lipoprotein-cholesterol) levels. The vast majority of FH patients carry a mutation in the coding region of LDLR, APOB, or PCSK9. We set out to identify the culprit genetic defect in a large family with clinical FH, in whom no mutations were identified in the coding regions of these FH genes. METHODS Whole genome sequencing was performed in 5 affected and 4 unaffected individuals from a family with an unexplained autosomal dominant FH trait. The effect on splicing of the identified novel intronic LDLR mutation was ascertained by cDNA sequencing. The prevalence of the novel variant was assessed in 1 245 FH patients without an FH causing mutation identified by Sanger sequencing and in 2 154 patients referred for FH analysis by next-generation sequencing (covering the intronic region). RESULTS A novel deep intronic variant in LDLR (c.2140+103G>T) was found to cosegregate with high LDL-C in 5 patients, but was not present in 4 unaffected family members. The variant was shown to result in a 97 nucleotides insertion leading to a frameshift and premature stop codon in exon 15 of LDLR. The prevalence of the intronic variant was 0.24% (3/1245) in a cohort of FH patients without a known FH causing mutation and 0.23% (5/2154) in a population of FH patients referred for analysis by next-generation sequencing. Cosegregation analysis of a second family showed full penetrance of the novel variant with the FH phenotype over 3 generations. CONCLUSIONS The c.2140+103G>T mutation in LDLR is a novel intronic variant identified in FH that cosegregates with the FH phenotype. Our findings underline the need to analyze the intronic regions of LDLR in patients with FH, especially those in whom no mutation is found in the coding regions of LDLR, APOB, or PCSK9.
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Affiliation(s)
- Laurens F Reeskamp
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (L.F.R., M.L.H., G.M.D.-T., G.K.H.)
| | - Merel L Hartgers
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (L.F.R., M.L.H., G.M.D.-T., G.K.H.)
| | - Jorge Peter
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (J.P., G.M.D.-T., A.G.)
| | - Geesje M Dallinga-Thie
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (L.F.R., M.L.H., G.M.D.-T., G.K.H.).,Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (J.P., G.M.D.-T., A.G.)
| | - Linda Zuurbier
- Department of Clinical Genetics, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (L.Z., J.C.D.)
| | - Joep C Defesche
- Department of Clinical Genetics, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (L.Z., J.C.D.)
| | - Aldo Grefhorst
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (J.P., G.M.D.-T., A.G.)
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands (L.F.R., M.L.H., G.M.D.-T., G.K.H.)
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Montasser ME, O'Hare EA, Wang X, Howard AD, McFarland R, Perry JA, Ryan KA, Rice K, Jaquish CE, Shuldiner AR, Miller M, Mitchell BD, Zaghloul NA, Chang YPC. An APOO Pseudogene on Chromosome 5q Is Associated With Low-Density Lipoprotein Cholesterol Levels. Circulation 2019; 138:1343-1355. [PMID: 29593015 DOI: 10.1161/circulationaha.118.034016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/18/2022]
Abstract
BACKGROUND Elevated levels of low-density lipoprotein cholesterol (LDL-C) are a major risk factor for cardiovascular disease via its contribution to the development and progression of atherosclerotic lesions. Although the genetic basis of LDL-C has been studied extensively, currently known genetic variants account for only ≈20% of the variation in LDL-C levels. METHODS Through an array-based association analysis in 1102 Amish subjects, we identified a variant strongly associated with LDL-C levels. Using a combination of genetic analyses, zebrafish models, and in vitro experiments, we sought to identify the causal gene driving this association. RESULTS We identified a founder haplotype associated with a 15 mg/dL increase in LDL-C on chromosome 5. After recombination mapping, the associated region contained 8 candidate genes. Using a zebrafish model to evaluate the relevance of these genes to cholesterol metabolism, we found that expression of the transcribed pseudogene, APOOP1, increased LDL-C and vascular plaque formation. CONCLUSIONS Based on these data, we propose that APOOP1 regulates levels of LDL-C in humans, thus identifying a novel mechanism of lipid homeostasis.
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Affiliation(s)
- May E Montasser
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Elizabeth A O'Hare
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore.,The present affiliation for Dr O'Hare is Department of Biological Sciences, Towson University, MD
| | - Xiaochun Wang
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Alicia D Howard
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Rebecca McFarland
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - James A Perry
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Kathleen A Ryan
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Kenneth Rice
- Department of Biostatistics, University of Washington, Seattle (K.R.)
| | - Cashell E Jaquish
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (C.E.J.)
| | - Alan R Shuldiner
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Michael Miller
- Division of Cardiovascular Medicine (M.M.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, MD (B.D.M.)
| | - Norann A Zaghloul
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Yen-Pei C Chang
- Division of Endocrinology, Diabetes and Nutrition (M.E.M., E.A.O., X.W., A.D.H., R.M., J.A.P., K.A.R., A.R.S., B.D.M., N.A.Z., Y.-P.C.C.), Department of Medicine, University of Maryland School of Medicine, Baltimore
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Oni-Orisan A, Hoffmann TJ, Ranatunga D, Medina MW, Jorgenson E, Schaefer C, Krauss RM, Iribarren C, Risch N. Characterization of Statin Low-Density Lipoprotein Cholesterol Dose-Response Using Electronic Health Records in a Large Population-Based Cohort. Circ Genom Precis Med 2019; 11:e002043. [PMID: 30354326 DOI: 10.1161/circgen.117.002043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Low-density lipoprotein cholesterol (LDL-C) response to statin therapy has not been fully elucidated in real-world populations. The primary objective of this study was to characterize statin LDL-C dose-response and its heritability in a large, multiethnic population of statin users. METHODS We determined the effect of statin dosing on lipid measures utilizing electronic health records in 33 139 statin users from the Kaiser Permanente GERA cohort (Genetic Epidemiology Research on Adult Health and Aging). The relationship between statin defined daily dose and lipid parameter response (percent change) was determined. RESULTS Defined daily dose and LDL-C response was associated in a log-linear relationship (β, -6.17; SE, 0.09; P<10-300) which remained significant after adjusting for prespecified covariates (adjusted β, -5.59; SE, 0.12; P<10-300). Statin type, sex, age, smoking status, diabetes mellitus, and East Asian race/ethnicity were significant independent predictors of statin-induced changes in LDL-C. Based on a variance-component method within the subset of statin users who had at least 1 first-degree relative who was also a statin user (n=1036), heritability of statin LDL-C response was estimated at 11.7% (SE, 8.6%; P=0.087). CONCLUSIONS Using electronic health record data, we observed a statin LDL-C dose-response consistent with the rule of 6% from prior clinical trial data. Clinical and demographic predictors of statin LDL-C response exhibited highly significant but modest effects. Finally, statin-induced changes in LDL-C were not found to be strongly inherited. Ultimately, these findings demonstrate (1) the utility of electronic health records as a reliable source to generate robust phenotypes for pharmacogenomic research and (2) the potential role of statin precision medicine in lipid management.
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Affiliation(s)
- Akinyemi Oni-Orisan
- Department of Clinical Pharmacy (A.O.), University of California, San Francisco, CA.,Institute for Human Genetics (A.O., T.J.H., N.R.), University of California, San Francisco, CA
| | - Thomas J Hoffmann
- Institute for Human Genetics (A.O., T.J.H., N.R.), University of California, San Francisco, CA.,Department of Epidemiology and Biostatistics (T.J.H., C.I., N.R.), University of California, San Francisco, CA
| | - Dilrini Ranatunga
- Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Marisa W Medina
- Children's Hospital Oakland Research Institute, Oakland, CA (M.W.M., R.M.K.)
| | - Eric Jorgenson
- Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Catherine Schaefer
- Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Ronald M Krauss
- Department of Medicine (R.M.K.), University of California, San Francisco, CA.,Children's Hospital Oakland Research Institute, Oakland, CA (M.W.M., R.M.K.)
| | - Carlos Iribarren
- Department of Epidemiology and Biostatistics (T.J.H., C.I., N.R.), University of California, San Francisco, CA.,Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
| | - Neil Risch
- Institute for Human Genetics (A.O., T.J.H., N.R.), University of California, San Francisco, CA.,Department of Epidemiology and Biostatistics (T.J.H., C.I., N.R.), University of California, San Francisco, CA.,Kaiser Permanente Northern California Division of Research, Oakland, CA (D.R., E.J., C.S., C.I., N.R.)
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29
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Sabatine MS, De Ferrari GM, Giugliano RP, Huber K, Lewis BS, Ferreira J, Kuder JF, Murphy SA, Wiviott SD, Kurtz CE, Honarpour N, Keech AC, Sever PS, Pedersen TR. Clinical Benefit of Evolocumab by Severity and Extent of Coronary Artery Disease: Analysis From FOURIER. Circulation 2019; 138:756-766. [PMID: 29626068 DOI: 10.1161/circulationaha.118.034309] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [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: 12/20/2022]
Abstract
BACKGROUND The FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk) recently showed that the PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor evolocumab significantly reduced major vascular events in patients with stable atherosclerotic cardiovascular disease, including patients with prior myocardial infarction (MI). Within the broad group of patients with prior MI, we hypothesized that readily ascertainable features would identify subsets who derive greater clinical risk reduction with evolocumab. METHODS The 22 351 patients with a prior MI were characterized on the basis of time from most recent MI, number of prior MIs, and presence of residual multivessel coronary artery disease (≥40% stenosis in ≥2 large vessels). The relative and absolute risk reductions in major vascular events, including the primary end point (cardiovascular death, MI, stroke, hospitalization for unstable angina, or coronary revascularization) and the key secondary end point (cardiovascular death, MI, or stroke), with evolocumab in these subgroups were compared. RESULTS A total of 8402 patients (38%) were within 2 years of their most recent MI; 5285 patients (24%) had ≥2 prior MIs; and 5618 patients (25%) had residual multivessel coronary artery disease. In a multivariable-adjusted model that simultaneously included all 3 high-risk features and other baseline covariates, more recent MI, multiple prior MIs, and residual multivessel coronary disease remained independent predictors of cardiovascular outcomes, with adjusted hazard ratios (HRs) for the primary end point of 1.37 (95% confidence interval [CI],1.22-1.53), 1.78 (95% CI, 1.59-1.99), and 1.39 (95% CI, 1.24-1.56; all P<0.001). The relative risk reductions with evolocumab for the primary end point tended to be greater in the high-risk subgroups and were 20% (HR, 0.80; 95% CI, 0.71-0.91), 18% (HR, 0.82; 95% CI, 0.72-0.93), and 21% (HR, 0.79; 95% CI, 0.69-0.91) for those with more recent MI, multiple prior MIs, and residual multivessel coronary artery disease, whereas they were 5% (HR, 0.95; 95% CI, 0.85-1.05), 8% (HR, 0.92; 95% CI, 0.84-1.02), and 7% (HR, 0.93; 95% CI, 0.85-1.02) in those without, respectively. Given the higher baseline risk, the respective absolute risk reductions at 3 years exceeded 3% in the high-risk groups (3.4%, 3.7%, and 3.6%) versus ≈1% in the low-risk groups (0.8%, 1.3%, and 1.2%). CONCLUSIONS Patients closer to their most recent MI, with multiple prior MIs, or with residual multivessel coronary artery disease are at high risk for major vascular events and experience substantial risk reductions with low-density lipoprotein cholesterol lowering with evolocumab. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01764633.
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Affiliation(s)
- Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.S.S., R.P.G., J.F.K., S.A.M., S.D.W.)
| | - Gaetano M De Ferrari
- Department of Molecular Medicine, University of Pavia and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, Istituto di Ricerca e Cura a Carattere Scientifico Fondazione Policlinico San Matteo, Italy (G.M.D.F.)
| | - Robert P Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.S.S., R.P.G., J.F.K., S.A.M., S.D.W.)
| | - Kurt Huber
- Third Department of Medicine, Cardiology, and Intensive Care Medicine and Sigmund Freud University, Medical School, Vienna, Austria (K.H.)
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, Haifa, Israel (B.S.L.)
| | | | - Julia F Kuder
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.S.S., R.P.G., J.F.K., S.A.M., S.D.W.)
| | - Sabina A Murphy
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.S.S., R.P.G., J.F.K., S.A.M., S.D.W.)
| | - Stephen D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.S.S., R.P.G., J.F.K., S.A.M., S.D.W.)
| | | | | | - Anthony C Keech
- Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.)
| | - Peter S Sever
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK (P.S.S.)
| | - Terje R Pedersen
- Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway (T.R.P.)
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30
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Virani SS, Kennedy KF, Akeroyd JM, Morris PB, Bittner VA, Masoudi FA, Stone NJ, Petersen LA, Ballantyne CM. Variation in Lipid-Lowering Therapy Use in Patients With Low-Density Lipoprotein Cholesterol ≥190 mg/dL: Insights From the National Cardiovascular Data Registry-Practice Innovation and Clinical Excellence Registry. Circ Cardiovasc Qual Outcomes 2019; 11:e004652. [PMID: 29748356 DOI: 10.1161/circoutcomes.118.004652] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 02/08/2018] [Accepted: 04/17/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL are at high risk of atherosclerotic cardiovascular disease events. Treatment guidelines recommend intensive treatment in these patients. Variation in the use of lipid-lowering therapies (LLTs) in these patients in a national sample of cardiology practices is not known. METHODS AND RESULTS Using data from the American College of Cardiology National Cardiovascular Data Registry-Practice Innovation and Clinical Excellence registry, we assessed the proportion of patients with LDL-C ≥190 mg/dL (n=49 447) receiving statin, high-intensity statin, LLT associated with ≥50% LDL-C lowering, ezetimibe, or a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor between January 2013 and December 2016. We assessed practice-level rates and variation in LLT use using median rate ratio (MRR) adjusted for patient and practice characteristics. MRRs represent the likelihood that 2 random practices would differ in treatment of identical patients with LDL-C ≥190 mg/dL. The proportion of patients receiving a statin, high-intensity statin, LLT associated with ≥50% LDL-C reduction, ezetimibe, or PCSK9 inhibitor were 58.5%, 31.9%, 34.6%, 8.5%, and 1.5%, respectively. Median practice-level rates and adjusted MRR for statin (56% [interquartile range, 47.3%-64.8%]; MRR, 1.20 [95% confidence interval [CI], 1.17-1.23]), high-intensity statin (30.2% [interquartile range, 12.1%-41.1%]; MRR, 2.31 [95% CI, 2.12-2.51]), LLT with ≥50% LDL-C lowering (31.8% [interquartile range, 15.3%-45.5%]; MRR, 2.12 [95% CI, 1.95-2.28]), ezetimibe (5.8% [interquartile range, 2.8%-9.8%]; MRR, 2.42 [95% CI, 2.21-2.63]), and PCSK9 inhibitors (0.16% [interquartile range, 0%-1.9%]; MRR, 2.38 [95% CI, 2.04-2.72]) indicated significant gaps and >200% variation in receipt of several of these medications for patients across practices. Among those without concomitant atherosclerotic cardiovascular disease, even larger treatment gaps were noted (proportion of patients on a statin, high-intensity statin, LLT with ≥50% LDL-C reduction, ezetimibe, or PCSK9 inhibitor were 50.8%, 25.25%, 26.8%, 4.9%, and 0.74%, respectively). CONCLUSIONS Evidence-based LLT use remains low among patients with elevated LDL-C with significant variation in care. System-level interventions are needed to address these gaps and reduce variation in care of these high-risk patients.
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Affiliation(s)
- Salim S Virani
- Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX (S.S.V., J.M.A., L.A.P.) .,Section of Health Services Research, Department of Medicine (S.S.V., J.M.A., L.A.P.).,Section of Cardiovascular Research, Department of Medicine (S.S.V., C.M.B.), Baylor College of Medicine, Houston, TX.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.).,Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.).,Aga Khan University, Karachi, Pakistan (S.S.V.)
| | - Kevin F Kennedy
- Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO (K.F.K.)
| | - Julia M Akeroyd
- Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX (S.S.V., J.M.A., L.A.P.).,Section of Health Services Research, Department of Medicine (S.S.V., J.M.A., L.A.P.)
| | | | - Vera A Bittner
- Division of Cardiovascular Disease, University of Alabama, Birmingham (V.A.B.)
| | - Frederick A Masoudi
- Colorado Cardiovascular Outcomes Research Consortium, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Neil J Stone
- Northwestern University Feinberg School of Medicine, Chicago, IL (N.J.S.)
| | - Laura A Petersen
- Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX (S.S.V., J.M.A., L.A.P.).,Section of Health Services Research, Department of Medicine (S.S.V., J.M.A., L.A.P.)
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine (S.S.V., C.M.B.), Baylor College of Medicine, Houston, TX.,Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX (S.S.V., C.M.B.)
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31
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Affiliation(s)
- Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.)
| | - Seth S Martin
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.M.)
| | - Salim S Virani
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
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32
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Welsh C, Celis-Morales CA, Brown R, Mackay DF, Lewsey J, Mark PB, Gray SR, Ferguson LD, Anderson JJ, Lyall DM, Cleland JG, Jhund PS, Gill JMR, Pell JP, Sattar N, Welsh P. Comparison of Conventional Lipoprotein Tests and Apolipoproteins in the Prediction of Cardiovascular Disease. Circulation 2019; 140:542-552. [PMID: 31216866 PMCID: PMC6693929 DOI: 10.1161/circulationaha.119.041149] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [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: 12/21/2022]
Abstract
BACKGROUND Total cholesterol and high-density lipoprotein cholesterol (HDL-C) measurements are central to cardiovascular disease (CVD) risk assessment, but there is continuing debate around the utility of other lipids for risk prediction. METHODS Participants from UK Biobank without baseline CVD and not taking statins, with relevant lipid measurements (n=346 686), were included in the primary analysis. An incident fatal or nonfatal CVD event occurred in 6216 participants (1656 fatal) over a median of 8.9 years. Associations of nonfasting lipid measurements (total cholesterol, HDL-C, non-HDL-C, direct and calculated low-density lipoprotein cholesterol [LDL-C], and apolipoproteins [Apo] A1 and B) with CVD were compared using Cox models adjusting for classical risk factors, and predictive utility was determined by the C-index and net reclassification index. Prediction was also tested in 68 649 participants taking a statin with or without baseline CVD (3515 CVD events). RESULTS ApoB, LDL-C, and non-HDL-C were highly correlated (r>0.90), while HDL-C was strongly correlated with ApoA1 (r=0.92). After adjustment for classical risk factors, 1 SD increase in ApoB, direct LDL-C, and non-HDL-C had similar associations with composite fatal/nonfatal CVD events (hazard ratio, 1.23, 1.20, 1.21, respectively). Associations for 1 SD increase in HDL-C and ApoA1 were also similar (hazard ratios, 0.81 [both]). Adding either total cholesterol and HDL-C, or ApoB and ApoA, to a CVD risk prediction model (C-index, 0.7378) yielded similar improvement in discrimination (C-index change, 0.0084; 95% CI, 0.0065, 0.0104, and 0.0089; 95% CI, 0.0069, 0.0109, respectively). Once total and HDL-C were in the model, no further substantive improvement was achieved with the addition of ApoB (C-index change, 0.0004; 95% CI, 0.0000, 0.0008) or any measure of LDL-C. Results for predictive utility were similar for a fatal CVD outcome, and in a discordance analysis. In participants taking a statin, classical risk factors (C-index, 0.7118) were improved by non-HDL-C (C-index change, 0.0030; 95% CI, 0.0012, 0.0048) or ApoB (C-index change, 0.0030; 95% CI, 0.0011, 0.0048). However, adding ApoB or LDL-C to a model already containing non-HDL-C did not further improve discrimination. CONCLUSIONS Measurement of total cholesterol and HDL-C in the nonfasted state is sufficient to capture the lipid-associated risk in CVD prediction, with no meaningful improvement from addition of apolipoproteins, direct or calculated LDL-C.
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Affiliation(s)
- Claire Welsh
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Carlos A Celis-Morales
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Rosemary Brown
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Daniel F Mackay
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom.,Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - James Lewsey
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Lyn D Ferguson
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Jana J Anderson
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Donald M Lyall
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - John G Cleland
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Pardeep S Jhund
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Jason M R Gill
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Jill P Pell
- Institute of Health and Wellbeing (D.F.M., J.L., J.J.A., D.M.L., J.G.C., J.P.P.), University of Glasgow, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences (C.W., C.A.C.-M., R.B., P.B.M., S.R.G., L.D.F., P.S.J., J.M.R.G., N.S., P.W.), University of Glasgow, United Kingdom
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33
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Affiliation(s)
- Tamio Teramoto
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan.
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34
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Hovland A, Mundal LJ, Igland J, Veierød MB, Holven KB, Bogsrud MP, Tell GS, Leren TP, Retterstøl K. Risk of Ischemic Stroke and Total Cerebrovascular Disease in Familial Hypercholesterolemia: A Register Study From Norway. Stroke 2019; 50:172-174. [PMID: 30580708 DOI: 10.1161/strokeaha.118.023456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background and Purpose- Familial hypercholesterolemia (FH) is a common autosomal dominant disease leading to increased level of serum LDL (low-density lipoprotein) cholesterol and risk of coronary heart disease. Whether FH increases the risk of cerebrovascular disease, including ischemic stroke, is debated. Accordingly, we studied the incidence of cerebrovascular disease in a cohort of people with genetically verified FH compared with the entire Norwegian population and examined whether people in this cohort with previous cohort had increased risk of cerebrovascular disease. Methods- Incidence rates of hospitalization for cerebrovascular disease (among 3144 people with FH) and ischemic stroke (among 3166 people with FH) were estimated by linkage of FH people to Cardiovascular Disease in Norway-a nationwide database of cardiovascular disease hospitalizations (2001-2009). We calculated standardized incidence ratios and used Cox regression to estimate hazard ratios. Results- A total of 46 cases (19 women and 27 men) of cerebrovascular disease were observed in the cohort of people with FH, with no increased risk of cerebrovascular disease compared with the general population (standardized incidence ratio, 1.0; 95% CI, 0.8-1.4). Total number of ischemic strokes in the cohort of people with FH was 26 (9 women and 17 men), with no increased risk compared with the general population (standardized incidence ratio, 1.0; 95% CI, 0.7-1.5). Prior coronary heart disease significantly increased cerebrovascular disease risk in women (hazard ratio, 3.29; 95% CI, 1.20-9.00) but not in men (hazard ratio, 1.03; 95% CI, 0.45-2.37; Pinteraction=0.04). Conclusions- In a large cohort of genetically verified FH, risks of cerebrovascular disease and ischemic stroke were not increased compared with the total Norwegian population.
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Affiliation(s)
- Anders Hovland
- From the Division of Internal Medicine, Nordland Hospital, Bodø, Norway (A.H.)
- Department of Clinical Medicine, University of Tromsø, Norway (A.H.)
| | - Liv J Mundal
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, Norway (L.J.M., K.R.)
| | - Jannicke Igland
- Department of Health and Social Science, Centre for Evidence-Based Practice, Western Norway University of Applied Science, Bergen (J.I.)
- Department of Global Public Health and Primary Care, University of Bergen, Norway, (J.I., G.S.T.)
| | - Marit B Veierød
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology (M.B.V.), University of Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition (K.B.H., K.R.), University of Oslo, Norway
- National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Norway (K.B.H., M.P.B.)
| | - Martin Prøven Bogsrud
- National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Norway (K.B.H., M.P.B.)
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway, (J.I., G.S.T.)
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway (G.S.T.)
| | - Trond P Leren
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital Ullevål, Norway (T.P.L.)
| | - Kjetil Retterstøl
- The Lipid Clinic, Oslo University Hospital Rikshospitalet, Norway (L.J.M., K.R.)
- Department of Nutrition (K.B.H., K.R.), University of Oslo, Norway
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Baldeón ME, Fornasini M, Flores N, Merriam PA, Rosal M, Zevallos JC, Ocken I. Impact of training primary care physicians in behavioral counseling to reduce cardiovascular disease risk factors in Ecuador. Rev Panam Salud Publica 2018; 42:e139. [PMID: 31093167 PMCID: PMC6386001 DOI: 10.26633/rpsp.2018.139] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 07/12/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the feasibility of implementing a physician-based, patient-centered counseling intervention model in Ecuador to improve the ability of primary care physicians (PCPs) to reduce cardiovascular disease (CVD) risk factors among patients. METHODS This was a randomized clinical trial conducted in primary care clinics in Quito in 2014 - 2016. Participants included 15 PCPs and their adult patients at high risk of developing type-2 diabetes. A physician-based and patient-centered counseling program was delivered to eight PCPs. Seven PCPs who did not receive the training comprised the control group. The patient experience was assessed by a patient exit interview (PEI). Assessment of the patient's anthropometrics, blood pressure, and blood biochemistry parameters were conducted. Changes within and between groups were estimated utilizing chi-square, ANOVA, paired t-tests, and coefficient with intervention. RESULTS A total of 197 patients participated, 113 in the intervention care group (ICG) and 84 in the usual care group (UCG); 99 patients (87.6%) in the ICG and 63 (75%) in the UCG completed the study. Counseling steps, measured by the PEI, were significantly higher in the ICG (8.9±1.6 versus 6.6±2.3; P = 0.001). Comparison of the estimated difference between the ICG and the UCG showed greater decreases in HbA1c and total cholesterol in the ICG. Within the ICG, there were significant improvements in weight, BMI, HbA1C, total cholesterol, and LDL-cholesterol. CONCLUSIONS Training PCPs in a patient-centered behavioral intervention for CVD risk factor reduction is feasible and efficacious for reducing CVD risk factors in Ecuador. Developed and developing countries alike could benefit from such an intervention.
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Affiliation(s)
- Manuel E. Baldeón
- Center for Biomedical Research, Eugenio Espejo College of Health Science, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - Marco Fornasini
- Center for Biomedical Research, Eugenio Espejo College of Health Science, Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - Nancy Flores
- Center for Translational Research, Universidad de las Américas, Quito, Ecuador
| | - Philip A. Merriam
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Milagros Rosal
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Juan C. Zevallos
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States
| | - Ira Ocken
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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Affiliation(s)
- Cecilia Vitali
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (C.V., M.C.)
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (A.T.R.)
| | - Marina Cuchel
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (C.V., M.C.)
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Kofink D, Eppinga RN, van Gilst WH, Bakker SJL, Dullaart RPF, van der Harst P, Asselbergs FW. Statin Effects on Metabolic Profiles: Data From the PREVEND IT (Prevention of Renal and Vascular End-stage Disease Intervention Trial). ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001759. [PMID: 29237679 DOI: 10.1161/circgenetics.117.001759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 03/14/2017] [Accepted: 10/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Statins lower cholesterol by inhibiting HMG-CoA reductase, the rate-limiting enzyme of the metabolic pathway that produces cholesterol and other isoprenoids. Little is known about their effects on metabolite and lipoprotein subclass profiles. We, therefore, investigated the molecular changes associated with pravastatin treatment compared with placebo administration using a nuclear magnetic resonance-based metabolomics platform. METHODS AND RESULTS We performed metabolic profiling of 231 lipoprotein and metabolite measures in the PREVEND IT (Prevention of Renal and Vascular End-stage Disease Intervention Trial) study, a placebo-controlled randomized clinical trial designed to test the effects of pravastatin (40 mg once daily) on cardiovascular risk. Metabolic profiles were assessed at baseline and after 3 months of treatment. Pravastatin lowered low-density lipoprotein cholesterol (change in SD units [95% confidence interval]: -1.01 [-1.14, -0.88]), remnant cholesterol (change in SD units [95% confidence interval]: -1.03 [-1.17, -0.89]), and apolipoprotein B (change in SD units [95% confidence interval]: -0.98 [-1.11, -0.86]) with similar effect magnitudes. In addition, pravastatin globally lowered levels of lipoprotein subclasses, with the exception of high-density lipoprotein subclasses, which displayed a more heterogeneous response pattern. The lipid-lowering effect of pravastatin was accompanied by selective changes in lipid composition, particularly in the cholesterol content of very-low-density lipoproteinparticles. In addition, pravastatin reduced levels of several fatty acids but had limited effects on fatty acid ratios. CONCLUSIONS These randomized clinical trial data demonstrate the widespread effects of pravastatin treatment on lipoprotein subclass profiles and fatty acids. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT03073018.
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Affiliation(s)
- Daniel Kofink
- From the Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, The Netherlands (D.K., F.W.A.); Department of Cardiology (R.N.E., W.H.v.G., P.v.d.H.), Department of Internal Medicine (S.J.L.B.), and Department of Endocrinology, University Medical Center Groningen (R.P.F.D.), University of Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (P.v.d.H., F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Ruben N Eppinga
- From the Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, The Netherlands (D.K., F.W.A.); Department of Cardiology (R.N.E., W.H.v.G., P.v.d.H.), Department of Internal Medicine (S.J.L.B.), and Department of Endocrinology, University Medical Center Groningen (R.P.F.D.), University of Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (P.v.d.H., F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Wiek H van Gilst
- From the Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, The Netherlands (D.K., F.W.A.); Department of Cardiology (R.N.E., W.H.v.G., P.v.d.H.), Department of Internal Medicine (S.J.L.B.), and Department of Endocrinology, University Medical Center Groningen (R.P.F.D.), University of Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (P.v.d.H., F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Stephan J L Bakker
- From the Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, The Netherlands (D.K., F.W.A.); Department of Cardiology (R.N.E., W.H.v.G., P.v.d.H.), Department of Internal Medicine (S.J.L.B.), and Department of Endocrinology, University Medical Center Groningen (R.P.F.D.), University of Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (P.v.d.H., F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Robin P F Dullaart
- From the Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, The Netherlands (D.K., F.W.A.); Department of Cardiology (R.N.E., W.H.v.G., P.v.d.H.), Department of Internal Medicine (S.J.L.B.), and Department of Endocrinology, University Medical Center Groningen (R.P.F.D.), University of Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (P.v.d.H., F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Pim van der Harst
- From the Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, The Netherlands (D.K., F.W.A.); Department of Cardiology (R.N.E., W.H.v.G., P.v.d.H.), Department of Internal Medicine (S.J.L.B.), and Department of Endocrinology, University Medical Center Groningen (R.P.F.D.), University of Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (P.v.d.H., F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.)
| | - Folkert W Asselbergs
- From the Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, The Netherlands (D.K., F.W.A.); Department of Cardiology (R.N.E., W.H.v.G., P.v.d.H.), Department of Internal Medicine (S.J.L.B.), and Department of Endocrinology, University Medical Center Groningen (R.P.F.D.), University of Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht (P.v.d.H., F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, United Kingdom (F.W.A.).
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Taguchi I, Iimuro S, Iwata H, Takashima H, Abe M, Amiya E, Ogawa T, Ozaki Y, Sakuma I, Nakagawa Y, Hibi K, Hiro T, Fukumoto Y, Hokimoto S, Miyauchi K, Yamazaki T, Ito H, Otsuji Y, Kimura K, Takahashi J, Hirayama A, Yokoi H, Kitagawa K, Urabe T, Okada Y, Terayama Y, Toyoda K, Nagao T, Matsumoto M, Ohashi Y, Kaneko T, Fujita R, Ohtsu H, Ogawa H, Daida H, Shimokawa H, Saito Y, Kimura T, Inoue T, Matsuzaki M, Nagai R. High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial. Circulation 2018; 137:1997-2009. [PMID: 29735587 PMCID: PMC5959207 DOI: 10.1161/circulationaha.117.032615] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/28/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Current guidelines call for high-intensity statin therapy in patients with cardiovascular disease on the basis of several previous "more versus less statins" trials. However, no clear evidence for more versus less statins has been established in an Asian population. METHODS In this prospective, multicenter, randomized, open-label, blinded end point study, 13 054 Japanese patients with stable coronary artery disease who achieved low-density lipoprotein cholesterol (LDL-C) <120 mg/dL during a run-in period (pitavastatin 1 mg/d) were randomized in a 1-to-1 fashion to high-dose (pitavastatin 4 mg/d; n=6526) or low-dose (pitavastatin 1 mg/d; n=6528) statin therapy. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization. The secondary composite end point was a composite of the primary end point and clinically indicated coronary revascularization excluding target-lesion revascularization at sites of prior percutaneous coronary intervention. RESULTS The mean age of the study population was 68 years, and 83% were male. The mean LDL-C level before enrollment was 93 mg/dL with 91% of patients taking statins. The baseline LDL-C level after the run-in period on pitavastatin 1 mg/d was 87.7 and 88.1 mg/dL in the high-dose and low-dose groups, respectively. During the entire course of follow-up, LDL-C in the high-dose group was lower by 14.7 mg/dL than in the low-dose group (P<0.001). With a median follow-up of 3.9 years, high-dose as compared with low-dose pitavastatin significantly reduced the risk of the primary end point (266 patients [4.3%] and 334 patients [5.4%]; hazard ratio, 0.81; 95% confidence interval, 0.69-0.95; P=0.01) and the risk of the secondary composite end point (489 patients [7.9%] and 600 patients [9.7%]; hazard ratio, 0.83; 95% confidence interval, 0.73-0.93; P=0.002). High-dose pitavastatin also significantly reduced the risks of several other secondary end points such as all-cause death, myocardial infarction, and clinically indicated coronary revascularization. The results for the primary and the secondary composite end points were consistent across several prespecified subgroups, including the low (<95 mg/dL) baseline LDL-C subgroup. Serious adverse event rates were low in both groups. CONCLUSIONS High-dose (4 mg/d) compared with low-dose (1 mg/d) pitavastatin therapy significantly reduced cardiovascular events in Japanese patients with stable coronary artery disease. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01042730.
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Affiliation(s)
- Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan (I.T.)
| | - Satoshi Iimuro
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (S.I., T. Kaneko)
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.)
| | - Hiroaki Takashima
- Department of Cardiology, Aichi Medical University, Nagakute, Japan (H.T.)
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan (M.A.)
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan (E.A.)
| | - Takanori Ogawa
- Department of Cardiovascular Medicine, Hokuto Social Medical Corp, Hokuto Hospital, Obihiro, Japan (T.O.)
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan (Y. Ozaki)
| | - Ichiro Sakuma
- Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan (I.S.)
| | | | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan (K.H., K. Kimura)
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (T.H., A.H.)
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (Y.F.)
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Kumamoto University Hospital, Japan (S.H.)
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.)
| | - Tsutomu Yamazaki
- Clinical Research Support Center, University of Tokyo Hospital, Japan (T.Y.)
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Japan (H.I.)
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kita-Kyushu, Japan (Y. Otsuji)
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Japan (K.H., K. Kimura)
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.T., H.S.)
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (T.H., A.H.)
| | | | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Japan (K. Kitagawa)
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Japan (T.U.)
| | - Yasushi Okada
- Clinical Research Institute and Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.)
| | - Yasuo Terayama
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan (Y.T.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - Takehiko Nagao
- Department of Neurology, Nippon Medical School Tama-Nagayama Hospital, Tama, Japan (T.N.)
| | - Masayasu Matsumoto
- Japan Community Healthcare Organization, Hoshigaoka Medical Center, Hirakata, Japan (M. Matsumoto)
| | - Yasuo Ohashi
- Department of Integrated Science and Technology for Sustainable Society, Chuo University, Tokyo, Japan (Y. Ohashi)
| | - Tetsuji Kaneko
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (S.I., T. Kaneko)
| | - Retsu Fujita
- Department of Clinical Research Medicine, School of Medicine, Teikyo University, Tokyo, Japan (R.F.)
| | - Hiroshi Ohtsu
- National Center for Global Health and Medicine, Center for Clinical Sciences, Tokyo, Japan (H. Ohtsu)
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Japan (H. Ogawa)
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.)
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.T., H.S.)
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (T. Kimura).
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan (T.I.).
| | | | - Ryozo Nagai
- Jichi Medical University, Shimotsuke, Japan (R.N.)
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Affiliation(s)
- William G Herrington
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - David Preiss
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Jane Armitage
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
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Hindy G, Engström G, Larsson SC, Traylor M, Markus HS, Melander O, Orho-Melander M. Role of Blood Lipids in the Development of Ischemic Stroke and its Subtypes: A Mendelian Randomization Study. Stroke 2018; 49:820-827. [PMID: 29535274 PMCID: PMC5895121 DOI: 10.1161/strokeaha.117.019653] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/19/2018] [Accepted: 02/15/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Statin therapy is associated with a lower risk of ischemic stroke supporting a causal role of low-density lipoprotein (LDL) cholesterol. However, more evidence is needed to answer the question whether LDL cholesterol plays a causal role in ischemic stroke subtypes. In addition, it is unknown whether high-density lipoprotein cholesterol and triglycerides have a causal relationship to ischemic stroke and its subtypes. Our aim was to investigate the causal role of LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides in ischemic stroke and its subtypes through Mendelian randomization (MR). METHODS Summary data on 185 genome-wide lipids-associated single nucleotide polymorphisms were obtained from the Global Lipids Genetics Consortium and the Stroke Genetics Network for their association with ischemic stroke (n=16 851 cases and 32 473 controls) and its subtypes, including large artery atherosclerosis (n=2410), small artery occlusion (n=3186), and cardioembolic (n=3427) stroke. Inverse-variance-weighted MR was used to obtain the causal estimates. Inverse-variance-weighted multivariable MR, MR-Egger, and sensitivity exclusion of pleiotropic single nucleotide polymorphisms after Steiger filtering and MR-Pleiotropy Residual Sum and Outlier test were used to adjust for pleiotropic bias. RESULTS A 1-SD genetically elevated LDL cholesterol was associated with an increased risk of ischemic stroke (odds ratio: 1.12; 95% confidence interval: 1.04-1.20) and large artery atherosclerosis stroke (odds ratio: 1.28; 95% confidence interval: 1.10-1.49) but not with small artery occlusion or cardioembolic stroke in multivariable MR. A 1-SD genetically elevated high-density lipoprotein cholesterol was associated with a decreased risk of small artery occlusion stroke (odds ratio: 0.79; 95% confidence interval: 0.67-0.90) in multivariable MR. MR-Egger indicated no pleiotropic bias, and results did not markedly change after sensitivity exclusion of pleiotropic single nucleotide polymorphisms. Genetically elevated triglycerides did not associate with ischemic stroke or its subtypes. CONCLUSIONS LDL cholesterol lowering is likely to prevent large artery atherosclerosis but may not prevent small artery occlusion nor cardioembolic strokes. High-density lipoprotein cholesterol elevation may lead to benefits in small artery disease prevention. Finally, triglyceride lowering may not yield benefits in ischemic stroke and its subtypes.
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Affiliation(s)
- George Hindy
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.).
| | - Gunnar Engström
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Susanna C Larsson
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Matthew Traylor
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Hugh S Markus
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Olle Melander
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
| | - Marju Orho-Melander
- From the Department of Clinical Sciences, Lund University, Malmö, Sweden (G.H., G.E., O.M., M.O.-M.); Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (G.H.); Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (S.C.L.); and Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, United Kingdom (M.T., H.S.M.)
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Basu D, Hu Y, Huggins LA, Mullick AE, Graham MJ, Wietecha T, Barnhart S, Mogul A, Pfeiffer K, Zirlik A, Fisher EA, Bornfeldt KE, Willecke F, Goldberg IJ. Novel Reversible Model of Atherosclerosis and Regression Using Oligonucleotide Regulation of the LDL Receptor. Circ Res 2018; 122:560-567. [PMID: 29321129 DOI: 10.1161/circresaha.117.311361] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 11/16/2022]
Abstract
RATIONALE Animal models have been used to explore factors that regulate atherosclerosis. More recently, they have been used to study the factors that promote loss of macrophages and reduction in lesion size after lowering of plasma cholesterol levels. However, current animal models of atherosclerosis regression require challenging surgeries, time-consuming breeding strategies, and methods that block liver lipoprotein secretion. OBJECTIVE We sought to develop a more direct or time-effective method to create and then reverse hypercholesterolemia and atherosclerosis via transient knockdown of the hepatic LDLR (low-density lipoprotein receptor) followed by its rapid restoration. METHODS AND RESULTS We used antisense oligonucleotides directed to LDLR mRNA to create hypercholesterolemia in wild-type C57BL/6 mice fed an atherogenic diet. This led to the development of lesions in the aortic root, aortic arch, and brachiocephalic artery. Use of a sense oligonucleotide replicating the targeted sequence region of the LDLR mRNA rapidly reduced circulating cholesterol levels because of recovery of hepatic LDLR expression. This led to a decrease in macrophages within the aortic root plaques and brachiocephalic artery, that is, regression of inflammatory cell content, after a period of 2 to 3 weeks. CONCLUSIONS We have developed an inducible and reversible hepatic LDLR knockdown mouse model of atherosclerosis regression. Although cholesterol reduction decreased early en face lesions in the aortic arches, macrophage area was reduced in both early and late lesions within the aortic sinus after reversal of hypercholesterolemia. Our model circumvents many of the challenges associated with current mouse models of regression. The use of this technology will potentially expedite studies of atherosclerosis and regression without use of mice with genetic defects in lipid metabolism.
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Affiliation(s)
- Debapriya Basu
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Yunying Hu
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Lesley-Ann Huggins
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Adam E Mullick
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Mark J Graham
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Tomasz Wietecha
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Shelley Barnhart
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Allison Mogul
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Katharina Pfeiffer
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Andreas Zirlik
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Edward A Fisher
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Karin E Bornfeldt
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Florian Willecke
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.)
| | - Ira J Goldberg
- From the Department of Medicine, New York University Langone Health, New York (D.B., Y.H., L.-A.H., A.M., E.A.F., I.J.G.); Ionis Pharmaceuticals, Carlsbad, CA (A.E.M., M.J.G.); Division of Cardiology, Department of Medicine (T.W.), Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, UW Diabetes Institute (S.B., K.E.B.), and Department of Pathology (K.E.B.), University of Washington, Seattle; and Department of Cardiology and Angiology I, Heart Center, Freiburg University, Germany (K.P., A.Z., F.W.).
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Lamarche F, Agharazii M, Nadeau-Fredette AC, Madore F, Goupil R. Central and Brachial Blood Pressures, Statins, and Low-Density Lipoprotein Cholesterol: A Mediation Analysis. Hypertension 2018; 71:415-421. [PMID: 29295849 DOI: 10.1161/hypertensionaha.117.10476] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 10/25/2017] [Accepted: 12/09/2017] [Indexed: 01/20/2023]
Abstract
Central blood pressure may be a better predictor of cardiovascular disease than brachial pressure. Although statins reduce brachial pressure, their impact on central pressure remains unknown. Furthermore, whether this effect is mediated through a decrease in low-density lipoprotein cholesterol (LDL-c) is unknown. This study aims to characterize the association of statins and LDL-c with central and brachial blood pressures and to quantify their respective effects. Of the 20 004 CARTaGENE participants, 16 507 had available central blood pressure, LDL-c, and Framingham risk score. Multivariate analyses were used to evaluate the association between central pressure and LDL-c in subjects with or without statins. The impact of LDL-c on the association between statin and pressure parameters was determined through mediation analyses. LDL-c was positively associated with systolic and diastolic central pressure in nonusers (β=0.077 and 0.106; P<0.001) and in participants with statins for primary (β=0.086 and 0.114; P<0.001) and secondary prevention (β=0.120 and 0.194; P<0.003). Statins as primary prevention were associated with lower central systolic, diastolic, and pulse pressures (-3.0, -1.6, and -1.3 mm Hg; P<0.001). Mediation analyses showed that LDL-c reduction contributed to 15% of central systolic and 44% of central diastolic pressure changes associated with statins and attenuated 22% of the effects on central pulse pressure. Similar results were found with brachial pressure components. In conclusion, reduction of LDL-c was associated with only a fraction of the lower blood pressures in statin user and seemed to be mostly associated with improvement of steady (diastolic) pressure, whereas non-LDL-c-mediated pathways were mostly associated with changes in pulsatile pressure components.
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Affiliation(s)
- Florence Lamarche
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Mohsen Agharazii
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Annie-Claire Nadeau-Fredette
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - François Madore
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.)
| | - Rémi Goupil
- From the Hôpital du Sacré-Cœur de Montréal (F.L., F.M., R.G.) and Hôpital Maisonneuve-Rosemont (A.-C.N.-F.), Université de Montréal, Canada; and CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Canada (M.A.).
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Bonaca MP, Nault P, Giugliano RP, Keech AC, Pineda AL, Kanevsky E, Kuder J, Murphy SA, Jukema JW, Lewis BS, Tokgozoglu L, Somaratne R, Sever PS, Pedersen TR, Sabatine MS. Low-Density Lipoprotein Cholesterol Lowering With Evolocumab and Outcomes in Patients With Peripheral Artery Disease: Insights From the FOURIER Trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). Circulation 2017; 137:338-350. [PMID: 29133605 DOI: 10.1161/circulationaha.117.032235] [Citation(s) in RCA: 469] [Impact Index Per Article: 67.0] [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: 10/13/2017] [Accepted: 10/25/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor evolocumab reduced low-density lipoprotein cholesterol and cardiovascular events in the FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). We investigated the efficacy and safety of evolocumab in patients with peripheral artery disease (PAD) as well as the effect on major adverse limb events. METHODS FOURIER was a randomized trial of evolocumab versus placebo in 27 564 patients with atherosclerotic disease on statin therapy followed for a median of 2.2 years. Patients were identified as having PAD at baseline if they had intermittent claudication and an ankle brachial index of <0.85, or if they had a prior peripheral vascular procedure. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, hospital admission for unstable angina, or coronary revascularization. The key secondary end point was a composite of cardiovascular death, myocardial infarction, or stroke. An additional outcome of interest was major adverse limb events defined as acute limb ischemia, major amputation, or urgent peripheral revascularization for ischemia. RESULTS Three thousand six hundred forty-two patients (13.2%) had PAD (1505 with no prior myocardial infarction or stroke). Evolocumab significantly reduced the primary end point consistently in patients with PAD (hazard ratio [HR] 0.79; 95% confidence interval [CI], 0.66-0.94; P=0.0098) and without PAD (HR 0.86; 95% CI, 0.80-0.93; P=0.0003; Pinteraction=0.40). For the key secondary end point, the HRs were 0.73 (0.59-0.91; P=0.0040) for those with PAD and 0.81 (0.73-0.90; P<0.0001) for those without PAD (Pinteraction=0.41). Because of their higher risk, patients with PAD had larger absolute risk reductions for the primary end point (3.5% with PAD, 1.6% without PAD) and the key secondary end point (3.5% with PAD, 1.4% without PAD). Evolocumab reduced the risk of major adverse limb events in all patients (HR, 0.58; 95% CI, 0.38-0.88; P=0.0093) with consistent effects in those with and without known PAD. There was a consistent relationship between lower achieved low-density lipoprotein cholesterol and lower risk of limb events (P=0.026 for the beta coefficient) that extended down to <10 mg/dL. CONCLUSIONS Patients with PAD are at high risk of cardiovascular events, and PCSK9 inhibition with evolocumab significantly reduced that risk with large absolute risk reductions. Moreover, lowering of low-density lipoprotein cholesterol with evolocumab reduced the risk of major adverse limb events. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01764633.
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Affiliation(s)
- Marc P Bonaca
- Thrombolysis In Myocardial Infarction Study Group, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (M.P.B., R.P.G., E.K., J.K., M.S.S.)
| | - Patrice Nault
- McGill University, Montreal, and Division of Vascular and Endovascular Surgery, Centre Intégré de la santé et des services sociaux de l'Outaouais, Gatineau, Canada (P.N.)
| | - Robert P Giugliano
- Thrombolysis In Myocardial Infarction Study Group, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (M.P.B., R.P.G., E.K., J.K., M.S.S.)
| | - Anthony C Keech
- Sydney Medical School, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Australia (A.C.K.)
| | | | - Estella Kanevsky
- Thrombolysis In Myocardial Infarction Study Group, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (M.P.B., R.P.G., E.K., J.K., M.S.S.)
| | - Julia Kuder
- Thrombolysis In Myocardial Infarction Study Group, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (M.P.B., R.P.G., E.K., J.K., M.S.S.)
| | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.W.J.)
| | - Basil S Lewis
- Lady Davis Carmel Medical Center and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (B.S.L.)
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University, Ankara, Turkey (L.T.)
| | | | - Peter S Sever
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK (P.S.S.)
| | - Terje R Pedersen
- Oslo University Hospital, Ullevål and Medical Faculty, University of Oslo, Norway (T.R.P.)
| | - Marc S Sabatine
- Thrombolysis In Myocardial Infarction Study Group, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA (M.P.B., R.P.G., E.K., J.K., M.S.S.)
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Sathiyakumar V, Park J, Golozar A, Lazo M, Quispe R, Guallar E, Blumenthal RS, Jones SR, Martin SS. Fasting Versus Nonfasting and Low-Density Lipoprotein Cholesterol Accuracy. Circulation 2017; 137:10-19. [PMID: 29038168 DOI: 10.1161/circulationaha.117.030677] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [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: 06/21/2017] [Accepted: 09/25/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Recent recommendations favoring nonfasting lipid assessment may affect low-density lipoprotein cholesterol (LDL-C) estimation. The novel method of LDL-C estimation (LDL-CN) uses a flexible approach to derive patient-specific ratios of triglycerides to very low-density lipoprotein cholesterol. This adaptability may confer an accuracy advantage in nonfasting patients over the fixed approach of the classic Friedewald method (LDL-CF). METHODS We used a US cross-sectional sample of 1 545 634 patients (959 153 fasting ≥10-12 hours; 586 481 nonfasting) from the second harvest of the Very Large Database of Lipids study to assess for the first time the impact of fasting status on novel LDL-C accuracy. Rapid ultracentrifugation was used to directly measure LDL-C content (LDL-CD). Accuracy was defined as the percentage of LDL-CD falling within an estimated LDL-C (LDL-CN or LDL-CF) category by clinical cut points. For low estimated LDL-C (<70 mg/dL), we evaluated accuracy by triglyceride levels. The magnitude of absolute and percent differences between LDL-CD and estimated LDL-C (LDL-CN or LDL-CF) was stratified by LDL-C and triglyceride categories. RESULTS In both fasting and nonfasting samples, accuracy was higher with the novel method across all clinical LDL-C categories (range, 87%-94%) compared with the Friedewald estimation (range, 71%-93%; P≤0.001). With LDL-C <70 mg/dL, nonfasting LDL-CN accuracy (92%) was superior to LDL-CF accuracy (71%; P<0.001). In this LDL-C range, 19% of fasting and 30% of nonfasting patients had differences ≥10 mg/dL between LDL-CF and LDL-CD, whereas only 2% and 3% of patients, respectively, had similar differences with novel estimation. Accuracy of LDL-C <70 mg/dL further decreased as triglycerides increased, particularly for Friedewald estimation (range, 37%-96%) versus the novel method (range, 82%-94%). With triglycerides of 200 to 399 mg/dL in nonfasting patients, LDL-CN <70 mg/dL accuracy (82%) was superior to LDL-CF (37%; P<0.001). In this triglyceride range, 73% of fasting and 81% of nonfasting patients had ≥10 mg/dL differences between LDL-CF and LDL-CD compared with 25% and 20% of patients, respectively, with LDL-CN. CONCLUSIONS Novel adaptable LDL-C estimation performs better in nonfasting samples than the fixed Friedewald estimation, with a particular accuracy advantage in settings of low LDL-C and high triglycerides. In addition to stimulating further study, these results may have immediate relevance for guideline committees, laboratory leadership, clinicians, and patients. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01698489.
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Affiliation(s)
- Vasanth Sathiyakumar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
| | - Jihwan Park
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
| | - Asieh Golozar
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mariana Lazo
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
| | - Renato Quispe
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Eliseo Guallar
- Department of Epidemiology (J.P., A.G., M.L., E.G.)
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
| | - Steven R Jones
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.)
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (V.S., R.Q., R.S.B., S.R.J., S.S.M.).
- Welch Center for Prevention, Epidemiology, and Clinical Research, Department of Epidemiology (A.G., R.Q., E.G., S.S.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG, Stone NJ, Van Horn LV. Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation 2017; 136:e1-e23. [PMID: 28620111 DOI: 10.1161/cir.0000000000000510] [Citation(s) in RCA: 731] [Impact Index Per Article: 104.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.
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Abstract
The statins have been used for 30 years to prevent coronary artery disease and stroke. Their primary mechanism of action is the lowering of serum cholesterol through inhibiting hepatic cholesterol biosynthesis thereby upregulating the hepatic low-density lipoprotein (LDL) receptors and increasing the clearance of LDL-cholesterol. Statins may exert cardiovascular protective effects that are independent of LDL-cholesterol lowering called pleiotropic effects. Because statins inhibit the production of isoprenoid intermediates in the cholesterol biosynthetic pathway, the post-translational prenylation of small GTP-binding proteins such as Rho and Rac, and their downstream effectors such as Rho kinase and nicotinamide adenine dinucleotide phosphate oxidases are also inhibited. In cell culture and animal studies, these effects alter the expression of endothelial nitric oxide synthase, the stability of atherosclerotic plaques, the production of proinflammatory cytokines and reactive oxygen species, the reactivity of platelets, and the development of cardiac hypertrophy and fibrosis. The relative contributions of statin pleiotropy to clinical outcomes, however, remain a matter of debate and are hard to quantify because the degree of isoprenoid inhibition by statins correlates to some extent with the amount of LDL-cholesterol reduction. This review examines some of the currently proposed molecular mechanisms for statin pleiotropy and discusses whether they could have any clinical relevance in cardiovascular disease.
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Affiliation(s)
- Adam Oesterle
- From the Section of Cardiology, Department of Medicine, The University of Chicago, IL (A.O., J.K.L.); and Division of Cardiology, Department of Medicine, The University of Saarland, Homburg, Germany (U.L.)
| | - Ulrich Laufs
- From the Section of Cardiology, Department of Medicine, The University of Chicago, IL (A.O., J.K.L.); and Division of Cardiology, Department of Medicine, The University of Saarland, Homburg, Germany (U.L.)
| | - James K Liao
- From the Section of Cardiology, Department of Medicine, The University of Chicago, IL (A.O., J.K.L.); and Division of Cardiology, Department of Medicine, The University of Saarland, Homburg, Germany (U.L.).
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Pankow JS, Tang W, Pankratz N, Guan W, Weng LC, Cushman M, Boerwinkle E, Folsom AR. Identification of Genetic Variants Linking Protein C and Lipoprotein Metabolism: The ARIC Study (Atherosclerosis Risk in Communities). Arterioscler Thromb Vasc Biol 2017; 37:589-597. [PMID: 28082259 DOI: 10.1161/atvbaha.116.308109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 07/01/2016] [Accepted: 12/30/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Previous studies have identified common genetic variants in 4 chromosomal regions that together account for 14% to 15% of the variance in circulating levels of protein C. To further characterize the genetic architecture of protein C, we obtained denser coverage at some loci, extended investigation of protein C to low-frequency and rare variants, and searched for new associations in genes known to influence protein C. APPROACH AND RESULTS Genetic associations with protein C antigen level were evaluated in ≤10 778 European and 3190 black participants aged 45 to 64 years. Analyses included >26 million autosomal variants available after imputation to the 1000 Genomes reference panel along with additional low-frequency and rare variants directly genotyped using the Illumina ITMAT-Broad-CARe chip and Illumina HumanExome BeadChip. Genome-wide significant associations (P<5×10-8) were found for common variants in the GCKR, PROC, BAZ1B, and PROCR-EDEM2 regions in whites and PROC and PROCR-EDEM2 regions in blacks, confirming earlier findings. In a novel finding, the low-density lipoprotein cholesterol-lowering allele of rs12740374, located in the CELSR2-PSRC1-SORT1 region, was associated with lower protein C level in both whites and blacks, reaching genome-wide significance in a meta-analysis combining results from both groups (P=1.4×10-9). To further investigate a possible link between lipid metabolism and protein C level, we conducted Mendelian randomization analyses using 185 lipid-related genetic variants as instrumental variables. The results indicated that triglycerides, and possibly low-density lipoprotein cholesterol, influence protein C levels. CONCLUSIONS Discovery of variants influencing circulating protein C levels in the CELSR2-PSRC1-SORT1 region may indicate a novel genetic link between lipoprotein metabolism and hemostasis.
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Affiliation(s)
- James S Pankow
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.).
| | - Weihong Tang
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.)
| | - Nathan Pankratz
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.)
| | - Weihua Guan
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.)
| | - Lu-Chen Weng
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.)
| | - Mary Cushman
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.)
| | - Eric Boerwinkle
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.)
| | - Aaron R Folsom
- From the Division of Epidemiology and Community Health (J.S.P., W.T., L.-C.W., A.R.F.), Department of Laboratory Medicine and Pathology (N.P.), and Division of Biostatistics (W.G.), University of Minnesota, Minneapolis; Department of Medicine (M.C.) and Department of Pathology (M.C.), University of Vermont, Burlington; and Human Genetics Center and Institute of Molecular Medicine, University of Texas Health Science Center at Houston (E.B.)
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Ray KK, Ginsberg HN, Davidson MH, Pordy R, Bessac L, Minini P, Eckel RH, Cannon CP. Reductions in Atherogenic Lipids and Major Cardiovascular Events: A Pooled Analysis of 10 ODYSSEY Trials Comparing Alirocumab With Control. Circulation 2016; 134:1931-1943. [PMID: 27777279 PMCID: PMC5147039 DOI: 10.1161/circulationaha.116.024604] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/06/2016] [Indexed: 01/14/2023]
Abstract
Supplemental Digital Content is available in the text. Background: A continuous relationship between reductions in low-density lipoprotein cholesterol (LDL-C) and major adverse cardiovascular events (MACE) has been observed in statin and ezetimibe outcomes trials down to achieved levels of 54 mg/dL. However, it is uncertain whether this relationship extends to LDL-C levels <50 mg/dL. We assessed the relationship between additional LDL-C, non–high-density lipoprotein cholesterol, and apolipoprotein B100 reductions and MACE among patients within the ODYSSEY trials that compared alirocumab with controls (placebo/ezetimibe), mainly as add-on therapy to maximally tolerated statin. Methods: Data were pooled from 10 double-blind trials (6699 patient-years of follow-up). Randomization was to alirocumab 75/150 mg every 2 weeks or control for 24 to 104 weeks, added to background statin therapy in 8 trials. This analysis included 4974 patients (3182 taking alirocumab, 1174 taking placebo, 618 taking ezetimibe). In a post hoc analysis, the relationship between average on-treatment lipid levels and percent reductions in lipids from baseline were correlated with MACE (coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or unstable angina requiring hospitalization) in multivariable analyses. Results: Overall, 33.1% of the pooled cohort achieved average LDL-C <50 mg/dL (44.7%–52.6% allocated to alirocumab, 6.5% allocated to ezetimibe, and 0% allocated to placebo). In total, 104 patients experienced MACE (median time to event, 36 weeks). For every 39 mg/dL lower achieved LDL-C, the risk of MACE appeared to be 24% lower (adjusted hazard ratio, 0.76; 95% confidence interval, 0.63–0.91; P=0.0025). Percent reductions in LDL-C from baseline were inversely correlated with MACE rates (hazard ratio, 0.71; 95% confidence interval, 0.57–0.89 per additional 50% reduction from baseline; P=0.003). Strengths of association materially similar to those described for LDL-C were observed with achieved non–high-density lipoprotein cholesterol and apolipoprotein B100 levels or percentage reductions. Conclusions: In a post hoc analysis from 10 ODYSSEY trials, greater percentage reductions in LDL-C and lower on-treatment LDL-C were associated with a lower incidence of MACE, including very low levels of LDL-C (<50 mg/dL). These findings require further validation in the ongoing prospective ODYSSEY OUTCOMES trial. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01507831, NCT01623115, NCT01709500, NCT01617655, NCT01644175, NCT01644188, NCT01644474, NCT01730040, NCT01730053, and NCT01709513.
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Affiliation(s)
- Kausik K Ray
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.).
| | - Henry N Ginsberg
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.)
| | - Michael H Davidson
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.)
| | - Robert Pordy
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.)
| | - Laurence Bessac
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.)
| | - Pascal Minini
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.)
| | - Robert H Eckel
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.)
| | - Christopher P Cannon
- From Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, London, UK (K.K.R.); Columbia University, New York, NY (H.N.G.); Department of Medicine, University of Chicago Medicine, Chicago, IL (M.H.D.); Regeneron Pharmaceuticals, Inc Tarrytown, NY (R.P.); Sanofi, Paris, France (L.B.); Biostatistics and Programming, Sanofi, Chilly-Mazarin, France (P.M.); University of Colorado, Anschutz Medical Campus, Aurora (R.H.E.); and Harvard Clinical Research Institute, Boston, MA (C.P.C.)
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Affiliation(s)
- Fatima Rodriguez
- From Stanford University, Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, CA
| | - Joshua W Knowles
- From Stanford University, Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, CA.
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Shimada SL, Allison JJ, Rosen AK, Feng H, Houston TK. Sustained Use of Patient Portal Features and Improvements in Diabetes Physiological Measures. J Med Internet Res 2016; 18:e179. [PMID: 27369696 PMCID: PMC4947193 DOI: 10.2196/jmir.5663] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [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: 02/22/2016] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 11/18/2022] Open
Abstract
Background Personal health records (PHRs) have the potential to improve patient self-management for chronic conditions such as diabetes. However, evidence is mixed as to whether there is an association between PHR use and improved health outcomes. Objective The aim of this study was to evaluate the association between sustained use of specific patient portal features (Web-based prescription refill and secure messaging—SM) and physiological measures important for the management of type 2 diabetes. Methods Using a retrospective cohort design, including Veterans with diabetes registered for the My Health e Vet patient portal who had not yet used the Web-based refill or SM features and who had at least one physiological measure (HbA1c, low-density lipoprotein (LDL) cholesterol, blood pressure) in 2009-2010 (baseline) that was above guideline recommendations (N=111,686), we assessed portal use between 2010 and 2014. We calculated the odds of achieving control of each measure by 2013 to 2014 (follow-up) by years of using each portal feature, adjusting for demographic and clinical characteristics associated with portal use. Results By 2013 to 2014, 34.13% (38,113/111,686) of the cohort was using Web-based refills, and 15.75% (17,592/111,686) of the cohort was using SM. Users were slightly younger (P<.001), less likely to be eligible for free care based on economic means (P<.001), and more likely to be women (P<.001). In models adjusting for both features, patients with uncontrolled HbA1c at baseline who used SM were significantly more likely than nonusers to achieve glycemic control by follow-up if they used SM for 2 years (odds ratio—OR=1.24, CI: 1.14-1.34) or 3 or more years (OR=1.28, CI: 1.12-1.45). However, there was no significant association between Web-based refill use and glycemic control. Those with uncontrolled blood pressure at baseline who used Web-based refills were significantly more likely than nonusers to achieve control at follow-up with 2 (OR=1.07, CI: 1.01-1.13) or 3 (OR=1.08, CI: 1.02-1.14) more years of Web-based refill use. Both features were significantly associated with improvements in LDL cholesterol levels at follow-up. Conclusions Although rates of use of the refill function were higher within the population, sustained SM use had a greater impact on HbA1c. Evaluations of patient portals should consider that individual components may have differential effects on health improvements.
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Affiliation(s)
- Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.
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