2022 Taiwan lipid guidelines for primary prevention.

Elevated circulating low-density lipoprotein cholesterol (LDL-C) is a major risk factor of atherosclerotic cardiovascular disease (ASCVD). Early control of LDL-C to prevent ASCVD later in life is important. The Taiwan Society of Lipids and Atherosclerosis in association with the other seven societies developed this new lipid guideline focusing on subjects without clinically significant ASCVD. In this guideline for primary prevention, the recommended LDL-C target is based on risk stratification. A healthy lifestyle with recommendations for foods, dietary supplements and alcohol drinking are described. The pharmacological therapies for LDL-C reduction are recommended. The aim of this guideline is to decrease the risk of ASCVD through adequate control of dyslipidemia in Taiwan.

Real-World Analyses of the Safety Outcome among a General Population Treated with Statins: An Asian Population-Based Study.

AIM: The safety concern of statins is still a major issue for Asians. The aim of this study is to compare the risk of statin-associated adverse events among potent statins. METHODS: We included patients from the Taiwan National Health Insurance Research Database who had been treated with atorvastatin, rosuvastatin, or pitavastatin and were without diabetes at baseline. They were classified into three groups: usual-dose statin (atorvastatin 10 mg/d or rosuvastatin 5-10 mg/d), high-dose statin (atorvastatin 20-40 mg/d and rosuvastatin 20 mg/d), and pitavastatin (2-4 mg/d). The primary endpoint is a composite of safety events, including hepatitis, myopathy, and new-onset diabetes mellitus (NODM). We matched age, sex, and year of recruitment among the three groups (n=50,935 in each group) and then used the multivariate Cox proportional hazards model to evaluate the relation between the safety endpoint and different statin groups. RESULTS: After a mean follow-up of 3.08±0.83 years, the safety events occurred in 9.84% in the pitavastatin group, 10.88% in the usual-dose statin group, and 10.49% in high-dose statin group. The multivariate Cox proportional hazards model indicated that usual-dose statin and high-dose statin were associated with a higher risk of the composite safety events compared with pitavastatin (adjusted hazard ratio [aHR]: 1.12, 95% confidence interval [CI]: 1.08-1.17 for usual-dose statin and aHR: 1.06, 95% CI: 1.02-1.10 for high-dose statin). The risks of hepatitis requiring hospitalization and NODM were especially lower in pitavastatin group. CONCLUSIONS: Compared with atorvastatin and rosuvastatin, pitavastatin might be associated with a lower risk of safety events in Asians.

Two new quinolone alkaloids from the nearly ripe fruits of Tetradium ruticarpum.

Tetradium ruticarpum (Juss.) Benth. belong to the family of Rutaceae. The complete and nearly ripe fruits of T. ruticarpum is used as traditional Chinese medicine and phytochemical investigations have been conducted on extracts of the seeds of T. ruticarpum to provide scientific validation of its properties. In this study, we successfully isolated two new quinolone alkaloids (1-2) from the MeOH extractive of nearly ripe fruits of T. ruticarpum. The structure elucidation of these compounds was determined by one- and two-dimensional nuclear magnetic resonance, ultraviolet and electrospray ionisation time-of-flight mass spectrometry. This finding expands the understanding of the natural constituents of the Rutaceae, in particular, the Tetradium genera.

2017 Taiwan lipid guidelines for high risk patients.

In Taiwan, the prevalence of hyperlipidemia increased due to lifestyle and dietary habit changes. Low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) are all significant predicting factors of coronary artery disease in Taiwan. We recognized that lipid control is especially important in patients with existed atherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), ischemic stroke and peripheral arterial disease (PAD). Because the risk of ASCVD is high in patients with diabetes mellitus (DM), chronic kidney disease (CKD) and familial hypercholesterolemia (FH), lipid control is also necessary in these patients. Lifestyle modification is the first step to control lipid. Weight reduction, regular physical exercise and limitation of alcohol intake all reduce triglyceride (TG) levels. Lipid-lowering drugs include HMG-CoA reductase inhibitors (statins), cholesterol absorption inhibitors (ezetimibe), proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, nicotinic acids (niacin), fibric acids derivatives (fibrates), and long-chain omega-3 fatty acids. Statin is usually the first line therapy. Combination therapy with statin and other lipid-lowering agents may be considered in some clinical settings. For patients with acute coronary syndrome (ACS) and stable CAD, LDL-C < 70 mg/dL is the major target. A lower target of LDL-C <55 mg/dL can be considered in ACS patients with DM. After treating LDL-C to target, non-HDL-C can be considered as a secondary target for patients with TG ≥ 200 mg/dL. The suggested non-HDL-C target is < 100 mg/dL in ACS and CAD patients. For patients with ischemic stroke or transient ischemic attack presumed to be of atherosclerotic origin, statin therapy is beneficial and LDL-C < 100 mg/dL is the suggested target. For patients with symptomatic carotid stenosis or intracranial arterial stenosis, in addition to antiplatelets and blood pressure control, LDL-C should be lowered to < 100 mg/dL. Statin is necessary for DM patients with CV disease and the LDL-C target is < 70 mg/dL. For diabetic patients who are ≥ 40 years of age, or who are < 40 years of age but have additional CV risk factors, the LDL-C target should be < 100 mg/dL. After achieving LDL-C target, combination of other lipid-lowering agents with statin is reasonable to attain TG < 150 mg/dL and HDL-C >40 in men and >50 mg/dL in women in DM. LDL-C increased CV risk in patients with CKD. In adults with glomerular filtration rate (GFR) < 60 mL/min/1.73m2 without chronic dialysis (CKD stage 3-5), statin therapy should be initiated if LDL-C ≥ 100 mg/dL. Ezetimibe can be added to statin to consolidate the CV protection in CKD patients. Mutations in LDL receptor, apolipoprotein B and PCSK9 genes are the common causes of FH. Diagnosis of FH usually depends on family history, clinical history of premature CAD, physical findings of xanthoma or corneal arcus and high levels of LDL-C. In addition to conventional lipid lowering therapies, adjunctive treatment with mipomersen, lomitapide, or PCSK9 inhibitors become necessary to further reduce LDL-C in patients with FH. Overall, these recommendations are to help the health care professionals in Taiwan to treat hyperlipidemia with current scientific evidences. We hope the prescription rate of lipid lowering drugs and control rate of hyperlipidemia in high risk patients could be increased by implementation of the clinical guidelines. The major purpose is to improve clinical outcomes of these high risk patients through the control of hyperlipidemia.

A novel inhibitory effect of Antrodia camphorata extract on vascular smooth muscle cell migration and neointima formation in mice.

Antrodia camphorata (AC) is a well-known traditional Chinese medicine that has been shown to inhibit proliferation and migration of cancer cells. We examined whether AC could inhibit rat aortic smooth muscle cell (RASMC) proliferation and migration and evaluated its effect on neointima formation in mouse carotid artery after injury. In Transwell migration assay and wound scratch assay, RASMCs were treated with AC or saline, and the number of migrated cells was counted or the distance was determined. Both assays showed that AC significantly inhibited platelet-derived growth factor (PDGF)-induced SMC migration. In 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) and 5-bromo-2' deoxyuridine (BrdU) proliferation assays, RASMCs were pretreated with AC or saline and stimulated with PDGF. Both assays showed that AC inhibited PDGF-induced SMC proliferation. The left common carotid arteries of C57BL/6 mice were ligated near the carotid bifurcation. The mice were given water or AC for 4 weeks. The severity of neointima formation was expressed as the neointima/media (N/M) ratio. The AC-treated mice had less neointima formation at 4 weeks after carotid ligation (N/M ratio, water versus 250 versus 1250 mg/kg AC; 1.33 +/- 0.87 versus 0.83 +/- 0.45 versus 0.63 +/- 0.32, P < 0.05).Our data indicate that AC is an effective inhibitor of PDGF-induced RASMC proliferation and migration. AC treatment reduced neointima formation in this mouse carotid ligation model.

Supplements of L-arginine attenuate the effects of high-fat meal on endothelial function and oxidative stress.

BACKGROUND: Postprandial hypertriglyceridemia is known to cause endothelial dysfunction and increased oxidative stress. Oral supplements of l-arginine have been found to improve endothelial function. However, the effects of supplements of l-arginine on the influences of postprandial hypertriglyceridemia were not studied before. METHODS: Forty young healthy men without any risk factors were equally divided into two groups. l-arginine group (age 22+/-1 years, body mass index 23.5+/-1.2 kg/m(2)) received a standard high-fat meal with 15 g oral l-arginine. Control group (age 22+/-1 years, body mass index 23.8+/-0.9 kg/m(2)) received a standard high-fat meal with placebo. A standard high-fat meal consisted of 900 kcal and 50 g of fat. Flow-mediated vasodilation (FMD), von Willebrand factor (vWF), p-Selectin, and glutathione peroxidase (GSH-Px) were measured before and 2 h after the high-fat meal. RESULTS: Serum triglyceride levels were significantly increased 2 h after the high-fat meal in both groups. In the control group, FMD (10.5+/-1.2% vs. 6.8+/-1.4%, p<0.001) and GSH-Px (23.5+/-6.2 vs. 21.9+/-5.0 mug/ml, p=0.029) were significantly decreased after the high-fat meal. P-Selectin (20.0+/-7.7 vs. 25.9+/-10.5 mg/l, p=0.025) and vWF (731.2+/-131.5 vs. 934.9+/-133.8 mU/ml, p<0.001) were significantly increased after the high-fat meal. In the l-arginine group, FMD (10.3+/-1.3 vs. 9.3+/-0.9%, p<0.001) was slightly but significantly decreased after the high-fat meal but not GSH-Px (23.6+/-3.6 vs. 23.0+/-4.8%, p=0.468). P-Selectin (20.1+/-5.9 vs. 25.7+/-10.2 mg/l, p=0.001) and vWF (793.2+/-146.0 vs. 944.4+/-136.8 mU/ml, p<0.001) were significantly increased after the high-fat meal. Degree of FMD attenuation following the high-fat meal was significantly less in the l-arginine group (1.0+/-0.9 vs. 3.8+/-1.5%, p<0.001). CONCLUSIONS: Concomitant supplements of l-arginine improved endothelial dysfunction and oxidative stress induced by postprandial hypertriglyceridemia. However, changes of p-Selectin and vWF were not affected by supplements of l-arginine with the high-fat meal.

Adult-onset acute rheumatic fever: possible resurgence in southern Taiwan.

BACKGROUND: By the late 1980s, acute rheumatic fever (ARF) had become a rare disease in Taiwan. The low prevalence rate in this area is attributed to a better economic status, which has led to improved public health and adequate medical services. OBJECTIVES: The increasing number of patients with adult-onset ARF in the United States described in the literature prompted us to evaluate the cases diagnosed in our medical center. METHODS: A retrospective chart review was performed for patients with arthritis from July 1988 to October 2004. To be included, patients had to meet revised Jones criteria. RESULTS: Three adult patients with ARF have been diagnosed since June 2001, with no childhood ARF being diagnosed. All cases presented with migratory polyarthritis, whereas 1 had erythema marginatum and transient carditis. These patients responded well to treatment with antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Clinicians must provide careful assessment and treatment to patients presenting with acute pharyngitis. A possible resurgence of ARF can be eradicated by primary prevention of streptococcal pharyngitis.