Journal of clinical lipidology最新文献

{"title":"Association of lipids and lipid-lowering drugs with peripheral arterial disease: A Mendelian randomization study","authors":"Mengjun Tao MD, Yuanxiang Zhang MD, Qi Li MD, Xuebing Feng PhD, Cheng Ping MD","doi":"10.1016/j.jacl.2024.06.007","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.06.007","url":null,"abstract":"It remains unclear whether lipid profiles and lipid-lowering medications are causally related to PAD. Explain whether there is a causal relationship between lipid status and lipid-lowering drugs and PAD. In this two-sample Mendelian randomization (MR) analysis, we assessed the causal relationship between lipid traits, including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs), total cholesterol (TC), and LDL-associated genetic variants (), and the risk of peripheral arterial disease (PAD) using genetic variants associated with these lipid markers. The study analyzed data from 1,654,960 individuals derived from the Global Lipid Genetics Consortium and the UK Biobank, ensuring a robust and comprehensive genetic insight into the effects of lipid dysfunction on PAD. We found genetically predicted associations between HDL (: 0.83, 95% : 0.83-0.77), LDL-c (: 1.29, 95% : 1.12-1.50), TC (: 1.14, 95% : 1.01- 1.29), TG (:1.16, 95% : 1.04-1.24), (: 1.31, 95% : 1.16-1.48), and (:0.84, 95%: 0.77-0.97), and the risk of PAD. In addition, inhibition of was associated with a reduced risk of PAD (:0.68, 95% : 0.57-0.79, <0.001), while no association between the other three gene proxies of LDL inhibition including (=1.21, 95% : 0.87-1.69, =0.250), NPC1L1 (:0.77, 95% 0.44-1.33, =0.344), and APOB (:1.01, 95% :0.87-1.26, =0.890), and the risk of PAD were found. Based on genetic evidence, dyslipidemia is an important risk factor for PAD. PCSK9 inhibitors may be an effective strategy for the treatment of PAD.","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"80 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141611954","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":"What's next for lipoprotein(a)? A national lipid association report from an expert panel discussion","authors":"Marlys L. Koschinsky PhD FNLA FRSC, Daniel E. Soffer MD FNLA FACP, Michael B. Boffa PhD","doi":"10.1016/j.jacl.2024.06.005","DOIUrl":"https://doi.org/10.1016/j.jacl.2024.06.005","url":null,"abstract":"This is an exciting time in the lipoprotein(a) (Lp(a)) field. Attention to this important lipoprotein and potent cardiovascular risk marker is transitioning from the purview of the specialist to that of the general practitioner. Its clinical adoption as an important test is increasing in momentum. There is evidence that Lp(a) contributes to the pathology of atherothrombotic disease, aortic valve stenosis, and childhood ischemic strokes. Three large, Phase 3, randomized, cardiovascular outcomes trials in which Lp(a) is specifically and substantially lowered by mRNA-directed therapies in secondary prevention settings are in progress and will start to report results as early as 2025. Regardless of outcomes, there remain many unanswered questions about Lp(a), ranging from fundamental unknowns about Lp(a) biology, to the complexity of its measurement, optimal screening strategies, and clinical management in individuals with high Lp(a) levels both with and without overt cardiovascular disease. Accordingly, The National Lipid Association (NLA) convened an Expert Discussion involving clinicians and fundamental researchers to identify knowledge gaps in our understanding of Lp(a) biology and pathogenicity and to discuss approaches in the management of elevated Lp(a) in different clinical settings. (183 words)","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"20 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141611955","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":"Attitudes and Barriers to Lipoprotein(a) Testing: A Survey of Providers at the University of Pennsylvania Health System","authors":"Archna Bajaj MD,&nbsp;Jillian D'souza BS","doi":"10.1016/j.jacl.2024.04.007","DOIUrl":"10.1016/j.jacl.2024.04.007","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Lipoprotein(a) [Lp(a)] is an independent, genetic, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Elevated Lp(a) levels increase a person's risk for myocardial infarction, coronary artery disease, ischemic stroke, and aortic stenosis. Guidelines generally recommend testing for Lp(a) in high-risk patients, with some recent guidelines recommending testing once in all adults. It is estimated that &gt;20% of the population carry Lp(a) levels high enough to increase risk, however due to undertesting, many of these patients have not been identified.</p></div><div><h3>Objective/Purpose</h3><p>To understand the attitudes and barriers to testing for Lp(a) across relevant clinical settings and specialties at the University of Pennsylvania Health Systems (UPHS).</p></div><div><h3>Methods</h3><p>A brief IRB-approved survey in REDCap was distributed via email to select groups of UPHS providers in Cardiology, Neurology, Primary Care, and Vascular Surgery.</p></div><div><h3>Results</h3><p>The survey was sent to approximately 525 providers in December 2023. Of these, 116 providers completed the survey (54% Internal Medicine/Family Practice, 31% Cardiology, 10% Neurology, 4% Vascular Surgery). Approximately 31.0% (n=36) of all providers routinely tested for Lp(a) in their practice, but this varied by specialty (44% of Cardiologists versus 22% of Internal Medicine/Family Practice providers). For these providers, the most common reasons for testing included a familial history of ASCVD, a history of ASCVD in the patient, and high cholesterol (Table 1). A total of 80 providers (69%) responded that they do not regularly test for Lp(a). The most common reasons for not testing included lack of familiarity with Lp(a), insurance/billing concerns, lack of clinical trial outcomes data, and lack of available pharmaceutical interventions (Table 2).</p></div><div><h3>Conclusions</h3><p>While there is likely selection bias in the providers who chose to complete the survey, a surprisingly high number of responders (69%) described not regularly testing for Lp(a) in their practice. While results from ongoing clinical trial investigations of novel Lp(a)-lowering treatments may address provider hesitation toward utility of Lp(a)-testing, there is still a large gap to fill in Lp(a) awareness. Increasing provider knowledge of Lp(a) and incorporation into broader clinical guidelines are needed.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e487-e488"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838428","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":"Familial Hypercholesterolemia: Can Continuing Medical Education Help Address Barriers to Screening in Children?","authors":"Pamela Morris MD,&nbsp;Seth Martin MD,&nbsp;Carole Drexel PhD,&nbsp;Kristin Della Volpe BA","doi":"10.1016/j.jacl.2024.04.064","DOIUrl":"10.1016/j.jacl.2024.04.064","url":null,"abstract":"<div><h3>Study Funding</h3><p>This CME activity was supported by an educational grant from Regeneron Pharmaceuticals, Inc.</p></div><div><h3>Background/Synopsis</h3><p>Despite the clear benefit of early treatment of homozygous familial hypercholesterolemia (HoFH) in reducing the risk of progressive atherosclerotic cardiovascular disease (ASCVD), many patients remain undiagnosed until advanced ASCVD is present. Diagnostic delays may relate to low screening rates found among at-risk children &lt;9 years old.</p></div><div><h3>Objective/Purpose</h3><p>To study the impact of an online CME program to enhance health care providers' (HCPs') competence in diagnosing and managing HoFH and to overcome barriers to screening for at-risk children.</p></div><div><h3>Methods</h3><p>A 60-minute CME activity was launched live online on 8/2/23 and is available on-demand for 1 year. Knowledge, attitude, and practice-pattern questions were administered before and immediately after the activity (pre vs post). Chi-square tests compared paired responses (P&lt;0.05; pre/post).</p></div><div><h3>Results</h3><p>As of 1/2/24, 260 HCPs engaged in the program (30% cardiologists, 6% endocrinologists, 29% PCPs; 17% specialize in lipid management or are lipidologists). Nearly 60% of HCPs reported managing patients with very high lipid levels (&gt;400 mg/dL) and the average number of patients with very high lipid levels managed by these participants is 17 per year (approximately 5 of whom are &lt;9 years of age). HCPs' knowledge of the diagnostic criteria for HoFH (30% vs 58%), mechanism of action of ANGPTL3 inhibitors (22% vs 43%), and treatment intensification strategies (48% vs 62%) increased significantly during the CME activity.</p><p>Before the activity, approximately 20% of respondents did not measure lipid levels in children &lt;9 years old, 20% only measured in children with a parent diagnosed with familial hypercholesterolemia (FH) or with a family history of CVD, and 24% only measured in children with HoFH symptoms. After the activity, HCPs estimated that 60% of their patients with very high lipid levels (&gt;400 mg/dL) may have undiagnosed HoFH. The proportion of HCPs who strongly agreed with the American Academy of Pediatrics' recommendation for lipid screening for children with a genetic risk of FH or ASCVD as early as age 2 years increased from 14% to 37%.</p></div><div><h3>Conclusions</h3><p>CME can break down barriers to lipid screening in children at risk for HoFH by enhancing HCPs' knowledge of HoFH diagnosis and risk factors. While the activity enhanced knowledge about the evolving treatment landscape, future education on guidelines and treatment intensification can address remaining gaps in the adoption of best practices and novel agents for HoFH.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e537-e538"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839781","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":"*Pericardial and Pleural Effusions after Evolocumab in a Patient with Severe Familial Hypercholesterolemia","authors":"Maia Pavlovic BA,&nbsp;Eugenia Gianos MD,&nbsp;Anthony Szema MD,&nbsp;Tia Bimal MD","doi":"10.1016/j.jacl.2024.04.034","DOIUrl":"10.1016/j.jacl.2024.04.034","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;p&gt;Inhibitors of PCSK9 by monoclonal antibodies (PSCK9mAb) are efficacious lipid lowering therapies with established outcome benefits. Side effects include nasopharyngitis, influenza-like illness, and injection site reactions.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;p&gt;To describe a less-commonly reported adverse reaction to evolocumab in a patient with severe familial hyperlipidemia (FH), outline applicable testing, and treatment strategies.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We report a patient with severe FH who developed fever, elevated liver function tests (LFTs), pericardial and pleural effusions with evolocumab.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A 70-year-old gentleman with hyperlipidemia presented to preventive cardiology clinic for consultation. His baseline LDL-cholesterol (LDL-C) was 400 mg/dL and examination revealed bilateral arcus senilis and xanthomas. Patient's paternal family members were all on lipid-lowering therapy although there were no early atherosclerotic events. Dutch criteria scoring was 21 (definite FH). His lifestyle was optimal, including a Mediterranean diet with daily walking. Risk assessment revealed a calcium score of 3000 AU, carotid atherosclerosis, and lipoprotein (a) of 233.1 nmol/L. Treatment with ezetimibe 10 mg oral daily and rosuvastatin 40 mg oral daily was initiated, achieving a post-treatment LDL-C of 130 mg/dL. To further improve the patient's outcomes by targeting a LDL-C of &lt;70 mg/dL, evolocumab 140 mg subcutaneous biweekly was prescribed. After the first dose, he had fever. Two weeks after the second dose, he was hospitalized with: fever, elevated inflammatory markers and LFTs, pericardial and pleural effusions. Discontinuation resolved symptoms. Post-hospital discharge, laboratory abnormalities normalized. Colchicine and steroids were administered for pericarditis.&lt;/p&gt;&lt;p&gt;This case underscores complexities of managing lipid disorders when confronted with adverse reactions. Based on delayed-onset symptoms and laboratory abnormalities after medication, it is critically-important to consider the possibility of an immune-mediated reaction. The needle cover of the single-dose prefilled autoinjector of evolocumab contains a derivative of latex, a potential risk factor for triggering Gell-Coombs Type I and IV allergic reactions in latex-sensitive individuals. Percutaneous latex skin prick testing is pending. Evolocumab is fully humanized, reducing the risk of immunogenicity, yet this does not exclude adverse drug reactions. The mechanism for common adverse events associated with monoclonal antibodies involves a cytokine-mediated type alpha immune response, explaining flu-like symptoms and injection site reactions. Because of our patient's extensive atherosclerotic disease, additional evaluation will assist us in risk-stratifying treatment: alirocumab, inclisiran, evanicumab or lipoprotein apheresis to reach a target LDL-C of &lt;70 mg/dL.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e506-e507"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845257","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":"Lipoprotein (a) Discovery Project: Initiative to Identify Awareness and Models of Lipoprotein (a) Testing for National Education","authors":"David Pena,&nbsp;Liz Olson BA,&nbsp;Michelle Congdon MBA,&nbsp;Kristin Colson MS","doi":"10.1016/j.jacl.2024.04.010","DOIUrl":"10.1016/j.jacl.2024.04.010","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Funding&lt;/h3&gt;&lt;p&gt;Novartis is proud to support the American Heart Association's Lp(a) Discovery Project.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;p&gt;It is estimated that 1 in 5 Americans have high lipoprotein (a) [Lp(a)] levels. High levels of Lp(a) are an independent, predominantly inherited, and causal risk factor for atherosclerotic cardiovascular disease even in the setting of effective reduction of plasma low-density lipoprotein cholesterol. Race and ethnicity also play a role in Lp(a) regulation. There are currently no standard management approaches for diagnosis or risk assessment, nor any targeted treatments available to lower Lp(a).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;p&gt;The American Heart Association (AHA) is implementing a national 3-year initiative called the Lp(a) Discovery Project to understand system-level practice patterns for patients tested for elevated Lp(a). We aim to improve the number of patients tested for Lp(a) by improving processes and workflows across care settings through dissemination of national testing models.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;The AHA has engaged 10 champions from diverse health systems with established Lp(a) screening processes and workflows to participate in a Learning Healthcare System model called an Expert Forum. The health systems share best practices and inform on models for Lp(a) testing. Virtual, monthly AHA-led consultant interviews with the health systems are used to document existing provider and health system level Lp(a) testing processes, resources, and barriers. Findings are presented quarterly during virtual Expert Forum meetings, with all participating health systems, to come to consensus on models for national dissemination. Professional education topics identified during these calls are explored to build awareness for the importance of Lp(a) testing. Data on testing rates will be collected through the AHA's Get With The Guidelines (GWTG)-Stroke and GWTG-Coronary Artery Disease modules.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;From consultations, AHA found that Lp(a) testing awareness for providers and patients varies. There is inconsistent provider knowledge about the importance of Lp(a) testing for a patient's overall cardiovascular risk profile. Providers are sometimes reluctant to order an Lp(a) test because of lack of awareness of next steps for patients with elevated Lp(a), such as intensive management of other risk factors. There is also a need to educate providers on how to talk with their patients about Lp(a) testing and cascade testing for family members for those who have elevated Lp(a).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Improving provider and patient awareness of the importance of Lp(a) testing is critical to improving patient care. The Lp(a) Discovery Project is identifying gaps in patient and professional education for Lp(a), barriers to streamlined testing, and implementing strategies to improve national Lp(a) testing rates through professional education a","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e489-e490"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845530","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":"Lomitapide in Pediatric Patients with Homozygous Familial Hypercholesterolemia – Analysis of Secondary and Safety Endpoints from the APH-19 Study","authors":"Claus Schmitt MD,&nbsp;Alberto Zambon MD,&nbsp;Christina Taylan MD,&nbsp;Joenna Driemeyer MD,&nbsp;Hofit Cohen MD,&nbsp;Paola Buonuomo MD,&nbsp;Abdullah Alashwal MD,&nbsp;Mohammed Al-Dubayee MD,&nbsp;José Diaz-Diaz MD,&nbsp;Faouzi Maatouk MD,&nbsp;Sergio Martinez-Hervas MDMD,&nbsp;Brian Mangal MSc,&nbsp;Naji Kholaif MD,&nbsp;Sandra Löwe MD,&nbsp;Zsuzsanna Tamas MD,&nbsp;Luis Masana MD","doi":"10.1016/j.jacl.2024.04.076","DOIUrl":"10.1016/j.jacl.2024.04.076","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Homozygous familial hypercholesterolemia (HoFH) is characterized by mutations in the low-density lipoprotein (LDL) receptor leading to highly elevated levels of LDL-cholesterol (LDL-C). As a result, patients with HoFH develop atherosclerotic cardiovascular disease in childhood and have a low life expectancy of ∼18 years without appropriate treatment. Diagnosis in early childhood is essential to reduce morbidity and mortality. Lomitapide is a selective microsomal triglyceride transfer protein inhibitor approved for adults with HoFH that works independently of the LDL receptor to lower LDL-C. APH-19 (NCT04681170) is the first clinical trial of lomitapide in pediatric patients with HoFH and met its primary endpoint (LDL-C reduction of -53.5% at Week 24; p&lt;0.0001).</p></div><div><h3>Objective/Purpose</h3><p>We report additional parameters from APH-19 relating to the efficacy and safety of lomitapide in pediatric patients.</p></div><div><h3>Methods</h3><p>APH-19 is a phase 3, open-label, single-arm clinical trial in HoFH patients aged 5–17 years (N=43) consisting of a run-in period followed by 24-week efficacy and 80-week safety phases. Patients were stratified by age into three dose escalation groups, where the maximum doses were 20, 40 and 60 mg. Here, additional data at Week 24 of patient-level LDL-C reductions, lipoproteins (apolipoprotein B [ApoB] and lipoprotein A [Lp(a)]) and additional safety endpoints (growth/maturation and fat-soluble vitamin levels) are reported.</p></div><div><h3>Results</h3><p>Lomitapide treatment resulted in up to a 95% reduction of LDL-C from baseline at Week 24 with 53.5% of patients (n=23) having &gt;50% reduction in LDL-C from baseline (Figure). Mean reduction in ApoB was -52.4% at Week 24 (p&lt;0.0001); an ApoB subgroup analysis indicated general consistency across a range of parameters. Mean change from baseline in Lp(a) was -23.6% (p=0.0030) for nmol/L methodology and -11.3% (p=0.2884, Fisher Combined p-value p=0.0070) for mg/dL analysis. Subgroup results will be presented.</p><p>There were no clinically significant mean changes in weight or height from Baseline to Week 24. The mean change in weight-for-age Z-score was -0.371 for patients aged 5–10 years (11–17, N/A). Changes in height-for-age Z-score were -0.064 and -0.060 for patients aged 5–10 and 11–17 years, respectively. Fat-soluble vitamins at Week 24 were within normal range for individuals aged 5–17 years; vitamin E increased in 10.0% of patients aged 5–10 years, considered mild in severity.</p></div><div><h3>Conclusions</h3><p>These data further support the efficacy and safety of lomitapide across various parameters in pediatric patients. The lack of impact on patient maturation endpoints is encouraging; however, further long-term data are required.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e545-e546"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845760","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":"Accelerated Atherosclerosis in a Patient With Multifactorial Chylomicronemia Syndrome (MCS), Elevated Lp(a), APOE2/4 Genotype and Diabetes Mellitus.","authors":"Mendel Roth PhD,&nbsp;Tiffany Haynes MD,&nbsp;Robert Fishberg MD,&nbsp;Loba Alam MD","doi":"10.1016/j.jacl.2024.04.065","DOIUrl":"10.1016/j.jacl.2024.04.065","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;p&gt;Multifactorial chylomicronemia syndrome (MCS), also known as type V hyperlipoproteinemia, is a rare polygenic disorder characterized by severe hypertriglyceridemia. It is triggered by uncontrolled diabetes mellitus (DM), obesity, metabolic syndrome, and certain medications. It is not known whether hypertriglyceridemia associated with MCS accelerates atherosclerotic cardiovascular disease (ASCVD).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;p&gt;To speculate the relationship between ASCVD in a patient with hypertriglyceridemia caused by MCS, uncontrolled DM, and polymorphic APOA5, APOE2/4, LMF1 and LP(a) intron mutations.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We present a 60-year-old male with PMH of severe hypertriglyceridemia (highest 6000mg/dL) with acute pancreatitis at age 40, CAD s/p CABG at age 50, PAD s/p bypass at age 57, HTN, mixed hyperlipidemia, uncontrolled DM, and family history of premature ASCVD. He was subsequently followed at the advanced lipid clinic where his medications included rosuvastatin, ezetimibe, evolocumab, fenofibrate, and icosapent ethyl. He underwent advanced genetic testing with GBinsight.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;GBinsight identified various polymorphic genes causing hypertriglyceridemia as follows:&lt;/p&gt;&lt;p&gt;APOA5 - c.*158C&gt;T(rs2266788)&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;p&gt;This variant is found in ∼10% of the global population and has been associated with hypertriglyceridemia by multiple genome-wide association studies.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;APOA5 - c.457G&gt;A(p.Val153Met)(rs3135507)&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;p&gt;This variant is found in ∼5-10% of the global population and has been associated with modest hypertriglyceridemia and lower HDL-C in the UKBiobank cohort.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;APOE2&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;p&gt;This allele has been associated with a reduction of the major lipolytic enzyme, lipoprotein lipase (LPL) activity, causing modest hypertriglyceridemia.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;LMF1 - p.Arg354Trp(rs143076454)&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;p&gt;This variant is found in ∼2% of the global population, and has been associated with a reduction of LPL activity causing modest hypertriglyceridemia.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;GBinsight identified various pathogenic genes causing elevated Lp(a) as follows:&lt;/p&gt;&lt;p&gt;LPA - Heterozygous for intron c.3947+467T&gt;C(rs10455872)&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;p&gt;This variant serves a genetic proxy for short isoforms and is strongly associated with increased Lp(a), total and LDL-cholesterol levels, and increased ASCVD risk.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;p&gt;APOE4&lt;/p&gt;&lt;p&gt;&lt;/p&gt;&lt;ul&gt;&lt;li&gt;&lt;span&gt;-&lt;/span&gt;&lt;span&gt;&lt;p&gt;This allele is associated with increased Lp(a) levels.&lt;/p&gt;&lt;/span&gt;&lt;/li&gt;&lt;/ul&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;We speculate that the combination of these polymorphisms works together to increase risk of severe hypertriglyceridemia, also known as MCS. Several smaller studies have suggested MCS is caused by either ","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e538"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847022","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":"Multidisciplinary Management of Lipoprotein X-Induced Hyperlipidemia Secondary to Drug-Induced Liver Injury","authors":"Samuel Kim MD,&nbsp;Amrita Krishnamurthy MD","doi":"10.1016/j.jacl.2024.04.028","DOIUrl":"10.1016/j.jacl.2024.04.028","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background/Synopsis&lt;/h3&gt;&lt;p&gt;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 &gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective/Purpose&lt;/h3&gt;&lt;p&gt;Recognize sequelae of lipoprotein X accumulation including pseudohyponatremia, xanthomas, and hyperviscosity. Discuss multidisciplinary management of lipoprotein X-induced hyperlipidemia.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Clinical case management at a tertiary care lipid program.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;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}