Journal of clinical lipidology最新文献

{"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}

{"title":"Integrating lipoprotein(a) into a cardiometabolic health curriculum for internal medicine residents: Gamified vs. traditional lecture for knowledge retention","authors":"Christian Leung MD,&nbsp;Ji-Cheng Hsieh MD,&nbsp;Rahul Rege MD,&nbsp;Spencer Weintraub MD,&nbsp;Lauren Block MD,&nbsp;Cassie Wang MD,&nbsp;Shafkat Salam MD,&nbsp;Andrew Cyr MD","doi":"10.1016/j.jacl.2025.04.035","DOIUrl":"10.1016/j.jacl.2025.04.035","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Lipoprotein(a) (Lp(a)) is an important biomarker to help identify patients at high risk of atherosclerosis and aortic stenosis. Despite the evolving literature on Lp(a) and recommendations from the National Lipid Association for a single lifetime test for all adult patients, screening rates remain low. Gamification in medical education promotes active learning that increases engagement, but its impact on educating providers on Lp(a) remains unclear.</div></div><div><h3>Objective/Purpose</h3><div>We aimed to assess whether internal medicine residents could benefit from content on Lp(a) and whether delivery via traditional lecture or a gamified format improved learning outcomes.</div></div><div><h3>Methods</h3><div>We integrated Lp(a) content into our cardiometabolic health curriculum for internal medicine residents at a large academic residency program. Content was drawn from the National Lipid Association and American College of Cardiology guidelines. Residents received a 50-minute online case-review style lecture in a traditional, slide-based format or a gamified format utilizing KAHOOT!®. Pre-post surveys included 5-point Likert scales to assess self-reported knowledge of professional guidelines, knowledge-based questions, and format preference. Data were analyzed using paired Student's t-tests with unequal variance to compare matched pre-post Likert scale ratings and knowledge test scores.</div></div><div><h3>Results</h3><div>Of 108 participating residents, 19 (17.6%) completed pre-post surveys, with 12/65 (18.4%) in the gamified group and 7/43 (16.2%) in the traditional group. Before the session, 47% of residents reported having no confidence in performing Lp(a) screening. There were significant pre-post increases in test scores in the gamified (mean 45% to 87%, p &lt; 0.01) and traditional (mean 42% to 85%, p &lt;0.01) groups. Between groups, there was no difference in the increase of Likert scale ratings or test scores. 91% of residents found the lecture engaging and relevant to future practice. 71% of residents in the traditional group and 91% in the gamified group preferred a gamified format.</div></div><div><h3>Conclusions</h3><div>Gamified and traditional lecture formats were effective in educating residents on Lp(a). Residents found Lp(a) material relevant to clinical practice and preferred the gamified format. Further studies will assess whether integration of gamified Lp(a) content increases guideline-based screening of Lp(a) in our resident clinics.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e26"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167930","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 burdens and barriers of optimizing LDL-C management: A survey of physicians in the United States","authors":"Taruja Karmarkar PhD,&nbsp;Jordan Schmier MA,&nbsp;Sayeli Jayade MPH,&nbsp;Kyle Roney MPH,&nbsp;Ross Simpson Jr. MD,&nbsp;Jason Exter PharmD,&nbsp;Seth Baum MD,&nbsp;Lawrence Leiter MD,&nbsp;Lori Bash PhD","doi":"10.1016/j.jacl.2025.04.011","DOIUrl":"10.1016/j.jacl.2025.04.011","url":null,"abstract":"<div><h3>Funding</h3><div>This research was supported by Merck &amp; Co., Inc.</div></div><div><h3>Background/Synopsis</h3><div>Despite evidence of the benefits of lowering low-density lipoprotein cholesterol (LDL-C) in reducing the risk of atherosclerotic cardiovascular disease (ASCVD) and the availability of safe and effective lipid lowering therapies (LLT) to do so, the burden of elevated LDL-C and underuse of LLT remain high.</div></div><div><h3>Objective/Purpose</h3><div>We describe barriers related to optimizing LDL-C management, which are not yet well understood.</div></div><div><h3>Methods</h3><div>From April 2024 through June 2024, US cardiologists and primary care providers (PCPs) (practicing for &gt; 2 years, prescribing LLT to &gt; 50 patients monthly), were invited to participate in a 30-minute online survey on the barriers of managing LDL-C and optimizing LLT. The survey was informed by literature and expert opinion and analyzed descriptively.</div></div><div><h3>Results</h3><div>We report on 200 cardiologists and 200 PCPs (mean age 49 years, mostly male [76.5%] and white [53%]) who treat an average of 299 patients/month, of whom 55% manage at least 100 patients with LLT monthly. Overall, ∼8% of physicians reported their patients refuse any LLT more than half of the time; in contrast, more than twice as many (∼23%) physicians reported patient refusal of injectable LLT more than half of the time. The most often reported reasons for patients declining LLT were preferences for lifestyle changes (82%), concern about potential side effects (83%), and not wanting medication in general (75%). The most frequently reported reasons for declining injectables were cost/insurance reasons (73%) and fear/discomfort of injections (73%). Most cardiologists (55%) and PCPs (57%) reported counseling of patients takes longer when prescribing PCSK9is than for oral LLTs due to time spent educating on administration. Of those surveyed, physicians perceived secondary prevention patients, those with LLT experience, and those with greater understanding of ASCVD risk (compared to primary prevention, LLT-naïve and those with less understanding of their risk) to have higher LLT adherence.</div></div><div><h3>Conclusions</h3><div>Among 400 US physicians surveyed, a number of barriers to optimal lipid management were reported. These included more patient refusals specific to LLT injectables than LLT in general, with different reasons for refusal, as well as physician concerns related to time and resource constraints when initiating treatment. Responses suggest patient, clinician, and system barriers may all hinder LDL-C management and adherence. Further research is required to understand the association between perceived barriers and real-world behaviors to better inform optimization of lipid management.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e7"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167938","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 monitoring of LPL gene replacement therapy: A lexicon of lessons for gene editing or oligonucleotide-based lipid lowering treatments","authors":"Miriam Larouche MSc,&nbsp;Isabelle Gaudet PsyD,&nbsp;François Forest PharmD,&nbsp;Diane Brisson PhD,&nbsp;Daniel Gaudet MD,&nbsp;Jasmine Chebli PhD","doi":"10.1016/j.jacl.2025.04.096","DOIUrl":"10.1016/j.jacl.2025.04.096","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Glybera® (alipogene tiparvovec) was the first gene replacement therapy to be approved in the occidental world. Glybera targeted lipoprotein lipase deficiency (LPLD) which causes persistent chylomicronemia. A 15-year safety follow-up was a requirement of the European Medicines Agency (EMA). The long-term trajectory of treated patients has not been reported and might provide useful data for the follow-up of dyslipidemic patients treated with emerging oligonucleotide or gene-based treatments.</div></div><div><h3>Objective/Purpose</h3><div>To review the long-term trajectory of patients treated with Glybera in light of the emergence of ASO, siRNA, gene replacement or gene editing treatments for lipid disorders.</div></div><div><h3>Methods</h3><div>A total of 19 patients were treated with Glybera and followed for 15 years. Markers of efficacy, safety, and response to emerging therapies introduced over the years were monitored.</div></div><div><h3>Results</h3><div>After 3 months of Glybera administration, TG levels returned to baseline suggesting limited efficacy, while patients reported improved alertness and quality of life. One year after treatment, the analysis of injected muscle biopsies demonstrated the presence and lipolytic effectiveness of LPL, whereas chylomicron kinetic analyses using stable isotopes showed normalization. After 5 years, 44.4% of the participants still showed signs of improvement in chylomicron kinetics. The slight decrease in the incidence of pancreatitis observed after 5 years was difficult to relate to Glybera. A mitochondrial integration of the LPL transgene was noted in 2 subjects without further off-target signals. Four treated subjects died from consequences of LPLD, not of Glybera administration. Pregnancies occurred during the follow-up period and went well. Over time, most patients participated in trials using oligonucleotide-based treatments. No difference in response to these treatments was noted between subjects who received Glybera compared the others.</div></div><div><h3>Conclusions</h3><div>Lessons learned from the long-term follow-up of Glybera treated patients are of interest for next generation of oligonucleotide-based or gene editing therapies for lipid disorders.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e69"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167952","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":"Double heterozygosity for variants in ABCG8 and ABCG5 and potential association with sitosterolemia","authors":"Mauricio De Castro MD,&nbsp;Sidney Brown BS","doi":"10.1016/j.jacl.2025.04.097","DOIUrl":"10.1016/j.jacl.2025.04.097","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Sitosterolemia is a rare autosomal recessive lipid disorder caused by pathogenic variants in the ABCG5 and/or ABCG8 genes. These genes encode ATP-binding cassette transporters responsible for the regulation of sterol absorption and excretion. Sitosterolemia leads to the accumulation of plant sterols in the blood, resulting in hypercholesterolemia, xanthomas, premature atherosclerosis, and other complications. We present the case of an individual with abnormal plant sterol levels and heterozygous variants in both genes. This case supports nascent evidence that double heterozygosity in ABCG5 and ABCG8 could lead to sitosterolemia.</div></div><div><h3>Objective/Purpose</h3><div>Very few cases of double heterozygosity in ABCG5 and ABCG8 leading to sitosterolemia have been reported in the literature. This case adds to the growing body of evidence supporting this association.</div></div><div><h3>Methods</h3><div>Comprehensive cholesterol balance panel including plant sterols was performed through a commercial laboratory (Boston Heart Diagnostics). Genetic testing was performed through a direct-to-consumer (DTC) testing platform and results validated through a CLIA-approved laboratory. The effectiveness of interventions was assessed through biochemical markers and clinical assessment.</div></div><div><h3>Results</h3><div>A 24-year-old female with syncope episodes and gastrointestinal symptoms underwent comprehensive testing including a cholesterol panel that showed elevated low-density lipoprotein (125 mg/dL) and considerably elevated plant sterol levels (Beta-sitosterol 244 µmol x 100/mmol and Campesterol 345 µmol x 100/mmol) suggestive of sitosterolemia. Genetic testing identified a pathogenic heterozygous variant in the ABCG8 gene (rs137852987 G&gt;A), as well as a heterozygous variant of uncertain significance in the ABCG5 gene (rs778605187 G&gt;C). Based on laboratory results and clinical findings, the patient received a presumptive diagnosis of sitosterolemia. Dietary changes and ezetimibe therapy resulted in significant symptom improvement, reduction in LDL levels, and normalization of plant sterol levels.</div></div><div><h3>Conclusions</h3><div>This case underscores the need for further research into the clinical impact of heterozygous and VUS mutations in ABCG5/ABCG8. It highlights the importance of personalized dietary and pharmacologic interventions in managing sitosterolemia-like presentations. The findings have implications for the evaluation and management of patients with rare genetic disorders, particularly those involving sterol metabolism.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e69"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167953","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":"Coronary artery disease in a zero calcium score patient: questioning the reliability of CAC in high-risk individuals","authors":"Nosagie Ohonba MBBS,&nbsp;Tanay Modi MBBS,&nbsp;Paige Seepaulsingh MBBS,&nbsp;Tiffany Haynes MD,&nbsp;Robert Fishberg MD,&nbsp;Marlin Mousa MB ChB","doi":"10.1016/j.jacl.2025.04.048","DOIUrl":"10.1016/j.jacl.2025.04.048","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Coronary calcium score (CAC) is a non-invasive test that measures calcified plaque in the coronary arteries. It is often used to improve risk assessment in patients with a borderline 10-year ASCVD risk (5-7.5%) or with a strong family history of ASCVD. A CAC score of 0 has a high negative predictive value (95%-99%) and is reassuring. While CAC detects calcified plaques, it cannot identify non-calcified, potentially unstable plaques, which could contribute to acute coronary syndromes. This limitation is important in patients who are symptomatic despite a zero score.</div></div><div><h3>Objective/Purpose</h3><div>To evaluate the predictability of CAC in risk assessment of CAD in patients with high clinical risk.</div></div><div><h3>Methods</h3><div>A 47-year-old female with a history of hypertension, preeclampsia, and antiphospholipid syndrome presented with intermittent chest pain for weeks. Her echocardiogram and Holter monitoring were negative for CAD. She had no history of venous thromboembolism or smoking, but has a family history of SCAD, CABG, MI, and CVA. Initial ECG, troponin, and CAC score (0) were normal. LDL was 81, triglycerides 160, and ASCVD risk 0.8%. No further diagnostic test was pursued. However, she subsequently developed typical chest pain. ECG showed anterolateral STEMI, though troponins remained negative.</div></div><div><h3>Results</h3><div>PCI with left heart catheterization was done and showed non calcified plaque in proximal LAD with an 80% stenosis. A drug eluting stent was inserted, and she was treated with dual antiplatelet therapy and high intensity statins.</div></div><div><h3>Conclusions</h3><div>This case highlights the limitations of over-relying on CAC for risk assessment. While a CAC=0 has a high predictive value (95-99%) for obstructive CAD, the “power of zero” applies to asymptomatic patients and does not reliably exclude CAD risk in symptomatic younger patients.</div><div>Complementary functional tests could have helped make the correct diagnosis such as cardiac stress test, with sensitivity and specificity of 68% and 77% or Sestamibi Scintigraphy with a sensitivity and specificity of 92% and 68%. Coronary Computed Tomography Angiography (CCTA) with a sensitivity of 96% and NPV of 99% for excluding severe (≥ 70%) coronary stenosis could have been considered. This case highlights the importance of applying the correct diagnostic test when evaluating patients with chest pain. This is particularly important in women who are less likely to have coronary calcification and often have a lower calculated ASCVD risk score.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e35"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168311","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":"Lipid-lowering intensification post-ACS in very high-risk patients on high-intensity statins: Insights from a mayo clinic registry","authors":"Danielle Sparenga DNP,&nbsp;Regis Fernandes MD,&nbsp;Winston Wang MD","doi":"10.1016/j.jacl.2025.04.019","DOIUrl":"10.1016/j.jacl.2025.04.019","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>After experiencing acute coronary syndrome (ACS), particularly in very high-risk (VHR) patients, current guidelines recommend a 50% reduction in low-density lipoprotein (LDL) levels, aiming for an LDL target below 55 mg/dL. We hypothesize that a significant number of VHR patients who present with ACS and are already on high-intensity statins (HIS) do not have their lipid-lowering therapy (LLT) intensified. This leads to an underutilization of non-statin therapies that could help achieve these LDL goals.</div></div><div><h3>Objective/Purpose</h3><div>To quantify the practice gap in intensifying LLT for patients who present with acute coronary syndrome while already on high-intensity statins.</div></div><div><h3>Methods</h3><div>We reviewed all patients from January 2019 to August 2024 who underwent percutaneous coronary intervention (PCI) for ACS at Mayo Clinic Arizona and were already on HIS. Ninety-one patients met these criteria, and of these, 45 were followed at Mayo Clinic and had repeat lipid panels drawn between 2 and 12 months after the ACS event. A one-tailed, two-sample t-test was used to determine statistical significance.</div></div><div><h3>Results</h3><div>Out of the 91 patients presenting with ACS already on HIS, 59 (64.8%) maintained the same LLT. Among these patients, 65 (71.4%) met the American College of Cardiology (ACC) criteria for VHR, but 22 of these (66.2%) did not have their therapy intensified. Notably, 37 patients (45.7%) had already achieved their LDL target upon presentation, with a median LDL of 60 mg/dL (54 mg/dL for VHR). The mean change in LDL for the group that had their LLT increased was -15.1% (standard deviation = 33.3%), while the mean change for the unchanged therapy group was significantly higher at +14.6% (standard deviation = 65.4%) (p = 0.0455).</div></div><div><h3>Conclusions</h3><div>Our analysis highlights a significant gap between best practices and the actual intensification of LLT in VHR patients on HIS following ACS. Approximately 66% of these patients did not have their LLT adjusted. Additionally, 45% of patients on HIS had already achieved their LDL target upon presentation. Adjunctive therapies such as ezetimibe and PCSK9 inhibitors were underutilized in the acute care setting. There is a pressing need for further initiatives to improve LDL control in this high-risk population. We hope our study will encourage the initiation of non-statin therapies during hospitalization, promote the establishment of educational programs for physicians, and lead to the implementation of automated prompts in electronic medical records when appropriate.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e13-e14"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168317","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":"Outcomes of percutaneous coronary intervention among patients with metabolic dysfunction-associated steatotic liver disease: A nationwide study","authors":"Derek Ugwendum MD,&nbsp;Aseed Mestarihi MD,&nbsp;Oluwatoyosi Awotorebo MD,&nbsp;Ikponmwosa Ogieuhi MD,&nbsp;Karldon Nwaezeapu MD,&nbsp;Godbless Ajenaghughrure MD,&nbsp;Anuoluwa Oyetoran MD,&nbsp;Kayode Ogunniyi MBBS","doi":"10.1016/j.jacl.2025.04.084","DOIUrl":"10.1016/j.jacl.2025.04.084","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Metabolic dysfunction-assoc-iated steatotic liver disease (MASLD) is increasingly recognized as a multisystemic disorder and an independent risk factor for cardiovascular disease. Although MASLD has been implicated in worsened atherosclerosis, its direct impact on percutaneous coronary intervention (PCI) outcomes remains uncertain.</div></div><div><h3>Objective/Purpose</h3><div>To evaluate whether MASLD (in the absence of cirrhosis, alcohol use disorder, or alcoholic fatty liver) affects in-hospital outcomes among patients undergoing PCI.</div></div><div><h3>Methods</h3><div>Using data from the 2021 National Inpatient Sample, we identified patients who underwent PCI and classified them based on MASLD status, as determined by the International Classification of Diseases codes (ICD-10 codes). We excluded patients with co-existing alcohol use disorder, alcoholic fatty liver disease, or cirrhosis. Outcomes of interest were in-hospital mortality, vasopressor requirements, length of hospital stay, and total hospital charges. Multivariate logistic regression models, adjusted for age, sex, and Charlson comorbidity index, were used to assess the association between MASLD and these outcomes.</div></div><div><h3>Results</h3><div>A total of 314,505 patients underwent PCI, of whom 4,320 (1.4%) had MASLD. These patients were younger (median age 61 vs. 66 years; p &lt; 0.001) but had a higher comorbidity burden (Charlson comorbidity index of 3.9 vs. 2.8; p &lt; 0.001), with no significant difference in gender distribution. In unadjusted analyses, there were no differences in in-hospital mortality (p = 0.725) or vasopressor requirement (p = 0.376). Patients with MASLD experienced a slightly longer hospital stay (additional 0.47 days; p = 0.02) and higher total charges (+8,496 USD; p = 0.039). After adjustment for confounders, MASLD was not associated with increased in-hospital mortality (p = 0.634), vasopressor requirement (p = 0.234), length of stay (p = 0.102), or total hospital charges (p = 0.514).</div></div><div><h3>Conclusions</h3><div>In this nationwide cohort, MASLD was not independently associated with adverse in-hospital outcomes following PCI. Despite having a higher comorbidity burden, patients with MASLD did not experience increased in-hospital mortality or need for vasopressors. Further research is warranted to explore the long-term implications of MASLD on PCI outcomes</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e61-e62"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168319","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":"Attrition of adipose: Type 2 familial partial lipodystrophy manifesting in severe premature CAD","authors":"Ranvir Bhatia MD,&nbsp;Daniel Soffer MD,&nbsp;Michael Karamardian BS","doi":"10.1016/j.jacl.2025.04.050","DOIUrl":"10.1016/j.jacl.2025.04.050","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Lipodystrophy constitutes a heterogeneous group of rare acquired or inherited conditions characterized by adipose tissue deficiency, typically manifesting in hypertriglyceridemia, insulin resistance, hyperglycemia, and fatty liver. Type 2 Familial Partial Lipodystrophy (FPLD2), also known as Dunnigan variant, is an autosomal dominant disorder with onset around puberty characterized by absence of adiposity in limbs and trunk with increased face and neck fat deposition, sometimes associated with skeletal muscle hypertrophy and phlebomegaly. Here, we describe a patient with history of severe hypertriglyceridemia (HTG) and type 1 diabetes (T1DM) who developed premature multivessel coronary artery disease (CAD) and ischemic cardiomyopathy, ultimately diagnosed with FPLD2.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;Not applicable to this case study abstract submission.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Case study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;LD is a 41-year-old female with newly diagnosed ischemic cardiomyopathy (EF 38%), triple-vessel CAD status-post drug-eluting stent to mid-LAD, severe HTG complicated by recurrent acute pancreatitis, and T1DM. Since childhood, LD reported insatiable appetite despite a thin, muscular frame disproportionate to normal activity. At 19, she was diagnosed simultaneously with T1DM, acute pancreatitis, and severe HTG. Family history was notable for a maternal aunt with similar body morphology and metabolic disease. At evaluation, her only complaint was persistent hunger, though less intense than during early adulthood. Hgb A1C was 7.0% on a continuous insulin pump at 1U/hr requiring minimal bolus dosing for meals. Physical exam was notable for absence of abdominal adiposity below the upper chest with sparing of the head and neck, muscular calf muscles, and prominent peripheral veins, consistent with FPLD2. Figure 1 reports lipid panel on high-intensity statin. She had normal serum creatinine, transaminase levels, thyroid stimulating hormone, and urine albumin-creatinine ratio. She was prescribed icosapent ethyl and introduced to a lipodystrophy patient advocacy group. Fasting leptin and genetic testing were ordered, but not completed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Lipodystrophy is a clinical diagnosis based on physical exam, family and personal history, and metabolic features of insulin resistance and may be supported by genetic testing. Based on LD's adipose distribution, dyslipidemia, and family history, FPLD2 was diagnosed. Initial management involves targeting insulin resistance and treatment of comorbid sequelae. Metreleptin (recombinant leptin analog) is approved for severe generalized lipodystrophy and under investigation for partial lipodystrophy, while a similar leptin receptor agonist trial was terminated. LD expressed gratitude that knowing her diagnosis and connecting with others made her feel less alone and more supported. This case highlights the","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e36-e37"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168730","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":"Hypercholesterolemia management in a patient with mitochondrial encephalomyopathy lactic acidosis, and stroke-like episodes","authors":"Susan Halli Demeter APRN,&nbsp;Karen Drechsel APRN,&nbsp;Gretchen Anderson APRN","doi":"10.1016/j.jacl.2025.04.056","DOIUrl":"10.1016/j.jacl.2025.04.056","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes (MELAS) is a rare, genetic neurodegenerative disorder caused by mutations in mitochondrial DNA (mtDNA) or nuclear DNA (nDNA) Belal et al. (2022), Chakrabarty et al. (2021), and Cheng et al. (2022). MELAS can present with a wide range of symptoms, including stroke-like episodes, lactic acidosis, and multi-organ involvement. Statins are contraindicated in MELAS due to potentially exacerbating mitochondrial dysfunction via Coenzyme Q10 (CoQ10) depletion. Non-statin lipid lowering therapies in MELAS patients have appeared favorable.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;To highlight the challenges in hypercholesterolemia management with existing mitochondrial disorders and the potential of non-statin options.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Statins inhibit CoA reductase activity, which also affects the synthetic pathway of CoQ10 (Argov, 2024). CoQ10 is a component of normal mitochondrial function, and low levels of CoQ10 in muscle tissue have been found in statin associated myopathy (Lamperti et al., 2005). Two reported case studies describe a MELAS-like clinical syndrome that occurred after several months of statin therapy (Chariot et al., 1993; Tsivgoulis et al., 2006). Both developed rhabdomyolysis with elevated CK (20,000 U/L and 45,000-48,000 U/L, respectively). No mitochondrial DNA mutation was identified, yet the statin unmasked a subclinical mitochondrial muscle disease.&lt;/div&gt;&lt;div&gt;Research on use of non-statin therapies (ezetimibe and PCSK9 inhibitors) in patients with MELAS or mitochondrial disorders is limited. However, one case study in a patient with mitochondrial myopathy due to heteroplasmic mitochondrial DNA missence mutation in MTCO1 gene (m.7671T&gt;A) demonstrated stable CK levels without recurrence of myalgia while taking alirocumab 75 mg every 2 weeks, ezetimibe 10 mg daily, marine omega 3 fatty acids daily, and 145 mg of micronized fenofibrate every 2 days (Cicero et al., 2020).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A 48-year-old male presented with MELAS due to a mitochondrial mutation. He had a history of hypercholesterolemia with debilitating myalgias on simvastatin, atorvastatin and rosuvastatin prior to MELAS diagnosis. His baseline total cholesterol was 248 mg/dL, HDL 38 mg/dL, LDL-C 254 mg/dL, triglycerides 278 mg/dL, and non-HDL 310 mg/dL. Ezetimibe 10 mg daily and icosapent ethyl 4 g daily was initiated and well tolerated. His total cholesterol improved to 221 mg/dL, HDL 37 mg/dL, LDL-C 155 mg/dL, triglycerides 146 mg/dL, non-HDL 184 mg/dL. Evolocumab 140 mg subcutaneous every 14 days was prescribed and tolerated without side effects. His cholesterol further improved to 108 mg/dL, HDL 38 mg/dL, LDL-C 43 mg/dL, triglycerides 162 mg/dL, and non-HDL 70 mg/dL. AST and ALT remained normal throughout treatment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This case highlights consideration for MELAS in young ","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e41-e42"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168784","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}