Journal of clinical lipidology最新文献

{"title":"*The association between lipoprotein(a) testing, lipid lowering therapy intensification, and low-density lipoprotein cholesterol goal attainment","authors":"Adam Furst JD, Ramzi Dudum MD, Natasha Din MBBS, David Maron MD, Paul Heidenreich MD, Jonathan Ward PharmD, Anthony Lozama PhD, Alexander Sandhu MD, Fatima Rodriguez MD, Shyon Parsa MD","doi":"10.1016/j.jacl.2025.04.060","DOIUrl":"10.1016/j.jacl.2025.04.060","url":null,"abstract":"<div><h3>Funding</h3><div>Novartis provided research funding.</div></div><div><h3>Background/Synopsis</h3><div>Elevated Lipoprotein(a) [Lp(a)] has a causal role in the development of atherosclerotic cardiovascular disease (ASCVD). While therapies targeting Lp(a) are in development, Lp(a) testing can help refine risk of ASCVD and help intensify lipid lowering therapy (LLT). The contemporary association between Lp(a) testing and LLT intensification is not well understood across large health systems.</div></div><div><h3>Objective/Purpose</h3><div>This study investigates the association between Lp(a) testing and Lp(a) levels with LLT intensification and LDL-C goal attainment.</div></div><div><h3>Methods</h3><div>Using Veterans Affairs electronic health record data, we performed a retrospective cohort study of veterans with lipid testing between January 1, 2017 to June 30, 2024. First, we compared a 2:1 propensity matched cohort of veterans with LDL-C and Lp(a) testing with those with LDL-C testing alone. Second, we compared veterans with normal vs. elevated Lp(a) level (defined as > 50 mg/dL). The primary outcome was LLT intensification (initiation or uptitration) within 12 months following lipid testing. Secondary outcomes included LDL-C testing and LDL-C goal attainment within 12 months (< 100 mg/dL for primary prevention and < 70 mg/dL for secondary prevention). Multivariable logistic regression models were adjusted for year of test, age, sex, race, ethnicity, diabetes mellitus type 2, hypertension, body mass index, ASCVD history, baseline LLT, baseline LDL-C, SVI, rurality, and cardiology visits in the prior year.</div></div><div><h3>Results</h3><div>Among 2,004,597 total eligible veterans with LDL-C testing, 10,386 (0.5%) had concurrent Lp(a) testing. The cohort included 2,562 Veterans with elevated Lp(a). The final study cohort included 20,768 propensity-matched patients (12.4% women and 19.2% of self-identified Black race; mean [SD] age, 58.4 [15.3] years) with a mean (SD) initial LDL-C of 110 [48.7]. In fully adjusted models, Lp(a) testing was associated with increased LLT intensification (OR [95%CI]: 2.11 [1.95 – 2.29]), increased LDL-C testing (OR [95%CI]: 1.27 [1.19 – 1.36]) and LDL-C goal attainment (OR [95%CI]: 1.22 [1.12 – 1.33]). In fully adjusted models, elevated Lp(a) was associated with increased LLT intensification (OR [95%CI]: 1.73 [1.55 – 1.94]) and similar LDL-C testing (OR [95%CI]: 0.99 [0.88 – 1.10]). There was not a significant association with LDL-C goal attainment (OR [95%CI]: 0.88 [0.76 – 1.02]) (Figure 1) overall, but there was lower LDL-C goal attainment among individuals with Lp(a) > 100 mg/dL (OR [95%CI]: 0.68 [0.56 – 0.84]).</div></div><div><h3>Conclusions</h3><div>Lp(a) testing was associated with increased LLT intensification and LDL-C goal attainment. Veterans found to have elevated Lp(a) were also more likely to undergo LLT intensification. Lp(a) testing may provide a valuable opportunity for motivatin","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e45"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168788","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":"Adherence to recent evidence-based guidelines for statin therapy in primary prevention for type 2 diabetes patients: A quality improvement initiative","authors":"Benjamin Hsieh MD, Lorenzo Cotugno MD, Sana Saeed MD, Ethan Swartz MD, Prit Patel DO","doi":"10.1016/j.jacl.2025.04.076","DOIUrl":"10.1016/j.jacl.2025.04.076","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Cardiovascular disease is the leading cause of morbidity and mortality in type 2 diabetes patients. The 2024 American Diabetes Association (ADA) guidelines recommend high-intensity statin therapy for individuals aged 40–75 with diabetes and elevated cardiovascular risk, aiming for a ≥50% LDL reduction and a target LDL of <70 mg/dL. Moderate-intensity therapy is advised if high-intensity therapy is contraindicated. Despite clear guidelines, gaps remain in adherence and achieving LDL goals, especially in high-risk outpatient populations.</div></div><div><h3>Objective/Purpose</h3><div>This quality improvement project aimed to assess adherence to the updated ADA guidelines for statin therapy in type 2 diabetes patients at Cooperman Barnabas Medical Center (CBMC). Objectives included evaluating whether statin prescriptions and dosages followed guidelines, checking LDL goal achievement, and documenting the use of cholesterol-lowering medications like statins, ezetimibe, and PCSK9 inhibitors.</div></div><div><h3>Methods</h3><div>A retrospective cohort of 50 adult patients with type 2 diabetes, aged 40 - 75, was selected from the CBMC clinic between June and December 2024. Patients with a history of major atherosclerotic cardiovascular disease were excluded. Adherence to the January 2024 ADA guidelines was assessed using data from Epic, including lipid panels, cholesterol-lowering medications, and ASCVD risk factors. LDL therapy was adjusted during clinical visits, with high-intensity statins initiated or escalated for patients not meeting LDL targets, and follow-up included lipid panels and visits to monitor efficacy and adherence.</div></div><div><h3>Results</h3><div>Among the cohort, 62% (31/50) did not achieve the LDL goal of < 70 mg/dL. Of the patients not meeting LDL goals, 83.9% were on high-intensity statins, 12.9% on moderate-intensity statins, and 3.2% were not on relevant therapy. Furthermore, 16.1% (5/31) of those not achieving LDL goals were eligible for statin therapy escalation, including four requiring a transition to high-intensity statins and one needing therapy initiation. Combination therapies, such as ezetimibe or PCSK9 inhibitors, were underutilized, with 80.6% (25/31) patients underutilizing both therapies. A substantial portion of the cohort exhibited multiple ASCVD risk factors, including hypertension, obesity, and chronic kidney disease (CKD), underscoring the high-risk nature of this population.</div></div><div><h3>Conclusions</h3><div>This initiative highlights the importance of adhering to guideline-based practices to improve cardiovascular outcomes in patients with type 2 diabetes. While statin therapy adherence is strong, gaps in achieving LDL goals point to the need for statin escalation, combination regimens, and enhanced follow-up care. Leveraging tools like Epic smart phrases can help standardize care delivery, identify patients requiring therapy intensification, and align cli","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e56-e57"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168815","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 gift that keeps on giving: Post-menopausal elevation in lipoprotein(a)","authors":"Matthew Sangoi MD,&nbsp;Daniel Soffer MD,&nbsp;Ranvir Bhatia MD","doi":"10.1016/j.jacl.2025.04.054","DOIUrl":"10.1016/j.jacl.2025.04.054","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Lipoprotein(a) [Lp(a)] is an established causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Lp(a) is 70-90% genetically determined, traditionally thought to reach steady state adult levels by age 5 in most individuals. However, certain biological states have been shown to alter Lp(a) plasma levels. Driven by adverse cardiometabolic changes in the absence of estrogen, menopause has been shown to accelerate cardiovascular risk. Population-based studies have identified an association between the menopause transition and an increase in Lp(a) levels, with a blunted response conferred by hormone replacement therapy. Here we describe a patient who developed a marked increase in Lp(a) levels after both menopause and initiation of anastrozole therapy for breast cancer (BC).</div></div><div><h3>Objective/Purpose</h3><div>To understand the effect of meno-pause on serum Lp(a).</div></div><div><h3>Methods</h3><div>Manual chart review of clinic visits.</div></div><div><h3>Results</h3><div>A 68-year-old female with estrogen receptor positive localized BC status post lumpectomy and radiation, on anastrozole maintenance therapy, 32-pack-year smoking history in remission, class I obesity, and hypercholesteremia presented to the preventive cardiology clinic for evaluation of elevated Lp(a). At age 48, her Lp(a) was 12 mg/dL. At age 53, she attained menopause after a bilateral salpingo-oophorectomy. At age 63, she was diagnosed with BC, underwent resection and 52 fractions of radiation followed by maintenance anastrozole therapy. Evaluation was notable for Lp(a) 151 mg/dL (&gt; 4x ULN) (Figure 1) and Coronary Artery Calcium (CAC) score 64 (74th percentile for age). The patient's cardiovascular risk was addressed with the addition of aspirin to her existing regimen of high-intensity statin and ezetimibe therapy.</div></div><div><h3>Conclusions</h3><div>In this case, our patient was found to have &gt; 12-fold increase in Lp(a) 15 years post-menopause and 5 years post initiation of anastrozole. The patient's elevated CAC is likely multifactorial, driven by her smoking history, recent radiation therapy, elevated Lp(a), and hypercholesterolemia. Limited data exists on the effect of anastrozole on Lp(a) expression. In one study of post-menopausal BC patients, anastrozole led to an increase in Lp(a) levels only in patients previously treated with tamoxifen. This effect was thought to be driven by tamoxifen withdrawal rather than directly from anastrozole itself. Further investigation is needed to elucidate the mechanism of Lp(a) expression and its association with menopause and aromatase inhibitors. This will help inform whether repeat Lp(a) testing is warranted in post-menopausal women to guide CV risk-management in this elevated risk population.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e39"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168310","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 diagnostic genetic testing and clinical scoring results for familial chylomicronemia syndrome (FCS) in the 66-patient Balance study","authors":"Philippe Moulin MD,&nbsp;Andrew Dibble PhD,&nbsp;Veronica Alexander PhD,&nbsp;Daniel Gaudet MD,&nbsp;Sotirios Tsimikas MD,&nbsp;Robert Hegele MD,&nbsp;Alan Brown MD","doi":"10.1016/j.jacl.2025.04.102","DOIUrl":"10.1016/j.jacl.2025.04.102","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;This study was sponsored by Ionis Pharmaceuticals, Inc., Carlsbad, CA, USA. The first draft was written by Mary Beth DeYoung, PhD of Ionis Pharmaceuticals, Inc., Carlsbad, CA, USA. Editorial support was provided by Red Nucleus and funded by Ionis Pharmaceu&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Familial chylomicronemia syndrome (FCS), a rare, pancreatitis-associated genetic disorder, is commonly misdiagnosed. An FDA-approved treatment for FCS in the United States increases the urgency for accurate, reliable and timely diagnosis. While potentially definitive, FCS diagnosis based on genetic testing may not be accessible or conclusive. Clinical scoring systems have been devised as a diagnostic alternative. For instance, the North American (NA) FCS scoring system was devised using the RAND/UCLA modified Delphi process as a practical, rapid, validated tool to diagnose FCS (Hegele et al, J Clin Lipidol 2024). The detection sensitivity of a score ≥ 45 is 89% and the specificity is 97%.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;To evaluate the sensitivity of the NAFCS scoring system in the 66 genetically identified FCS patients enrolled in Balance, a phase 3 study on the efficacy and safety of olezarsen. Olezarsen is an APOC3 directed antisense oligonucleotide approved by the United States FDA as an adjunct to diet to reduce triglycerides in adults with FCS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;NAFCS scores were calculated individually for Balance patients using established methodology. Scoring parameters include age of severe hypertriglyceridemia (sHTG) onset; body-mass index (BMI) &lt; 25 kg/m&lt;sup&gt;2&lt;/sup&gt;; history of pancreatitis; secondary factors contributing to sHTG; and laboratory values (TG &gt; 880 mg/dL, TG/TC &gt; 8.00, and ApoB-100 &lt; 1.00 g/L). A NAFCS score &gt; 45 and ≥ 60 identified patients with “likely” or “definite” genetic FCS, respectively. Genetic testing procedures and results are described in the Balance publication (PMID: 38587247).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mean (SD) NAFCS score overall was 66 (14); range 33 to 93. Of 66 patients, 63 (95%) and 49 (74%) had NAFCS scores ≥ 45 and ≥ 60, respectively. Variability was found in some key attributes (Table). A high proportion (&gt; 95%) of FCS patients had TG &gt; 880 mg/dL and ApoB-100 &lt; 1.00 g/L at screening, nearly 80% had no secondary risk factors for sHTG, and ∼70% had a history of acute pancreatitis. More than half of patients had BMI &lt; 25 kg/m&lt;sup&gt;2&lt;/sup&gt;. Although the sample was small, patients with NAFCS scores &lt; 45 in Balance appeared less likely to have pathogenic LPL variants than patients with scores ≥ 45 (1/3 [33%] versus 54/63 [86%], respectively).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The NAFCS score incorporates laboratory parameters, particularly low ApoB-100, which was found in nearly all FCS patients in Balance. In Balance, the NAFCS score showed a sensitivity of 74% for the highly selective score o","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e73"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168359","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":"Bridging the gap: enhancing lipoprotein(a) testing and education in federally qualified health centers","authors":"David Peña MPH,&nbsp;Kristin Colson MS,&nbsp;Meg Yuan MPH,&nbsp;Eliana Collins MPH,&nbsp;CarriAnne Crabill BS,&nbsp;Jeremy Skinner BS","doi":"10.1016/j.jacl.2025.04.028","DOIUrl":"10.1016/j.jacl.2025.04.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;Yes, Novartis is proud to support the American Heart Association's Lp(a) Federally Qualified Health Centers Discovery Project.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Lipoprotein(a) [Lp(a)] is a significant genetic risk factor for atherosclerotic cardiovascular disease (ASCVD), particularly among Black/African American and South Asian populations who have been shown to have higher levels of Lp(a) compared to other groups. These populations are served by Federally Qualified Health Centers (FQHCs), which provide critical care to under-resourced and high-risk communities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;The American Heart Association's (AHA) 3-year Lp(a) FQHC Discovery Project aims to assess current practices and identify barriers to Lp(a) testing in FQHCs, establish site-specific improvement goals, enhance clinician knowledge of Lp(a) and its role in ASCVD risk management, and improve patient education to support shared decision-making between clinicians and patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The AHA selected 10 FQHCs based on their 1) capacity to implement quality improvement (QI) initiatives, 2) patient education practices, 3) patient demographics, and 4) rural-urban classification. In-person qualitative interviews were conducted with clinical and quality champions to map current clinical workflows and patient pathways, identify barriers and establish goals for Lp(a) testing. The AHA program consultants analyzed the results to identify opportunities for integrating Lp(a) testing into clinical care. Proposed Lp(a) testing strategies were incorporated into monthly virtual consultations led by an AHA QI Consultant. Quarterly learning collaboratives provide opportunities to share progress, exchange best practices, and refine strategies. Findings from another initiative, the Lp(a) Discovery Project, which gathered insights from health systems with established Lp(a) testing practices, support the development of educational resources for the FQHCs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The cohort collectively serves over 250,000 patients including priority populations at higher risk for elevated Lp(a) levels. Baseline assessments identified barriers such as patient and clinician engagement and education, staffing, and testing costs. Notably, no significant out-of-pocket costs for Lp(a) testing have been reported by patients. Podcasts, webinars, and an eModule were developed for clinician education on Lp(a) testing, while a health lesson, care kit, infographics, and video were developed in consultation with FQHCs for culturally relevant patient education. The in-person interviews and consultations revealed that annual visits are the best opportunity for clinicians to recommend and educate patients on Lp(a) testing.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The Lp(a) FQHC Discovery Project highlights the importance of targeted interventions to enhance clinician and patient education, boost engage","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e21"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168568","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":"Risk of acute pancreatitis among patients with hypertriglyceridemia (HTG) or severe hypertriglyceridemia (sHTG)","authors":"Kirti Batra MBA,&nbsp;Qiana Amos PhD,&nbsp;Seth Baum MD,&nbsp;Montserrat Vera-Llonch PhD,&nbsp;Daniel Soffer MD,&nbsp;Asia Sikora Kessler PhD","doi":"10.1016/j.jacl.2025.04.093","DOIUrl":"10.1016/j.jacl.2025.04.093","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>HTG is associated with an increased risk of acute pancreatitis (AP). However, real-world evidence evaluating the risk of AP at varying levels of elevated triglycerides (TG) is limited.</div></div><div><h3>Objective/Purpose</h3><div>This study evaluates the incidence of AP event in patients with HTG and sHTG levels compared to normal TG levels.</div></div><div><h3>Methods</h3><div>This retrospective cohort study was conducted using the Optum Research Database between 01 January 2016 – 31 March 2022. Adults 18 years and older with ≥ 1 diagnostic test for serum/plasma TG were included. Patients were assigned to four cohorts: normal TG (35 ≤ TG &lt; 150 mg/dL), HTG (150 ≤ TG &lt; 500 mg/dL), and sHTG (placed into 500 ≤ TG &lt; 880 mg/dL or TG ≥ 880 mg/dL cohorts). The index date was the cohort-specific earliest TG measurement. Patients had at least 12 months of pre- and post-index continuous enrollment. The primary study outcome was AP event, defined as having one of the following: ≥ 2 AP-specific medical claims; ≥ 1 claim for AP hospitalization; ≥ 1 claim for upper abdominal pain (UAP) and serum/plasma lipase or amylase level &gt; 200 U/L within 15 days of the UAP claim. Incidence rates were calculated per 100,000 person-years (PY) at risk. Kaplan-Meier analysis and an adjusted Cox proportional hazards model were conducted to estimate the risk of AP event in the HTG cohort and sHTG cohorts compared with the normal TG cohort.</div></div><div><h3>Results</h3><div>A total of 134,316 patients were identified across the four cohorts. The mean (SD) age of patients was 56.3 (15.7) years, 54% were males, and the mean follow-up was 987 days. AP incidence rates were significantly higher for the HTG (171.8), the 500 ≤ TG &lt; 880 mg/dL (377.8), and the TG ≥ 880 mg/dL (977.6) cohorts, compared to the normal TG cohort (92.2; all p &lt; 0.001). The cumulative incidence of AP events at 3 years was 0.5% in the HTG cohort, 1.1% in the 500 ≤ TG &lt; 880 mg/dL cohort, and 2.8% in the TG ≥ 880 mg/dL cohort, compared to 0.3% in the normal TG cohort (Figure; all p &lt; 0.001). In the adjusted Cox regression model, the hazard ratio (95% CI) of AP was 1.50 (1.20–1.87) in the HTG cohort, 2.63 (2.06–3.35) in the 500 ≤ TG &lt; 880 mg/dL cohort, and 4.78 (3.45–6.61) in the TG ≥ 880 mg/dL cohort, compared to the normal TG cohort (Table).</div></div><div><h3>Conclusions</h3><div>Patients with elevated TG levels had higher risk of AP event compared to patients with normal levels, with risk of AP increasing with higher TG levels, demonstrating the need for improved therapeutic interventions focused on the clinical management of sHTG.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e67"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between apolipoprotein B and obesity: A cross-sectional analysis of NHANES data","authors":"Jason Holligan MD,&nbsp;Moatamn Skuk MD,&nbsp;Wael Kanjo MD,&nbsp;Walter Agyeman MD,&nbsp;Elsie Kodjoe MD","doi":"10.1016/j.jacl.2025.04.080","DOIUrl":"10.1016/j.jacl.2025.04.080","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Apolipoprotein B (apoB) plays a critical role in the development of atherosclerosis, making it an essential biomarker for cardiovascular disease (CVD). Obesity, a significant global health concern affects 40.3% of adults in the United States of America (US) according to the Centers for Disease Control and Prevention (CDC). As rates of both obesity and CVD continue to rise globally, understanding the relationship between obesity and apoB levels is crucial for developing targeted strategies to reduce cardiovascular risks. Despite its importance, few studies have explored the effect of obesity on apoB levels in a large cohort of adults in the US.</div></div><div><h3>Objective/Purpose</h3><div>This study aims to investigate the association between obesity and apoB levels among US adults.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2009–2016. The sample included 10,539 adults aged 18 years and older who had apoB levels measured, representing approximately 62 million non-institutionalized US adults. Participants were classified as obese (BMI ≥ 30 kg/m²) or non-obese (BMI &lt;30 kg/m²). Apo B was analyzed as a continuous variable. Linear regression was performed to assess the association between obesity and apoB levels, adjusting for potential confounders including age, sex, race, diabetes, hypertension, and socioeconomic status. Effect modification was examined by sex and age group (&lt; 65 years vs. ≥ 65 years).</div></div><div><h3>Results</h3><div>Among the 10,539 participants, the mean age was 48 years, 51% were female, and 41% were White. The average apoB level was 90.5 mg/dL. Obese adults had higher apoB levels (94 mg/dL) compared to non-obese adults (88 mg/dL). A one-unit increase in obesity was associated with a statistically significant 6.91 mg/dL increase in apoB levels [Coefficient: 6.91; p &lt; 0.001; 95% CI: 5.90, 7.95]. After adjusting for confounders, the association remained statistically significant [Coefficient: 6.66; p &lt; 0.001; 95% CI: 5.52, 7.81]. There was no significant difference in the association by sex; however, the association was stronger among younger individuals compared to older adults.</div></div><div><h3>Conclusions</h3><div>Obesity is significantly associated with higher apoB levels, particularly in younger individuals. Addressing obesity as a key component of CVD prevention strategies may help reduce apoB levels and the associated cardiovascular risk.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e59"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167947","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":"Utilizing gamification to educate internal medicine residents on managing lipids in patients with inflammatory conditions","authors":"Jack Jnani MD,&nbsp;Ji-Cheng (Jason) Hsieh MD,&nbsp;Cassie Wang MD,&nbsp;Nadim Ammari MD,&nbsp;Yisrael Wallach MD,&nbsp;Spencer Weintraub MD,&nbsp;Lauren Block MD,&nbsp;Rahul Rege MD","doi":"10.1016/j.jacl.2025.04.016","DOIUrl":"10.1016/j.jacl.2025.04.016","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Inflammatory conditions such as human immunodeficiency virus (HIV) and autoimmune diseases increase patients’ risk of atherosclerotic cardiovascular disease (ASCVD). Trainees in the primary care setting may not be familiar with management of ASCVD risk in the setting of these conditions. Gamification, a novel educational tool, can improve learners’ engagement and knowledge to help them better manage ASCVD risk for those living with inflammatory conditions.</div></div><div><h3>Objective/Purpose</h3><div>We studied the effectiveness of gamification in educating internal medicine residents on management of ASCVD in patients with inflammatory conditions.</div></div><div><h3>Methods</h3><div>At a single large academic internal medicine residency program, we compared a resident-led virtual gamified curriculum utilizing KAHOOT® to a traditional slide-based curriculum. All residents in the program received a 1-hour case-based session summarizing American College of Cardiology, National Lipid Association and American Heart Association guidelines on enhanced cardiovascular risk in the setting of HIV and autoimmune diseases. Pre-post-surveys included knowledge questions, 5-point Likert scales (1 to 5) assessing self-reported confidence in managing cardiovascular risk and referencing guidelines, motivation to adhere to guidelines, engagement, and format preference. Matched pre-post test data and unmatched Likert scale data were analyzed with two-tailed students’ t-tests.</div></div><div><h3>Results</h3><div>65/108 (60.2%) categorical internal medicine residents received the gamified format and 43/108 (39.8%) received the traditional format. 14/65 (21.5%) residents in the gamified group and 7/43 (16.3%) in the traditional group completed pre-post tests and were analyzed as matched pairs. There was a significant increase in test performance in the gamified (pre- 0.43 to post- 0.76, p&lt;0.01) and traditional (pre- 0.55 to post- 0.81, p = 0.02) groups. There was no difference (gamified 0.33 vs. traditional 0.26, p = 0.52) in the post-pre change in test performance between groups. There were significant increases in Likert scale ratings of confidence in counseling patients and referencing guidelines in both gamified and traditional groups. There was a trend towards greater motivation to adhere to guidelines (gamified 4.5 vs. traditional 4, p = 0.06) in the gamified group. 15/21 (71.4%) of residents preferred a gamified format.</div></div><div><h3>Conclusions</h3><div>Both gamified and traditional lectures significantly improved residents’ knowledge of management of ASCVD in the setting of inflammatory conditions. Gamification was the favored method for lectures. Further research is needed to identify if gamification education on ASCVD risk in inflammatory disease can impact clinical practice and outcomes.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e11-e12"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168314","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":"Racial disparities in LDL-C control, ASCVD risk reclassification by statin use, coronary artery calcium scores, and the Pooled Cohort Equation","authors":"Benjamin Hsieh MD,&nbsp;Lorenzo Cotugno MD,&nbsp;Sana Saeed MD,&nbsp;Ethan Swartz MD,&nbsp;Prit Patel DO","doi":"10.1016/j.jacl.2025.04.066","DOIUrl":"10.1016/j.jacl.2025.04.066","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>ASCVD is a leading cause of morbidity and mortality, with LDL-C control essential for prevention. Significant racial disparities exist in LDL-C control, statin adherence, and ASCVD risk assessment. The Pooled Cohort Equation (PCE) estimates risk but may lack precision for racial minorities. Adding Coronary Artery Calcium Score (CACS) can refine risk stratification, but its impact on reclassification across racial groups, combined with statin adherence, is not well understood. This study addresses these gaps to improve risk assessment and reduce disparities.</div></div><div><h3>Objective/Purpose</h3><div>This study examines the interplay between LDL-C control, statin adherence, CACS, and the PCE in refining ASCVD risk stratification across racial groups. It aims to explore how CACS and PCE contribute to risk reclassification, focusing on the role of statin therapy.</div></div><div><h3>Methods</h3><div>A retrospective cohort of adults aged 40–75 without CAD from the MESA study was analyzed. Participants with complete data on LDL-C, statin use, CACS, and PCE variables (age, gender, race, blood pressure, diabetes, smoking, and cholesterol) were included. LDL-C control, statin use, and PCE-based risk were compared by race. ASCVD risk reclassification by CACS (0, 1–99, ≥ 100 HU) was assessed alongside PCE, stratified by statin adherence. Multivariable models evaluated interactions between race, statin use, CACS, and risk reclassification.</div></div><div><h3>Results</h3><div>The study included 3,282 participants. Whites exhibited the highest LDL-C control rates (mean LDL-C: 105.3 mg/dL), followed by Asians (115.6 mg/dL), Blacks (120.2 mg/dL), and Hispanics (125.4 mg/dL). Statin adherence varied significantly, with Whites showing the highest adherence rates (65%), compared to 52% in Blacks and 48% in Hispanics. CACS and PCE-based risk estimates demonstrated racial disparities, with 31.6% of Blacks having CACS = 0 compared to 31.6% of Whites. Reclassification of ASCVD risk by combining PCE and CACS led to a reduction in predicted risk for 15% of Black participants compared to 10% of Whites. Statin therapy improved CACS- and PCE-based reclassification consistency, especially among racial minorities. Interaction models demonstrated that LDL-C control, PCE-estimated risk, and statin adherence significantly influenced reclassification outcomes, with race modifying these effects.</div></div><div><h3>Conclusions</h3><div>Racial disparities in LDL-C control, statin adherence, and CACS distribution affect PCE-based ASCVD risk estimation. Incorporating CACS and PCE improves stratification, especially for minorities. These findings underscore the importance of integrating statin adherence, PCE, and advanced imaging techniques into personalized risk assessment strategies. Further research should assess the long-term clinical impact.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e50"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168736","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":"Accelerating evidence generation to implementation in cardiometabolic health: Establishment of the LATTICE Consortium","authors":"Ankeet Bhatt MD,&nbsp;Leandro Boer MD,&nbsp;Gemme Campbell-Salome PhD,&nbsp;Erica Davis,&nbsp;Nihar Desai MD,&nbsp;Jyothis George MD,&nbsp;Ty Gluckman MD,&nbsp;Lisa Head PharmD,&nbsp;Francoise Marvel MD,&nbsp;Marc Penn MD,&nbsp;Eric Peterson MD,&nbsp;Nishant Shah MD,&nbsp;Katherine Wilemon,&nbsp;Bethany Kalich PharmD,&nbsp;Seth Martin MD,&nbsp;Laney Jones PharmD","doi":"10.1016/j.jacl.2025.04.008","DOIUrl":"10.1016/j.jacl.2025.04.008","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Recent scientific advancements have led to the development of innovative therapies to reduce the risk of cardiometabolic events, offering new hope to address the world's leading cause of mortality. However, the time from evidence generation in the research-setting to implementation in the care-setting is elongated, has resulted in a high rate of cardiovascular and metabolic consequences for patients, clinicians, and health systems in the United States.</div></div><div><h3>Objective/Purpose</h3><div>Improved collaboration among patients, clinicians, health systems, payers, patient advocacy, and life science companies to translate evidence-based advancements into clinical practice is key to closing this health care gap.</div></div><div><h3>Methods</h3><div>Utilizing implementation science theories, methods, and frameworks can improve translation of evidence-based practices to improve cardiometabolic care. To close the gaps in cardiometabolic care, we will evaluate implementation tools, methodologies, and strategies. We will then measure both implementation and health outcomes.</div></div><div><h3>Results</h3><div>We describe the establishment of the LATTICE consortium, Leading Awareness to Action through Implementation of Cardiometabolic Efforts. LATTICE is a first-of-its-kind community dedicated to addressing cardiometabolic patient needs through implementation efforts (Figure). The LATTICE consortium helps unite partners contributing to the overall mission of improving cardiometabolic health by creating an inclusive platform for sharing evidence-based tools, methodologies, and strategies and collaborating to improve the effectiveness of cardiometabolic patient care at scale.</div></div><div><h3>Conclusions</h3><div>Success of LATTICE consortium will be measured by reducing time from evidence generation to implementation, improved awareness, and downstream implementation by individuals of successful, scalable, and sustainable care strategies that close cardiometabolic care gaps in meaningful ways.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e5-e6"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167920","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}