Journal of clinical lipidology最新文献

{"title":"Integrating genetics and lifestyles for precision nutrition in hypertriglyceridemia: A UK Biobank and KoGES analysis.","authors":"Haeng Jeon Hur, Hye Jeong Yang, Min Jung Kim, Hyun-Jun Jang, Myung-Sunny Kim, Sunmin Park","doi":"10.1016/j.jacl.2025.04.202","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.202","url":null,"abstract":"<p><strong>Background: </strong>Hypertriglyceridemia is an independent risk factor for cardiovascular disease.</p><p><strong>Objective: </strong>This study examined the polygenic variants associated with high serum triglyceride concentration (high-TG) and their interactions with lifestyle factors using data from the UK Biobank (n = 479,300) and the Korean Genome and Epidemiology Study (KoGES; n = 57,939).</p><p><strong>Methods: </strong>High-TG group was categorized based on over 200 mg/dL fasting serum TG concentrations (Caucasians, UK Biobank, n = 100,543; Koreans, KoGES, n = 7211). Polygenic risk scores (PRS) were calculated using risk alleles from genetic variants identified through a genome-wide association study (GWAS) and generalized multifactor dimensionality reduction (GMDR) analyses.</p><p><strong>Results: </strong>Koreans showed higher frequencies of risk alleles in GCKR, APOA5, SIK3, and APOE genes compared to Caucasians. After adjusting for covariates, a PRS including lipoprotein lipase (LPL)_rs328, apolipoprotein A5 (APOA5)_rs2072560, and glucokinase regulator (GCKR)_rs780093 showed a 2.2-fold (UK Biobank) and 2.6-fold (KoGES) increased risk of high-TG among Caucasians and Koreans, respectively. In both cohorts, the PRS was positively associated with metabolic syndrome, serum low high-density lipoprotein (HDL)-cholesterol, and high low-density lipoprotein (LDL)-cholesterol concentrations, but inversely associated with high-TG. These variants were linked to the chylomicron and very low-density lipoprotein (VLDL) remodeling pathways in Multimarker Analysis of GenoMic Annotation (MAGMA) gene analysis. Significant interactions were observed between the PRS and lifestyle factors, namely plant-based diet (P = .0008), alcohol consumption (P = .0022), and smoking status (P < .001) in both cohorts. Additionally, in the KoGES cohort, vitamin D intake (P = .027) and the glycemic index (P = .045) interacted with the PRS to influence high-TG risk.</p><p><strong>Conclusion: </strong>Similar genetic variants affected high-TG risk across populations despite ethnic differences in risk allele frequencies. The identified PRS significantly interacted with plant-based diet, alcohol consumption, and smoking status in both cohorts, with additional interactions observed with vitamin D intake and glycemic index in the Korean cohort.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293779","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":"Evaluation of lipid-lowering therapy in patients with elevated lipoprotein(a) levels.","authors":"Michael S Kelly, Ruth N Jeminiwa, Fatima Gohar, Mario Fanous, Pablo Ramirez, Dave L Dixon","doi":"10.1016/j.jacl.2025.04.200","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.200","url":null,"abstract":"<p><strong>Background: </strong>Elevated lipoprotein(a) (Lp(a)) is a recognized independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and other cardiovascular-related disorders. To mitigate the increased risk associated with elevated Lp(a), intensified treatment is recommended for modifiable ASCVD risk factors, such as hypertension, hyperglycemia, and dyslipidemia. However, limited evidence has assessed how clinicians are modifying lipid-lowering therapy in response to elevated Lp(a) levels.</p><p><strong>Objective: </strong>To evaluate changes to lipid-lowering therapy and assess which patient characteristics are associated with intensifying lipid-lowering medications.</p><p><strong>Methods: </strong>This retrospective, observational case-control study evaluated changes to lipid-lowering therapy in patients with elevated Lp(a) values from January 1, 2020, through May 31, 2024.</p><p><strong>Results: </strong>Of 1042 patients with an Lp(a) value of 30 mg/dL (75 nmol/L) or higher during our study period, 539 met full inclusion eligibility. Of the 539 patients, 120 (22.3%) had their lipid-lowering therapy modified within 30 days of the elevated Lp(a) result. The most common interventions were adding ezetimibe (33.3%) and intensifying statin therapy (32.5%). Elevated low-density lipoprotein cholesterol (LDL-C) was the most significant predictor of whether patients' lipid medications were modified, concordant with current recommendations for mitigating increased ASCVD risk associated with elevated Lp(a).</p><p><strong>Conclusion: </strong>Intensification of lipid-lowering medication within 30 days occurred in less than one-quarter of patients with elevated Lp(a). Future studies are needed to determine if aggressive LDL-C lowering is superior to Lp(a)-lowering to prevent ASCVD events in patients with elevated Lp(a).</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225605","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":"Characterization of familial chylomicronemia syndrome in a compound heterozygote for 2 APOA5 nonsense variants.","authors":"Paul A Mueller, Sara Rosario, Joshua Hay, Paige Bergstrom, Silvia Cecilia Pacheco-Velázquez, Robert A Hegele, Nathalie Pamir, Jonathan Q Purnell","doi":"10.1016/j.jacl.2025.04.196","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.196","url":null,"abstract":"<p><strong>Objective: </strong>A 3-year-old patient presented with severe hypertriglyceridemia and suspected familial chylomicronemia syndrome. Genetic analysis of the patient's DNA revealed the presence of 2 different heterozygous nonsense variants in the APOA5 gene encoding apolipoprotein (apo) A-V, namely p.Q275X and p.L242C fs X54. Our objective was to characterize the structural and functional consequences of the patient's co-occuring compound heterozygous variants in APOA5.</p><p><strong>Methods: </strong>Biozentrum's SWISS-MODEL was employed to predict the structure of apo A-V variants. Plasma from the patient and their family was used to determine lipid profiles, quantify apo C-II and apo C-III protein levels, and measure lipoprotein lipase (LPL) activity. High-density lipoprotein (HDL) was isolated from plasma and was used to assess sterol efflux capacity and proteome.</p><p><strong>Results: </strong>Structural characterization of the patient's APOA5 variants indicated premature truncation of the C-terminus of apo A-V that comprises the lipid binding domain. The patient's apo A-V was completely absent from the very-low density lipoprotein (VLDL) plasma fraction, associating almost exclusively with the low-density lipoprotein (LDL) and lipoprotein-free fractions. The patient's plasma also demonstrated reduced LPL activity and elevated apo C-II and C-III compared to other family members. The patient's HDL had the lowest sterol efflux capacity of all family members and a distinct proteome with reduced phospholipid transfer protein. Dietary intervention alone was effective in preventing recurring hypertriglyceridemia.</p><p><strong>Conclusions: </strong>These findings add to the current knowledge of apo A-V's role in plasma lipid homeostasis, pointing to a critical role for apo A-V binding to the lipoprotein particle in normal hydrolysis of triglyceride-rich lipoproteins.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275005","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":"Using healthcare claims data to identify health disparities for individuals with familial hypercholesterolemia.","authors":"Mary P McGowan, Chao Xing, Amit Khera, Chun-Yuan Huang, Yanqiu Shao, Michelle Xing, Eric J Brandt, Diane E MacDougall, Catherine D Ahmed, Katherine A Wilemon, Zahid Ahmad","doi":"10.1016/j.jacl.2025.04.199","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.199","url":null,"abstract":"<p><strong>Background: </strong>Intensive lipid-lowering therapy is crucial for individuals with familial hypercholesterolemia (FH) to reach target low-density lipoprotein cholesterol (LDL-C) levels. However, there are limited data on disparities in therapy use among FH patients in the US.</p><p><strong>Methods: </strong>An epidemiologic analysis of a US healthcare claims database (2016-2020) covering 324 million individuals. Inclusion criteria for this study comprised of individuals with a diagnosis of FH, defined by an ICD-10 diagnosis code of E.78.01. The G-computation approach based on multiple logistic regression models was used to estimate the marginal effects of demographic and socioeconomic variables on prescriptions for high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i).</p><p><strong>Results: </strong>In the FH cohort (n = 85,457), 45.9% were female, 79.4% identified as White, 12.2% as Black, and 8.4% as Hispanic. Males were more likely to be prescribed high-intensity statins than females: risk difference (RD) [95% CI] = 0.091 [0.086, 0.096]; odds ratio (OR) [95% CI] = 2.03 [1.95, 2.11]. White individuals were more likely to get ezetimibe, PCSK9i, or combination therapy compared to Black individuals (RDs: 0.006-0.041; ORs: 1.22-1.32). Higher income was associated with increased odds of receiving these treatments (RDs: 0.005-0.060 and ORs: 1.17-1.58 for incomes >$50,000). Higher education was linked to a higher likelihood of receiving these treatments (RDs: 0.004-0.038 and ORs: 1.06-1.49 for education levels of some college and higher).</p><p><strong>Conclusion: </strong>These findings highlight significant disparities, with more intensive lipid-lowering therapies prescribed to White, higher-income, and better-educated individuals. This underscores the need for equitable cardiovascular risk reduction strategies for all FH patients.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302203","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":"Global trends in sitosterolemia research: A bibliometric and visualization analysis.","authors":"Hui Wu, Yinfei Xu, Rong Cheng, Haoyang Zhou, Ying Li, Ziyi Lu, Cheng Zhang, Chunyu Li, Yan Chen","doi":"10.1016/j.jacl.2025.04.201","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.201","url":null,"abstract":"<p><strong>Background: </strong>Sitosterolemia is a rare autosomal recessive genetic lipid metabolism disorder characterized by high concentrations of plant sterols in plasma and tissues, which can cause a variety of clinical symptoms, such as xanthomatosis, atherosclerosis, and arthritis. In recent years, more and more scholars have begun to pay attention to the special disease of sitosterolemia. Bibliometrics analysis, as a method of quantitative analysis of scientific literature, can help us systematically understand the research status and development trends in this field. In this study, CiteSpace software was used to analyze the literature on sitosterolemia.</p><p><strong>Sources of material: </strong>Publications on sitosterolemia were collected from the Web of Science Core Collection (WOSCC) and Pubmed. The bibliometric tools CiteSpace software and Microsoft Excel were used to identify the historical features, the evolution of active topics, and emerging trends in the sitosterolemia field.</p><p><strong>Abstract of findings: </strong>A total of 885 publications were retrieved and 416 publications were included in the analysis after the removal of duplicates. From 1974 to 2024, the number of publications and the related citations show an obvious fluctuating trend. The top 3 institutions with the most publications were the University of Bonn, the University of Texas System, and the University of Texas Southwestern Medical Center Dallas; the top 3 authors with the most publications were Patel, Shailendra B, Tada Hayato and Salen, G. The research hotspots on sitosterolemia mainly focus on phytosterols, whole exome sequencing and lipid metabolism. The top 5 keywords by frequency of occurrence were \"sitosterolemia,\" \"humans,\" \"dietary-cholesterol,\" \"cholesterol,\" and \"absorption.\" There is extensive scientific research cooperation among the sitosterolemia research institutions. Genetic research remains an important and ongoing area of interest in the study of sitosterolemia, given the fundamental role of genetic mutations in the disease's pathogenesis.</p><p><strong>Conclusion: </strong>The findings based on the bibliometric studies provide the current status and trends in sitosterolemia research and may help researchers identify hot topics and explore new research directions in this field.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248143","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":"Cardiovascular risk and lipid control in older adults: Compliance with LDL, non-HDL cholesterol, and triglyceride goals in a national cross-sectional study.","authors":"Cristian Orlando Porras Bueno, Jesús Andres Beltrán España, Carolina Murgueitio Guzmán, Cándida Diaz-Brochero, Ángel Alberto García Peña","doi":"10.1016/j.jacl.2025.04.197","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.197","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Low-density lipoprotein cholesterol (LDL-C) is a key therapeutic target, yet data on compliance with lipid goals in older adults from low- and middle-income countries are limited.</p><p><strong>Objective: </strong>To evaluate the compliance with lipid profile goals in older adults.</p><p><strong>Methods: </strong>This cross-sectional study analyzed 1270 adults aged ≥60 years from the Survey on Health, Well-being, and Ageing in Latin America and the Caribbean (SABE) Colombia 2015 survey. Cardiovascular risk was assessed via Framingham, ASCVD 2013, and SCORE2 models calibrated for Colombia, and lipid profile compliance was evaluated.</p><p><strong>Results: </strong>Most participants were at high or very high risk according to the SCORE2 (54.10%), ASCVD (10%), and Framingham (10.87%) criteria. LDL-C target compliance was low, ranging from 0.72% (Framingham) to 3.93% (ASCVD). Triglyceride targets were better achieved, with 54.88% meeting goals in the highest SCORE2 category.</p><p><strong>Conclusions: </strong>Older Colombian adults have poor compliance with lipid goals, underscoring the urgent need for enhanced preventive strategies in this population.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142569","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":"Circulating apolipoprotein B levels in statin-treated type 2 diabetic patients with coronary artery disease: Implications for coronary atheroma progression and instability.","authors":"Sayaka Funabashi, Yu Kataoka, Stephen J Nicholls, Satoshi Kitahara, Hisashi Makino, Masaki Matsubara, Miki Matsuo, Yoko Omura-Ohata, Ryo Koezuka, Mayu Tochiya, Tamiko Tamanaha, Tsutomu Tomita, Kyoko Honda-Kohmo, Michio Noguchi, Kota Murai, Kenichiro Sawada, Takamasa Iwai, Hideo Matama, Satoshi Honda, Masashi Fujino, Kazuhiro Nakao, Shuichi Yoneda, Kensuke Takagi, Fumiyuki Otsuka, Yasuhide Asaumi, Kiminori Hosoda, Satoshi Yasuda, Teruo Noguchi","doi":"10.1016/j.jacl.2025.04.204","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.204","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetic patients exhibited an increased secretion of triglyceride-rich lipoproteins and low high-density lipoprotein cholesterol levels with a greater amount of small dense low-density lipoprotein (LDL). Given that apolipoprotein B (apoB), a proatherogenic lipoprotein, exists at both triglyceride-rich lipoproteins and LDL particles, circulating apoB may associate with diabetic coronary atherosclerosis.</p><p><strong>Methods: </strong>The OPTIMAL study was a prospective randomized-controlled study which employed serial near-infrared spectroscopy (NIRS)/intravascular ultrasound (IVUS) imaging to evaluate the efficacy of glycemic control on coronary atherosclerosis in 94 statin-treated type 2 diabetic patients with coronary artery disease (CAD) (UMIN000036721). Of these, 78 patients with both serial apoB levels and NIRS/IVUS images at baseline and week 48 were analyzed. NIRS/IVUS-derived plaque measures were compared in those with and without any reduction of apoB levels.</p><p><strong>Results: </strong>All of the study subjects received a statin, and 60.6% of the study subjects exhibited any reduction of apoB levels. There was no significant difference in the atheroma progression rate between the 2 groups (-0.27 ± 0.15% vs -0.33 ± 0.51%, P = .44). However, patients with any reduction of apoB levels exhibited a greater frequency of change in maximal lipid-core burden index at 4-mm segment (maxLCBI_4mm) (-13.4 ± 22.2% vs 70.3 ± 28.7%, P = .03) and maxLCBI_4mm regression (61.1 ± 0.08 vs 31.0 ± 0.09%, p = .02). Multivariate analysis demonstrated change in apoB as an independent factor associated with maxLCBI_4mm regression (odds ratio = 0.92, 95% CI = 0.87-0.98, P = .01).</p><p><strong>Conclusions: </strong>In statin-treated type 2 diabetic patients with CAD, a greater delipidation of coronary atherosclerosis was observed in association with a reduction of apoB levels. The current findings indicate a potential anti-atherosclerotic effect of lowering apoB levels, which may ultimately mitigate future coronary events risk in statin-treated type 2 diabetic patients with CAD.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484564","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":"Hypertriglyceridemia and its relationship with all-cause mortality and pancreatitis: Results from a large retrospective clinical registry.","authors":"Bogdan Vlacho, Josep Julve, Idoia Genua, Berta Fernández-Camins, Jordi Real, Josep Franch-Nadal, Didac Mauricio, Emilio Ortega","doi":"10.1016/j.jacl.2025.04.195","DOIUrl":"https://doi.org/10.1016/j.jacl.2025.04.195","url":null,"abstract":"<p><strong>Background: </strong>Hypertriglyceridemia (HTG) is a potential risk factor for mortality and pancreatitis; however, real-world data remain limited.</p><p><strong>Objective: </strong>We aimed to investigate whether elevated TG levels may identify individuals at a higher risk of all-cause mortality or increased incidence of all-cause pancreatitis in our Mediterranean primary care population.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the SIDIAP primary care database to assess HTG prevalence and its association with all-cause mortality and pancreatitis. Subjects were categorized into 5 triglyceride (TG) level groups, (from <150 mg/dL to >880 mg/dL). Logistic and Cox regression models adjusted for different covariates were used.</p><p><strong>Results: </strong>HTG (>150 mg/dL) had a prevalence of 22.8%, whereas that of severe HTG (>500 mg/dL) was 0.8%. From 2010 to 2020, 2,256,261 individuals were followed up for a median of 7.78 years. The cumulative incidence rates for all-cause pancreatitis and all-cause mortality were 0.44% and 8.37%, respectively. Individuals with previously reported pancreatitis (n = 6527, 0.3%) showed higher incidence rates of all-cause pancreatitis (7.37%) and all-cause mortality (22.54%) than those without previous history of this outcome (pancreatitis: 0.42%; mortality: 8.33%), respectively. Adjusted analyses revealed an increasingly higher risk of all-cause pancreatitis across TG categories, with the highest risk for TG ≥ 880 mg/dL levels (hazard ratio [HR]: 3.79, 95% CI: 3.10; 4.63). The risk for all-cause mortality (HR: 1.08, 95% CI: 1.06; 1.09 and HR: 1.11, 95% CI: 1.07; 1.14) was observed for TG (150-299, 300-499) compared to those with TG < 150 mg/dL. Individuals with TG ≥ 500 mg/dL had the highest excess risk for all-cause pancreatitis (HR: 2.66, 95% CI: 2.30; 3.07) and mortality (HR: 1.15, 95% CI: 1.08; 1.23), even after adjusting for confounders.</p><p><strong>Conclusion: </strong>HTG is common and independently predicts mortality and pancreatitis in a real-world primary care setting. Future trials should evaluate lifestyle and TG-lowering interventions to mitigate these risks.</p>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225618","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}