Journal of clinical lipidology最新文献

{"title":"Genetic variants in triglyceride metabolism genes among individuals with hypertriglyceridemia in Colombia","authors":"Kathalina Puerto-Baracaldo MD, Mateo Amaya-Montoya MD, Gustavo Parra-Serrano MD, Diana C. Prada-Robles BSc MSc, Sergio Serrano-Gómez MD MSc, Lina M. Restrepo-Giraldo MD MSc, María C. Fragozo-Ramos MD, Verónica Tangarife BSc MSc, Germán C. Giraldo-González MD PhD, Carlos A. Builes-Barrera MD, Melisa S. Naranjo-Vanegas MD MSc, Andrés Gómez-Aldana MD, Juan Pablo Llano MD, Nayibe Gil-Ochoa BSc, Luz D. Nieves-Barreto MV MSc, Paula V. Gaete MD MSc, Maritza Pérez-Mayorga MD, Carlos O. Mendivil MD MSc PhD","doi":"10.1016/j.jacl.2024.08.006","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.006","url":null,"abstract":"The genetic substrate of severe hypertriglyceridemia (sHTG) in Latin America is insufficiently understood. To identify genetic variants in genes related to triglyceride (TG) metabolism among adults with sHTG from Colombia. In individuals with plasma TG≥880 mg/dL at least once in their lifetime, we amplified and sequenced all exons and intron/exon boundaries of the genes and . For each variant we ascertained its location, zygosity, allelic frequency and pathogenicity classification according to American College of Medical Genetics (ACMG) criteria. The study included 166 participants (62 % male, mean age 50), peak TG levels ranged between 894 and 11,000 mg/dL. We identified 92 variants: 19 in , 7 in , 11 in , 38 in , and 17 in . Eighteen of these variants had not been reported. We identified a new pathogenic variant in (c.41C>A; p.Ser14*), a new likely pathogenic variant in (c.1527 C > T; p.Pro509=, also expressed as c.1447C>T; p.Gln483*), and a known pathogenic variant in (c.779G>A; p.Trp260*). Four participants were heterozygous for variant c.953A>G; p.Asn318Ser in , a known risk factor for hypertriglyceridemia. Participants with variants of unknown significance (VUS) in had significantly higher peak TG than those with VUS in other genes. Peak TG were 4317 mg/dL in participants with a history of pancreatitis, and 1769 mg/dL in those without it ( = 0.001). Our study identified variants associated with sHTG among Latinos, and showed that genetic variation in may be frequently associated with sHTG in this population.","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"2 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of moderate-intensity statin plus ezetimibe versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease: A meta-analysis","authors":"Francinny Alves Kelly MD, Francisco Cezar Aquino de Moraes, Artur de Oliveira Macena Lôbo, Victória Morbach Siebel, Marianna Leite, Artur Menegaz de Almeida, Fernanda Marciano Consolim-Colombo MD","doi":"10.1016/j.jacl.2024.07.013","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.07.013","url":null,"abstract":"Atherosclerotic cardiovascular disease (ASCVD), affects approximately 18.6 million individuals worldwide and poses a significant healthcare related challenge. Despite the established efficacy of both high-intensity statin monotherapy (HIS) and moderate-intensity statin plus ezetimibe (MIS+EZT) in ASCVD management, the optimal treatment strategy remains unclear. A thorough literature study was conducted across PubMed, Embase, and the Cochrane databases, focusing on studies that compared the effects of moderate-intensity statins plus ezetimibe with high-intensity statin monotherapy in ASCVD patients. In the 13 included studies, involving 8,592 patients, 4,525 (52.67 %) of which received moderate-intensity statin plus ezetimibe treatment. The follow-up period ranged from 4 to 156 weeks, with participant ages varying LDL-C from 55.2 to 71 years old. Analysis revealed significant MIS+EZT-associated with greater percentages of patients achieved the goal in Low-Density Lipoprotein (LDL-C) < 70 (Odds Ratio (OR) 1.76; 95 % CI [1.26; 2.45]; = 0.001; I² = 73 %), LDL-C reduction (Mean Difference (MD) -5.05 mg/dL; 95 % CI [-9.02;-1.07]; < 0.013; I² = 56 %;); Total Cholesterol reduction (MD -7.91 mg/ dL; 95 % CI [-14.90; -0.91]; < 0.027; I² = 60 %); Triglycerides reduction (MD -8.20 mg/ dL; 95 % CI [-13.05; -3.35]; < 0.001; I² = 2 %;); There was no statistical difference between groups in Drug Adverse reaction (Risk Ratio (RR) 1.19; 95 % CI [0.79; 1.78]; = 0.404; I² = 0 %); and Drug intolerance (RR 0.78; 95 % CI [0.32; 1.92]; = 0.584; I² = 35 %). This meta-analysis highlights the effectiveness of MIS+EZT in improving significant lipid profile components for ASCVD patients, as can been seen through the greater percentage of patients achieving the LDL-C < 70 mg/dL target and lower LDL-C, total cholesterol and triglycerides levels. Importantly, there were no significant differences in the occurrence of overall adverse events and adverse drug reactions between the two groups.","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"15 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long term association of low-density lipoprotein subtypes with coronary artery calcium score and atherosclerotic cardiovascular disease events: Insights from HeartSCORE study","authors":"Alaa Sayed MD MSc, Justin Swanson, Kevin Kip, Eshika Kumari Jesrani, Steven Reis, Anum Saeed MD","doi":"10.1016/j.jacl.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.003","url":null,"abstract":"Elevated low-density lipoprotein (LDL) cholesterol is associated with risk of atherosclerotic cardiovascular disease (ASCVD). However, the association of midlife LDL subtypes in long-term clinical and subclinical ASCVD remains unknown. We examine LDL pattern associations with subclinical ASCVD. LDL subtypes were assessed in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study participants. Baseline coronary artery calcium (CAC) scores were calculated and long-term ASCVD events were assessed. Adjusted odds ratios and hazard ratios (95 % CI) were calculated to estimate the independent association between LDL patterns and CAC and ASCVD events, stratified by sex and race. 1,884 participants (age 59 ± 7.5 years. 66 % women, 44 % Black) were involved in the survival analysis; a subset of 740 (age 60.7 ± 7.3 years, 44 % women and 47 % Black) had their CAC score assessed. Men and Black individuals with LDL pattern AB had higher odds for positive CAC score (ORmen,patternAB = 2.47, 95 % CI [1.11-5.58]). Individuals with LDL patterns B (HR = 1.98, 95 % CI [1.22-3.21]; p-value < 0.05) and AB (HR = 1.54, 95 % CI of [1.00-2.38]; p-value < 0.05) were at a higher risk of ASCVD events. Self-identified Black individuals with type B and AB had higher risk of ASCVD events. In cohort of Black and White community dwellers, LDL patterns B and AB showed a higher risk of ASCVD events. Pattern AB was associated with positive CAC in men and Black individuals. Further studies investigating LDL patterns in ASCVD risk based on race and sex are needed to drive precise preventive strategies for ASCVD.","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"2011 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrinogen and plasma clot properties are associated with apolipoprotein B and apolipoprotein B-containing lipoproteins in Africans","authors":"Daniel Bruwer MSc, Zelda de Lange-Loots PhD, Marlys L. Koschinsky PhD, Michael B. Boffa PhD, Marlien Pieters PhD","doi":"10.1016/j.jacl.2024.08.004","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.08.004","url":null,"abstract":"Case-control, intervention and laboratory studies have demonstrated a link between apolipoprotein B-containing lipoproteins and clot structure and thrombosis. There is, however, limited evidence on population level. We determined the cross-sectional relationship between lipoprotein(a) (Lp(a)), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (ApoB) with fibrinogen and plasma clot properties in 1 462 Black South Africans, a population with higher fibrinogen and Lp(a) levels compared with individuals of European descent. Data were obtained from participants in the South African arm of the Prospective Urban and Rural Epidemiology study. Clot properties analysed included lag time, slope, maximum absorbance, and clot lysis time (turbidity). Lp(a) was measured in nM using particle-enhanced immunoturbidimetry. General linear models (GLM) were used to determine the associations between ApoB and ApoB-containing lipoproteins with fibrinogen and plasma clot properties. Stepwise regression was used to determine contributors to clot properties and Lp(a) variance. GLM and regression results combined, indicated fibrinogen concentration and rate of clot formation (slope) had the strongest association with Lp(a); clot density associated positively with both Lp(a) and LDL-C; time to clot formation associated negatively with ApoB; and CLT demonstrated strong positive associations with both ApoB and LDL-C, while its association with Lp(a) was fibrinogen concentration dependent. These findings suggest that ApoB and the lipoproteins carrying it contribute to prothrombotic clot properties in Africans on epidemiological level and highlight potential novel prothrombotic roles for these (apo)lipoproteins to be considered for the development of targeted therapeutic approaches to address thrombotic conditions related to clot properties.","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"34 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between ceramide profile and residual inflammatory risk in patients with coronary artery disease: Insights from an prospective study","authors":"Liang Zhang M.D., YaoDong Ding M.D., MingHui Chen, XinPing Gao, HuiQing Liang M.D., DaWei Tan M.D., XiuFen Li, Lin Li PhD, Yong Zeng M.D.","doi":"10.1016/j.jacl.2024.07.009","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.07.009","url":null,"abstract":"Although progress has been made in managing cholesterol, targeting inflammation is essential for further reducing cardiovascular risk, as CVDs remain the leading cause of death globally. This study aimed to explore the association between plasma ceramide levels and residual inflammatory risk in patients with CAD. A cross-sectional observational design was adopted using data from a secondary analysis of a multicenter prospective cohort study in China. Patients were categorized into two groups based on a hs-CRP level of 2.0mg/L. Plasma ceramide levels were measured using the LC-MS/MS system. By collecting and statistically analyzing patient demographic and clinical characteristics, differences were compared between the low residual inflammatory risk group (Low RIR) and the high residual inflammatory risk group (High RIR). Multivariate logistic regression analysis was used to assess the interaction of plasma ceramides with high residual inflammation risk. A total of 778 patients with confirmed CAD were included in the study. Compared to the Low RIR, Cer (d18:1/16:0), Cer (d18:1/18:0), Cer (d18:1/20:0), Cer (d18:1/22:0), Cer (d18:1/24:0), and Cer (d18:1/24:1), were significantly elevated in the High RIR group. Spearman correlation analysis indicated that Cer (d18:1/16:0) levels were positively correlated with hsCRP. Further multivariable logistic regression analysis revealed that Cer (d18:1/16:0) was a significant independent indicator of high RIR beyond conventional cardiovascular risk factors. This study found a significant association between specific plasma ceramide Cer (d18:1/16:0) and high residual inflammatory risk in CAD patients, suggesting it could be an important inflammatory biomarker in the management of cardiovascular diseases.","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"34 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141948098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of lipids and lipid-lowering drugs with peripheral arterial disease: A Mendelian randomization study","authors":"Mengjun Tao MD, Yuanxiang Zhang MD, Qi Li MD, Xuebing Feng PhD, Cheng Ping MD","doi":"10.1016/j.jacl.2024.06.007","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.06.007","url":null,"abstract":"It remains unclear whether lipid profiles and lipid-lowering medications are causally related to PAD. Explain whether there is a causal relationship between lipid status and lipid-lowering drugs and PAD. In this two-sample Mendelian randomization (MR) analysis, we assessed the causal relationship between lipid traits, including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs), total cholesterol (TC), and LDL-associated genetic variants (), and the risk of peripheral arterial disease (PAD) using genetic variants associated with these lipid markers. The study analyzed data from 1,654,960 individuals derived from the Global Lipid Genetics Consortium and the UK Biobank, ensuring a robust and comprehensive genetic insight into the effects of lipid dysfunction on PAD. We found genetically predicted associations between HDL (: 0.83, 95% : 0.83-0.77), LDL-c (: 1.29, 95% : 1.12-1.50), TC (: 1.14, 95% : 1.01- 1.29), TG (:1.16, 95% : 1.04-1.24), (: 1.31, 95% : 1.16-1.48), and (:0.84, 95%: 0.77-0.97), and the risk of PAD. In addition, inhibition of was associated with a reduced risk of PAD (:0.68, 95% : 0.57-0.79, <0.001), while no association between the other three gene proxies of LDL inhibition including (=1.21, 95% : 0.87-1.69, =0.250), NPC1L1 (:0.77, 95% 0.44-1.33, =0.344), and APOB (:1.01, 95% :0.87-1.26, =0.890), and the risk of PAD were found. Based on genetic evidence, dyslipidemia is an important risk factor for PAD. PCSK9 inhibitors may be an effective strategy for the treatment of PAD.","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"80 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141611954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's next for lipoprotein(a)? A national lipid association report from an expert panel discussion","authors":"Marlys L. Koschinsky PhD FNLA FRSC, Daniel E. Soffer MD FNLA FACP, Michael B. Boffa PhD","doi":"10.1016/j.jacl.2024.06.005","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.06.005","url":null,"abstract":"This is an exciting time in the lipoprotein(a) (Lp(a)) field. Attention to this important lipoprotein and potent cardiovascular risk marker is transitioning from the purview of the specialist to that of the general practitioner. Its clinical adoption as an important test is increasing in momentum. There is evidence that Lp(a) contributes to the pathology of atherothrombotic disease, aortic valve stenosis, and childhood ischemic strokes. Three large, Phase 3, randomized, cardiovascular outcomes trials in which Lp(a) is specifically and substantially lowered by mRNA-directed therapies in secondary prevention settings are in progress and will start to report results as early as 2025. Regardless of outcomes, there remain many unanswered questions about Lp(a), ranging from fundamental unknowns about Lp(a) biology, to the complexity of its measurement, optimal screening strategies, and clinical management in individuals with high Lp(a) levels both with and without overt cardiovascular disease. Accordingly, The National Lipid Association (NLA) convened an Expert Discussion involving clinicians and fundamental researchers to identify knowledge gaps in our understanding of Lp(a) biology and pathogenicity and to discuss approaches in the management of elevated Lp(a) in different clinical settings. (183 words)","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141611955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and Barriers to Lipoprotein(a) Testing: A Survey of Providers at the University of Pennsylvania Health System","authors":"Archna Bajaj MD,&nbsp;Jillian D'souza BS","doi":"10.1016/j.jacl.2024.04.007","DOIUrl":"10.1016/j.jacl.2024.04.007","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Lipoprotein(a) [Lp(a)] is an independent, genetic, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Elevated Lp(a) levels increase a person's risk for myocardial infarction, coronary artery disease, ischemic stroke, and aortic stenosis. Guidelines generally recommend testing for Lp(a) in high-risk patients, with some recent guidelines recommending testing once in all adults. It is estimated that &gt;20% of the population carry Lp(a) levels high enough to increase risk, however due to undertesting, many of these patients have not been identified.</p></div><div><h3>Objective/Purpose</h3><p>To understand the attitudes and barriers to testing for Lp(a) across relevant clinical settings and specialties at the University of Pennsylvania Health Systems (UPHS).</p></div><div><h3>Methods</h3><p>A brief IRB-approved survey in REDCap was distributed via email to select groups of UPHS providers in Cardiology, Neurology, Primary Care, and Vascular Surgery.</p></div><div><h3>Results</h3><p>The survey was sent to approximately 525 providers in December 2023. Of these, 116 providers completed the survey (54% Internal Medicine/Family Practice, 31% Cardiology, 10% Neurology, 4% Vascular Surgery). Approximately 31.0% (n=36) of all providers routinely tested for Lp(a) in their practice, but this varied by specialty (44% of Cardiologists versus 22% of Internal Medicine/Family Practice providers). For these providers, the most common reasons for testing included a familial history of ASCVD, a history of ASCVD in the patient, and high cholesterol (Table 1). A total of 80 providers (69%) responded that they do not regularly test for Lp(a). The most common reasons for not testing included lack of familiarity with Lp(a), insurance/billing concerns, lack of clinical trial outcomes data, and lack of available pharmaceutical interventions (Table 2).</p></div><div><h3>Conclusions</h3><p>While there is likely selection bias in the providers who chose to complete the survey, a surprisingly high number of responders (69%) described not regularly testing for Lp(a) in their practice. While results from ongoing clinical trial investigations of novel Lp(a)-lowering treatments may address provider hesitation toward utility of Lp(a)-testing, there is still a large gap to fill in Lp(a) awareness. Increasing provider knowledge of Lp(a) and incorporation into broader clinical guidelines are needed.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e487-e488"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Familial Hypercholesterolemia: Can Continuing Medical Education Help Address Barriers to Screening in Children?","authors":"Pamela Morris MD,&nbsp;Seth Martin MD,&nbsp;Carole Drexel PhD,&nbsp;Kristin Della Volpe BA","doi":"10.1016/j.jacl.2024.04.064","DOIUrl":"10.1016/j.jacl.2024.04.064","url":null,"abstract":"<div><h3>Study Funding</h3><p>This CME activity was supported by an educational grant from Regeneron Pharmaceuticals, Inc.</p></div><div><h3>Background/Synopsis</h3><p>Despite the clear benefit of early treatment of homozygous familial hypercholesterolemia (HoFH) in reducing the risk of progressive atherosclerotic cardiovascular disease (ASCVD), many patients remain undiagnosed until advanced ASCVD is present. Diagnostic delays may relate to low screening rates found among at-risk children &lt;9 years old.</p></div><div><h3>Objective/Purpose</h3><p>To study the impact of an online CME program to enhance health care providers' (HCPs') competence in diagnosing and managing HoFH and to overcome barriers to screening for at-risk children.</p></div><div><h3>Methods</h3><p>A 60-minute CME activity was launched live online on 8/2/23 and is available on-demand for 1 year. Knowledge, attitude, and practice-pattern questions were administered before and immediately after the activity (pre vs post). Chi-square tests compared paired responses (P&lt;0.05; pre/post).</p></div><div><h3>Results</h3><p>As of 1/2/24, 260 HCPs engaged in the program (30% cardiologists, 6% endocrinologists, 29% PCPs; 17% specialize in lipid management or are lipidologists). Nearly 60% of HCPs reported managing patients with very high lipid levels (&gt;400 mg/dL) and the average number of patients with very high lipid levels managed by these participants is 17 per year (approximately 5 of whom are &lt;9 years of age). HCPs' knowledge of the diagnostic criteria for HoFH (30% vs 58%), mechanism of action of ANGPTL3 inhibitors (22% vs 43%), and treatment intensification strategies (48% vs 62%) increased significantly during the CME activity.</p><p>Before the activity, approximately 20% of respondents did not measure lipid levels in children &lt;9 years old, 20% only measured in children with a parent diagnosed with familial hypercholesterolemia (FH) or with a family history of CVD, and 24% only measured in children with HoFH symptoms. After the activity, HCPs estimated that 60% of their patients with very high lipid levels (&gt;400 mg/dL) may have undiagnosed HoFH. The proportion of HCPs who strongly agreed with the American Academy of Pediatrics' recommendation for lipid screening for children with a genetic risk of FH or ASCVD as early as age 2 years increased from 14% to 37%.</p></div><div><h3>Conclusions</h3><p>CME can break down barriers to lipid screening in children at risk for HoFH by enhancing HCPs' knowledge of HoFH diagnosis and risk factors. While the activity enhanced knowledge about the evolving treatment landscape, future education on guidelines and treatment intensification can address remaining gaps in the adoption of best practices and novel agents for HoFH.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e537-e538"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"*Pericardial and Pleural Effusions after Evolocumab in a Patient with Severe Familial Hypercholesterolemia","authors":"Maia Pavlovic BA,&nbsp;Eugenia Gianos MD,&nbsp;Anthony Szema MD,&nbsp;Tia Bimal MD","doi":"10.1016/j.jacl.2024.04.034","DOIUrl":"10.1016/j.jacl.2024.04.034","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;p&gt;Inhibitors of PCSK9 by monoclonal antibodies (PSCK9mAb) are efficacious lipid lowering therapies with established outcome benefits. Side effects include nasopharyngitis, influenza-like illness, and injection site reactions.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;p&gt;To describe a less-commonly reported adverse reaction to evolocumab in a patient with severe familial hyperlipidemia (FH), outline applicable testing, and treatment strategies.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We report a patient with severe FH who developed fever, elevated liver function tests (LFTs), pericardial and pleural effusions with evolocumab.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A 70-year-old gentleman with hyperlipidemia presented to preventive cardiology clinic for consultation. His baseline LDL-cholesterol (LDL-C) was 400 mg/dL and examination revealed bilateral arcus senilis and xanthomas. Patient's paternal family members were all on lipid-lowering therapy although there were no early atherosclerotic events. Dutch criteria scoring was 21 (definite FH). His lifestyle was optimal, including a Mediterranean diet with daily walking. Risk assessment revealed a calcium score of 3000 AU, carotid atherosclerosis, and lipoprotein (a) of 233.1 nmol/L. Treatment with ezetimibe 10 mg oral daily and rosuvastatin 40 mg oral daily was initiated, achieving a post-treatment LDL-C of 130 mg/dL. To further improve the patient's outcomes by targeting a LDL-C of &lt;70 mg/dL, evolocumab 140 mg subcutaneous biweekly was prescribed. After the first dose, he had fever. Two weeks after the second dose, he was hospitalized with: fever, elevated inflammatory markers and LFTs, pericardial and pleural effusions. Discontinuation resolved symptoms. Post-hospital discharge, laboratory abnormalities normalized. Colchicine and steroids were administered for pericarditis.&lt;/p&gt;&lt;p&gt;This case underscores complexities of managing lipid disorders when confronted with adverse reactions. Based on delayed-onset symptoms and laboratory abnormalities after medication, it is critically-important to consider the possibility of an immune-mediated reaction. The needle cover of the single-dose prefilled autoinjector of evolocumab contains a derivative of latex, a potential risk factor for triggering Gell-Coombs Type I and IV allergic reactions in latex-sensitive individuals. Percutaneous latex skin prick testing is pending. Evolocumab is fully humanized, reducing the risk of immunogenicity, yet this does not exclude adverse drug reactions. The mechanism for common adverse events associated with monoclonal antibodies involves a cytokine-mediated type alpha immune response, explaining flu-like symptoms and injection site reactions. Because of our patient's extensive atherosclerotic disease, additional evaluation will assist us in risk-stratifying treatment: alirocumab, inclisiran, evanicumab or lipoprotein apheresis to reach a target LDL-C of &lt;70 mg/dL.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e506-e507"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}