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Postprandial hyperlipidemia as a risk factor in patients with type 2 diabetes.
Tomlinson, B, Chan, P, Lam, CWK
Expert review of endocrinology & metabolism. 2020;(3):147-157
Abstract
Introduction: Postprandial hyperlipidemia is a common feature of the atherogenic dyslipidemia in patients with type 2 diabetes. Quantification of this with oral fat tolerance tests is not used routinely in clinical practice and abnormal postprandial lipids are usually inferred from non-fasting plasma triglyceride levels. Identifying excessive postprandial hyperlipidemia may help to refine cardiovascular risk assessment but there are no treatments currently available which selectively target postprandial lipids and no large cardiovascular outcome trials using this as the entry criterion.Areas covered: In this review of relevant published material, we summarize the findings from the most important publications in this area.Expert opinion: Postprandial hyperlipidemia appears to contribute to the cardiovascular risk in patients with diabetes. Non-fasting triglyceride levels provide a surrogate marker of postprandial hyperlipidemia but more specific markers such as apoB48 levels may prove to be more reliable. Omega-3 fatty acids, fibrates and ezetimibe can reduce postprandial lipids but may not correct them completely. Several novel treatments have been developed to target hypertriglyceridemia and some of these may be particularly effective in improving postprandial levels. Further clinical trials are needed to establish the role of postprandial lipids in assessment of cardiovascular risk and to identify the most effective treatments.
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Coronary and peripheral artery plaques: do differences in plaque characteristics translate to differences in lipid management?
Tsai, S, Vega, GL
Journal of investigative medicine : the official publication of the American Federation for Clinical Research. 2020;(6):1141-1151
Abstract
Optimal medical management of patients with peripheral arterial disease (PAD) includes statin therapy, which has been shown to decrease the risk of major cardiovascular events. However, the relationship between low-density lipoprotein (LDL) lowering, PAD progression and limb outcomes remains controversial. Although prevention of coronary and cerebrovascular events is a priority, limb outcomes are still important determinants of quality of life and healthcare spending. This review will highlight differences between coronary artery disease (CAD) and PAD, and in particular, the more prevalent role of lipids and LDL cholesterol in CAD versus calcification in PAD. This difference may contribute to the differential impact of LDL cholesterol levels on coronary events and outcomes versus limb outcomes. Beyond LDL lowering, immune modulators have emerged as another agent to treat atherosclerosis in CAD, however similar data in PAD are lacking. Small studies have suggested that other lipids besides LDL cholesterol, such as triglycerides or small dense LDL, may have a greater impact on limb outcomes in patients with PAD. Although statin therapy is central in the management of patients with PAD, current understanding of the distinctions between PAD and CAD suggest that there may be other non-LDL targets for risk reduction that require further study.
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3.
[The role of dietary fibers in the nutrition of the population].
Pyryeva, EA, Safronova, AI
Voprosy pitaniia. 2019;(6):5-11
Abstract
Dietary fibers are the important components of the diet with functional properties. The importance of optimal intake of dietary fibers for saving health, gastrointestinal functions, prevention of metabolic disorders (overweight, obesity, hyperlipidemia), reducing the risk of cardiovascular and cancer diseases has been proved. The dose-dependent effect of dietary fibers, their quantitative and qualitative characteristics, as well as food sources in the structure of nutrition are discussed. Different approaches to standardization the consumption of dietary fibers, existing in the world practice, are presented.
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Structure and Function of Proprotein Convertase Subtilisin/kexin Type 9 (PCSK9) in Hyperlipidemia and Atherosclerosis.
Lu, X
Current drug targets. 2019;(10):1029-1040
Abstract
BACKGROUND One of the important factors in Low-Density Lipoprotein (LDL) metabolism is the LDL receptor (LDLR) by its capacity to bind and subsequently clear cholesterol derived from LDL (LDL-C) in the circulation. Proprotein Convertase Subtilisin-like Kexin type 9 (PCSK9) is a newly discovered serine protease that destroys LDLR in the liver and thereby controls the levels of LDL in plasma. Inhibition of PCSK9-mediated degradation of LDLR has, therefore, become a novel target for lipid-lowering therapy. METHODS We review the current understanding of the structure and function of PCSK9 as well as its implications for the treatment of hyperlipidemia and atherosclerosis. RESULTS New treatments such as monoclonal antibodies against PCSK9 may be useful agents to lower plasma levels of LDL and hence prevent atherosclerosis. CONCLUSION PCSK9's mechanism of action is not yet fully clarified. However, treatments that target PCSK9 have shown striking early efficacy and promise to improve the lives of countless patients with hyperlipidemia and atherosclerosis.
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Endocrine diseases as causes of secondary hyperlipidemia.
Bułdak, Ł, Marek, B, Kajdaniuk, D, Urbanek, A, Janyga, S, Bołdys, A, Basiak, M, Maligłówka, M, Okopień, B
Endokrynologia Polska. 2019;(6):511-519
Abstract
Cardiovascular diseases are among the leading causes of increased morbidity and mortality in developed and developing countries. One of the most important risk factors responsible for atherosclerosis and subsequent cardiovascular diseases is hyperlipidaemia. Currently, hyperlipidaemias are divided into several clinical entities. The greatest risk is associated with hypercholesterolaemia. As a result, modern guidelines for the treatment and prevention of atherosclerosis focus predominantly on the reduction of LDL-cholesterol. Hypertriglyceridaemia and atherogenic dyslipidaemia, which are responsible for a less significant increase in the cardiovascular risk, are nowadays secondary targets of the treatment. During the work-up for hyperlipidaemia one of the essential actions is the exclusion of secondary causes of the lipid abnormalities. Those include, among others, endocrine diseases, diabetes, drugs, nephrotic syndrome, and pregnancy. Data regarding the impact of endocrine disease and diabetes on the lipid profile are scattered. In this review, the authors aimed to perform a thorough analysis of the available publications regarding the topic and the preparation of a comprehensive review dealing with the incidence, clinical features, and the therapy of hyperlipidaemias in patients with endocrine disease.
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Acupuncture for hyperlipidemia: Protocol for a systematic review and meta-analysis.
Peng, Q, Yao, X, Xiang, J, Wang, Y, Lin, X
Medicine. 2018;(50):e13041
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Abstract
BACKGROUND Hyperlipidemia is a major risk factor for cardiovascular and cerebrovascular diseases. Acupuncture has been widely applied in the treatment of hyperlipidemia. But its efficacy has not been evaluated scientifically and systematically. Therefore, we provide a protocol of systematic evaluation to assess the effectiveness and safety of acupuncture treatment on patient with hyperlipidemia. METHODS We will search the following databases electronically, including 3 English literature databases (i.e., PubMed, Embase, and Cochrane Library) and 4 Chinese literature databases (i.e., Chinese Biological and Medical database, China National Knowledge Infrastructure, VIP, and Wanfang Database). We will also search randomized-controlled trials about acupuncture treatment for hyperlipidemia and the search time limit is from its establishment to October 2018. The primary outcome is lipid-lowering efficacy. Secondary outcomes are total cholesterol, low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol levels. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. RESULTS This study will provide a high-quality synthesis to assess the effectiveness and safety of acupuncture treatment on patient with hyperlipidemia. CONCLUSION The conclusion of our systematic review will provide evidence to judge whether acupuncture is an effective intervention for patient with hyperlipidemia.
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Comparative Effectiveness of Inclisiran 100, 300, and 500 mg in a Population with Hyperlipidemia: A Network Meta-Analysis of Randomized Controlled Trials.
Wang, Y, Wang, J, Wang, S
American journal of cardiovascular drugs : drugs, devices, and other interventions. 2018;(4):271-282
Abstract
BACKGROUND To our knowledge, inclisiran was the first agent composed of small interfering RNAs (siRNAs) to be preliminarily used to reduce proatherogenic lipoprotein cholesterol levels. Inclisiran was evaluated in large clinical trials but did not receive government approval. The ability of inclisiran to reduce low-density lipoprotein cholesterol (LDL-C) greatly improved its chances of becoming a novel therapeutic option for patients with hyperlipidemia. OBJECTIVE Our goal was to summarize the preliminary effectiveness and safety data for inclisiran. METHODS We conducted a comprehensive search of PubMed, Scopus, Web of Science, the OVID EMB Reviews database, and Clinical Trials with the keyword "inclisiran" to find all related randomized controlled trials (RCTs). Five recently published RCTs involving 583 adults aged 18-65 years with hyperlipidemia were included in the analysis. RESULTS Subgroup analysis suggested that inclisiran 100 mg (standard mean difference [SMD] - 2.09; 95% confidence interval [CI] - 2.51 to - 1.66; p < 0.05), 300 mg (SMD - 2.74; 95% CI - 3.61 to - 1.87; p < 0.05), and 500 mg (SMD - 2.21; 95% CI - 2.62 to - 1.80; p < 0.05) significantly (p < 0.05) reduced LDL-C and total cholesterol even though pooled analysis showed no LDL-C-lowering effect (SMD 0.15; 95% CI - 0.34 to 0.04; p = 0.116). Compared with patients receiving placebo, pooled and subgroup analysis of patients receiving inclisiran showed no favorable changes in triglycerides or high-density lipoprotein cholesterol (p > 0.05). The most commonly reported adverse events were musculoskeletal pain, nasopharyngitis, headache, and elevated C-reactive protein (CRP), none of which were significant (p > 0.05). CONCLUSIONS To date, inclisiran has been effective in treating hyperlipidemia. Major adverse events were not identified, although other possible adverse events may be discovered with more RCTs and extensive long-term follow-up.
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Optimising treatment of hyperlipidaemia: Quantitative evaluation of UK, USA and European guidelines taking account of both LDL cholesterol levels and cardiovascular disease risk.
Soran, H, Adam, S, Durrington, PN
Atherosclerosis. 2018;:135-142
Abstract
BACKGROUND AND AIMS Guidelines for cholesterol-lowering medication either advocate fixed dose statin treatment without low density lipoprotein (LDL) cholesterol targets or treatment aimed at LDL cholesterol goals. The decrease in LDL cholesterol concentration determines the reduction in atherosclerotic cardiovascular disease (CVD) risk. METHODS As indices of the effectiveness of reductions in LDL cholesterol concentration achieved by the various guidelines, the number of CVD events prevented in 100 people during 10 years of treatment (N100) and the number of people, who must be treated for 10 years to prevent one CVD event (NNT), were calculated taking into account both CVD risk and pretreatment LDL cholesterol concentration. That our method of calculating NNT and N100, could be extended to statin regimens of different intensity or of statin combined with adjunctive cholesterol-lowering medication was demonstrated by meta-analysis. RESULTS Reductions in LDL-cholesterol concentration are determined by the choice and dose of medication and by the pre-treatment LDL-cholesterol concentration. At similar CVD risk, whatever cholesterol-lowering strategy is adopted, people with higher pre-treatment LDL cholesterol benefit more than those with lower levels. Fixed dose statin regimens are less effective than target LDL cholesterol levels of 1.8 or 1.4 mmol/l when pre-treatment LDL-cholesterol levels exceed 4 mmol/l. However, fixed dose statin is more effective in people with lower initial LDL cholesterol. The predicted NNT and N100 were closely related to the observed reduction in CVD risk in our meta-analysis. CONCLUSIONS In hypercholesterolaemia, aiming for LDL cholesterol targets with statin dose titration (and when necessary adjunctive medication) is essential to optimise benefit.
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Clinical utility of evolocumab in the management of hyperlipidemia: patient selection and follow-up.
Dixon, DL, Buckley, LF, Trankle, CR, Kadariya, D, Abbate, A
Drug design, development and therapy. 2017;:2121-2129
Abstract
Inhibition of PCSK9 is a novel therapeutic strategy aimed at reducing low-density-lipoprotein cholesterol (LDL-C) and cardiovascular risk. Evolocumab is a fully humanized monoclonal antibody that inhibits PCSK9, an enzyme that binds to LDL receptors and prevents them from recycling to the hepatocyte surface. Clinical trials have demonstrated 50%-70% reductions in LDL-C with evolocumab when used in combination with statin therapy. The recent FOURIER trial demonstrated that evolocumab further reduces cardiovascular events, but not mortality, in high-risk patients already receiving statin therapy. Furthermore, evolocumab did not affect neurocognitive function and was not associated with antidrug-antibody production in over 60,000 patient-years of drug exposure. Appropriate candidates for evolocumab primarily are individuals at high cardiovascular risk, including those with familial hypercholesterolemia and/or established cardiovascular disease, who are already on statin therapy. At this time, the use of evolocumab monotherapy seems appropriate only for individuals deemed statin-intolerant despite attempting several statins. Consideration must be given toward patient willingness to self-inject evolocumab and issues concerning third-party coverage, given the current costs of evolocumab.
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An Overview on Indications and Chemical Composition of Aromatic Waters (Hydrosols) as Functional Beverages in Persian Nutrition Culture and Folk Medicine for Hyperlipidemia and Cardiovascular Conditions.
Hamedi, A, Moheimani, SM, Sakhteman, A, Etemadfard, H, Moein, M
Journal of evidence-based complementary & alternative medicine. 2017;(4):544-561
Abstract
Hydrosol beverages in Persian nutrition culture and ethnomedicine are the side products of essential oil industry that are used as delicious drinks or safe remedies. To investigate indications and chemical composition of hydrosol beverages for hyperlipidemia and cardiovascular conditions, Fars province was selected as the field of study. Ethnomedical data were gathered by questionnaires. The constituents of hydrosols were extracted with liquid/liquid extraction and analyzed by gas chromatography-mass spectrometry. Statistical analysis were used to cluster their constituents and find the relevance of their composition. A literature survey was also performed on plants used to prepare them. Thymol was the major or second major component of these beverages, except for wormwood and olive leaf hydrosols. Based on clustering methods, although some similarities could be found, composition of barberry, will fumitory, dill, and aloe hydrosols have more differences than others. These studies may help in developing some functional beverages or new therapeutics.