Journal of clinical lipidology最新文献

{"title":"Process Mapping the Lipid Management Patient Pathway in Six Health Systems for Identification of Barriers to Guideline-Directed Care","authors":"","doi":"10.1016/j.jacl.2024.04.008","DOIUrl":"10.1016/j.jacl.2024.04.008","url":null,"abstract":"<div><h3>Study Funding</h3><p>Novartis Pharmaceuticals supports the American Heart Association's Integrated ASCVD Management Initiative.</p></div><div><h3>Background/Synopsis</h3><p>The American Heart Association (AHA) began implementation of a 3-year multi-site, health system initiative in 2021 aimed at improving guideline-directed lipid management for patients with atherosclerotic cardiovascular disease (ASCVD). In alignment with the 2018 Guideline on the Management of Blood Cholesterol, the initiative worked to identify and refine lipid management care models and monitored adherence to quality performance metrics focused on guideline-directed care.</p></div><div><h3>Objective/Purpose</h3><p>To document existing lipid management care pathways, as one component of an implementation initiative, to identify gaps and barriers to care and inform strategies for increasing adoption of guideline-directed care.</p></div><div><h3>Methods</h3><p>Six U.S. health systems and their associated clinics were selected for the initiative. They varied in size, geography, rural or urban populations, and by teaching or non-teaching health system status. Virtual, qualitative interviews were held in 2022 and 2023 with health system staff to map lipid management care pathways. Positions interviewed varied by health system, but included: C-suite/Chiefs, service line directors, cardiologists, neurologists, pharmacists, quality directors, abstractors, primary care program management, and program administration. Interviewees were asked to describe the inpatient lipid management pathway for acute coronary syndrome patients from admission to discharge, as well as the outpatient secondary prevention process for the same population after discharge. Resulting process maps were created and reviewed with interviewees for accuracy. Results were analyzed by AHA initiative program consultants for gaps or deviations from guideline-directed care. Proposed interventions to address the gaps and deviations were incorporated into future calls with individual systems.</p></div><div><h3>Results</h3><p>Mapping revealed wide variations in lipid management patient pathways across health systems in both inpatient and outpatient prevention care. Gaps included: underdefined processes for post-discharge follow up of stroke patients, inadvertent exclusion of incoming transfer patients from defined follow-up processes, inconsistency in ownership of patient follow-up, and inconsistency in multi-disciplinary team collaboration among primary care, cardiology, and neurology. Mapping revealed consistent adherence to secondary prevention guidelines for follow-up lab cadence after statin initiation or dosing change, with most systems seeing the patient 1-2 weeks post-discharge and then again within 3 months.</p></div><div><h3>Conclusions</h3><p>Process mapping is an effective tool for identifying gaps in care in large-scale quality improvement projects and supports organizational alignment to identified pr","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842353","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":"Comparative Assessment of hsCRP and Apolipoprotein B as ASCVD Risk Biomarkers","authors":"","doi":"10.1016/j.jacl.2024.04.023","DOIUrl":"10.1016/j.jacl.2024.04.023","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>According to the American Heart Association, the accumulation of plaque in the walls of arteries is identified as the primary cause of atherosclerotic cardiovascular disease (ASCVD). Currently, ASCVD-related conditions remain the leading cause of morbidity and mortality globally. Apolipoprotein B has been identified as a more precise cardiovascular risk marker than LDL-C, while hsCRP has shown potential as a cardiovascular disease indicator. This study aims to investigate the diagnostic performance and routine screening cut-off of hsCRP for early atherosclerosis vascular diseases (ASCVD) risk in adult patients, comparing it with Apo B.</p></div><div><h3>Objective/Purpose</h3><p>To compare the diagnostic performance of high-sensitivity C-reactive protein (hsCRP) with apolipoprotein B in assessing ASCVD risk.</p></div><div><h3>Methods</h3><p>A sample of 494 individuals from the NHANES 2015-2016 laboratory dataset, with a mean age greater than 17 years, was used for this study. ASCVD risk was measured by non-HDL-C, categorized into low and high risk based on the Mayo Clinic reference range. Predictors included Apo B, and hs-CRP. Binomial logistic regression and ROC curve analyses were conducted using the generalised linear models and pROC packages in RStudio IDE. Hypotheses were validated at p≤0.05, and diagnostic performance metrics such as ROC AUC, sensitivity, and specificity were measured on a scale of 0-1.</p></div><div><h3>Results</h3><p>The findings revealed that for every 1g/L increase in apo B concentration, the odds of high ASCVD risk were approximately 3.8 × 1011 times higher. Additionally, the model indicated that the odds of high ASCVD risk were 1.03 times higher for every 1mg/L increase in hsCRP concentration. However, this indicate that hsCRP level was not associated with odds of ASCVD risk. The ROC AUC for apo B and hsCRP were approximately 0.9739 and 0.6165, respectively, with cut-off values (sensitivity, specificity) of approximately 0.9g/L (0.927, 0.897) and 2.4 mg/L (0.596, 0.601), respectively. Thus, levels above these thresholds for both apo B and hsCRP are associated with high ASCVD risk.</p></div><div><h3>Conclusions</h3><p>The study demonstrates that apo B exhibits high discriminatory and diagnostic accuracy, making it a suitable ASCVD risk biomarker compared to hsCRP. While hsCRP shows moderate diagnostic accuracy, it is not sufficient as a standalone ASCVD risk diagnostic marker. Therefore, apo B could serve as a replacement for LDL-C, while hsCRP could possibly serve as an add-on test in ASCVD risk assessment.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952462","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":"Cascade screening for familial hypercholesterolemia from pediatric index cases diagnosed through universal screening","authors":"","doi":"10.1016/j.jacl.2024.04.127","DOIUrl":"10.1016/j.jacl.2024.04.127","url":null,"abstract":"<div><p>Heterozygous familial hypercholesterolemia (HeFH) is an autosomal dominant disorder causing elevated low density lipoprotein cholesterol (LDL-C) and premature atherosclerotic cardiovascular disease. Universal cholesterol screening in childhood leads to children serving as the index case for their family, but efficacy of cascade screening and genetic counseling in this population is not well understood. The institutional pediatric lipid clinic database was queried from 2011 to 2022 for subjects &lt;18 years who met clinical HeFH diagnostic criteria (<em>N</em> = 256). Median peak LDL-C was 198 mg/dL (interquartile range 179–238 mg/dL) and 69.5 % of subjects were the index case. The number of new HeFH cases identified per index case was 3.55 ± 1.87. Genetic counseling was offered to 38.7 % of subjects and genetic testing was completed by 10.9 %, 53.6 % of whom had a pathogenic or likely pathogenic genetic variant for HeFH. Our findings highlight the effectiveness of cascade screening from pediatric index cases identified through universal screening. However, genetic counseling and genetic testing may be underutilized in this population.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763636","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":"High carrier frequency for abetalipoproteinemia and evidence of a founder variant in a French-Canadian population","authors":"","doi":"10.1016/j.jacl.2024.04.132","DOIUrl":"10.1016/j.jacl.2024.04.132","url":null,"abstract":"<div><p><span>Abetalipoproteinemia (ABL) is a rare recessive genetic disease caused by bi-allelic pathogenic variants in the microsomal triglyceride transfer protein (</span><em>MTTP</em>) gene. This disease is characterized by a deficiency in the secretion of apolipoprotein B-containing lipoproteins. Patients with ABL present with neurological, hematological, and gastrointestinal symptoms due to fat malabsorption and a deficiency in liposoluble vitamins. In this report, we present a total of four ABL cases, including three new cases, all originating from the same French-Canadian founder population in Saguenay-Lac-Saint-Jean, Québec, Canada. These individuals are homozygous for the same pathogenic variant in the <em>MTTP</em> gene (c.419dup, p.Asn140Lysfs*2). We found that this variant is more common than anticipated in this population, with an estimated carrier frequency of 1:203. Early diagnosis is essential to initiate treatment known to prevent complications associated with ABL. Population carrier screening or newborn screening for ABL should be considered in this French-Canadian founder population.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140933943","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":"Severe Medication Induced Dyslipidemia in an Adult with Breast Cancer","authors":"","doi":"10.1016/j.jacl.2024.04.091","DOIUrl":"10.1016/j.jacl.2024.04.091","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>A 57 year-old woman with recently diagnosed breast cancer receiving weekly neoadjuvant paclitaxel and biweekly doxorubicin and cyclophosphamide therapy with dexamethasone is referred to lipid clinic to evaluate for genetic testing for hyperlipidemia. Her other medications included loperamide, metformin, omeprazole, ondansetron, prochlorperazine, cyclobenzaprine, hydroxyzine, ibuprofen, tramadol, metoprolol, and olanzapine. The abnormal laboratory results were incidentally noted by her oncologist on routine blood work, and included a total cholesterol (TC) of 964 mg/dL, triglycerides (TG) of 5,031 mg/dL, and HDL-C of 31 mg/dL. She denies a history of dyslipidemia, abdominal pain, or pancreatitis. Family history is notable for her father who died of a myocardial infarction in his 40s. Examination revealed no xanthelasmas, tendinous xanthomas, achilles tendon thickening, hepatomegaly, or corneal arcus.</p></div><div><h3>Objective/Purpose</h3><p>To demonstrate the severity of iatrogenic dyslipidemia that may result from the combination of atypical antipsychotics and steroids.</p></div><div><h3>Methods</h3><p>Retrospective review of electronic medical records and literature review.</p></div><div><h3>Results</h3><p>Echocardiogram was unremarkable and recent CT chest suggested no coronary artery calcification. Repeat lipid panel showed TC of 1,043 mg/dL, TG of 4,593 mg/dL, and HDL-C of 26 mg/dL. TSH was 0.8 MIU/L and hemoglobin A1C was 9.6%. Her serum was noted to be cloudy. Prior lipid panel from PCP was requested and it showed TC, TG, and HDL-C levels of 238, 538, and 34 mg/dL, respectively just weeks prior to steroid and antipsychotic initiation. Given the history and temporal correlation, her hyperglycemia and dyslipidemia were attributed to the combination of olanzapine and dexamethasone and less likely due to genetic causes. After lifestyle modification counseling, atorvastatin 40 mg, icosapent ethyl 1 g, and fenofibrate 145 mg were initiated. Olanzapine was changed to another agent for symptom control. Urgent endocrinology referral also prompted maximization of her metformin dose and initiation of insulin therapy with home glucose monitoring. Repeat lipid panel showed improvement of TC and TG levels to 102 mg/dL and 190 mg/dL, respectively.</p></div><div><h3>Conclusions</h3><p>While atypical antipsychotics and steroids are known culprits of dyslipidemia and metabolic syndrome, the severity of dyslipidemia seen in this case is atypical. Cancer patients undergoing active therapy are particularly vulnerable. Identification of iatrogenic dyslipidemia should therapy alteration or discontinuation, if possible. Lifestyle modifications and aggressive lipid-lowering therapy remain indicated. Very high TG levels should prompt early initiation of multiple agents, including fibrates and omega-3 fatty acids, to prevent pancreatitis.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843242","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":"†High Rates of Cardiovascular Events in Patients with Multivessel Disease in the First Year Post-Myocardial Infarction: A Systematic Literature Review","authors":"","doi":"10.1016/j.jacl.2024.04.047","DOIUrl":"10.1016/j.jacl.2024.04.047","url":null,"abstract":"<div><h3>Study Funding</h3><p>This study was sponsored by CSL Behring and performed in collaboration with the Baim Institute.</p></div><div><h3>Background/Synopsis</h3><p>Patients who survive an acute myocardial infarction (AMI) are at a heightened risk of further major adverse cardiovascular events (MACE), particularly in the first few months following an AMI. Multivessel disease (MVD) is known to further exacerbate the risk of MACE. The elevated risk in this early post-AMI period is not addressed by current secondary preventative therapies.</p></div><div><h3>Objective/Purpose</h3><p>To evaluate the impact of MVD on clinical and patient-centered outcomes in the first year post-AMI, in the context of the current treatment landscape.</p></div><div><h3>Methods</h3><p>In this systematic literature review, relevant articles published between March 2019 and July 2022 were identified from MEDLINE, Embase, Cochrane databases, and cardiovascular (CV) and health outcomes conferences. Articles reporting on pre-specified clinical or patient-centered outcomes in post-AMI patients with MVD at timepoints within 1 year were eligible for inclusion. Studies that included patients with AMI and cardiogenic shock were excluded from this review.</p></div><div><h3>Results</h3><p>Clinical outcomes were reported in five randomized-controlled trials (RCTs) and 25 observational studies across 32 articles. Patient-centered outcomes were reported in one RCT across two articles. The definition of MVD varied across the studies; however, it was typically characterized by ≥50% stenosis in ≥1 non-infarct-related coronary artery. Of the individual MACE endpoints extracted for this review (all-cause mortality, CV mortality, AMI, stroke), all-cause mortality and AMI were most frequently reported. Although rates of individual MACE endpoints were variable (Table), likely due to heterogeneity in study populations and interventions, a trend was identified; MACE rates at 1-year post-AMI were typically not substantially higher than those reported at earlier timepoints. EQ-5D scores, indicative of quality of life (QoL), increased marginally from baseline to 1 year following treatment, indicating minimal improvements in QoL. Nevertheless, EQ-5D was only reported in one RCT.</p></div><div><h3>Conclusions</h3><p>MVD is associated with high rates of MACE early after AMI that persist at 1 year. Novel therapies that address CV risk in the early period post-AMI may support improved CV outcomes among patients with MVD. Further data on patient-centered outcomes are warranted to determine the impact of post-AMI treatment options on QoL.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853631","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 Variations in SGLT2 Inhibitor Prescriptions","authors":"","doi":"10.1016/j.jacl.2024.04.043","DOIUrl":"10.1016/j.jacl.2024.04.043","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are novel pharmacotherapies that improve mortality and reduce hospitalizations for patients with type 2 diabetes mellitus (T2DM) suffering from heart failure and chronic kidney disease (CKD). Prescription patterns vary amongst patient racial groups in goal directed medical therapy, however, this has not been thoroughly examined for SGLT2i.</p></div><div><h3>Objective/Purpose</h3><p>Here, we investigate the racial differences in SGLT2i prescriptions for diabetic patients. We hypothesize that there are differences between SGLT2i prescriptions based on race, compared to prevalence of diabetes in the local population.</p></div><div><h3>Methods</h3><p>We performed a retrospective analysis of patients started on SGLT2i in the Northwell Health system serving the Queens and Nassau County regions of New York state. Data was collected on patients from 2018 to 2023. The racial demographics of these patients were examined and compared between various specialties (cardiology, nephrology, endocrinology and primary care providers) that started these medications.</p></div><div><h3>Results</h3><p>A total of 11,255 patients were started on SGLT2i in the Northwell Health central region system from 2018 to 2023. Of these patients, 6,031 (53.6%) were white, 1,465 (13.0%) were black and 892 (7.9%) were Asian. These results were further subdivided by specialty prescribing the medication. Cardiologists started 3,765 patients on SGLT2i with 2,179 (57.9%) being white, 462 (12.3%) being black and 357 (9.5%) being Asian. Nephrologists started 355 patients on SGLT2i with 162 (45.6%) being white, 67 (18.9%) being black and 43 (12.1%) being Asian. Endocrinologists started 3,979 patients on SGLT2i with 1,953 (49.1%) being white, 590 (14.8%) being black and 280 (7.0%) being Asian. Primary care providers started 3191 patients on SGLT2i with 1737 (54.4%) being white, 346 (10.8%) being black and 212 (6.6%) being Asian.</p></div><div><h3>Conclusions</h3><p>The Queens and Nassau counties served by the central region of Northwell Health include a diverse population. Out of the T2DM population in this area, approximately 41% is white, 20% is black and 18% is Asian. Additionally, black and Asian (particularly South Asian) populations tend to have increased incidence of cardiovascular disease and CKD. From this analysis, it is evident that black and Asian patients are being prescribed SGLT2i at a lower rate as compared to white patients. This discrepancy is most seen in primary care providers and cardiologists, but pertinent for all specialties. Although our study highlights a potential underlying bias in differences in prescriber habits across racial groups, our comparison does not adjust for other confounding factors such as insurance, drug affordability, and contraindication rates.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843080","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 Familial Hypoalphalipoproteinemia: A Case Report","authors":"","doi":"10.1016/j.jacl.2024.04.030","DOIUrl":"10.1016/j.jacl.2024.04.030","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>A 37-year-old Caucasian female was referred for cardiology evaluation of dyslipidemia. Her past medical history included mitral valve prolapse, Gilbert syndrome, hypertension, and aortic atherosclerosis. The patient was physically active with no history of smoking, diabetes, or other cardiovascular risk factors. Family history was notable for low HDL-C levels in the patient's father and sister, with no known premature CAD. Physical examination revealed BMI of 21, well controlled blood pressure, and normal cardiovascular exam.</p><p>Initial lipid panel revealed total cholesterol (TC) 47 mg/dL, HDL-C 5 mg/dL, LDL-C 24 mg/dL, triglycerides 80 mg/dL, and VLDL 18 mg/dL. Further laboratory testing showed apolipoprotein B of 52 mg/dL, normal lipoprotein (a), and normal high-sensitivity CRP. Liver function tests, complete blood count, thyroid function tests, total serum protein, and basic metabolic profile were also normal. Genetic testing showed 2 variants of undetermined significance to the ABCA1 gene [ABCA1 c.2879T&gt;C (p.Leu960Pro); ABCA1 c.3626C&gt;T (p.Pro1209Leu)].</p></div><div><h3>Objective/Purpose</h3><p>N/A</p></div><div><h3>Methods</h3><p>N/A</p></div><div><h3>Results</h3><p>A coronary artery computed tomography (CTCA) demonstrated borderline obstructive areas of eccentric calcified plaque in the mid to distal left anterior descending (LAD) artery with 40-50% luminal diameter narrowing, nonobstructive eccentric calcified plaque in the proximal left circumflex (LCX) artery with less than 40% luminal diameter narrowing, and obstructive plaque in the mid right coronary artery (RCA) with greater than 50% luminal diameter narrowing, with whole-heart Agatston score of 981. A CT coronary angiography scan with fractional flow reserve (FFR) revealed a modeled stenosis in the mid RCA that demonstrated normal FFR measurement of 0.81, although was significant for abrupt relative change (.18) across the lesion. Invasive coronary angiography revealed nonobstructive coronary artery disease, demonstrating mid RCA 50% stenosis, mid LAD 40% stenosis, and ostial LCX 30% stenosis. The patient was initiated on statin and aspirin therapy. A fasting lipid profile at 2-month interval showed TC 26 mg/dL, LDL-C 5 mg/dL, and HDL-C remaining at 5 mg/dL.</p></div><div><h3>Conclusions</h3><p>Given ABCA1 gene variants, with absence of phenotypic findings of Tangier disease, the patient was presumed to have familial hypoalphalipoproteinemia. The inverse relationship between low HDL-C levels and cardiovascular risk has been well documented in population based observational studies. However, clinical trials have failed to show clinical benefit of therapy targeting increasing HDL-C levels. Further studies are needed to determine optimal medical therapy aimed at prevention of CAD in this population which may be genetically predisposed to higher risk of early coronary disease.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841351","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":"Trends in Age-Adjusted Cardiovascular Mortality Rates with Hyperlipidemia among the United States Population, from 1999–2023: A CDC Wonder Database Study","authors":"","doi":"10.1016/j.jacl.2024.04.055","DOIUrl":"10.1016/j.jacl.2024.04.055","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Despite the progress made in managing hyperlipidemia in recent years, the mortality trends among the general population in the United States remain understudied. The lack of evidence in the demographic variations hampers the ability to implement evidence-based interventions on community-based levels. Our synthesis is to analyze the trends in hyperlipidemia-related mortality among United States residents by demographic characteristics such as age, gender, race or ethnicity, urbanization, and census region. Furthermore, state-wise age-adjusted mortality rates (AAMR) and county-wise data for highly prevalent states were subsequently analyzed.</p></div><div><h3>Objective/Purpose</h3><p>Prior studies have reported cardiovascular mortality rates in general, but they lack sufficiently updated data and trends among variable demographic groups suffering from hyperlipidemia. Furthermore, there haven't been any prior studies conducted to show specific correlations between mortality rates and certain geographically vulnerable areas.</p></div><div><h3>Methods</h3><p>We abstracted national mortality data from the multiple cause of death/underlying case of death files in the CDC WONDER database retrieved from death certificates nationwide. The ICD-10 codes (E78.0-E78.9) were used to identify any type of hyperlipidemia-related deaths (including familial hypercholesterolemia) among the United States population from 1999 to 2023 in the multiple causes of death section. While ICD codes for cardiovascular (circulatory) system were identified by using I00–I99 for the underlying cause of death as a sensitivity analysis to only measure cardiovascular-related mortality in the hyperlipidemic population. Trends in age-adjusted mortality rate (AAMR) were assessed using joinpoint regression analysis (version 5.0.2) and the data was reported per 100,000 population. For 10-year increment age groups, only crude mortality rates were reported. Results were expressed as annual percentage changes (APC), average annual percentage changes (AAPC), and 95% confidence intervals (CI). For urbanization, the 2013 NCHS Urban-Rural Classification Scheme for Counties was used.</p></div><div><h3>Results</h3><p>Between 1999 and 2023, a total of 639,786 hyperlipidemia patients died secondary to cardiovascular causes within the United States (AAMR = 7.1 per 100,000; 95% CI: 7.0–7.2). Overall mortality trends increased at an annual rate of 6.21% (95% CI: 5.41–7.01) and were much higher in females from 1999–2006 and then 2018–2023; however, in the male population, APC was evidently higher in 1999–2006 and 2018–2021, respectively. Specifically, the trends in crude mortality rate would increase with each age group in 10-year increments, with the most steep rises from 1999–2004 and then 2018 onwards (P&lt;0.001). Hispanic race is least affected amongst all subgroups; however, both non-Hispanic whites and more recently non-Hispanic blacks were increasingly highly af","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141851404","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":"Atlantic Lipid Lowering Treatment Optimization Program (ALLTOP): A Comprehensive Approach to the Treatment of Familial Hypercholesterolemia and Comple","authors":"","doi":"10.1016/j.jacl.2024.04.015","DOIUrl":"10.1016/j.jacl.2024.04.015","url":null,"abstract":"<div><h3>Study Funding</h3><p>This study is supported by an unrestricted grant from Regeneron.</p></div><div><h3>Background/Synopsis</h3><p>Familial hypercholesterolemia (FH) confers a markedly increased risk of ASCVD and mortality if untreated or undertreated. Appropriate lipid lowering therapy relies on the clinician to recognize that a patient could benefit, prescribe the medication, and then use guideline recommended dosage levels. In 2022, the ACC revised their guidelines for using non-statins in patients at high and very high risk with LDL goals less than 70mg/dL and 55 mg/dL respectively. However, on a national level, very few patients with suspected FH ever reach these goals. We previously presented a pilot study where we identified patients in the Atlantic Health System (AHS) EPIC health record with the highest LDLs and reached out to their PCPs to enroll in our lipid clinic, first using EPIC letter, followed by EPIC chat. We found that EPIC chat generated a response rate of 28% compared to a prior response rate of 6.5% using Epic letter; we concluded that using EPIC chat as a method of outreach could help identify and treat the highest risk patients with suspected FH. The ALLTOP study is being initiated as a quality improvement project to address the prevalence of dyslipidemia and cardiometabolic comorbidities among existing AHS patients, particularly those who may be living with undiagnosed/untreated FH.</p></div><div><h3>Objective/Purpose</h3><p>Develop a model for primary and secondary prevention that integrates updated treatment gui-delines for patients with suspected FH.</p></div><div><h3>Methods</h3><p>600 potential participants will be screened and recruited through outreach to PCPs via secure EPIC chat and enrolled on an ongoing, rolling basis until 250 patients are obtained. Baseline LDL-C is taken at the initial visit and patients will be treated with the standard of care. An Advanced Practice Registered Nurse (APRN) will be directing the clinic under physician supervision. Follow-up visits will be scheduled every three to six months, with lab draws scheduled at 24 and 48 weeks to compare baseline LDL-C and goal LDL-C, respectively.</p></div><div><h3>Results</h3><p>The primary endpoint will be the proportion of patients that maintain LDL-C 100 mg/dL after 24 weeks and 48 weeks. The secondary end point will be the proportion of patients that maintain LDL-C &lt;70 mg/dL, LDL-C 55mg/dL, and overall percent reduction in LDL cholesterol.</p></div><div><h3>Conclusions</h3><p>The ALLTOP study will examine the benefit of comprehensive, wrap around, supportive care to lower elevated LDL and sustain healthy levels through 36 months from baseline enrollment using an APRN-led intervention. By screening patients in the EHR, reaching out to their PCPs via secure EPIC chat, and enrolling them in ALLTOP, we plan to show that we can reduce their LDL levels close to the 2022 ACC guidelines.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838366","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}