Journal of clinical lipidology最新文献

{"title":"Lipoprotein profiles across a spectrum of insulin signaling.","authors":"Michael Hwang, Robert D Shamburek, Maureen Sampson, Brent S Abel, Marissa Lightbourne, Rebecca J Brown","doi":"10.1016/j.jacl.2025.06.003","DOIUrl":"10.1016/j.jacl.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>Obesity and type 2 diabetes (T2D) are associated with insulin resistance (IR), a risk factor for atherosclerotic cardiovascular disease (ASCVD). In these conditions, IR affects only a subset of insulin signaling pathways, with preserved insulin signaling in others (termed \"pathway-selective IR\"). Consequently, individuals with obesity and T2D develop both hypertriglyceridemia from excess insulin signaling and hyperglycemia from insufficient insulin signaling.</p><p><strong>Objective: </strong>As IR involves biology mediated by both increased and decreased insulin signaling, we created a conceptual rare disease model to better understand whether ASCVD risk in states of IR is predominately driven by excessive insulin action, insufficient insulin action, or a combination of both.</p><p><strong>Methods: </strong>We compared nuclear magnetic resonance lipoprotein profiles (markers of ASCVD risk) in 14 patients (86% female, age 39 ± 17 years) with type B IR (TBIR), a disorder where autoantibodies against the insulin receptor block all insulin signaling (low insulin signaling), which is restored in remission (normal insulin signaling). Age and sex- matched patients with lipodystrophy were included to represent high insulin signaling.</p><p><strong>Results: </strong>Across the spectrum of insulin signaling, from lowest (TBIR active) to intermediate (TBIR remission) to highest (lipodystrophy), there were increases in all triglyceride-rich lipoprotein parameters. We also observed a shift toward smaller high-density lipoprotein (HDL) particles, with reciprocal decreases in large HDL-Ps and increases in small HDL-Ps across groups.</p><p><strong>Conclusion: </strong>Excess insulin signaling contributes to a proatherogenic lipoprotein profile. Interventions that downregulate or rebalance insulin signaling may offer cardiovascular benefits for individuals with severe (lipodystrophy) and mild (obesity and T2D) forms of pathway-selective IR.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of severe hyperlipidemia and associated cardiovascular outcomes: Data from a large healthcare system.","authors":"Cameron Hallihan, Jianhui Zhu, Floyd Thoma, Vijay Nambi, Anurag Mehta, Anandita Agarwala, Oscar Marroquin, Suresh Mulukutla, Anum Saeed","doi":"10.1016/j.jacl.2025.06.011","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.06.011","url":null,"abstract":"<p><strong>Background: </strong>High intensity statin therapy is currently recommended for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients with severe hyperlipidemia (HLD), defined as low-density lipoprotein cholesterol (LDL-C) of ≥190 mg/dL.</p><p><strong>Objective: </strong>We investigated rates and dosages of statin use and associated ASCVD outcomes for patients with severe HLD.</p><p><strong>Methods: </strong>In a large healthcare system network, patients without ASCVD with an LDL-C ≥ 190 mg/dL were identified and stratified further based on American College of Cardiology /American Heart Association 10-year risk score. Statin use was stratified as: guideline directed statin intensity (GDSI) (high intensity statin) or <GDSI (less than high intensity) or no statin use. Time to initiation of GDSI was calculated using the Kaplan-Meier method. Incident rates (per thousand person years) and Cox proportional hazards models were used to assess the relationship between statin use and adverse outcomes.</p><p><strong>Results: </strong>Out of 282,298 primary prevention patients, a total of 5205 (1.8%) had LDL-C ≥ 190 mg/dL out of whom 3.7% were on GDSI at the index visit. Over a 5-year follow up, 42% of high-risk patients with severe HLD achieved new GDSI initiation. Compared to patients on GDSI, those on no statin therapy were at significantly higher risk of myocardial infarction (MI) (hazard ratio [HR] = 2.36, 95% CI [1.38-4.04]) and stroke/transient ischemic attack (HR = 2.70, 95% CI [1.43-5.09]). Patients on <GDSI were found to have significantly higher risk of MI (HR = 1.72, 95% CI [1.05-2.81]) compared to patients on GDSI.</p><p><strong>Conclusion: </strong>High intensity statins are underutilized among patients with severe HLD, which is linked to greater risk of ASCVD events.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717993","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":"Patient experience with familial chylomicronemia syndrome before and after olezarsen treatment: Qualitative interviews with clinical trial participants.","authors":"Asia Sikora Kessler, T Michelle Brown, Emily Bratlee-Whitaker, Sheri Fehnel, Montserrat Vera-Llonch, Marcello Arca, Maurizio Averna, Alexis Baass, Seth J Baum, Jean Bergeron, Daniel Gaudet, Ovidio Muñiz-Grijalvo, Veronica J Alexander, Sotirios Tsimikas","doi":"10.1016/j.jacl.2025.06.014","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.06.014","url":null,"abstract":"<p><strong>Background: </strong>Familial chylomicronemia syndrome (FCS), a rare genetic disorder, markedly increases plasma triglycerides and the risk of acute pancreatitis. FCS symptoms can profoundly impact patients' quality of life.</p><p><strong>Objective: </strong>To explore the FCS patient experience during olezarsen treatment, including perceptions of meaningful changes in FCS symptoms and impacts.</p><p><strong>Methods: </strong>Patients with FCS continuing olezarsen treatment in an open-label extension (OLE) (NCT05130450) of the randomized, placebo-controlled phase 3 Balance study (NCT04568434) participated in 1-hour qualitative interviews. Thematic analysis was conducted.</p><p><strong>Results: </strong>Among 18 OLE participants who completed interviews (55.6% female; mean age, 43.5 years), 17 reported a history of pancreatitis, including 14 with pancreatitis events within 10 years prior to enrollment in the Balance study (13/14 requiring hospitalization). All participants reported having experienced FCS-related symptoms before trial enrollment (most commonly, abdominal pain [94.4%], physical fatigue [66.7%], diarrhea [55.6%], vomiting [50.0%], nausea [33.3%], and difficulty thinking [27.8%]) and impacts (most commonly, dietary restrictions [100%], mood/emotions [94.4%], hospitalizations [77.8%], and social activities [77.8]). Fifteen of 18 participants (83.3%) reported improvements with olezarsen treatment, including reductions in FCS-related symptoms (abdominal pain [n = 14/17; 82.4%], physical fatigue [n = 7/12; 58.3%], diarrhea [n = 6/10; 60.0%], vomiting [n = 7/8; 87.5%], nausea [n = 3/5; 60.0%], and difficulty thinking [n = 3/5; 60.0%]) and impacts (relationships [n = 6/7; 85.7.0%], hospital admittances [n = 11/14; 78.6%], finances [n = 3/4; 75.0%], and mood/emotions [n = 12/17; 70.6%]). Most participants (15/18; 83.3%) reported meaningful improvements and indicated they were satisfied with olezarsen treatment.</p><p><strong>Conclusion: </strong>Results of this qualitative study underscore the significant burden of FCS and support the effectiveness of olezarsen from the patient perspective.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717992","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":"A novel homozygous variant in GPIHBP1: A case series of familial chylomicronemia syndrome from Colombia.","authors":"Alejandro Román González, Oriana F Arroyo-Ripoll, Andrés F Garcia-Ramos, Claudia Monsalve, Salomon Daguer, Francisco Barón, Gabriela Berg, Gregorio Fariña, Nora Alejandra Zuluaga, Adriana Carolina Forero, Juan Patricio Nogueira","doi":"10.1016/j.jacl.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.06.006","url":null,"abstract":"<p><p>Familial chylomicronemia syndrome (FCS) is a rare monogenic disorder characterized by severe hypertriglyceridemia caused by pathogenic variants in genes involved in triglyceride metabolism. Glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1 (GPIHBP1) plays a critical role in the lipolytic processing of triglyceride-rich lipoproteins. We present three unrelated cases of FCS with a newly identified homozygous complex insertion-deletion variant in GPIHBP1, namely c.460_461delinsAAA, p.Ala154Lysfs*153. All three cases presented with severe hypertriglyceridemia, a high FCS clinical score, and significantly reduced LPL activity (being 6.6 mUI the value corresponding to 20% of normal activity). These observations expand the spectrum of pathogenic GPIHBP1 variants in FCS. The identification of GPIHBP1 variant reinforces the causal link between GPIHBP1 mutations and LPL deficiency, as evidenced by diminished LPL activity, and further expands the genetic landscape of FCS. All three cases presented with severe hypertriglyceridemia, a high FCS clinical score and significantly reduced LPL activity (being 6.6 mUI the value corresponding to 20% of normal activity). These observations expand the spectrum of pathogenic GPIHBP1 variants in FCS.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144799246","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":"LDL cholesterol management simplified in adults-Lower for longer is better: Guidance from the National Lipid Association.","authors":"Elizabeth J Jackson, Kaye-Eileen Willard, Christie M Ballantyne","doi":"10.1016/j.jacl.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.06.002","url":null,"abstract":"<p><strong>Background: </strong>ASCVD remains the #1 cause of death in the United States and has been on the rise for more than a decade after more than 40 years of steady decline. Low-density lipoprotein cholesterol (LDL-C) is a well-established causal factor for the development of ASCVD that should be monitored in a timely manner and may be modified through both lifestyle and pharmacological interventions. Despite the existence of cholesterol guidelines, universal screening ages, risk assessment tools, and recommendations for LDL-C management based on risk, data show that LDL-C measurement and management in patients with ASCVD are not meeting guideline-directed objectives. Further, there is no single clinical guideline that presents LDL-C measurement frequency, risk assessment, management, and desirable LDL-C levels for adults based on risk.</p><p><strong>Objective: </strong>This document aims to summarize the numerous guidelines and recommendations from leading professional organizations to help clinicians and patients improve evidence-based measurement and management of LDL-C.</p><p><strong>Methods: </strong>Guidelines and updates from the American College of Cardiology, American Heart Association, National Lipid Association, and other relevant professional organizations were systematically reviewed. Key recommendations were synthesized and translated into a simplified, patient-centered message for clinical application.</p><p><strong>Results: </strong>The synthesis revealed consistent recommendations across major guidelines emphasizing early identification of risk, aggressive lipid lowering in high-risk populations, and the use of shared decision-making to improve adherence. The resulting simplified message aligns with current evidence and is intended to support clinical teams in delivering consistent, guideline-directed care.</p><p><strong>Conclusion: </strong>Integrating major cardiovascular and lipid management guidelines into a unified, simplified message may improve provider clarity and patient understanding. This approach supports team-based care, reduces variation in practice, and enhances the implementation of evidence-based strategies to reduce atherosclerotic cardiovascular disease risk. The primary goals for LDL-C management are to achieve an acceptable level for the patient's risk category and to maintain that over time because lower for longer is better to reduce ASCVD risk.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717991","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":"Pelacarsen: Mechanism of action and Lp(a)-lowering effect.","authors":"Harpreet S Bhatia, Archna Bajaj, Sascha N Goonewardena, Patrick M Moriarty","doi":"10.1016/j.jacl.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>Lipoprotein(a) (Lp[a]) is an apolipoprotein B100 (apoB)-containing lipoprotein with a single apolipoprotein(a) (apo[a]) covalently bound to apoB via a disulfide bond and oxidized phospholipids linked to apoB and apo(a), which is associated with proinflammatory, prothrombotic, and proatherogenic mechanisms. Elevated Lp(a) (≥125 nmol/L [≥50 mg/dL]) is an independent, causal, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD), affecting >1.4 billion individuals worldwide.</p><p><strong>Sources of material: </strong>There are no pharmacological Lp(a)-lowering therapies approved in the United States; however, lipoprotein apheresis may be considered under certain circumstances. Germany is the only country where apheresis is approved for patients with elevated Lp(a) and progressing ASCVD.</p><p><strong>Abstract of findings: </strong>Existing lipid-lowering therapies including proprotein convertase subtilisin/kexin type 9 inhibitors have shown modest effects on Lp(a) levels but fallen short of clinically meaningful reductions of >50 to 100 mg/dL. Several Lp(a)-lowering, RNA-targeted agents are in development, including antisense oligonucleotides (ASOs) and small interfering RNAs. Pelacarsen is a second-generation ASO that targets the production of apo(a) and includes chemical modifications such as triantennary N-acetylgalactosamine that improve biostability, decrease off-target toxicity compared with unmodified ASOs, and allow rapid, specific uptake by hepatocytes, the site of apo(a) synthesis. A phase 2b study of pelacarsen showed ≥80% reduction in Lp(a) concentration with a favorable safety profile in patients with established ASCVD.</p><p><strong>Conclusion: </strong>The ongoing phase 3 Lp(a)HORIZON study is evaluating whether the Lp(a)-lowering effects of pelacarsen translate into reductions in the incidence of major cardiovascular events, also in patients with established ASCVD. Herein, we review the mechanism of action of pelacarsen and evidence for its Lp(a)-lowering effects.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804203","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":"Central adiposity contributes to the association between vascular cell adhesion molecule-1 and carotid intima-media thickness in children and adolescents with congenital heart disease.","authors":"Michele Honicky, Silvia Meyer Cardoso, Laura Maria Martin Nascimento, Jennyffer Souza, Alexandra Latini, Isabela de Carlos Back, Yara Maria Franco Moreno","doi":"10.1016/j.jacl.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.05.022","url":null,"abstract":"<p><strong>Background: </strong>Children and adolescents with congenital heart disease (CHD) after cardiac procedures are more vulnerable to vascular inflammation due to obesity, a cardiovascular risk factor.</p><p><strong>Objective: </strong>This study aimed to investigate the inflammatory biomarkers associated with carotid intima-media thickness (cIMT) stratified by central adiposity.</p><p><strong>Methods: </strong>Cross-sectional study using data from the Floripa CHild (Congential Heart dIsease and atheroscLerosis in ChilDren and adolescents) Study (2021/2022). Blood pressure, lipid and glucose profiles, anthropometric parameters, and behavioral factors were assessed as risk factors. Central adiposity was defined as waist circumference percentile ≥90th by age and sex. Serum inflammatory biomarkers, including interleukins and adhesion molecules, were measured. cIMT was evaluated using ultrasonography. Multivariate linear regression was applied, and statistical significance was set at P < .05.</p><p><strong>Results: </strong>A total of 118 patients with CHD (median age, 13 years [IQR 10-14] and 50.8% female) were evaluated. The prevalence of central adiposity was 16.1%. Patients with central adiposity had higher high-sensitivity C-reactive protein (P < .001). In the multiple linear regression stratified by central adiposity, vascular cell adhesion molecule-1 was positively associated with cIMT only in patients with central adiposity (0.023).</p><p><strong>Conclusion: </strong>Central adiposity may play an important role in the onset of vascular inflammation and early cardiovascular disease in children and adolescents with CHD.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717989","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":"Evaluating the underutilization of lipid-lowering therapy in Asian patients – A high-risk population","authors":"Christian Leung MD,&nbsp;Rahul Rege MD,&nbsp;Vidhi Patel PhD,&nbsp;Manila Jindal MD,&nbsp;Sri Nuvvula MD","doi":"10.1016/j.jacl.2025.04.003","DOIUrl":"10.1016/j.jacl.2025.04.003","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>In 2019, cardiovascular disease caused 10.8 million deaths in Asia (35% of all deaths), 39% of which were premature. Lipid-lowering therapy (LLT) is a key strategy for reducing the risk of atherosclerotic cardiovascular disease (ASCVD). South Asians have a significantly higher risk of heart disease and should have a goal LDL of less than 100 mg/dL. ACC/AHA guidelines note South Asian ancestry to be a risk enhancing factor and suggest LDL goal of 70 mg/dL.</div></div><div><h3>Objective/Purpose</h3><div>We reviewed hospital visits by Asian patients in the largest medical system in New York State to identify if we utilized the opportunity to initiate LLT on discharge when appropriate.</div></div><div><h3>Methods</h3><div>A retrospective electronic medical record review of all patients aged 18 or above who self-identified as Asians during registration and seen either in the emergency department or admitted to one of the 14 locations of our medical health system between 09/01/2018 to 09/01/2023. All patients included had LDL levels 70 mg/dL or above. Lipid lowering medications reviewed included rosuvastatin, atorvastatin, lovastatin, pravastatin, ezetimibe, and evolocumab.</div></div><div><h3>Results</h3><div>We found a total of 12,338 visits by Asian patients. LDL levels were stratified in three categories: 70-99 mg/dL, 100-189 mg/dL, and 190 mg/dL or above and were found to be in 48% (n = 5,961), 49% (n = 6,090), and 2.3% (n = 287) of the patients respectively. More specifically, as patients with LDL &gt; 189 mg/dL are at the highest risk of cardiovascular events, we found that only 34.1% (n = 98/287) of these patients were on LLT on admission, and surprisingly, 11% (n = 11) of the patients already on LLT on admission were discharged without LLT. Overall, 33.3% (n = 96) of the patients were not discharged on LLT and 18% (n = 52) of patients had LDL levels greater than 250 mg/dL (Figure II). Our results show that 4.5% (n =13) died, 14.2% (n = 41) had a myocardial infarction, and 12.2% (n = 35) had a stroke with one year (Figure 1).</div></div><div><h3>Conclusions</h3><div>Although the guidelines are clear regarding the initiation of LLT in any patient with LDL 190 mg/dL or greater, our study shows that a large percentage of patients were not discharged with LLT after a high-value encounter at hospitals. This is especially notable given the higher risk of ASCVD and its clinical impact in Asian population. We aim to further research into determining the cause of this discrepancy and addressing the gap to improve patient outcomes in this community.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e1-e2"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168565","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 atherogenic index of plasma (AIP) and remnant-like particle cholesterol (RLP-C) as prognostic biomarkers of post-PCI adverse cardiovascular events","authors":"John Nelson MD,&nbsp;Hamed Rafiee MD,&nbsp;Pegah Bahrami MD,&nbsp;Mohammad Mehdi Zare MD,&nbsp;Davood Semirani-Nezhad MD,&nbsp;Amir Parsa Abhari MD,&nbsp;Sima Shamshiri Khamene MD,&nbsp;Parham Dastjerdi MD,&nbsp;Fatemeh Fathabadi MD,&nbsp;Hamidreza Soleimani MD,&nbsp;Kaveh Hosseini MD","doi":"10.1016/j.jacl.2025.04.031","DOIUrl":"10.1016/j.jacl.2025.04.031","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>AIP is a lipid index correlating with lipoprotein particle size and atherogenicity. RLP-C is a subset of triglyceride-rich lipoproteins, associated with residual atherogenic risk observed despite taking lipid-lowering medications. Several studies have identified AIP and RLP-C as potential predictors of post-percutaneous coronary intervention (PCI) prognosis; however, contradicting results exist.</div></div><div><h3>Objective/Purpose</h3><div>To investigate and compare the predictive capacities of AIP and RLP-C for post-PCI adverse cardiovascular (CV) events.</div></div><div><h3>Methods</h3><div>This was a secondary data analysis on patients undergoing PCI from 2015 to 2021. AIP was calculated as log [TG / HDL-C] and RLP-C as [TC – HDL-C – LDL-C]. The primary outcome was the first episode of MACCE (defined as all-cause mortality, myocardial infarction (MI), stroke, target vessel revascularization, target lesion revascularization, and coronary artery bypass graft). Secondary outcomes were the first incidence of MI, all-cause mortality, and stroke. Parametric survival models with Gompertz and Weibull distributions were used. Model 1 was crude. Model 2 was adjusted for age, gender, smoking, and BMI. Model 3 was additionally adjusted for hypertension, diabetes, dyslipidemia, previous ACS, previous PCI, and creatinine levels. Time-dependent receiver operating characteristic (ROC) curve analysis was performed.</div></div><div><h3>Results</h3><div>A total of 13,392 patients were included and followed for a median time of 376 days. In model 3, no significant associations were observed between the indices and MACCE or stroke. While RLP-C showed significant association with MI in model 3 (HR = 1.36, 95% CI: 1.03 to 1.80, P = 0.029) the same association for AIP was insignificant by a small margin (HR = 1.32, 95% CI: 0.99 to 1.75, p-value = 0.058). However, MI was best predicted by AIP (AUC: 0.659 vs 0.650) in ROC curve analysis. Both AIP and RLP-C were significantly associated with all-cause mortality as continuous variables (AIP: HR = 1.83, 95% CI: 1.02 to 3.28, P = 0.043; RLP-C: HR = 1.38, 95% CI: 1.11 to 1.72, P = 0.003) as opposed to categorical. RLP-C exhibited higher prediction ability for mortality in ROC curve analysis (AUC: 0.650 vs 0.641).</div></div><div><h3>Conclusions</h3><div>To the best of our knowledge this is the first study to compare the predictive utility of both AIP and RLP-C for post-PCI adverse CV events. Both AIP and RLP-C had significant associations with post-PCI mortality, and RLP-C showed better predictive ability. RLP-C was also significantly associated with post-PCI MI, however, AIP had superior predictive ability.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e23-e24"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168571","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":"Comparison of the performance of three diagnosis scoring systems in patients with persistent chylomicronemia of different causes","authors":"Miriam Larouche MSc,&nbsp;Christie Ballantyne MD,&nbsp;Daniel Gaudet MD,&nbsp;Diane Brisson PhD","doi":"10.1016/j.jacl.2025.04.034","DOIUrl":"10.1016/j.jacl.2025.04.034","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Familial chylomicronemia syndrome (FCS) is a rare syndromic cause of chylomicronemia (TG&gt;1000 mg/dL) that persists despite treatment of secondary causes and the use of conventional lipid lowering treatment. FCS affects carriers of bi-allelic combinations of pathogenic variants in the LPL gene machinery. A significant number of individuals with persistent chylomicronemia do not meet this genetic criterion although presenting all FCS characteristics (clinical FCS) while other chylomicronemic patients (persistent or episodic) present different characteristics (MCS). Emerging treatments targeting persistent chylomicronemia are developed. Clinical diagnosis scoring systems have been proposed to help clinicians to accurately differentiate FCS from MCS patients.</div></div><div><h3>Objective/Purpose</h3><div>The objective of this study was to assess the ability of 3 published FCS diagnosis scoring systems to discriminate biallelic FCS from other forms of persistent chylomicronemia.</div></div><div><h3>Methods</h3><div>Sensitivity and specificity of 3 published FCS diagnosis scoring systems were evaluated in 52 patients with persistent chylomicronemia. FCS-causing genes were sequenced in all patients. FCS diagnosis score cut-off values were ≥ 9 in the French-Canadian (model A), ≥ 10 in the European (model B) and ≥ 60 in the North American (model C) FCS scoring systems.</div></div><div><h3>Results</h3><div>None of the scoring systems perfectly discriminated genetically proven FCS from other forms of persistent chylomicronemia. Models A and B presented similar performance (specificity [95%CI]: 0 [0 – 23.2] and 21.4 [4.7 – 50.8]; sensitivity: 92.1 [78.6-98.3] and 86.8 [71.9-95.6], respectively). Model C showed very high specificity (100 [76.8-100]) but relatively low sensitivity (63.2 [46.0-78.2]).</div></div><div><h3>Conclusions</h3><div>FCS clinical diagnosis scoring systems fairly identifiy patients presenting features of FCS without having the ability to easily distinguish beween genetically proven FCS and clinical FCS. Patients with persistent MCS present low scores but also represent an unmet medical need that should be treated similarly with respect to access to innovative precision therapies.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e25-e26"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167929","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}