Journal of clinical lipidology最新文献

{"title":"A novel gamified ambulatory curriculum to educate internal medicine residents on lifestyle medicine and counseling","authors":"Rahul Rege MD, Yisrael Wallach MD, Ji-Cheng (Jason) Hsieh MD, Cassie Wang MD, Jack Jnani MD, Spencer Weintraub MD, Lauren Block MD, Nadim Ammari MD","doi":"10.1016/j.jacl.2025.04.021","DOIUrl":"10.1016/j.jacl.2025.04.021","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Appropriate counseling of patients in nutrition and physical activity remains a cornerstone in cardiovascular disease prevention. Effective education of internal medicine residents on guideline-based dietary and exercise recommendations is essential in mitigating cardiovascular risk. Gamification is a useful tool given its potential benefits on engagement and knowledge in medical education.</div></div><div><h3>Objective/Purpose</h3><div>We compared a novel gamified ambulatory curriculum to traditional slide-based curriculum on test performance and ratings of confidence, knowledge, and motivation among categorical internal medicine residents.</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. Residents received a 1-hour case-based session summarizing American College of Lifestyle Medicine guidelines. Pre-post-surveys included knowledge questions, 5-point Likert scales (1 to 5) assessing self-reported confidence in lifestyle medicine counseling and referencing guidelines, motivation to adhere to guidelines, engagement, and a question regarding 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. 22/65 (33.8%) residents in the gamified group and 8/43 (18.6%) in the traditional group completed pre- and post-tests and were analyzed as matched pairs. There was a significant increase in pre- to post-test performance in the gamified (pre- 0.34, post- 0.62, p<0.01) and traditional (pre- 0.35, post- 0.67, p = 0.02) groups. There was no significant difference in the post-pre change in test performance between groups. There were significant increases in Likert scale ratings of confidence in counseling patients in the gamified (pre- 2.61 to post- 4.0, p<0.01) and traditional (pre- 3.26 to post- 4.0, p=0.01) groups. There were significant increases in Likert scale ratings of confidence in referencing guidelines in both gamified (pre- 1.90 to post- 3.73, p<0.01) and traditional (pre- 2.47 to post- 3.90, p<0.01) groups. There was no significant difference between groups in post-survey only Likert scale ratings of engagement or motivation to adhere to guidelines. 16/22 (72.7%) of residents in the gamified group and 6/8 (75%) of residents in the traditional group preferred a gamified format.</div></div><div><h3>Conclusions</h3><div>The gamified ambulatory curriculum on Lifestyle Medicine was effective in improving resident knowledge, with similar outcomes to a traditional slide-based format. A gamified format was generally preferred by residents. Next steps warrant assessment of whether effective gamified educati","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e15"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166973","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 lipid leaderboards: A virtual gamified curriculum to educate internal medicine residents on guideline-based management of hyperlipidemia","authors":"Rahul Rege MD,&nbsp;Shafkat Salam MD,&nbsp;Spencer Weintraub MD,&nbsp;Cassie Wang MD,&nbsp;Andrew Cyr MD,&nbsp;Christian Leung MD,&nbsp;Lauren Block MD,&nbsp;Ji-Cheng (Jason) Hsieh MD","doi":"10.1016/j.jacl.2025.04.004","DOIUrl":"10.1016/j.jacl.2025.04.004","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Dyslipidemia remains a prevalent risk factor for cardiac disease, and effective education of trainees on best practice guidelines is essential. There is an increasing interest in gamification as a tool for medical education, due to its benefits on learner engagement and knowledge.</div></div><div><h3>Objective/Purpose</h3><div>We investigated the effectiveness of gamification in educating internal medicine residents on hyperlipidemia at a single, large academic internal medicine program. We compared a gamified interactive curriculum to a traditional slide-based curriculum on objective measures of test performance as well as self-reported ratings of confidence, knowledge, and motivation.</div></div><div><h3>Methods</h3><div>Residents received a 45-minute resident-led, case-based session summarizing 2018 ACC/AHA Guidelines, the 2022 AHA Expert Consensus Decision Pathway, and 2022 USPSTF Guidelines on management of hyperlipidemia delivered in a gamified format utilizing KAHOOT!® or a traditional slide-based format. Residents were invited to complete pre- and post-surveys which included knowledge questions, 5-point Likert scales (1 to 5) assessing knowledge, engagement, and motivation, and one question regarding preference of format. Matched pre-post data was analyzed with paired students’ t-tests with unequal variance.</div></div><div><h3>Results</h3><div>37 of 108 total residents (34.2%) completed pre-post surveys: 24/65 (36.9%) in the gamified and 13/43 (40.2%) in the traditional group. The gamified (mean pre- 56% to post- 74%, p = &lt; 0.01) and traditional (mean pre- 44% to post- 63%, p = 0.01) groups had significant increases in knowledge test scores after the session. Between both groups, there was no difference in the increase in test scores (gamified post-pre 17.8% vs. traditional 18.3%, p = 0.46) or increase in Likert scale ratings of knowledge (gamified post-pre 0.95 vs. traditional 0.91, p = 0.43). There was also no difference in post-session Likert scale ratings of engagement (gamified 4.3 vs. traditional 4.4, p = 0.42) or motivation in adhering to guidelines (gamified 4.3 vs. 4.5, p = 0.14). 42% of residents in the traditional group and 92% in the gamified group desired a gamified format for future sessions.</div></div><div><h3>Conclusions</h3><div>Both gamified and traditional formats significantly improved knowledge of hyperlipidemia guidelines. A gamified format was non-inferior to traditional format in post-session Likert scale ratings of engagement and motivation. A greater majority of residents desired a gamified format for future sessions. Gamification is an effective teaching method with similar outcomes to traditional methods. Effective education on professional guidelines pertaining to hyperlipidemia may lead to more evidence driven management of dyslipidemia and improve clinical outcomes.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Page e2"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167916","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":"Improving adherence with lipid-lowering agents","authors":"Gissette Soffer MD,&nbsp;Susan Renz PhD,&nbsp;Lau Yan Yung DNP","doi":"10.1016/j.jacl.2025.04.075","DOIUrl":"10.1016/j.jacl.2025.04.075","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Atherosclerotic cardiovascular disease (ASCVD) remains a major cause of death and disability, particularly in patients with hypercholesterolemia who require lipid-lowering agents to reduce ASCVD risk. However, non-adherence to lipid-lowering drugs can diminish the benefits of medications and increase cardiovascular risk.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;To determine whether sending medication adherence reminders through the patient portal and incorporating education for patients with hypercholesterolemia can improve medication adherence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The project enrolled new patients referred to the clinic with hypercholesterolemia who required lipid-lowering agents for ASCVD risk reduction. Participants were required to have the patient portal installed and manage the patient's portal apps independently. The eligible participants for the project were English-speaking, aged &gt; 18 years, and never on lipid-lowering medications or added new lipid-lowering agents to achieve the therapeutic goal. The interventions included sending weekly medication adherence reminders through the patient portal and incorporating education on medication adherence during the initial visit. All participants were asked to complete the Medication Adherence Report Scale-5 (MARS-5) questionnaire during their initial and post-treatment visits. Lipid profiles are the standard of care for monitoring medication responses. Additional data: Patient self-report of medication adherence, patient review message report from Epic, and participants' show-up rate in the post-treatment follow-up at 6 weeks as additional data to measure medication adherence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Eight participants were enrolled in the project. Data were analyzed using the Wilcoxon signed-rank test to compare pre-and post-LDL-C, Triglycerides, and MARS-5. A statistically significant comparison of pre-and post-intervention for LDL-C was found p =0.012, z = -2.52. The comparison of pre- and post-intervention triglyceride levels was p =0 .484, z = -0.70. The comparison of the pre-and post-intervention MARS-5 scores for medication adherence was p =0.11, z = 1.60. The patient self-reported adherence rate was 97%, the patient message review rate was 70%, and post-treatment follow-up at 6 weeks was 100%.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This project demonstrated improved medication adherence based on self-reported adherence, LDL-C reduction, and high MARS-5 scores. The participants’ feedback also indicated that education on medication adherence improved their awareness of disease prevention. The project was unable to show that sending messages of medication adherence reminders via Epic to the patient portal was associated with improved medication adherence; however, patient portals have demonstrated improved patient engagement and outcomes. The post-treatment follow-up rate in this study was 100%. Future studies s","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e55-e56"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168256","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 hyperglycemic emergencies among Asian Americans compared to Caucasians: A survey-weighted nationwide assessment of health equity","authors":"Oluwatoyosi Awotorebo MD,&nbsp;Ikponmwosa Ogieuhi MD,&nbsp;Aseed Mestahiri MD,&nbsp;Zeth Tolu-Akinnawo MD,&nbsp;Karldon Nwaezeapu MD,&nbsp;Godbless Ajenaghughrure MD,&nbsp;Anuoluwa Oyetoran MD,&nbsp;Kayode Ogunniyi MBBS","doi":"10.1016/j.jacl.2025.04.068","DOIUrl":"10.1016/j.jacl.2025.04.068","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Hyperglycemic emergencies—diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)—are life-threatening conditions that can lead to significant morbidity and mortality. Although previous studies have shown racial differences in diabetes-related complications, data on acute hyperglycemic crises among Asian Americans remain limited.</div></div><div><h3>Objective/Purpose</h3><div>We aimed to investigate disparities in in-hospital outcomes among Asian Americans compared to Caucasians hospitalized for hyperglycemic emergencies, focusing on mortality, mechanical ventilation, vasopressor use, acute kidney injury (AKI), length of stay (LOS), and hospital charges.</div></div><div><h3>Methods</h3><div>Using survey-weighted analyses of a nationally representative inpatient database (2021), we identified adult patients (≥ 18 years) admitted with a principal diagnosis of DKA or HHS. We compared Asian Americans (race code=4) and Caucasians (race code=1). Outcomes were assessed via logistic or linear regression, both unadjusted and adjusted for age, Charlson Comorbidity Index, sex, and median household income quartile by ZIP code.</div></div><div><h3>Results</h3><div>Unadjusted models showed that Asian Americans had higher odds of mortality (odds ratio [OR] 1.25, p=0.033) and AKI (OR 1.09, p=0.002), longer LOS (p=0.029), and greater total charges (p &lt; 0.001) compared to Caucasians, with no significant difference in mechanical ventilation or vasopressor use. After multivariable adjustment, the gap in mortality was no longer statistically significant (OR 1.13, p=0.233), and AKI risk was attenuated (OR 1.05, p=0.082). Differences in LOS also became non-significant (p=0.432). However, Asian Americans continued to incur significantly higher hospital charges (difference + $3,956, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In this survey-weighted, nationally representative analysis, Asian Americans presenting with hyperglycemic emergencies displayed higher unadjusted mortality, AKI rates, and healthcare costs than Caucasians. After adjustment, racial differences in clinical outcomes were largely diminished, but higher total charges persisted. These findings highlight the need for deeper investigation into potential drivers of cost disparities and suggest that tailored interventions may help reduce financial burdens and ensure equitable care for all patients experiencing severe hyperglycemic episodes.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e51-e52"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of hyperchylomicronemia and recurrent pancreatitis in a patient with the pArg333His variant of the lipoprotein lipase gene","authors":"Mendel Roth PhD,&nbsp;Richard Childress MD,&nbsp;Marshall Elam MD,&nbsp;Nicholas Townsend PharmD,&nbsp;Bryan Jett PharmD,&nbsp;Mariko Thel PharmD,&nbsp;Lonnell Gant DNP","doi":"10.1016/j.jacl.2025.04.043","DOIUrl":"10.1016/j.jacl.2025.04.043","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>A 69-year-old African American male with severe hypertriglyceridemia, hyperchylomicronemia (&gt; 4,000), and recurrent pancreatitis associated with the p.Arg333His variant of the Lipoprotein Lipase (LPL) gene. The patient did not respond to multiple triglyceride-lowering medications and continued to experience recurring episodes of pancreatitis. Severe hypertriglyceridemia, poor response to pharmacologic therapy, and history of recurrent pancreatitis prompted consideration of primary chylomicronemia. Genetic testing identified two single nucleotide variants of the LPL gene: p.Arg333His and a rare variant of unknown significance (VUS), p.His71Gln. Dietary control, collaboration with a nutritionist, and Orlistat have been successful.</div></div><div><h3>Objective/Purpose</h3><div>Show the correlation of likely pathogenic multivariant genes and the intersectionality of environmental factors’ roles in severe hypertriglyceridemia.</div></div><div><h3>Methods</h3><div>Due to the severity of the hypertriglyceridemia, we conducted cascade screening and genetic testing for the patient and family.</div></div><div><h3>Results</h3><div>Genetic testing identified the pathogenic pArg333His variant of the LPL gene, along with a 92nd percentile polygenic risk score for hypertriglyceridemia in the proband, resulting in a diagnosis of multifactorial chylomicronemia syndrome (MCS). A second variant of the LPL gene (p.His71Gln) was observed, and cascade screening revealed that this and the pathogenic gene variant were carried on different LPL gene alleles in the proband (compound heterozygote). A family member carrying only the p.His71Gln gene variant was found to have moderate hypertriglyceridemia despite a low polygenic risk score for hypertriglyceridemia.</div></div><div><h3>Conclusions</h3><div>Genetic testing identified a pathogenic variant LPL gene combined with a high polygenic risk score for hypertriglyceridemia, which led to the diagnosis of multifactorial hyperchylomicronemia. Cascade screening suggested the second LPL gene variant (p.His71Gln) in biallelic configuration to the pathogenic p.Arg333His variant contributed to the severity of the patient's hypertriglyceridemia. The genetic findings guided the treatment referral to a nutritionist, a 10-15% fat-restricted diet, and adherence to Orlistat, which inhibits fat absorption. The patient has maintained triglyceride levels below 400 mg/dL and no further episodes of pancreatitis. The novel p.His71Gln variant warrants further investigation to clarify its role in the pathogenesis of multifactorial chylomicronemia syndrome.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e31-e32"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167934","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":"Phytosterolemia: A case of paradoxical hypercholesterolemia in response to a mediterranean diet","authors":"Rahul Rege MD,&nbsp;Carol Kirkpatrick PhD,&nbsp;Alexandria Wolz RD,&nbsp;Eugenia Gianos MD,&nbsp;Saman Suleman BS","doi":"10.1016/j.jacl.2025.04.047","DOIUrl":"10.1016/j.jacl.2025.04.047","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Phytosterolemia is a rare autosomal recessive lipid disorder caused by variants of the sterol efflux transporter genes ABCG5 and ABCG8 leading to increased intestinal absorption and decreased hepatic elimination of plant sterols. Patients may be misdiagnosed with heterozygous familial hypercholesterolemia. Additionally, they may present with atypical responses to nutrition interventions recommended for atherosclerotic cardiovascular disease (ASCVD) prevention.</div></div><div><h3>Objective/Purpose</h3><div>To describe the clinical pathway of a patient who experienced increased total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels after adopting a Mediterranean dietary pattern and outline diagnostic testing and management strategies for a rare lipid disorder.</div></div><div><h3>Methods</h3><div>We present a case report.</div></div><div><h3>Results</h3><div>HT is a 54-year-old post-menopausal woman who presented to preventive cardiology clinic for consultation for hypercholesterolemia. Baseline TC was 256 mg/dL and LDL-C was 148 mg/dL. HT was physically active with no history of smoking. Family history was negative for premature ASCVD. On physical exam, she had a BMI of 22.49 kg/m², a normal cardiovascular exam, and no xanthomas were noted.</div><div>HT's 10-year ASCVD risk score indicated low-risk (1.1%). HT was encouraged to follow the Mediterranean dietary pattern (MedDiet) to address her elevated LDL-C levels. HT demonstrated good adherence and increased her intake of whole grains, legumes, nuts, avocados, and olive oil. Follow-up laboratory results at two months demonstrated TC increased to 317 mg/dL and LDL-C to 203 mg/dL (see Figure).</div><div>The atypical response to the MedDiet resulted in further diagnostic testing, which revealed a significantly elevated beta-sitosterol level of 11 mg/L (normal &lt;5 mg/L) highly suggestive of phytosterolemia. HT was prescribed ezetimibe 10 mg, discontinued the MedDiet, and was educated on a low-plant sterol diet. After one month, TC was 193 mg/dL and LDL-C was 106 mg/dL. After 6 months on the treatment plan, TC decreased to 180 mg/dL, LDL-C decreased to 90 mg/dL, and beta-sitosterol decreased to 2.8 mg/L. She was encouraged to continue with the current therapeutic regimen and referred to a registered dietitian to assure optimal nutrition with a low-plant sterol diet</div></div><div><h3>Conclusions</h3><div>Though extremely rare, phytosterolemia should be considered in patients with hypercholesterolemia who have paradoxical responses to whole food, plant-based diets or those with early ASCVD without obvious etiology. In this patient, diagnosis was via laboratory assays that showed elevated plasma plant sterol levels, including beta-sitosterol. Variants of ABCG5 and ABCG8 genes can provide genetic confirmation. Lipid-lowering was achieved with a low-plant sterol diet and ezetimibe 10 mg.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e34-e35"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167940","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":"Impact of baseline demographics on lipid profile in patients with ACS: Unmasking hidden drivers","authors":"Monika Bhandari MD,&nbsp;Pravesh Vishwakarma MD,&nbsp;Abhishek Singh MD,&nbsp;Rishi Sethi MD,&nbsp;Jyoti Bajpai MD,&nbsp;Akshyaya Pradhan MD","doi":"10.1016/j.jacl.2025.04.091","DOIUrl":"10.1016/j.jacl.2025.04.091","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Acute coronary syndromes (ACS) remain a major global cardiovascular challenge with evolving treatment paradigms. Despite advances in management, the influence of baseline patient demographics on lipid profiles at presentation has received limited attention.</div></div><div><h3>Objective/Purpose</h3><div>This study explores the associations between demographic factors and lipid profile in ACS patients.</div></div><div><h3>Methods</h3><div>In this single-center, retrospective study, we analyzed data from 1,671 consecutive ACS patients admitted for treatment. Baseline demographics—including age, gender, comorbidities (diabetes mellitus and hypertension), and smoking status—were examined in relation to lipid profile components (total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) measured upon admission. Additionally, among the 853 patients who underwent coronary angiography, we evaluated the relationship between lipid levels and angiographic severity. Clinical presentations were categorized as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina.</div></div><div><h3>Results</h3><div>The mean age of the cohort was 56.29 ± 11.73 years, with a male predominance (81.5%). Patients under 40 years exhibited significantly higher mean levels of total cholesterol, LDL-C, and triglycerides compared to those between 41 and 60 years and over 60 years (p = 0.002, 0.001, and &lt; 0.001, respectively), potentially reflecting the more frequent use of lipid-lowering therapies in older patients. Females had higher levels of total cholesterol and HDL-C than males (p = 0.027 and &lt; 0.001, respectively). Diabetic patients (n = 475) and hypertensive patients (n = 538) demonstrated lower LDL-C levels relative to non-diabetics and non-hypertensive individuals (p &lt; 0.001), suggesting more aggressive lipid management and adherence to lifestyle modifications in these populations. Smokers (n = 799) presented with elevated total cholesterol and LDL-C levels compared to non-smokers (p = 0.002 and 0.02, respectively). In the subset undergoing coronary angiography, significant correlations emerged between angiographic severity and both total cholesterol and LDL-C levels (p = 0.005). Moreover, patients presenting with STEMI (68.7% of the cohort) had markedly higher total cholesterol and LDL-C levels compared to those with NSTEMI or unstable angina (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In this South Asian cohort of ACS patients, baseline lipid profiles varied significantly with age, gender, comorbidities, smoking status, angiographic findings, and clinical presentation. These findings highlight the importance of considering demographic factors in risk stratification and tailoring lipid management strategies to improve outcomes in ACS patients.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e65-e66"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167946","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":"*Sitosterolemia due to a new combination of ABCG8 variants presenting as hemolytic anemia and thrombocytopenia: A case report","authors":"Natalie Bavli MD,&nbsp;Zahid Ahmad MD,&nbsp;FNU Anum MBBS","doi":"10.1016/j.jacl.2025.04.057","DOIUrl":"10.1016/j.jacl.2025.04.057","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Sitosterolemia is a rare autosomal recessive disorder caused by mutations in ATP binding cassette subfamily G member 5 or 8 (ABCG5/8), leading to excessive plant sterol absorption and accumulation. Patients can present with xanthelasma, tendon xanthomas, premature atherosclerosis, and hematologic abnormalities.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;Here, we report a case of sitosterolemia in an adult male presenting with hemolytic anemia, macrothrombocytopenia, and hypercholesterolemia. His diagnosis was ultimately confirmed through genetic testing, which identified a new combination of ABCG8 variants&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Case Presentation: A 61-year-old man with a history of hypothyroidism, hypercholesterolemia, obesity, and metabolic dysfunction-associated steatotic liver disease (MASLD) was referred to the Hematology Clinic at UT Southwestern for the evaluation of hemolytic anemia and moderate thrombocytopenia. He was diagnosed with hypercholesterolemia in early adulthood and was taking Rosuvastatin 5 mg daily for several years.&lt;/div&gt;&lt;div&gt;On examination, he had splenomegaly and bilateral xanthelasma (Figure 1). Laboratory evaluation revealed LDL-C of 126 mg/dL, low hemoglobin and platelet count, elevated lactate dehydrogenase, and undetectable haptoglobin (Table 1). A peripheral blood smear revealed marked stomatocytosis and macrothrombocytopenia (Figure 2).&lt;/div&gt;&lt;div&gt;Given the combination of hemolytic anemia, macro-thrombocytopenia, and stomatocytosis, sitosterolemia was suspected. Serum plant sterol levels were markedly elevated (Table1). Genetic testing identified multiple heterozygous variants in ABCG8. A likely pathogenic c.250_280dup variant on one allele, and two variants (c.1721G&gt;A [p.Gly574Glu] and c.1723G&gt;C [p. Gly575Arg]) on the other which together cause a novel deletion and insertion of two amino acids. Cascade screening revealed his healthy sister carried c.250_280dup variant.&lt;/div&gt;&lt;div&gt;He was subsequently seen at the UT Southwestern Lipid Metabolism Clinic and was started on ezetimibe 10 mg daily in addition to the Rosuvastatin 5 mg daily. He consulted a nutritionist to transition his diet from a heart-healthy diet to a low plant sterol diet. At three months follow-up, his lipid profile and hemoglobin had improved, but platelet counts and markers of sterol absorption remain unchanged (Table 1).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;This case underscores key clinical features of sitosterolemia, including xanthelasma and hematologic abnormalities. His genetic findings expand the known spectrum of ABCG8 mutations: the c.250_280dup variant has not been previously reported in sitosterolemia, and while the c.1721G&gt;A (p.Gly574Glu) and c.1723G&gt;C (p.Gly575Arg) missense variants have been individually documented, their co-occurrence on the same allele, leading to a novel mutation, is unreported.&lt;/div&gt;&lt;div&gt;Improvement in plant sterol levels and platelet counts can ta","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e42-e43"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168785","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":"Hypercoagulability or coronary artery disease? Polygenic risk score unveils the mystery","authors":"Douglas Jacoby MD,&nbsp;Sohil Golwala MD","doi":"10.1016/j.jacl.2025.04.058","DOIUrl":"10.1016/j.jacl.2025.04.058","url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>CB is a 58 year old nonsmoker without significant cardiovascular risk factors presented with a myocardial infarction with unclear etiology.</div></div><div><h3>Objective/Purpose</h3><div>To review a clinical scenario involving use of polygenic risk score (PRS) to clarify the etiology of cardiovascular event and further risk stratify to guide lipid management.</div></div><div><h3>Methods</h3><div>CB was seen in the office at Lipid Clinic at Penn for further evaluation.</div></div><div><h3>Results</h3><div>CB is a 58 year old nonsmoker male without family history of premature coronary artery disease (CAD) or any major cardiovascular risk factors, found to have extensive CAD when he presented with a STEMI s/p DES to RCA and PCI to PLA and PDA, along with non-critical lesions (30-40% stenosis) in LAD and Lcx. The STEMI occurred in the setting of COVID-19 infection, raising the question about true etiology.</div><div>Using conventional risk calculators, his 10-year ASCVD risk is estimated at about 6% (“borderline risk”), therefore underestimating his risk and extensive CAD. Some clinicians evaluating the patient focused towards hypercoagulability and thrombosis in the setting of his COVID infection, however that would not sufficiently explain his atherosclerotic disease.</div><div>Keeping in mind that the patient has two children and five siblings, it was important to assess his genetic risk despite lack of family history of CAD. His polygenic risk score for CAD riskshowed the 97th percentile risk, clarifying his cardiovascular risk factor and also prompting for more aggressive preventive treatment and cascade screening for family.</div></div><div><h3>Conclusions</h3><div>Cardiovascular disease is the leading cause of death in the United States and globally. While the Framingham Risk Score and the Pooled Cohort Equations (PCE) provide a useful construct to guide the use of medications for cardiovascular prevention, they miss certain opportunities at early intervention, especially for patients with significant genetic risk. Hence, incorporation of genetics into risk prediction frameworks offer a wide range of opportunity for early detection toward earlier and targeted risk reduction strategies.</div><div>Polygenic risk score (PRS) is a novel tool in precision medicine to quantify inherited risk for a given disease based on the cumulative impact of many common sites of DNA variation. Although we do not anticipate PRS to replace traditional guideline based approach, it may indeed be helpful - and akin to other CAD risk-enhancing factors - when there is clinical uncertainty. As seen in our case, using a PRS for CAD can help explain the etiology of CAD, modify treatment goals, and more effectively screen relatives for otherwise unrecognized cardiovascular risk.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e43-e44"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168786","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":"Prevalence of blood cholesterol screening, elevated levels, and medication use among adults – United States, 2019-2023","authors":"Magdalena Pankowska MPH,&nbsp;Ahlia Sekkarie PhD,&nbsp;Omoye Imoisili MD,&nbsp;Fleetwood Loustalot PhD,&nbsp;Kerui Xu PhD","doi":"10.1016/j.jacl.2025.04.078","DOIUrl":"10.1016/j.jacl.2025.04.078","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;div&gt;Elevated levels of total blood cholesterol are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Blood cholesterol levels increase with age, and disparities exist across sociodemographic characteristics. Clinical guidelines and recommendations encourage regular screening and management of blood cholesterol to reduce the risks of ASCVD in adults.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;div&gt;This study assessed recent national and state-level trends in the age-standardized prevalence of self-reported blood cholesterol screening, high blood cholesterol, and medication use among United States (US) adults aged ≥ 18 years using data from the 2019-2023 Behavioral Risk Factor Surveillance System (BRFSS).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;BRFSS is a system of health-related telephone surveys conducted among non-institutionalized US adults. Age-standardized prevalence of blood cholesterol screening during the preceding 5 years, high blood cholesterol among those who had ever screened, and medication use were assessed by sex, age group, race and ethnicity, educational attainment, and state of residence, including the District of Columbia. All percentages were age-stratified or age-standardized using the 2000 US census. The absolute (percentage point) and relative (percent) changes from 2019 to 2023 were calculated, and linear trends across survey periods were assessed using orthogonal polynomial coefficients. This analysis used SAS-callable SUDAAN to account for complex sampling design and weighting.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;After excluding respondents with missing cholesterol or sociodemographic data, the final analytic samples for 2019, 2021, and 2023 were 371,144, 385,954, and 383,892, respectively. From 2019 to 2023, there was a slight decrease in the prevalence of adults who reported of having blood cholesterol screened during the preceding 5 years, decreasing by 0.5% from 86.0% to 85.6% (-0.4 percentage points, p = 0.026). Among adults who had ever screened, the prevalence of high blood cholesterol increased by 13.7%, rising from 29.2% to 33.2% (4.0 percentage points, p &lt; 0.001). Among adults told to have high blood cholesterol, the prevalence of medication use remained at approximately 41.5%. The prevalence of screening, awareness, and medication use for high blood cholesterol varied by sociodemographic characteristics and state of residence. Notably, 34 US states experienced a significant increase in the prevalence of high blood cholesterol.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This analysis highlights the population-level disparities in screening, awareness, and treatment for high blood cholesterol. To achieve the Healthy People 2030 goals of reducing blood cholesterol and increasing treatment in US adults with high blood cholesterol, clinicians, policymakers, and public health practitioners should consider interventions that enhance awareness about the","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e57-e58"},"PeriodicalIF":3.6,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168817","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}