Journal of clinical lipidology最新文献

{"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}

{"title":"The Family Heart Foundation™ Flag, Identify, Network, Deliver—Familial Hypercholesterolemia (FIND-FH™) Program and Collaborative Learning Network (CL","authors":"Diane MacDougall MS,&nbsp;George Blike MD","doi":"10.1016/j.jacl.2024.04.019","DOIUrl":"10.1016/j.jacl.2024.04.019","url":null,"abstract":"<div><h3>Study Funding</h3><p>Funded in part by AMGEN.</p></div><div><h3>Background/Synopsis</h3><p>The Family Heart Foundation (FHF) developed a machine learning model (MLM), FIND-FH, to flag undiagnosed individuals at high risk for familial hypercholesterolemia (FH). The model utilizes structured electronic health record (EHR) data. Past implementation of FIND-FH in a large health system identified 2167 high risk patients appropriate for outreach; 153 (7%) were clinically assessed, 46 (30%) diagnosed with FH. FHF was not involved in developing the approach to patient outreach or patient facing materials in this initial deployment.</p></div><div><h3>Objective/Purpose</h3><p>To characterize interim progress and performance metrics regarding screening, outreach, and diagnosis of patients identified by FIND-FH at 5 health systems participating in FHF led Collaborative Learning Network (CLN).</p></div><div><h3>Methods</h3><p>The FHF CLN team works with CLN members using implementation and quality science tools including expert interviews, patient journey mapping, current state process mapping and rapid cycle tests of change. Patient facing materials are jointly developed by FHF in conjunction with FH patients and CLN members. Performance metrics include: #Identified as High Risk of FH; #Appropriate for Outreach/Assessment; #Completed Assessment; #New Diagnosis Definite/Probable/Possible FH; #Needing Other CV Risk Reduction Intervention(s).</p></div><div><h3>Results</h3><p>Currently ∼1.85M EHRs have been screened by FIND-FH, identifying 3,720 at high FH risk. To date, chart reviews completed on 1278 found 628/1278 (49%) unlikely to have FH. The remaining 650/1278 (51%) were deemed appropriate for outreach/assessment. Of 91/650 (14%) patients assessed thus far, 71/91 (78%) were diagnosed as definite/probable/possible FH. Multiple patients not diagnosed with FH, had conditions requiring intervention to lower cardiovascular risk. Patient facing letters and resources were found to be acceptable to individuals diagnosed with FH.</p></div><div><h3>Conclusions</h3><p>Deployment of FIND-FH through a CLN provides proof-of-concept of the ability of an implementation science framework to improve the diagnosis and care for patients with FH. Preliminary performance metrics are promising, yet difficult to directly compare to prior efforts. Health systems used targeted chart review to avoid outreach and assessment of patients “not likely to have FH.” Patient facing materials developed in conjunction with FH patients and made available to all CLN members prevented duplication of efforts at individual health systems. Insights gained from the CLN are informing the development of more efficient, effective, scalable and sustainable care delivery systems for “FIND”ing individuals living with FH.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e496-e497"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850118","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":"Development of a Clinical Diagnostic Score for Familial Chylomicronemia Syndrome (FCS)","authors":"Cynthia Campos MPH,&nbsp;Zahid Ahmad MD,&nbsp;Ambika Ashraf MD,&nbsp;Andrew Baldassarra BA,&nbsp;Alan Brown MD,&nbsp;Alan Chait MD,&nbsp;Steven Freedman MD,&nbsp;Brenda Kohn MD,&nbsp;Michael Miller MD,&nbsp;Nivedita Patni MD,&nbsp;Daniel Soffer MD,&nbsp;Sarah Gibbs MPH,&nbsp;Irina Yermilov MD,&nbsp;Eunice Chang PhD,&nbsp;Michael Broder MD,&nbsp;Robert Hegele MD","doi":"10.1016/j.jacl.2024.04.062","DOIUrl":"10.1016/j.jacl.2024.04.062","url":null,"abstract":"<div><h3>Study Funding</h3><p>This study was sponsored by Ionis Pharmaceuticals.</p></div><div><h3>Background/Synopsis</h3><p>Familial chylomicronemia syndrome (FCS) is an ultrarare, inherited disorder caused by impaired lipolysis leading to pathological accumulation of chylomicrons with severe hypertriglyceridemia (HTG) and systemic manifestations, the most serious of which is acute pancreatitis. FCS is challenging to manage, with lifelong implications for patients and their care providers. Genetic testing is the standard to confirm diagnosis but is not always feasible. Clinical FCS can be defined as both classical (autosomal recessive monogenic) and functional (signs/symptoms and biochemical traits of classical FCS without the classical variants or indeterminate genetic results). In 2017, European clinicians (Moulin et al.) developed a “FCS score” to differentiate between FCS and multifactorial chylomicronemia syndrome (MCS), a more common condition with some overlapping features. However, the applicability of this scoring system to North American FCS patients is unclear.</p></div><div><h3>Objective/Purpose</h3><p>Develop a clinical diagnostic score for North American practice patterns based on signs/symptoms and biochemical traits of FCS, regardless of genetic testing results.</p></div><div><h3>Methods</h3><p>The panel (9 United States and 1 Canadian physician with experience treating patients with FCS; 1 adult patient with FCS) followed the RAND/UCLA modified Delphi process by reviewing evidence on the diagnosis of FCS and developing 248 clinical scenarios of patients with varying characteristics such as age, triglyceride (TG) levels, and clinical history. Before and after a virtual meeting, panelists rated whether patients described in scenarios were likely to have classical or functional FCS or neither. Median post-meeting ratings were used to conduct linear regression analyses to develop a Clinical FCS Score. We assessed the score's face validity by totaling the Clinical FCS Score for each scenario and are calculating its sensitivity and specificity in a registry of patients.</p></div><div><h3>Results</h3><p>The final FCS score included age, HTG onset, body mass index, history of abdominal pain/pancreatitis, presence of secondary factors contributing to HTG, TG levels, ratio of TG/total cholesterol, and apolipoprotein B level (Figure). Experts agreed that scores ≥60 could be considered “Clinical FCS.”</p></div><div><h3>Conclusions</h3><p>We developed the first North American Clinical FCS Score that used a combination of signs/symptoms and biochemical traits. This score may aid clinicians in diagnosing patients with FCS who might otherwise be undiagnosed or misdiagnosed<strong>.</strong></p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e536"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842481","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":"Development of the Family Heart Foundation™ Flag, Identify, Network, Deliver—Familial Hypercholesterolemia (FIND-FH™) Implementation Toolkit","authors":"Diane MacDougall MS,&nbsp;George Blike MD","doi":"10.1016/j.jacl.2024.04.018","DOIUrl":"10.1016/j.jacl.2024.04.018","url":null,"abstract":"<div><h3>Study Funding</h3><p>Funded in part by AMGEN.</p></div><div><h3>Background/Synopsis</h3><p>Implementation scientists note that best practices often fail to generalize to other settings because of differences in culture, expertise, and infrastructure. Over 18 months, five healthcare systems and a team of patients with FH participated in a Family Heart Foundation (FHF) led collaborative learning network (CLN) with the aim to improve Familial Hypercholesterolemia (FH) diagnosis and care.</p></div><div><h3>Objective/Purpose</h3><p>To share best practices identified by the FIND-FH CLN to help primary and specialty care clinics improve diagnosis and care of patients with FH. To achieve this objective, we developed a flexible implementation toolkit for clinics to customize to meet their specific needs.</p></div><div><h3>Methods</h3><p>A novel implementation science approach is being used to design a FIND-FH Implementation Toolkit to arm care teams with effective quality improvement strategies. This framework organizes common problems/barriers and best practices identified via literature review, subject matter experts, patients with FH and field experiences at five participating CLN sites. This content is organized into a Problem(s)—General Solution(s)—Specific Solution Option(s) matrix using a multi-step process. CLN participants provide feedback and refinements to the matrix, which is curated by the FHF's implementation science team. A nominal group (expert consensus) technique is being used to assure the Problem—General Solution pairs are complete and a subsequent multi-voting process used to rate the importance of each problem-solution pair. Items with variation in ratings are discussed further and the voting repeated to arrive at consensus. The Specific Solution Option(s) in the toolkit describe: a) Option Details; b) Resource Needs; and c) Advantages/Tradeoffs.</p></div><div><h3>Results</h3><p>The methodology described has been completed for the “FLAG” and “IDENTIFY” steps of the FIND-FH process. 17 common Problems that undermine diagnosis of FH patients by PCPs and specialists, were identified. Up to four General Solutions were defined for each Problem with up to 6 Specific Solution Options for each General Solution. The expert consensus process allowed elimination of problems deemed low importance/impact. (See Supplemental Table 1)</p></div><div><h3>Conclusions</h3><p>Development of an implementation toolkit that provides multiple options to address common problems undermining FH care proved feasible. Next, we will complete the “NETWORK” and “DELIVER” steps of the FIND-FH process and validate the first version of this.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e495-e496"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141853044","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":"Clinical Outcomes And Mortality in Heart Failure And Chronic Kidney Disease Patients Admitted With Non-Variceal Upper Gastrointestinal Bleeding","authors":"Mohamad Hijazi MD,&nbsp;Mhd Kutaiba Albuni MD,&nbsp;Bassel Bitar MD,&nbsp;Godbless Ajenaghughrure MD,&nbsp;Amin Eshghabadi MD,&nbsp;Kamal Shemisa MD,&nbsp;Fayaz Khan MD,&nbsp;M Kenan Rahima MD","doi":"10.1016/j.jacl.2024.04.050","DOIUrl":"10.1016/j.jacl.2024.04.050","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease. Non-variceal upper gastrointestinal bleeding (NVUGIB) can be associated with various medical conditions, including heart failure (HF) and CKD. CKD and HF has been shown to further increase cardiovascular risks.</p></div><div><h3>Objective/Purpose</h3><p>Nevertheless, there is limited scientific evidence of clinical outcomes of NVUGIB in patients with CKD &amp; HF. Hence, we sought to investigate this population.</p></div><div><h3>Methods</h3><p>We queried National Inpatient Sample between 2017-2020 for adult patients who were hospitalized with NVUGIB and had CKD &amp; HF. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, acute kidney injury (AKI), intubation, length of stay (LOS) and total hospital charge. Multivariable logistic regression analysis was used to estimate clinical outcomes. P-value &lt; 0.05 was significant.</p></div><div><h3>Results</h3><p>There were 3,349,779 hospitalizations with NVUGIB and 459,980 (13.7%) had CKD &amp; HF. HF &amp; CKD and non-HF &amp; CKD cohorts were with mean age of 74 vs. 66 yrs; males 46.9% vs 53.1%; Caucasians 63.5% vs 66.6%; HTN 8% vs 39%; dyslipidemia 53.3% vs 37.2%; PE 3.9% vs 4.9%; DM 56% vs 30.4%; AF 24.4% vs 23.5%; obesity 19.5% vs 13.3%; AF 50.2% vs 21.1%; history of stroke 2.0% both, COPD 33.5% vs 18.4%; alcohol use 3% vs 13.8%, respectively. HF &amp; CKD cohort had significantly higher mortality and worse clinical outcomes (Table 1).</p></div><div><h3>Conclusions</h3><p>HF &amp; CKD cohort demonstrated significantly higher mortality, worse clinical outcomes and resource utilization. Patients were older, obese, female, fewer Caucasians, with more frequent dyslipidemia, DM, AF and COPD. HF &amp; CKD is associated with greater risk for cardiovascular events, renal failure, GIB, and ICU care. HF &amp; CKD is an important predictor of adverse outcomes in NVUGIB population. Further research is necessary to describe long-term outcomes.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Page e520"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841264","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":"Detailed Family History of Premature Atherosclerotic Cardiovascular Disease to Guide Lipoprotein(a) Testing: The Multi-Ethnic Study of Atherosclerosis","authors":"Harpreet Bhatia MD,&nbsp;Zeina Dardari PhD,&nbsp;Anurag Mehta MD,&nbsp;Khurram Nasir MD,&nbsp;Ron Blankstein MD,&nbsp;Ijeoma Isiadinso MD,&nbsp;Arshed Quyyumi MD,&nbsp;Viola Vaccarino MD,&nbsp;Muin Khoury MD,&nbsp;Jonathan Fialkow MD,&nbsp;Fatima Coronado MD,&nbsp;Matthew Budoff MD,&nbsp;Roger Blumenthal MD,&nbsp;Seamus Whelton MD,&nbsp;Martin Mortensen MD,&nbsp;Laurence Sperling MD,&nbsp;Kunihiro Matsushita MD,&nbsp;Michael Blaha MD,&nbsp;Omar Dzaye MD,&nbsp;Alexander Razavi MD","doi":"10.1016/j.jacl.2024.04.006","DOIUrl":"10.1016/j.jacl.2024.04.006","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>One in five individuals have elevated lipoprotein(a) [Lp(a)], an inherited risk factor for atherosclerotic cardiovascular disease (ASCVD). However, there is no clear consensus involving the appropriate testing criteria for Lp(a), specifically related to the role of a detailed family history of premature ASCVD for guidance.</p></div><div><h3>Objective/Purpose</h3><p>To assess the independent association between a detailed family history of premature ASCVD and Lp(a).</p></div><div><h3>Methods</h3><p>We studied 4,244 participants from the Multi-Ethnic Study of Atherosclerosis who had measures of Lp(a) (Visit 1) and completed detailed family history questionnaires (Visit 2). Family history of premature ASCVD (&lt;55 years old in men, &lt;65 years old in women) was defined as any myocardial infarction or stroke in a first-degree relative (mother, father, sibling). A combined family history of premature ASCVD score (0, 1, &gt;2 first-degree relatives) was constructed. Modified Poisson regression modeling calculated prevalence ratios (PR) for Lp(a) &gt;50 mg/dL according to family history of premature ASCVD after adjusting for age, sex, race/ethnicity, health insurance status, estimated glomerular filtration rate, and lipid-lowering medications.</p></div><div><h3>Results</h3><p>The mean age of participants was 61.7 years old, 52% were women, 28% were Black, and the median Lp(a) was 18 mg/dL (Q1: 8, Q3: 40). One in five individuals (21%) reported a family history of premature ASCVD, but the proportion of individuals who reported two or more first-degree relatives affected by premature ASCVD was two-fold higher among those with Lp(a) &gt;50 versus &lt;50 (4% versus 2%, p=0.003). There was a stepwise increment of Lp(a) and greater prevalence of Lp(a) &gt;50 as the number of reported family members with premature ASCVD increased (Figure). In multivariable analyses considering individuals without a family history of premature ASCVD as reference, there was no significantly higher prevalence of Lp(a) &gt;50 for individuals reporting one family member with premature ASCVD (PR=1.05, 95% CI: 0.90-1.22), though persons who had two or more family members affected by premature ASCVD had a 38% higher prevalence of Lp(a) &gt;50 (PR=1.38, 95% CI: 1.03-1.84).</p></div><div><h3>Conclusions</h3><p>Consideration of an ordinal family history of premature ASCVD score may help to better identify those most likely to have elevated Lp(a) compared to current binary family history questionnaires. Detailed documentation involving family history of premature ASCVD may facilitate targeted use of Lp(a)-specific risk assessment in clinical practice.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e486-e487"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842965","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":"ASCVD Risk Reduction in Patients with Immune-Mediated Inflammatory Disease: A Retrospective Quality Assessment Study","authors":"Nasser Monzer MD,&nbsp;Emma MacAllister CRNP,&nbsp;Archna Bajaj MD,&nbsp;Daniel Soffer MD,&nbsp;Douglas Jacoby MD,&nbsp;Srinivas Denduluri PhD,&nbsp;Deepak Vedamurthy MD","doi":"10.1016/j.jacl.2024.04.039","DOIUrl":"10.1016/j.jacl.2024.04.039","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>Patients with inflammatory immune-mediated disease (IMID) face a heightened risk of atherosclerotic cardiovascular disease (ASCVD). Current guidelines (2018, Grundy et al.) suggest considering a moderate-intensity statin for primary prevention if the 10-year ASCVD risk exceeds 5% in the presence of risk enhancers like IMID (Class IIb recommendation). However, many patients with IMID are undertreated with lipid-lowering therapies (LLT) as traditional ASCVD risk calculators often overlook this enhanced ASCVD risk. The 2022 ACC Expert Consensus decision pathway recommends a target LDL-C of at least 100 mg/dL and preferably less than 70 mg/dL for higher-risk patients for primary prevention. An LDL-C of less than 55 mg/dL is optimal for secondary ASCVD prevention.</p></div><div><h3>Objective/Purpose</h3><p>Identify the proportion of patients with IMID at our institution who meet criteria to start LLT (defined as ASCVD risk greater than 5% in the presence of risk enhancers or history of clinical ASCVD), proportion of such patients who are prescribed LLT, and the proportion of patients who meet goal LDL-C for primary and secondary prevention of ASCVD. Additionally, we sought to identify what proportion of those patients underwent coronary artery calcium scoring (CACS) and/or measurement of carotid intima-media thickness (CIMT) to guide decision-making in ASCVD risk management.</p></div><div><h3>Methods</h3><p>This is a retrospective quality assessment study using data from the Penn Medicine electronic medical records. Patients between 40 and 75 years of age, attending Rheumatology and Dermatology clinics during the calendar year 2022, with the following diagnoses were included: psoriasis, rheumatoid arthritis, systemic lupus erythematosus, gout, vasculitis, systemic sclerosis, antiphospholipid syndrome, mixed connective tissue disease, myositis. Patients with missing covariates to calculate the ASCVD risk score and study outcomes were excluded.</p></div><div><h3>Results</h3><p>1,907 patients were identified, 29% of which had clinical ASCVD. 69% (1,321) were eligible for LLT. 53% (702) of eligible patients were prescribed LLT, while 47% were not. Among patients who met criteria for LLT, 58% had their most recent LDL-C under 100 mg/dL, while 33% had their most recent LDL-C less than 70 mg/dL. 16% of patients with clinical ASCVD had their most recent LDL-C level less than 55 mg/dL. CACS or CIMT was performed on 10% of our cohort.</p></div><div><h3>Conclusions</h3><p>This study supports our hypothesis that ASCVD risk management in patients with IMID is suboptimal. With advances in subclinical atherosclerosis imaging and newer non-statin therapies, there is potential to improve cardiovascular outcomes in patients with IMID. Further studies are needed to bridge the management gaps in this patient population.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e510-e511"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844737","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 Cascade: On the Road to Universal Screening","authors":"Matthew Proute MBBS,&nbsp;Nosagie Ohonba MBBS,&nbsp;Jeffery Feldman MD,&nbsp;Robert Fishberg MD,&nbsp;Tiffany Haynes MD","doi":"10.1016/j.jacl.2024.04.071","DOIUrl":"10.1016/j.jacl.2024.04.071","url":null,"abstract":"<div><h3>Background/Synopsis</h3><p>The Atlantic Medical Group Lipid Workgroup at Atlantic Health System is composed of both adult and pediatric cardiologists, internists, endocrinologists and nephrologists. The goal of the workgroup is to address the need for optimal cardiometabolic diagnosis and treatment. Because familial hypercholesterolemia (FH) is dominantly inherited, cascade screening of family members can be highly effective.</p></div><div><h3>Objective/Purpose</h3><p>To highlight the benefits of collaboration of adult and pediatric specialties for the diagnosis and treatment of FH.</p></div><div><h3>Methods</h3><p>38-year-old female with a strong family history of early CAD, very high cholesterol levels and xanthelasmas presented to us to establish care. Her two children were diagnosed genetically with FH at age 3 and 6 with cholesterol levels of 269 mg/dL and &gt; 400 mg/dL, respectively. She was initiated on treatment with a statin. Her twin sister was also evaluated and found to have high cholesterol levels and xanthelasmas. This sister's children were also suspected of having FH and were referred to a pediatric cardiologist for diagnosis and treatment.</p></div><div><h3>Results</h3><p>The children of the index patient were found to be heterozygous for deletion (exon17-18) LDLR gene, pathologic for FH.</p></div><div><h3>Conclusions</h3><p>The collaborative efforts of adult and pediatric specialists make the Atlantic Medical Group Lipid workgroup unique. Through this program, cascade and reverse cascade screening is utilized to identify and diagnose individuals at risk for familial hypercholesterolemia. Identification of an index patient with FH with effective screening of relatives combines the benefits of universal and cascade screening and has the potential of detecting all living cases of FH. Basseling et al found that although capable of identifying asymptomatic individuals with hypercholesterolemia, the cost effectiveness of universal screening has not yet been determined and cascade screening has proven to be more cost effective than any other screening strategy currently available thus far.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"18 4","pages":"Pages e542-e543"},"PeriodicalIF":3.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846136","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}