Journal of clinical lipidology最新文献

{"title":"Multidisciplinary Management of Lipoprotein X-Induced Hyperlipidemia Secondary to Drug-Induced Liver Injury","authors":"Samuel Kim MD, Amrita Krishnamurthy MD","doi":"10.1016/j.jacl.2024.04.028","DOIUrl":"10.1016/j.jacl.2024.04.028","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>A 72-year-old woman presents with pruritis, jaundice, skin lesions, blurred vision, and facial droop. Blood work reveals a total bilirubin of 21.5 mg/dL (15.4 mg/dL direct, 6.1 mg/dL indirect), AST 388 U/L, ALT 444 U/L, alkaline phosphatase 1,900 U/L, sodium 119 mmol/L, total cholesterol >1350 mg/dL, HDL 7 mg/dL, and triglycerides 306 mg/dL; LDL cannot be calculated. Brain magnetic resonance imaging demonstrates no acute pathology. Viral and autoimmune serologies are negative. Magnetic resonance cholangiopancreatography demonstrates no biliary pathology.</p><p>She reports drinking various herbal tea preparations along with an unknown supplement she purchased on television. A liver biopsy demonstrates bile duct injury and centrilobular cholestasis most consistent with drug-induced liver injury. She is treated with ursodiol and bile acid sequestrants however has ongoing symptoms. Her serum viscosity level is elevated and additional testing detects lipoprotein X. She is treated with three rounds of plasma exchange with normalization of her sodium level, resolution of xanthomas and neurologic symptoms, and marked improvement in her lipid panel.</p></div><div><h3>Objective/Purpose</h3><p>Recognize sequelae of lipoprotein X accumulation including pseudohyponatremia, xanthomas, and hyperviscosity. Discuss multidisciplinary management of lipoprotein X-induced hyperlipidemia.</p></div><div><h3>Methods</h3><p>Clinical case management at a tertiary care lipid program.</p></div><div><h3>Results</h3><p>Lipoprotein-X induced hyperlipidemia is a rare lipoprotein disorder. The most common etiologies are cholestatic liver disease, lecithin:cholesterol acyltransferase (LCAT) deficiency, liver graft-versus-host disease, and lipid infusions. With cholestasis, bile excretion and synthesis are inhibited to prevent bile-induced hepatotoxicity. This results in lack of cholesterol excretion into bile and free cholesterol release into blood, where it merges with phospholipids, albumin, and apolipoproteins C and E, to form lipoprotein X. As lipoprotein X does not contain apolipoprotein B, it does not undergo hepatic clearance and its levels are not affected by lipid-lowering therapies such as statins. Lipoprotein X has a similar density to LDL and can lead to false elevations in LDL on standard lipid panels, therefore lipoprotein electrophoresis can be used to detect lipoprotein X.</p><p>Hyperlipidemia induced by lipoprotein X accumulation can lead to numerous clinical sequelae including xanthomas, pseudohyponatremia, and hyperviscosity syndrome with associated neurologic symptoms. The mainstay of therapy is treatment of the underlying cholestatic disorder, however with refractory symptoms therapeutic plasma exchange can provide rapid lipoprotein clearance.</p></div><div><h3>Conclusions</h3><p>Due to lack of LDL receptor-mediated hepatic clearance, traditional lipid-lowering therapies do not have a role in the management of lipoprotei","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e502-e503"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848923","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 Familial Hypercholesterolemia on Coronary Artery Dissection in Patients Undergoing Percutaneous Coronary Intervention (PCI)","authors":"Chris Yang MD,&nbsp;Ugochukwu Egolum MD,&nbsp;Riaz Mahmood DO","doi":"10.1016/j.jacl.2024.04.060","DOIUrl":"10.1016/j.jacl.2024.04.060","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Cardiac catheterization remains the gold standard for the evaluation of obstructive coronary artery disease in patients presenting with acute coronary syndrome (ACS). Although this procedure is lifesaving, there are several potential life-threatening complications such as coronary artery dissection. The impact of familial hypercholesterolemia (FH) on complication rates in patients presenting with acute coronary syndrome has not been well studied.</p></div><div><h3>Objective/Purpose</h3><p>The purpose of this study was to assess the impact of familial hypercholesterolemia on the development of coronary artery dissection in patients presenting with ACS undergoing percutaneous coronary intervention (PCI).</p></div><div><h3>Methods</h3><p>We performed a retrospective analysis of the NIS database from 2016 to 2018 to identify patients presenting with ACS and PCI using ICD-10-CM/PCS codes. We compared the primary outcome of coronary artery dissection in patients with and without familial hypercholesterolemia. The primary outcome was in-hospital mortality, and secondary outcomes were hypertension, acute kidney injury, cardiogenic shock, obesity, type 2 diabetes mellitus, length of stay, and total hospitalization cost. We performed multivariate logistic regression analysis to identify associations for coronary artery dissection.</p></div><div><h3>Results</h3><p>A total of 58,685 patients presented to the hospital with ACS and underwent PCI. The mean age was 64.85 ± 12.70 years, and most patients were male (69.69%) and Caucasian (75.51%). Patients with familial hypercholesterolemia (FH) had a higher coronary artery dissection rate at 2.27% vs. 1.22%, p = 0.52. There was a difference between patients with and without FH for in-hospital mortality, 0% compared to 4.40%, but not statistically significant (p = 0.15). The length of stay was longer for patients without FH, 4.45 days compared to 3.93 days (p = 0.38). Multiple logistic regression analysis revealed that type 2 diabetes was not a statistically significant predictor of coronary artery dissection, Table 1.</p></div><div><h3>Conclusions</h3><p>The presence of familial hypercholesterolemia was not a statistically significant predictor of coronary artery dissection, but cardiogenic shock was statistically significant. Further pragmatic clinical trials are needed to evaluate familial hypercholesterolemia and association with complications in patients presenting with acute coronary syndrome.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e534-e535"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849080","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 Niacin-ER Use, Safety, and Cardiovascular Events. A Single Center Experience.","authors":"Chris Caraang MD,&nbsp;Halima Tabani BSN","doi":"10.1016/j.jacl.2024.04.089","DOIUrl":"10.1016/j.jacl.2024.04.089","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Studies reveal increased incidences of cardiovascular events such as heart attacks and strokes in patients with elevated lipoprotein(a) levels. Niacin-ER has shown to lower lipoprotein(a) levels by approximately 30% though unknown if niacin-ER reduces cardiovascular events in this population. This single center study evaluates 129 patients with a personal or family history of a premature cardiovascular event whose lipoprotein(a) levels were greater than 75nmol/L and prescribed niacin-ER.</p></div><div><h3>Objective/Purpose</h3><p>Identify patients with personal or family history of premature cardiovascular events through history and screen patients for baseline serum lipoprotein(a); levels greater than or equal to 75nmol/L were included. Patients were monitored for incidences of cardiovascular events, elevation of liver enzymes, and side-effects of niacin-ER.</p><p>The study is an effort to determine if niacin-ER can reduce cardiovascular events. While current ASO-RNA and siRNA studies are undergoing trials, niacin-ER may be a less costly alternative.</p></div><div><h3>Methods</h3><p>The study followed 129 adult patients seen by a Board Certified Lipidologist/Cardiologist from 2014-2024 with baseline lipoprotein(a) greater than 75 nmol/L. Patients were started on 1000 mg-2000 mg (mean 1713 mg) of niacin-ER and a high intensity statin. In the study, 118 patients were prescribed niacin-ER, while 11 were a better fit for PCSK-9 therapy. Of the 118 patients, 36 could not tolerate the flushing, despite mitigating strategies. Patients’ hospital and outpatient records were reviewed for cardiovascular events.</p></div><div><h3>Results</h3><p>The average baseline value of lipoprotein(a) was 221.59 nmol/L, higher than 35-70 nmol/L in AIM-HIGH and HPS2-THRIVE trials. Current trials with siRNA and ASO-RNA therapies set inclusion criteria at &gt;150 nmol/L. The average lipoprotein(a) after starting niacin-ER amounted to 157.71 nmol/L, a 33.68% reduction.</p><p>Fifteen patients laboratory tests resulted in non-prohibitive mildly elevated liver function tests (LFTs), with maximum ALT and AST of 85 U/L and 68 U/L, respectively, after starting niacin.</p><p>All patients were on high-intensity statin.</p></div><div><h3>Conclusions</h3><p>Niacin-ER reduced lipoprotein(a) levels by 33.68%, comparable to published data of 30%.</p><p>Niacin-ER continues to be shown as safe and well-tolerated with no incidences of strokes, infections, gastrointestinal symptoms, or rhabdomyolysis; there was a non-significant elevation in LFTs.</p><p>In the 83 patients taking niacin-ER, there were no subsequent cardiovascular events up to ten years follow up.</p><p>Reduction in cardiovascular events could not be observed with the low sample size. The study reinforces the need to further assess the effectiveness of niacin-ER on cardiovascular events while prospective therapies continue through trials.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e554-e555"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852369","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 Rare Encounter: Familial Lipoprotein Lipase Deficiency in Pregnancy - Case Review and Emerging Therapies for Familial Chylomicronemia Syndrome","authors":"Aman Rajpal MD,&nbsp;Yasmin Bains DO","doi":"10.1016/j.jacl.2024.04.027","DOIUrl":"10.1016/j.jacl.2024.04.027","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Familial Chylomicronemia Syndrome (FCS) is a rare autosomal recessive disorder affecting chylomicron metabolism, resulting in severe hypertriglyceridemia (sHTG) associated with recurrent acute pancreatitis (AP). We present a case of young woman with a rare instance of familial lipoprotein lipase (LPL) deficiency during pregnancy.</p></div><div><h3>Objective/Purpose</h3><p>Despite that FCS is associated with poor quality of life and increased lifelong risk of sHTG and AP, there is lack of awareness about the disease. We aim to describe clinical features and complications associated with FCS, with the overarching objective of enhancing awareness regarding this condition. Additionally, we explore emerging therapies for the treatment of sHTG.</p></div><div><h3>Methods</h3><p>Literature review and retrospective review of electronic health records were performed.</p></div><div><h3>Results</h3><p>17-year-old Guatemalan female at 25 weeks gestation presented with acute abdominal pain and was found to have a lipase of 4076 mg/dL, amylase of 860 mg/dL and triglyceride (TG) level of 2233 mg/dL requiring apheresis for sHTG induced AP. She re-presented multiple times with sHTG and required treatment for recurrent AP. Genetic testing showed homozygous LPL gene mutation involving novel early truncation and ABCA1 transporter heterozygosity linked to reduced HDL levels. Patient continues to experience a sequela of complications despite treatment with fibrates, statins, omega-3-acid ethyl esters and a low-fat diet.</p></div><div><h3>Conclusions</h3><p>There are currently no treatments for FCS except for lifelong fat restrictive diet. Orlistat, a gastric and pancreatic lipase inhibitor has shown some promise in terms of reducing TG levels. Prior therapies have targeted various phenotypes of sHTG in familial combined hyperlipidemia syndromes with off-label use in FCS. More recently, targeted pharmacotherapies for FCS including apoC-III hepatocyte-directed antisense oligonucleotide such as Volanesorsen (approved in Europe) and Olezarsen (currently in phase-3 trial) have shown promise. Preliminary results from the CORE trials have shown significant reduction in TG levels in FCS patients and 100% reduction in AP. Additionally, small interfering ribonucleic acid (siRNA) based therapies are being studied in patients with FCS.</p><p>Albeit a rare genetic disorder, FCS should be suspected in patients with sHTG in the absence of secondary causes and should be referred to lipid specialists for further management. FCS in pregnancy can pose even more challenges given increased insulin resistance and fetal and maternal burden of disease. Trials for novel targeted therapies have shown encouraging results and may help reduce ASCVD risk and complications associated with FCS.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e502"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841924","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 Role of Structured Inpatient Lipid Protocols in Optimizing Non-Statin Lipid Lowering Therapy: A Review and Single-Center Experience","authors":"Chad Gier MD,&nbsp;Ian Gilchrist MD,&nbsp;Matthew Fordham MD,&nbsp;Nidhi Patel MD,&nbsp;Ella Milchan,&nbsp;Azad Mojahedi MD,&nbsp;Sahana Choudhury NP-C,&nbsp;Andreas Kalogeropoulos MD,&nbsp;John Reilly MD,&nbsp;Luke Riordan MD,&nbsp;Tara Kitz RN,&nbsp;Regina Cohen,&nbsp;Joseph Dougherty PharmD,&nbsp;On Chen MD,&nbsp;Tahmid Rahman MD","doi":"10.1016/j.jacl.2024.04.046","DOIUrl":"10.1016/j.jacl.2024.04.046","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;p&gt;Dyslipidemia is a leading contributor to atherosclerotic cardiovascular disease (ASCVD). There has been a significant improvement in the treatment of dyslipidemia in the past 10 years with the development of new pharmacotherapies. However adherence to guidelines and patients being prescribed appropriate therapy can be improved.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;p&gt;The intent of this review is help enhance clinicians understanding of non-statin lipid lowering therapies in accordance with the 2022 American College of Cardiology Expert Consensus Clinical Decision Pathway (ECDP) on the Role of Non-statin Therapies for LDL-Cholesterol Lowering. We also present a single-center experience implementing a systematic inpatient protocol for lipid lowering therapy (LLT) for secondary prevention of ASCVD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We review the clinical trials for ezetimibe, evolocumab, alirocumab, inclisiran, bempedoic acid and summarize how the medications are implemented for use in the 2022 American College of Cardiology Expert Consensus Clinical Decision Pathway. We conducted a quality improvement retrospective chart analysis study to assess the proportion of patients admitted with non-ST-elevation myocardial infarction or ST-elevation myocardial infarction who underwent percutaneous coronary intervention and were prescribed LLT at discharge from 1/1/2018 to 08/20/2021. A structured inpatient lipid protocol was implemented with the aim of identifying very-high-risk patients, standardizing the initiation and escalation of LLT, and ensuring appropriate monitoring and follow-up. We identify patients admitted with ASCVD event, and obtain baseline LDL-C level. Our pharmacist reviews the patients in the cardiology units and will make recommendations for next step in management. For patients on statin with an LDL-C above 70mg/dL or not on a statin with an LDL-C above 150mg/dL, we maximize the statin and add a PCSK9 inhibitor on discharge. For patients on statin with an LDL-C below 70mg/dL or not on a statin with an LDL-C below 150mg/dL, we maximize the statin and add either ezetimibe or bempedoic acid. The inpatient case manager determines cost and coverage and communicates with the care management specialist to ensure follow up on authorization for medications. For very high risk patients, a referral is placed in the electronic medical record to our advanced lipid management program and the office calls patient to ensure follow up visit is scheduled with repeat lipid panel checked in 4-12 weeks. Cases are reviewed with the lipidologists, care managers, and nurses during a weekly lipid board to discuss treatment plans for the patients scheduled for the upcoming week.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Prior to implementation, review of patients from 1/1/2018 to 08/20/2021, our analysis found that 92% of these patients were prescribed statin therapy, but only 66.2% of them had an LDL-C level below 70 mg/dL at their s","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e516-e518"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952465","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":"Disparities in access to pharmacotherapies for weight loss and cardiovascular prevention","authors":"P. Barton Duell MD,&nbsp;Kevin C. Maki PhD","doi":"10.1016/j.jacl.2024.08.001","DOIUrl":"10.1016/j.jacl.2024.08.001","url":null,"abstract":"","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e485-e487"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096117","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":"Real-World Evaluation of Lipid Testing Rate and Treatment Target Attainment Among High-Risk Patients: Post Release of the 2018 AHA/ACC Practice Guidelines","authors":"Jay Visaria PhD,&nbsp;Eric Stanek PharmD,&nbsp;Jeff White PharmD,&nbsp;Mark Cziraky PharmD,&nbsp;Nilesh Gangan PhD","doi":"10.1016/j.jacl.2024.04.016","DOIUrl":"10.1016/j.jacl.2024.04.016","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>The 2018 AHA/ACC clinical practice guidelines set standards for treatment selection and low-density lipoprotein cholesterol (LDL-C) lowering among patients with atherosclerotic cardiovascular disease (ASCVD) and/or type 2 diabetes mellitus (T2DM). However, real-world evidence on rates of lipid testing and LDL-C target attainment following guideline directed treatment (GDT) post-release of practice guidelines is limited.</p></div><div><h3>Objective/Purpose</h3><p>To assess the rates of lipid testing among patients with ASCVD and/or T2DM pre and post initiating statins or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and the extent of LDL-C target attainment in 12 months post-initiation after GDT versus non-GDT post-release of practice guidelines.</p></div><div><h3>Methods</h3><p>Adults initiating statins or PCSK9i between 01/01/2019 and 12/31/2020 with prior evidence of ASCVD and/or T2DM, and health plan enrollment for 12-month pre- and post-index pharmacy claim date (either statin or PCSK9i) were identified from the Healthcare Integrated Research Database. Lipid testing patterns and LDL-C target attainment rates (&lt;70mg/dL) based on procedure codes or available lab results were examined. GDT was defined as high-intensity statin initiation in patients with ASCVD, moderate- or high-intensity statin initiation in patients with T2DM without ASCVD, PCSK9i in patients with ASCVD added to high-intensity statin and sustained high-intensity statin while persistent on PCSK9i during the 12 months follow-up period. Descriptive statistics were reported, and no statistical testing was performed.</p></div><div><h3>Results</h3><p>In total, 71,581 statin initiators with ASCVD/T2DM, and 3,038 PCSK9i initiators with ASCVD were included (mean age: 61-65 years; males: 55-60%). Among statin initiators and PCSK9i initiators with prior ASCVD, 72% and 79% had lipid testing during 12-month baseline, and 69% and 75% during 12-month follow-up, respectively. LDL-C target attainment rates during 12-month post-initiation among a subset of patients with at least one valid LDL-C measurement is as follows: 53% in GDT statin initiators with prior ASCVD versus 35% for non-GDT, 35% in GDT statin initiators with prior T2DM without ASCVD versus 16% for non-GDT, 65% among GDT PCSK9i initiators with prior ASCVD versus 53% for non-GDT, and 80% among patients with prior ASCVD with sustained high-intensity statin while persistent on PCSK9i versus 64% for non-persistent PCSK9i/statin.</p></div><div><h3>Conclusions</h3><p>Lipid testing rates were moderate. LDL-C target attainment in high-risk patients with lipid testing treated per 2018 AHA/ACC guidelines (<em>i.e.,</em> GDT) were modestly improved versus non-GDT. Interventions to improve lipid testing rate may increase opportunities for treatment modification based on guidelines and better LDL-C target attainment to help reduce the risk of cardiovascular events.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e494-e495"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838735","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":"Atrial Fibrillation Outcome in Patients with Metabolic Syndrome.","authors":"Francisco Somoza-Cano MD,&nbsp;Brittany Smith BS,&nbsp;Michael Fatuyi MD,&nbsp;Henry Egbuchiem MD,&nbsp;Nkemputaife Onyechi MD,&nbsp;Joseph Amoah MD","doi":"10.1016/j.jacl.2024.04.092","DOIUrl":"10.1016/j.jacl.2024.04.092","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Overweight, in particular, is continuously increasing in the United States of America. In this respect, metabolic syndrome is a strong risk factor for atrial fibrillation.</p></div><div><h3>Objective/Purpose</h3><p>Our study sought to estimate the clinical outcome of patients admitted for atrial fibrillation with a history of metabolic syndrome.</p></div><div><h3>Methods</h3><p>Using the National Inpatients Sample Database of 2020, patients admitted with a principal diagnosis of atrial fibrillation with or without metabolic syndrome as a secondary diagnosis were identified. The primary outcome was inpatient mortality with secondary outcomes being the restoration of cardiac rhythm, acute kidney injury (AKI), ablation, post procedure complications, cardiogenic shock, length of hospital stay and charges.</p></div><div><h3>Results</h3><p>352,160 patients were admitted for atrial fibrillation. Of those, 0.18% had a history of metabolic syndrome. Patient with metabolic syndrome were younger (65 years, 95% C1 63 – 68 VS 71, 95% CI 71 – 71). There was no difference in in-hospital mortality (p=0.1287), ablation (p=0.6724), post procedure complication (p=0.5062), cardiogenic shock (p=0.3777) and acute kidney injury (p=0.9427). We noticed that patient with metabolic syndrome had increased restoration of cardiac rhythm when compared to the general population (p=0.0027). Patient with metabolic syndrome also had increased length of hospital stay (4 days, 95% CI 3.3 – 4.8 VS 3.3, 95% CI 3.3 – 3.4) and hospital charges ($61,006.79, 95% CI 42,662.56 - $79351.02 VS $55394.37 95% CI $ 53470.79 - $57317.95).</p></div><div><h3>Conclusions</h3><p>The study shows there is no statistically significant difference in inpatient mortality among patients with metabolic syndrome when compared to the general population admitted for atrial fibrillation. Patient with metabolic syndrome had increased restoration of cardiac rhythm, length of hospital stays and charges.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e556"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844965","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":"Rates of Lipid Testing among Patients with Atherosclerotic Cardiovascular Disease within a Large Community-Based Health System","authors":"Hsin-Fang Li PhD,&nbsp;Roshanthi Weerasinghe MPH,&nbsp;Staci Wendt PhD,&nbsp;Eduard Sidelnikov MD,&nbsp;Bethany Kalich PharmD,&nbsp;Niranjan Kathe PhD,&nbsp;Tyler Gluckman MD,&nbsp;Andrew Nute MPH","doi":"10.1016/j.jacl.2024.04.013","DOIUrl":"10.1016/j.jacl.2024.04.013","url":null,"abstract":"<div><h3>Study Funding</h3><p>This study was sponsored by Amgen, Inc., Thousand Oaks, California.</p></div><div><h3>Background/Synopsis</h3><p>Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines for blood cholesterol management recommend that patients on cholesterol lowering therapy undergo repeat lipid testing every 3 to 12 months to monitor medication adherence and therapeutic effect. Contemporary rates of testing are not well known.</p></div><div><h3>Objective/Purpose</h3><p>pending</p></div><div><h3>Methods</h3><p>We performed a retrospective cross-sectional analysis of patients with atherosclerotic cardiovascular disease (ASCVD) cared for within a large community-based health system within the western US between January 1, 2017, and December 31, 2022. Percentages of annual cohort snapshots were calculated by lipid testing rates using a 12-month look back, stratified by ASCVD risk status (very high-risk [VHR] vs not very high-risk [NVHR] per ACC/AHA guidelines). Additional analyses were performed to assess whether these percentages varied using 1) a 24-month look back (2018-2022) and 2) a 12-month look back plus 3-month look forward. Lipid tests performed outside of the health system were not available for review.</p></div><div><h3>Results</h3><p>A total of 855,258 unique patients with &gt;1 encounter for ASCVD were identified (annual patient counts ranged between 184,860 in 2017 and 430,481 in 2022). The mean age was 71.7 years, 44.8% were female, and 78.6% were White. Using a 12-month look back, only 33.6% and 37.2% of patients underwent some lipid testing in 2017 and 2022, respectively. Consistently higher percentages had some lipid testing among those that were VHR (36.2% in 2017 and 39.8% in 2022) compared to NVHR (29.2% in 2017 and 33.5% in 2022). With a 24-month look back, percentages with some lipid testing rose for all groups over time (47.8% for all patients, 50.9% for VHR patients, and 42.0% for NVHR patients in 2018; 51.5% for all patients, 54.1% for VHR patients, and 46.6% for NVHR patients in 2022). A similar, but less pronounced pattern was observed using a 12-month look back plus 3-month look forward (42.9% for all patients, 44.9% for VHR patients, and 39.3% for NVHR patients in 2017; 47.5% for all patients, 49.3% for VHR patients, and 44.0% for NVHR patients in 2022).</p></div><div><h3>Conclusions</h3><p>Despite guideline recommendations, a large percentage of patients did not undergo any lipid testing in our health system within 12 or 24 months prior to an encounter involving ASCVD. While annual percentages trended toward categories of higher lipid testing rates over time and were consistently higher among VHR patients, further investigation is needed to identify factors associated with different rates of lipid testing.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e492"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839846","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":"*Real-World Experience with Inclisiran at a Large Academic Lipid Clinic","authors":"Michael Wilkinson MD,&nbsp;Tommy Chiou MD,&nbsp;Pam Taub MD,&nbsp;Donya Mazdeyasnan BS","doi":"10.1016/j.jacl.2024.04.087","DOIUrl":"10.1016/j.jacl.2024.04.087","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Inclisiran is an siRNA that targets PCSK9 and lowers LDL-C by approximately 50%. Inclisiran is unique among lipid-lowering therapies (LLTs) available for LDL-C reduction as it is administered via subcutaneous injection by a healthcare professional every 6 months. Real-world data examining inclisiran use in US clinical practice are limited.</p></div><div><h3>Objective/Purpose</h3><p>Examine patient characteristics and LDL-C reduction during the initial two-year experience with inclisiran at a large academic lipid clinic.</p></div><div><h3>Methods</h3><p>We performed a retrospective chart review of 60 patients at a large academic lipid clinic who were prescribed inclisiran between March 2022 to November 2023 and had follow-up LDL-C measurements taken ≥ 30 days after initiating treatment as part of routine care. Background LLT was extracted from the medical record and reflects treatment at time of inclisiran initiation. Absolute and percent LDL-C reduction was examined during follow-up. LDL-C reduction from baseline was assessed within group using a paired samples t-test with two-sided p &lt; 0.05 considered significant.</p></div><div><h3>Results</h3><p>Among 60 patients, mean (± SD) age was 71 ± 9.2 years (52% women, 90% White, 2% Hispanic/Latino, 8% Asian), 87% with history of ASCVD, 70% with statin intolerance, 20% with HeFH, and 50% on background statin therapy (Table). During the 4.4 ± 2.8 months of follow-up from first dose of inclisiran to first LDL-C measurement, 2 patients had received three doses of inclisiran, 34 patients had received two doses, and 24 patients had received one dose. LDL-C decreased from 107 ± 47 mg/dL at baseline to 67 ± 42 mg/dL at first follow up (-37%, p &lt; 0.001). Excluding patients that switched from a PCSK9i monoclonal antibody (mAb) within approximately one month prior to starting inclisiran (n=12) or patients on no background LLT at time of inclisiran initiation (n=9), patients saw a decrease in mean LDL-C from 102 ± 42 mg/dL at baseline to 54 ± 40 mg/dL at first follow-up ((n=39) -47%, p &lt;0.001) (Figure).</p></div><div><h3>Conclusions</h3><p>Patients that remained on background lipid-lowering therapy and did not switch from PCSK9i mAb to inclisiran observed LDL-C reductions of approximately 50%, consistent with inclisiran clinical trials. Additional real-world data examining the impact of inclisiran on LDL-C are needed, across multiple centers and among patients on various background LLT regimens.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e553-e554"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840622","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}