Atherosclerosis. Supplements最新文献

{"title":"A complicated pregnancy in homozygous familial hypercholesterolaemia treated with lipoprotein apheresis: A case report","authors":"Seila Perrone ,&nbsp;Giuseppina Perrone ,&nbsp;Roberto Brunelli ,&nbsp;Serafina Di Giacomo ,&nbsp;Paola Galoppi ,&nbsp;Guendalina Flammini ,&nbsp;Claudia Morozzi ,&nbsp;Claudia Stefanutti","doi":"10.1016/j.atherosclerosissup.2019.08.033","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.033","url":null,"abstract":"<div><h3>Background and aims</h3><p>During pregnancy total cholesterol (TC) and low density lipoprotein<span><span> cholesterol (LDL-C) levels increase significantly and lipoprotein apheresis (LA) is considered the most effective therapy in homozygous </span>familial hypercholesterolaemia (HoFH) for modulating lipid and lipoprotein levels and reducing maternal and foetal complications.</span></p></div><div><h3>Clinical case</h3><p>A primigravida 28 years old Caucasian female patient, previously diagnosed as to be HoFH, was admitted at our outpatient service at the beginning of pregnancy.</p></div><div><h3>Methods</h3><p>The patient was continuously submitted to LA every two weeks without foetal complication. During pregnancy two methods have been utilised: selective apheresis, and later plasma exchange. At 33 weeks gestational age the patient developed progressively hypertension, associated to LDL-C levels increase. Weekly LA was favoured.</p></div><div><h3>Results</h3><p>At 34 weeks +5 days patient suddenly experienced acute chest pain and abnormal electrocardiogram heart tracing and cardiac enzymes increase.</p><p><span>An emergency caesarean section was performed without complications and the foetus was healthy. The patient was immediately transferred to Coronary </span>Intensive Care Unit, where she was diagnosed non-ST elevation myocardial infarction (NSTEMI). Notwithstanding the patient improved in few days and was quickly discharged in fair clinical condition.</p></div><div><h3>Conclusions</h3><p>LA is a safe and effective tool in HoFH subjects even in pregnancy. Evidence based guidelines for the management of these patients during pregnancy are still lacking.</p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 113-116"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86359403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein apheresis in Germany – Still more commonly indicated than implemented. How can patients in need access therapy?","authors":"Franz Heigl ,&nbsp;Tobias Pflederer ,&nbsp;Reinhard Klingel ,&nbsp;Reinhard Hettich ,&nbsp;Norbert Lotz ,&nbsp;Harduin Reeg ,&nbsp;Volker J.J. Schettler ,&nbsp;Eberhard Roeseler ,&nbsp;Peter Grützmacher ,&nbsp;Bernd Hohenstein ,&nbsp;Ulrich Julius","doi":"10.1016/j.atherosclerosissup.2019.08.038","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.038","url":null,"abstract":"<div><h3>Background</h3><p><span>Although lipid-lowering drugs<span><span>, especially statins, and recently also PCSK9 inhibitors can reduce LDL cholesterol<span> (LDL-C) and decrease the risk for cardiovascular disease (CVD) including coronary artery disease (CAD) events most efficiently, only 5–10% of high-risk cardiovascular patients reach the target values recommended by international guidelines. </span></span>In patients who cannot be treated adequately by drugs it is possible to reduce increased LDL-C and/or lipoprotein(a) (Lp(a)) values by the use of </span></span>lipoprotein<span> apheresis (LA) with the potential to decrease severe CVD events in the range of 70%-&gt;80%. Even in Germany, a country with well-established reimbursement guidelines for LA, knowledge about this life-saving therapy is unsatisfactory in medical disciplines treating patients with CVD.</span></p><p>Starting in 1996 our aim was to offer LA treatment following current guidelines for all patients in the entire region of our clinic as standard of care.</p></div><div><h3>Methods</h3><p>Based on the experience of our large apheresis competence center overlooking now nearly 80,000 LA treatments in the last two decades, we depict the necessary structure for identification of patients, defining indication, referral, implementation and standardisation of therapy as well as for reimbursement. LA is unfamiliar for most patients and even for many practitioners and consultants. Therefore nephrologists performing more than 90% of LA in Germany have to form a network for referral and ongoing medical education, comprising all regional care-givers, general practitioners as well as the respective specialists and insurances or other cost bearing parties for offering a scientifically approved therapeutic regimen and comprehensive care. The German Lipid Association (Lipid-Liga) has implemented the certification of a lipidological competence center as an appropriate way to realize such a network structure.</p></div><div><h3>Results</h3><p>Working as a lipidological and apheresis competence center in a region of 400,000 to 500,000 inhabitants, today we treat 160 patients in the chronic LA program. In spite of the availability of PCSK9 inhibitors since 2015, LA has remained as an indispensable therapeutic option for targeted lipid lowering treatment. An analysis of nearly 37,000 LA treatments in our own center documented a &gt;80% reduction of cardiovascular events in patients treated by regular LA when comparing with the situation before the start of the LA therapy.</p><p>We have implemented the concept of an apheresis competence center characterised by ongoing medical education with a focus on lipidological and cardiovascular aspects, interdisciplinary networking and referral.</p></div><div><h3>Conclusions</h3><p>Incidence and prevalence of LA patients in our region demonstrate that based on our ongoing patient-centered approach the access of patients in need to LA is substantially abo","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 23-29"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89003267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 red yeast rice (RYR) supplementation in plasma cholesterol control: A review and expert opinion","authors":"Maciej Banach ,&nbsp;Eric Bruckert ,&nbsp;Olivier S. Descamps ,&nbsp;Lars Ellegård ,&nbsp;Marat Ezhov ,&nbsp;Bernhard Föger ,&nbsp;Zlatko Fras ,&nbsp;Petri T. Kovanen ,&nbsp;Gustavs Latkovskis ,&nbsp;Winfried März ,&nbsp;Demosthenes B. Panagiotakos ,&nbsp;György Paragh ,&nbsp;Daniel Pella ,&nbsp;Angela Pirillo ,&nbsp;Andrea Poli ,&nbsp;Željko Reiner ,&nbsp;Günter Silbernagel ,&nbsp;Margus Viigimaa ,&nbsp;Michal Vrablík ,&nbsp;Alberico L. Catapano","doi":"10.1016/j.atherosclerosissup.2019.08.023","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.023","url":null,"abstract":"","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"39 ","pages":"Pages e1-e8"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89370619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney and liver are the main organs of expression of a key metabolic enzyme alanine:glyoxylate aminotransferase 2 in humans","authors":"Natalia Jarzebska ,&nbsp;Sophia Georgi ,&nbsp;Normund Jabs ,&nbsp;Silke Brilloff ,&nbsp;Renke Maas ,&nbsp;Roman N. Rodionov ,&nbsp;Christian Zietz ,&nbsp;Sabrina Montresor ,&nbsp;Bernd Hohenstein ,&nbsp;Norbert Weiss","doi":"10.1016/j.atherosclerosissup.2019.08.041","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.041","url":null,"abstract":"<div><h3>Background</h3><p><span><span><span>The metabolic syndrome is a cluster of cardiovascular risk factors and is highly predictive for development of cardiovascular diseases. An association between elevated plasma levels of the endogenous inhibitor of </span>nitric oxide synthases<span> asymmetric dimethylarginine (ADMA) and risk of cardiovascular diseases has been demonstrated in numerous epidemiological studies. ADMA can be catabolized by </span></span>dimethylarginine dimethylaminohydrolase<span> (DDAH) or metabolized through a much less understood alternative pathway by alanine:glyoxylate aminotransferase 2 (AGXT2) with the formation of α-keto-δ-(N,N-dimethylguanidino)valeric acid (ADGV). Previous RT-PCR and Western Blot studies suggested that </span></span><em>Agxt2</em> is expressed in the mouse kidney and liver at comparable levels, while Northern Blot and in-situ RNA-hybridisation experiments demonstrated that the kidney is the main organ of <em>Agxt2</em> expression in rats. Given this discrepancy, the goal of the current study was to analyse the expression of AGXT2 in human tissues.</p></div><div><h3>Material and methods</h3><p>We analyzed AGXT2 expression in human tissues from a normal tissue bank by RT-PCR and further validated the results by Western Blot. We also performed immunohistochemical staining for AGXT2 and double fluorescent staining with an anti-AGXT2 antibody and a monoclonal anti-mitochondrial antibody.</p></div><div><h3>Results</h3><p>We saw the strongest expression of <em>AGXT2</em> in the kidney and liver and confirmed this results on protein level. By IHC staining we were able to show that AGXT2 is present in the convoluted tubule in the kidney and in the liver hepatocytes. The double fluorescent staining revealed mitochondrial localization of AGXT2.</p></div><div><h3>Conclusions</h3><p>Our current data suggest that both hepatocytes and kidney tubular epithelial cells are the major sources of AGXT2 in humans. We also demonstrated the mitochondrial localization of human AGXT2 enzyme.</p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 106-112"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82217521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical coherence tomography of retinal and choroidal layers in patients with familial hypercholesterolaemia treated with lipoprotein apheresis","authors":"Claudia Stefanutti ,&nbsp;Dario Mesce ,&nbsp;Fernanda Pacella ,&nbsp;Serafina Di Giacomo ,&nbsp;Paolo Turchetti ,&nbsp;Michele Forastiere ,&nbsp;Edoardo Trovato Battagliola ,&nbsp;Giuseppe La Torre ,&nbsp;Gianpaolo Smaldone ,&nbsp;Elena Pacella","doi":"10.1016/j.atherosclerosissup.2019.08.031","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.031","url":null,"abstract":"<div><h3>Purpose</h3><p>Detect and quantify morpho-functional alterations of the retina and choroid in patients affected by familial hypercholesterolemia (FH) treated with lipoprotein apheresis (LA) using optic coherence tomography (OCT) and optic coherence tomography-angriography (OCTA).</p></div><div><h3>Design</h3><p>Observational study.</p></div><div><h3>Subjects</h3><p>To be diagnosed: A group of 20 patients (40 eyes) being clinically and genetically diagnosed as FH and under treatment (FH-Group)”, for at least 2 years, was compared to a control group of 20 healthy subjects (40 eyes), with a normal lipid profile and no ocular disease (CT-Group).</p></div><div><h3>Methods</h3><p>Participants were studied with the slit lamp, binocular indirect fundoscopy, OCT and OCTA.</p></div><div><h3>Main outcome measures</h3><p>Best corrected visual acuity (BVCA), spherical equivalent (SE), intraocular pressure (IOP), central macular thickness (CMT), choroidal thickness (CHT), retinal nerve fiber layer in four quadrants (RNFL (Superior = Sup; Inferior = Inf; Nasal = Nas Temporal = Temp), and the mean value across the four quadrants (RNFL G), foveal avascular zone (FAZ) and vascular density (VD).</p></div><div><h3>Results</h3><p>FH subjects had smaller RNFL superiorly (108 ± 19,38 μm OD/111 ± 16,56 μm OS FH-Group vs 127 ± 7,42 μm OD/129 ± 14,64 μm OS CT-Group; P &lt; 0,001 for both OD and OS) and inferiorly (108 ± 23,58 μm OD/115 ± 17,33 μm OS FH-Group vs 128 ± 18,15 μm OD/133 ± 17,38 μm OS CT-Group; P = 0,002 OD; P = 0,001 OS). G RNFL was consequently smaller (93 ± 12,94 μm OD/94 ± 10,49 μm OS FH-Group vs 101 ± 9,01 μm OD/101 ± 10,20 μm OS CT-Group; P = 0,03 OD; P = 0,02 OS). FH subjects had a larger FAZ (0,31 ± 0,08 mm² OD/0,33 ± 0,10 mm² in OS FH-Group vs 0,21 ± 0,05 mm² OD/0,21 ± 0,07 mm² OS CT-Group; P &lt; 0,001 OD; P = 0,002 OS).</p></div><div><h3>Conclusions</h3><p>Early signs of retinal vessel damage in FH patients can be detected and quantified with OCT and OCTA.</p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 49-54"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78771415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk factors in patients with premature cardiovascular events attending the University of Dresden Lipid Clinic","authors":"Ulrike Schatz ,&nbsp;Sabine Fischer ,&nbsp;Gabriele Müller ,&nbsp;Sergey Tselmin ,&nbsp;Andreas L. Birkenfeld ,&nbsp;Ulrich Julius ,&nbsp;Winfried März ,&nbsp;Stefan R. Bornstein","doi":"10.1016/j.atherosclerosissup.2019.08.044","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.044","url":null,"abstract":"<div><h3>Objectives</h3><p><span>Despite improved treatment, premature cardiovascular (CV) events remain a major </span>health problem<span>. Aim of this study was to evaluate the patterns of risk factors in patients with premature CV events.</span></p></div><div><h3>Methods</h3><p>CV risk factors (CVRF) were evaluated in 130 patients with a history of CV events (myocardial infarction, stroke, limb ischemia, stent and bypass intervention in any vessel bed) under 50 years of age attending our lipid clinic. Patients were also stratified according to their Lp(a) concentrations: group 1: 0–45 nmol/l (&lt;18 mg/dl); group 2: &gt;45–120 nmol/l (&gt;18–50 mg/dl); group 3: &gt;120 nmol/l (&gt;50 mg/dl).</p></div><div><h3>Results</h3><p><span><span>The most common risk factors in our patients were male sex (75%), current (61%) and previous smoking (9%), arterial hypertension (70%), and a positive family history of early CV events (54%) and hyperlipidemia (69%). Only 27% had a </span>BMI &gt;30 kg/m</span>²<span> and 14% had diabetes mellitus. 69% of patients with premature CV disease (CVD) showed Lp(a) levels &gt; 120 nmol/l (&gt;50 mg/dl). Patients with the highest Lp(a) showed a tendency of more frequent positive family histories of hyperlipidemia. They had experienced their first CV event on average 3 years earlier than those with low Lp(a). CV events predominantly involved coronary arteries. 85% of patients experienced at least one coronary event.</span></p></div><div><h3>Conclusion</h3><p>In patients with premature CV disease male sex, smoking, hypertension, a positive family history and elevated Lp(a) are the most important CV risk factors. Lp(a) should be considered in the management of young patients with CV disease.</p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 94-99"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75069643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apheresis as emerging treatment option in severe early onset preeclampsia","authors":"Christine Contini ,&nbsp;Gerhard Pütz ,&nbsp;Ulrich Pecks ,&nbsp;Karl Winkler","doi":"10.1016/j.atherosclerosissup.2019.08.028","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.028","url":null,"abstract":"<div><p>Based on an early suggestion by Winkler et al. 2003 and a subsequent successful study by Wang et al. 2006 using lipid apheresis<span> (LA) in 9 patients with preeclampsia<span> to prolong pregnancies, the use of apheresis as therapeutic option in severe early onset preeclampsia has received increasing attention. Further studies using different LA systems also prolonged pregnancy<span><span> and have been published in the last few years. Albeit using different LA systems and relying on different working hypothesis, all studies demonstrated a promising stabilisation against the disease's progression. Overall time from hospitalisation to the need for mandatory delivery was longer for those patients receiving apheresis compared to historical or matched control patients not receiving apheresis. These data will be reviewed and different hypotheses about the beneficial mechanism of action of apheresis will be discussed. Since up to now there is no curative </span>treatment for preeclampsia other than observation and delivery, future work shall be encouraged.</span></span></span></p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 61-67"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78347633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statin-induced muscular side effects at rest and exercise – An anatomical mapping","authors":"Theresa Berent ,&nbsp;Robert Berent ,&nbsp;Sabine Steiner ,&nbsp;Helmut Sinzinger","doi":"10.1016/j.atherosclerosissup.2019.08.026","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.026","url":null,"abstract":"<div><h3>Background and aims</h3><p>Muscle-related symptoms with or without creatine kinase<span><span> (CK) elevation are common adverse effects associated with statin use. Symptoms are ranging from benign myalgia to </span>myositis<span> and in rare cases to rhabdomyolysis. The aim was to characterize and describe muscular side effects and create an anatomical frequency mapping.</span></span></p></div><div><h3>Methods</h3><p>The prospective observational study was performed at a large lipidology outpatient unit in Vienna. 1111 consecutively admitted patients with muscular side effects on statin monotherapy<span> were included during a 4-year period. Anatomical mapping of the affected muscles, signs and symptoms, the onset of symptoms after starting statin therapy and disappearance after cessation of treatment was assessed.</span></p></div><div><h3>Results</h3><p>In 96.5% of the patients with muscle symptoms, there was no elevation of CK. The anatomical mapping revealed exercised muscles as being mainly affected in 84%. In the upper extremity, symptoms were mainly described at the dominating side. Mostly affected muscles were the pectoral (61.4%), followed by the quadriceps femoris (59.8%), the biceps brachii (54.3%) and the deltoid (22.5%) muscles. The majority of symptoms (76.9%, <em>n</em> = 854) appeared within 29 days. Symptoms disappeared after discontinuation of statin therapy at a mean of 5.4 days.</p></div><div><h3>Conclusions</h3><p>Physical activity seems to be a key trigger for onset of statin-induced muscular side effects. The appearance of symptoms can be symmetrical, asymmetrical, generalized or in isolated muscle groups only. Different statins usually produce similar symptoms, but often some patients tolerate one statin better than another.</p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 73-78"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80520221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One year follow-up of patients with reduced left ventricular ejection fraction (LVEF) on lipoprotein apheresis","authors":"Georgiana-Aura Giurgea ,&nbsp;Elodie Karkutli ,&nbsp;Susanne Granegger ,&nbsp;Robert Berent ,&nbsp;Kurt Derfler ,&nbsp;Helmut Sinzinger","doi":"10.1016/j.atherosclerosissup.2019.08.039","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.039","url":null,"abstract":"<div><h3>Background</h3><p><span>Left ventricular ejection fraction (LVEF) is a valuable measure to assess left ventricular </span>systolic function<span>. Lipid lowering therapy by statins has been shown to have an impact on LVEF already after a 6 months treatment. Higher doses of statins have been claimed to be more effective as compared to a conventional one and even a difference between lipophilic and hydrophilic compounds has been reported. The effect of regular lipoprotein-apheresis (LP-apheresis) on LVEF was previously poorly examined.</span></p><p>Patients involved in a regular LP-apheresis program are supposed to undergo a number of follow-up investigations among them myocardial scintigraphy<span> and LVEF, measured by radionuclide ventriculography.</span></p></div><div><h3>Methods</h3><p><span>We examined 18 patients before initiation and after one year of ongoing LP-apheresis. 13 patients (11 males, 2 females, mean age 58.3 ± 5.3 years, groups A) were since more than a year on stable, unchanged statin treatment (atorvastatin 40 mg, simvastatin<span> 40 mg, rosuvastatin 20 mg±ezetimibe), the other 5 patients (3 males, 2 females, mean age 57.1 ± 4.6 years, group B) were intolerant to statins being on micronized fenofibrate±resorption inhibitors (cholestyramine). All patients had a Lp(a) &lt; 30 mg/dl. As part of the usual follow-up monitoring, LVEF was determined by means of radionuclide ventriculography after application of 550 MBq </span></span>^99m Tc-pertechnetate.</p></div><div><h3>Results</h3><p>The follow-up LVEF was checked at a mean of 48.7 weeks in group A and 51.2 weeks in group B. Except in 1 patient (LVEF 46.8% before vs. 45.2% after LP-apheresis initiation) in group A we noted a significant increase in LVEF in 12 patients of group A (92%) and in all patients of group B. Mean LVEF increased significantly in both groups (A: 42.7±8.1 → 46.5±7.5% (p &lt; 0.001) and B: 41.9±8.4 → 46.5±6.3 %; p &lt; 0.001). The relative rise was nearly identical (group A 9.6%, in group B 9.7%).</p></div><div><h3>Conclusions</h3><p>Our findings indicate that regular long-term LP-apheresis treatment apparently increases LVEF, independently on current statin treatment. This implies a role of lowering of atherogenic lipoproteins as underlying mechanism. A prospective study should clarify the relative extent of LVEF improvement induced by LP-apheresis.</p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 44-48"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73692214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A successful term pregnancy with severe hypertriglyceridaemia and acute pancreatitis. Clinical management and review of the literature","authors":"Seila Perrone ,&nbsp;Roberto Brunelli ,&nbsp;Giuseppina Perrone ,&nbsp;Ilaria Zannini ,&nbsp;Paola Galoppi ,&nbsp;Serafina Di Giacomo ,&nbsp;Claudia Morozzi ,&nbsp;Livia Pisciotta ,&nbsp;Claudia Stefanutti","doi":"10.1016/j.atherosclerosissup.2019.08.032","DOIUrl":"10.1016/j.atherosclerosissup.2019.08.032","url":null,"abstract":"<div><h3>Background and aims</h3><p><span>Acute hyperlipidaemic<span> pancreatitis (HP) may develop in pregnancy </span></span>in patients<span> with genetic predisposition<span>. There are no accepted guidelines for the management of this rare but life-threatening condition in pregnancy. Plasma exchange (PEX) was suggested as a suitable option to treat HP in pregnancy; however, further evidence from case reports/case series are needed.</span></span></p></div><div><h3>Methods</h3><p>Three PEX procedures (2000 ml of plasma replaced with 5% albumin) were performed in one week in a pregnant patient at 25 weeks of gestational age with severe HP. Triglyceride<span> related genes (LPL, APOA5<span>, APOE, GPIHBP1, GPD1, LMF1, CREB3L3) were screened by DNA sequencing. Medline and Embase databases were searched electronically in January 2018 using different combinations of the relevant medical subject headings for “pancreatitis in pregnancy” and “therapeutic apheresis”.</span></span></p></div><div><h3>Results</h3><p>Gene profiling assessed a combined heterozygous state for the variants pSer19Trp of the APOA5 gene and pCys130Arg of the APOE (allele E4) gene.</p><p>PEX led to significant and progressive reduction of triglyceride plasma levels along with cholesterol and C-reactive protein. Meanwhile a fast improvement of pregnant clinical condition was observed. This allowed the delivery at term of a healthy newborn<span> without gestational complications. An outcome hardly achievable in patients managed exclusively by a pharmacological approach.</span></p></div><div><h3>Conclusions</h3><p>PEX led to a positive maternal outcome in absence of foetal and gestational complications in a case of severe HP in pregnancy. As clinical trials are lacking, case reports still represent the best way to reasonably implement clinical management of this rare but life-threatening disease.</p></div>","PeriodicalId":8592,"journal":{"name":"Atherosclerosis. Supplements","volume":"40 ","pages":"Pages 117-121"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.atherosclerosissup.2019.08.032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72600541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}