Recognition of Early Cardiovascular Disease Symptoms in Hypertensive and Dyslipidemic Individuals of Icheon, Korea: Insights into Educational Levels and Health Literacy.

The study aimed to explore the relationship between the presence of hypertension or dyslipidemia and the recognition of early symptoms of cardiovascular diseases (CVD), particularly acute myocardial infarction (AMI) and stroke. It is crucial for individuals with hypertension or dyslipidemia to recognize early symptoms of AMI and stroke, as timely and appropriate intervention can lead to favorable health outcomes. The study enrolled 104 participants aged 19 and above who are current residents of the Icheon region, Gyeonggi, Korea. The assessment of early symptoms of AMI and stroke utilized adapted items from the Korea Community Health Survey. In consideration of health literacy and education attainment, logistic regression analyses were conducted. While there was no significant association between hypertension and awareness of AMI or stoke symptoms, individuals with dyslipidemia demonstrated enhanced recognition of specific AMI symptoms, such as 'sudden chest pain or pressure' and 'sudden feeling of breathlessness'. No significant associations were observed between hypertension or dyslipidemia and awareness of stroke symptoms. The study emphasized the significance of targeted health education programs for individuals with chronic conditions to enhance their awareness of early symptoms of AMI and stroke.

The impact of overweight on lipid phenotype in different forms of dyslipidemia: a retrospective cohort study.

PURPOSE: Dyslipidemia plays a pivotal role in increasing cardiovascular risk. In clinical practice the misleading association between altered lipid profile and obesity is common, therefore genetically inherited dyslipidemias may not completely be addressed among patients with overweight. Thus, we aim to investigate the influence of overweight and obesity on the lipid phenotype in a cohort of patients with different forms of dyslipidemia. METHODS: A retrospective analysis was conducted on patients with dyslipidemia from 2015 to 2022. Patients were stratified in familial hypercholesterolemia (FH), familial combined hyperlipidemia (FCHL), non-familial hyperlipidemia or polygenic hypercholesterolemia (PH). Clinical characteristics and lipid profile were evaluated. RESULTS: Of the total of 798 patients, 361 were affected by non-familial hyperlipidemia (45.2%), while FCHL, FH and PH was described in 19.9%, 14.0% and 20.9% of patients, respectively. Overweight prevalence was higher in FCHL and non-familial hyperlipidemia patients than FH and PH patients. Subjects with overweight and obesity were independently associated with lower levels of high-density lipoprotein cholesterol (HDL-C) compared to patients with normal weight (52.4 and 46.0 vs 58.1, respectively; p < 0.0001); levels of triglycerides (TG) and non-HDL-C were higher in patients with overweight and obesity than patients with normal weight (257.3 and 290.9 vs 194.8, and 221.5 and 219.6 vs 210.1, p < 0.0001 and p = 0.01, respectively), while no differences were observed between patients with overweight and obesity. CONCLUSION: While dyslipidemias can be influenced by various factors, an important determinant may lie in genetics, frequently acting as an underlying cause of altered lipid profiles, even in cases of overweight conditions.

Effectiveness and safety of injectable PCSK9 inhibitors in dyslipidaemias’ treatment and cardiovascular disease prevention: An overview of 86 systematic reviews and a network metaanalysis / Eficacia y seguridad de los inyectables inhibidores de la PCSK9 en el tratamiento de dislipidemias y la prevención de enfermedades cardiovasculares: una visión general de 86 revisiones sistemáticas y un metaanálisis en red

Objective Multiple systematic reviews (SR) have been performed on the effects of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), often providing conflicting findings. This overview and network meta-analysis (NMA) aimed to summarize SR findings on the efficacy and safety of PCSK9i and provide an updated NMA. Materials and methods MEDLINE (Pubmed), Scopus, Cochrane, Epistemonikos and Google Scholar were searched from inception to September 21, 2023 for SRs of randomized controlled trials (RCTs) and from January 1, 2020 to September 21, 2023 for additional RCTs. Double-independent study selection, data extraction and quality assessment were performed. Qualitative analysis was performed for SRs and a frequentist random-effects model NMA was performed for RCTs. Results Totally, 86 SRs and 76 RCTs were included. Alirocumab (77/86 [90%]) and evolocumab (73/86 [85%]) were mostly analyzed. Associations from SRs (35/42 [83%]) and the updated NMA indicated PCSK9i benefit on major adverse cardiovascular events (MACEs). Reductions were also noted for cerebrovascular events (47/66 [71%]), coronary revascularization (29/33 [88%]) and myocardial infarction (41/63 [65%]). Alirocumab was associated with reductions on all-cause mortality (RR=0.82, 95%CI [0.72,0.94]). Data on any CV event reduction were conflicting (7/16 [44%]). Inclisiran appeared effective only on MACEs (RR=0.76, 95%CI [0.61,0.94]). No reductions in heart failure were observed (0/16). No increases were identified between PCSK9i and any (0/35) or serious adverse events (0/52). However, PCSK9i were associated with injection-site reactions (20/28 [71%]). Conclusion PCSK9i appeared to be effective in CV outcomes and their clinical application was generally safe. (AU)

Objetivo Las revisiones sistemáticas (RS) sobre los efectos de los inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 (PCSK9i), presentan resultados contradictorios. Esta revisión general y metaanálisis en red (MER) tiene como objetivo resumir los hallazgos sobre la eficacia y seguridad de los PCSK9i. Materiales y métodos Se realizaron búsquedas en MEDLINE (PubMed), Scopus, Cochrane, Epistemonikos y Google Scholar desde sus inicios hasta el 21 de septiembre de 2023 para las RS de ensayos controlados aleatorios (ECA) y desde el 1 de enero de 2020 hasta 21 de septiembre de 2023 para los ECA adicionales. La selección de estudios, extracción de datos y evaluación de calidad se llevaron a cabo de manera doble e independiente. Se realizó un análisis cualitativo de las SR y un modelo de efectos aleatorios frecuentistas MER para los ECA. Resultados En total, se incluyeron 86 SR y 76 RCT. Alirocumab (77/86 [90%]) y evolocumab (73/86 [85%]) fueron los más analizados. Se reconocieron beneficios de los PCSK9i en eventos cardiovasculares adversos mayores (ECVAM), reducción de eventos cerebrovasculares (47/66 [71%]), revascularización coronaria (29/33 [88%]) e infartos de miocardio (41/63 [65%]). Alirocumab redujo la mortalidad por todas las causas (RR: 0,82; IC del 95%: 0,72-0,94). Los resultados sobre la reducción de cualquier evento cardiovascular (CV) fueron contradictorios (7/16 [44%]). Inclisiran pareció ser efectivo solo en la reducción de ECVAM (RR: 0,76; IC del 95%: 0,61-0,94). No se observaron reducciones en insuficiencia cardíaca (0/16) o relación con eventos adversos serios (0/52). Sin embargo, se asociaron con reacciones en el lugar de la inyección (20/28 [71%]). (AU)

A targeted proteomics method for quantifying plasma apolipoprotein kinetics in individual mice using stable isotope labeling.

Altered apolipoprotein kinetics play a critical role in promoting dyslipidemia and atherogenesis. Human apolipoprotein kinetics have been extensively evaluated, but similar studies in mice are hampered by the lack of robust methods suitable for the small amounts of blood that can be collected at sequential time points from individual mice. We describe a targeted liquid chromatography tandem mass spectrometry method for simultaneously quantifying the stable isotope enrichment of several apolipoproteins represented by multiple peptides in serial blood samples (15 µl each) obtained after retro-orbital injection of 13C6,15N2-lysine (Lys8) in mice. We determined apolipoprotein fractional clearance rates (FCRs) and production rates (PRs) in WT mice and in two genetic models widely used for atherosclerosis research, LDL receptor-deficient (Ldlr-/-) and apolipoprotein E-deficient (Apoe-/-) mice. Injection of Lys8 produced a unique and readily detectable mass shift of labeled compared with unlabeled peptides with sensitivity allowing robust kinetics analyses. Ldlr-/- mice showed slower FCRs of APOA1, APOA4, total APOB, APOB100, APOCs, APOE and APOM, while FCRs of APOA1, APOB100, APOC2, APOC3, and APOM were not lower in Apoe-/- mice versus WT mice. APOE PR was increased in Ldlr-/- mice, and APOB100 and APOA4 PRs were reduced in Apoe-/- mice. Thus, our method reproducibly quantifies plasma apolipoprotein kinetics in different mouse models. The method can easily be expanded to include a wide range of proteins in the same biospecimen and should be useful for determining the kinetics of apolipoproteins in animal models of human disease.

Dyslipidemia: A Narrative Review on Pharmacotherapy.

Dyslipidemia plays a fundamental role in the development and progression of atherosclerosis. Current guidelines for treating dyslipidemia focus on low-density lipoprotein-cholesterol (LDL-C). Despite advances in the pharmacotherapy of atherosclerosis, the most successful agents used to treat this disease-statins-remain insufficient in the primary or secondary prevention of acute myocardial infarction. Advancing therapy for hypercholesterolemia with emerging new drugs, either as monotherapy or in combination, is expected to improve cardiovascular outcomes. An emerging field in dyslipidemia pharmacotherapy is research on genetic therapies and genetic modulation. Understanding the genetic mechanisms underlying lipid alterations may lead to the development of personalized treatments that directly target the genetic causes of dyslipidemia. RNA messenger (mRNA)-based therapies are also being explored, offering the ability to modulate gene expression to normalize lipid levels. Furthermore, nanotechnology raises new possibilities in drug delivery for treating dyslipidemia. Controlled-release systems, nanoparticles, and liposomes can enhance the effectiveness and safety of medications by providing more precise and sustained release. This narrative review summarizes current and emerging therapies for the management of patients with dyslipidemia.

Differences and Disparities Among Self-Referred and Physician-Referred Populations Undergoing Coronary Artery Calcium Scanning.

BACKGROUND: Coronary artery calcium computed tomography (CAC) is an important tool for identifying subclinical atherosclerosis and cardiovascular risk stratification. Despite robust evidence and inclusion in current guidelines, CAC is considered investigational by some US insurance carriers and requires out-of-pocket expenses. CAC can be obtained via self-referral (SR) or physician referral (PR). We aimed to examine differences in patient, socioeconomic, and CAC characteristics between referral groups. METHODS: We evaluated demographic, medical history, and CAC results of consecutive patients with a CAC completed at one of multiple Wisconsin sites from March 1, 2019, to June 30, 2021. We separated patients into SR and PR groups. Through census data, we analyzed socioeconomic variables at the block level including race and ethnicity, median income, average household size, and high school completion in the areas where patients resided at the time of CAC. RESULTS: The final analysis included 19 726 patients: 13 835 (70.1%) PR and 5891 (29.9%) SR. Most patients in both groups were White (95.2% versus 95.1%), with the Black/African American population representing 2.7% (SR) and 2.3% (PR). The PR group had a higher prevalence of cardiovascular risk factors. SR patients were more likely to have a score of 0 (41.2% versus 38.1%; P<0.001); PR patients had a higher prevalence of CAC >300 (16.8% versus 14.8%; P<0.001). SR patients were more likely to be women (55.1% versus 48.9%; P<0.001) and were found to live in higher income areas (19.5% versus 16.4%; P<0.001). Patients from low-income areas comprised the smallest proportion in both groups (7.5%). CONCLUSIONS: Patients who obtain out-of-pocket CAC live predominantly in medium- and high-income areas, and patients from lower income locations are less likely to obtain CAC despite having more cardiovascular disease risk factors. Consideration should be made from a policy perspective to promote health equity and improve utilization of CAC testing among underrepresented groups.

Trends in epidemiology of dyslipidemias in India.

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. High total cholesterol and its principal subtypes: low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (NHDL) cholesterol are the most important. Epidemiological and Mendelian randomization studies have confirmed role of raised triglycerides and lipoprotein(a). INTERHEART study reported a significant association of raised ApoB/ApoA1, total-, LDL-, and NHDL-cholesterol in South Asians. Prospective Urban Rural Epidemiology (PURE) study identified raised NHDL cholesterol as the most important risk factor. Regional and multisite epidemiological studies in India have reported increasing population levels of total-, LDL-, and NHDL cholesterol and triglycerides. India Heart Watch reported higher prevalence of total and LDL cholesterol in northern and western Indian cities. ICMR-INDIAB study reported regional variations in hypercholesterolemia (≥200 mg/dl) from 4.6 % to 50.3 %, with greater prevalence in northern states, Kerala, Goa, and West Bengal. Non-Communicable Disease Risk Factor Collaboration and Global Burden of Diseases Studies have reported increasing LDL- and NHDL-cholesterol in India. Studies among emigrant Indians in UK and USA have reported higher triglycerides in compared to Caucasians. Identification of regional variations and trends in dyslipidemias need more nationwide surveys. Prospective studies are needed to assess quantum of risk with CAD incidence.

Apolipoprotein B and Lipid Profile in Italian Children and Adolescents.

RATIONALE: The prevention of cardiovascular (CV) disease is mandatory from childhood onwards. Among biochemical markers related to the clinical cardiovascular outcome, LDL cholesterol (LDL-C), non-HDL-C and apolipoprotein B (ApoB) are recognized as main target parameters. Emphasis on ApoB concentrations is growing, as representative of any class of atherogenic lipoprotein. This consideration allows checking of subjects under 18 years of age when the CV risk occurs. The aim of this study is to evaluate ApoB levels in a sample of Italian hyperlipidemic children and adolescents, and their siblings, to test any relationship with their lipid profile. METHODS: A retrospective study, including 1877 children and adolescents (aged 0-18 years), was performed. Clinical and biochemical data were selected from a database, including the lipid profile, ApoB analysis and anthropometric parameters of any proband. Participants had been checked as potentially hyperlipidemia affected, the suspicion raised by familial CV risk or because the dyslipidemia was already known. Data from the first visit at the University Hospitals in Rome and Turin were collected. Patients affected by secondary hyperlipidemia or obesity were excluded. Blood test analysis was performed in fasting conditions by automated commercial kits. Participants were classified according to gender, age (stratified in subgroups: 0-5, 6-10, 11-14, and 15-18 years old) and anthropometric parameters, referred to as weight in Kg and height in cm, and BMI calculated. Lipid profile results were stratified in relation to acceptable, borderline, or increased levels, as indicated by NCEP, and any potential relation with ApoB established. Statistics were performed by Epi-Info 7 programs to evaluate the variance analysis. Either parent could sign the informed consent. RESULTS: Among the whole sample n.1010 and n.867 participants were females and males, respectively. TC values acceptable (≤170 mg/dL), borderline (171-200 mg/dL) and elevated (≥201 mg/dL) were found in 411 (22%), 585 (31%) and 881 (47%) participants, respectively. The LDL-C cut-off considered was 110 mg/dL (90° percentile). Mean ApoB progressively increased from 65 to 110 mg/dL according to TC levels and resulted in significant correlation when any age subgroup and gender was considered. The highest ApoB values, TC and LDL-C related, were found in the youngest subgroup, regardless of gender. CONCLUSION: ApoB results increase progressively and in parallel with TC and LDL-C and represent a further parameter to distinguish between normal and hyperlipidemic subjects. Serum levels are close to 70 mg/dL and to 100 mg/dL in the former and latter group, respectively.

ANGPTL3 deficiency impairs lipoprotein production and produces adaptive changes in hepatic lipid metabolism.

Angiopoietin-like protein 3 (ANGPTL3) is a hepatically secreted protein and therapeutic target for reducing plasma triglyceride-rich lipoproteins and low-density lipoprotein (LDL) cholesterol. Although ANGPTL3 modulates the metabolism of circulating lipoproteins, its role in triglyceride-rich lipoprotein assembly and secretion remains unknown. CRISPR-associated protein 9 (CRISPR/Cas9) was used to target ANGPTL3 in HepG2 cells (ANGPTL3-/-) whereupon we observed ∼50% reduction of apolipoprotein B100 (ApoB100) secretion, accompanied by an increase in ApoB100 early presecretory degradation via a predominantly lysosomal mechanism. Despite defective particle secretion in ANGPTL3-/- cells, targeted lipidomic analysis did not reveal neutral lipid accumulation in ANGPTL3-/- cells; rather ANGPTL3-/- cells demonstrated decreased secretion of newly synthesized triglycerides and increased fatty acid oxidation. Furthermore, RNA sequencing demonstrated significantly altered expression of key lipid metabolism genes, including targets of peroxisome proliferator-activated receptor α, consistent with decreased lipid anabolism and increased lipid catabolism. In contrast, CRISPR/Cas9 LDL receptor (LDLR) deletion in ANGPTL3-/- cells did not result in a secretion defect at baseline, but proteasomal inhibition strongly induced compensatory late presecretory degradation of ApoB100 and impaired its secretion. Additionally, these ANGPTL3-/-;LDLR-/- cells rescued the deficient LDL clearance of LDLR-/- cells. In summary, ANGPTL3 deficiency in the presence of functional LDLR leads to the production of fewer lipoprotein particles due to early presecretory defects in particle assembly that are associated with adaptive changes in intrahepatic lipid metabolism. In contrast, when LDLR is absent, ANGPTL3 deficiency is associated with late presecretory regulation of ApoB100 degradation without impaired secretion. Our findings therefore suggest an unanticipated intrahepatic role for ANGPTL3, whose function varies with LDLR status.

Spatial lipidomics of coronary atherosclerotic plaque development in a familial hypercholesterolemia swine model.

Coronary atherosclerosis is caused by plaque build-up, with lipids playing a pivotal role in its progression. However, lipid composition and distribution within coronary atherosclerosis remain unknown. This study aims to characterize lipids and investigate differences in lipid composition across disease stages to aid in the understanding of disease progression. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) was used to visualize lipid distributions in coronary artery sections (n = 17) from hypercholesterolemic swine. We performed histology on consecutive sections to classify the artery segments and to investigate colocalization between lipids and histological regions of interest in advanced plaque, including necrotic core and inflammatory cells. Segments were classified as healthy (n = 6), mild (n = 6), and advanced disease (n = 5) artery segments. Multivariate data analysis was employed to find differences in lipid composition between the segment types, and the lipids' spatial distribution was investigated using non-negative matrix factorization (NMF). Through this process, MALDI-MSI detected 473 lipid-related features. NMF clustering described three components in positive ionization mode: triacylglycerides (TAG), phosphatidylcholines (PC), and cholesterol species. In negative ionization mode, two components were identified: one driven by phosphatidylinositol(PI)(38:4), and one driven by ceramide-phosphoethanolamine(36:1). Multivariate data analysis showed the association between advanced disease and specific lipid signatures like PC(O-40:5) and cholesterylester(CE)(18:2). Ether-linked phospholipids and LysoPC species were found to colocalize with necrotic core, and mostly CE, ceramide, and PI species colocalized with inflammatory cells. This study, therefore, uncovers distinct lipid signatures correlated with plaque development and their colocalization with necrotic core and inflammatory cells, enhancing our understanding of coronary atherosclerosis progression.

Predicting the 10-year incidence of dyslipidemia based on novel anthropometric indices, using data mining.

BACKGROUND: The aim was to establish a 10-year dyslipidemia incidence model, investigating novel anthropometric indices using exploratory regression and data mining. METHODS: This data mining study was conducted on people who were diagnosed with dyslipidemia in phase 2 (n = 1097) of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, who were compared with healthy people in this phase (n = 679). The association of dyslipidemia with several novel anthropometric indices including Conicity Index (C-Index), Body Roundness Index (BRI), Visceral Adiposity Index (VAI), Lipid Accumulation Product (LAP), Abdominal Volume Index (AVI), Weight-Adjusted-Waist Index (WWI), A Body Shape Index (ABSI), Body Mass Index (BMI), Body Adiposity Index (BAI) and Body Surface Area (BSA) was evaluated. Logistic Regression (LR) and Decision Tree (DT) analysis were utilized to evaluate the association. The accuracy, sensitivity, and specificity of DT were assessed through the performance of a Receiver Operating Characteristic (ROC) curve using R software. RESULTS: A total of 1776 subjects without dyslipidemia during phase 1 were followed up in phase 2 and enrolled into the current study. The AUC of models A and B were 0.69 and 0.63 among subjects with dyslipidemia, respectively. VAI has been identified as a significant predictor of dyslipidemias (OR: 2.81, (95% CI: 2.07, 3.81)) in all models. Moreover, the DT showed that VAI followed by BMI and LAP were the most critical variables in predicting dyslipidemia incidence. CONCLUSIONS: Based on the results, model A had an acceptable performance for predicting 10 years of dyslipidemia incidence. Furthermore, the VAI, BMI, and LAP were the principal anthropometric factors for predicting dyslipidemia incidence by LR and DT models.

Association between Weight Change and Incidence of Dyslipidemia in Young Adults: A Retrospective Cohort Study of Korean Male Soldiers.

Background: Recent lifestyle changes have increased the prevalence of dyslipidemia in Korea. Young men are known to have a low awareness of dyslipidemia and a lack of motivation to maintain their weight. However, the association between weight change and dyslipidemia in young adults has not been thoroughly examined. Methods: Data from the Armed Forces Medical Command Defense Medical Information System database were used. In this study, 15,068 soldiers who underwent private and corporal health examinations between May 2020 and April 2022 were included. The difference in weights between the two different health examinations was used to quantify weight change. Four components of the lipid profile were used to assess dyslipidemia during the corporal health examination. Results: After adjusting for relevant covariates, weight gain was associated with increased risk of dyslipidemia (adjusted odds ratio [OR], 1.38 [95% confidence interval, CI, 1.15 to 1.64] for the 5% to 10% weight gain group; and OR, 2.02 [95% CI, 1.59 to 2.55] for the ≥10% weight gain group), whereas weight loss was associated with decreased risk (adjusted OR, 0.82 [95% CI, 0.68 to 0.98] for the 5% to 10% weight loss group; and OR, 0.38 [95% CI, 0.27 to 0.53] for the ≥10% weight loss group). In subgroup analysis based on the participants' baseline body mass index, smoking status, regular exercise habits, and hypertension status, there were no significant differences between the subgroups. Conclusion: Weight change was associated with dyslipidemia in Korean male soldiers. The findings suggest that limiting weight gain in young adults by encouraging a healthy lifestyle may help prevent dyslipidemia.

Lipid Profile and the Frequency of Dyslipidemia in Iranian Adolescents with Severe Obesity, Who Were Candidates for Bariatric Surgery.

PURPOSE: Although several studies have investigated the prevalence of dyslipidemia in adults undergoing bariatric surgery, the experience is limited in adolescents. This study aimed to evaluate the serum lipid profile and prevalence of dyslipidemia in Iranian adolescents with severe obesity undergoing bariatric surgery. MATERIALS AND METHODS: In this cross-sectional study, a total of 92 adolescents, aged < 20 years, with severe obesity (body mass index (BMI) ≥ 99th percentile), who were candidates for bariatric surgery were enrolled during 2016-2018. The fasting serum levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured in this study. Dyslipidemia was defined as TC, LDL-C, and TG ≥ 95th percentile or HDL-C < 10th percentile for age and sex. RESULTS: The mean age of the participants was 17.32 ± 1.88 years (age range, 11-19 years). Overall, 60.9% of the participants were female. Based on the results, 68.48% of the adolescents had dyslipidemia. The most frequent lipid disorder was hypertriglyceridemia (48.9%), followed by low HDL-C (39.6%), hypercholesterolemia (18.5%), and high LDL-C (16.5%). The serum concentrations of lipid components were not significantly different according to sex and age. CONCLUSION: The prevalence of dyslipidemia was found to be high among Iranian adolescents with severe obesity. Hypertriglyceridemia and low HDL-C were the most common types of dyslipidemia in this population. Therefore, screening for dyslipidemia may be clinically useful in adolescents with severe obesity; timely diagnosis and treatment may prevent the occurrence of coronary events in the future.

Impact of poor medication adherence on clinical outcomes and health resource utilization in patients with hypertension and/or dyslipidemia: systematic review.

INTRODUCTION: We aimed to summarize evidence on the effect of poor medication adherence on clinical outcomes and health resource utilization (HRU) among patients with hypertension and/or dyslipidemia. AREAS COVERED: A systematic review of studies reporting clinical outcomes and HRU for patients by status of adherence to antihypertensives and/or lipid-lowering medications was searched using Embase, MEDLINE, and MEDLINE In-Process and supplemented by manual searches of conference abstracts. In total, 45 studies were included, with most being retrospective observational studies (n = 36). Patients with poor adherence to antihypertensives and lipid-lowering medications compared with those with good adherence showed less reduction of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-c) after 6-12 months follow-up (∆ systolic BP: 1.2 vs. -4.5 mmHg; ∆LDL-c: -14.0 to -18.9 vs. -34.1 to -42.0 mg/dL). Poor adherence was also significantly associated with a higher risk of cardiovascular events (HR: 1.1-1.9) and mortality (HR: 1.4-1.8) in patients with hypertension and dyslipidemia and increased HRU (i.e. outpatient visits, risk of cardiovascular-related and all-cause hospitalization, annual inpatient days, total health-care costs). EXPERT OPINION: Poor adherence is associated with poor clinical outcomes and increased HRU, highlighting the need to enhance medication adherence in patients with hypertension and/or dyslipidemia.

High blood pressure is a leading cause of death and disease burden followed by high lipid levels in blood. Due to the silent nature of the diseases, patients can fall short of optimal medicinal treatment adherence and persistence, leading to poor outcomes and disease complications. The effectiveness of medicinal interventions depends on the appropriate medication-taking behavior of patients as lower adherence can lead to poor treatment benefits. Research was conducted to look for published studies that assessed the effect of lower medication adherence on clinical outcomes and health resource use among patients with high blood pressure, high lipid levels in blood, or both. Researchers were able to find 45 already published studies, from which 32 evaluated the use of blood pressure lowering medications and 7 evaluated the use of lipid-lowering medications, while 6 included patients treated with both types of medications. Refill of pharmacy prescription records was the most common method of assessing treatment adherence. Researchers found that patients with lower adherence to these medications compared with those with good adherence showed less decrease in blood pressure levels and less improvement in blood lipid levels after 6­12 months of follow-up. Patients who had lower adherence also had higher rates of cardiovascular events and deaths and increased usage of health services including visits to outpatient clinics, getting admitted to hospitals, and a longer stay of hospitalizations, leading to a higher overall healthcare cost. These findings suggest lower adherence is associated with poor clinical outcomes and increased health-care resource usage, highlighting the need to improve medication adherence in patients with high blood pressure and high lipid levels in blood.

Impact of anti-tumor necrosis factor treatment on lipid profiles in Korean patients with ankylosing spondylitis.

Objective: To investigate the effects of anti-tumor necrosis factor (TNF) treatment on lipid profiles and identify risk factors for an increase in total cholesterol (TC) after the anti-TNF treatment in ankylosing spondylitis (AS) patients. Methods: This retrospective cohort study analyzed AS patients who received the first-line anti-TNF treatment. Patients with at least nine months of follow-up were included; those who were under 18 years or on any lipid-lowering agent were excluded. A linear mixed model was used to assess the impact of anti-TNF inhibitors on disease activity and lipid profile (TC, low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides [TG]). Univariable and multivariable linear regression were used to identify risk factors for an increase in TC after 3 months of anti-TNF treatment. Results: A total of 315 AS patients were enrolled (78.1% male, median age 32.0 [26.0~41.0]). TC, HDL, and TG levels significantly increased particularly within the first 3 months of anti-TNF treatment, while LDL level did not show significant changes. Changes in inflammatory markers and lipid particles (TC, LDL, TG) were correlated over time, but HDL showed no significant correlation. Older age, higher baseline erythrocyte sedimentation rate, and lower baseline LDL level were related to an increase in TC after 3 months of the anti-TNF treatment. Conclusion: In AS patients, anti-TNF treatment has been found to increase lipid particles, potentially due to its anti-inflammatory effects. Future research should explore the underlying mechanism and the clinical implications of dyslipidemia, particularly the occurrence of cardiovascular events, following anti-TNF treatment in AS patients.

Effectiveness and safety of injectable PCSK9 inhibitors in dyslipidaemias' treatment and cardiovascular disease prevention: An overview of 86 systematic reviews and a network metaanalysis.

OBJECTIVE: Multiple systematic reviews (SR) have been performed on the effects of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), often providing conflicting findings. This overview and network meta-analysis (NMA) aimed to summarize SR findings on the efficacy and safety of PCSK9i and provide an updated NMA. MATERIALS AND METHODS: MEDLINE (Pubmed), Scopus, Cochrane, Epistemonikos and Google Scholar were searched from inception to September 21, 2023 for SRs of randomized controlled trials (RCTs) and from January 1, 2020 to September 21, 2023 for additional RCTs. Double-independent study selection, data extraction and quality assessment were performed. Qualitative analysis was performed for SRs and a frequentist random-effects model NMA was performed for RCTs. RESULTS: Totally, 86 SRs and 76 RCTs were included. Alirocumab (77/86 [90%]) and evolocumab (73/86 [85%]) were mostly analyzed. Associations from SRs (35/42 [83%]) and the updated NMA indicated PCSK9i benefit on major adverse cardiovascular events (MACEs). Reductions were also noted for cerebrovascular events (47/66 [71%]), coronary revascularization (29/33 [88%]) and myocardial infarction (41/63 [65%]). Alirocumab was associated with reductions on all-cause mortality (RR=0.82, 95%CI [0.72,0.94]). Data on any CV event reduction were conflicting (7/16 [44%]). Inclisiran appeared effective only on MACEs (RR=0.76, 95%CI [0.61,0.94]). No reductions in heart failure were observed (0/16). No increases were identified between PCSK9i and any (0/35) or serious adverse events (0/52). However, PCSK9i were associated with injection-site reactions (20/28 [71%]). CONCLUSION: PCSK9i appeared to be effective in CV outcomes and their clinical application was generally safe.

Effect of Ganoderma lucidum on serum lipid profiles: A systematic review and meta-analysis on animal studies.

Background: Ganoderma lucidum (G. lucidum) is one of the most popular edible mushrooms in the world which has various pharmacological components. Recently, some animal studies have investigated the lipid-lowering effects of G. lucidum and have shown contradictory results. This study aims to systematically review the effects of G. lucidum on lipid parameters in animal studies. Materials and Methods: A systematic search was conducted in the Medline database (PubMed), Scopus, Web of Science, Cochrane Library, and Google Scholar up to the end of January 2022. Only animal studies and all eligible randomized controlled trials (RCTs), including cluster RCTs and randomized crossover trials were included. The English language studies that assessed the effects of G. lucidum on lipid profiles including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and very low-density lipoproteins (VLDL) were selected. Results: Among 358 studies, 49 articles were included in the systematic review and meta-analysis. G. lucidum consumption was associated with decreased levels of TG (standardized mean difference [SMD] = -1.52, 95% CI: -1.79, -1.24), TC (SMD = -1.51, 95% CI: -1.75, -1.27), LDL-C (SMD = -2.03, 95% CI: -2.37, -1.69) and VLDL (SMD =-1.06, 95% CI: -1.638, -0.482). Furthermore, G. lucidum consumption was associated with increased levels of HDL-C (SMD = 1.03, 95% CI: 0.73, 1.33). Conclusion: G. lucidum has favorable effects on TG, TC, LDL-C, HDL-C, and VLDL. Different doses of G. lucidum have various degrees of effectiveness on lipid profiles.

Significant Gap Between Guidelines and Practice in the Management of LDL Cholesterol: Insight From the Survey of the Korean Society of Myocardial Infarction.

The Guidelines of the 2019 European Society of Cardiology (ESC) and the 5th Society of Lipid and Atherosclerosis (KSoLA) for the Management of Dyslipidemia advocate a more intensive lipid-lowering strategy. However, there is a lack of evidence regarding the current status of lipid management in Korean patients in real-world practice. The Korean Society of Myocardial Infarction conducted a survey among its members of the Korean Society of Cardiology on the new lipid guidelines. Although most participants were aware of the changes in the ESC and the KSoLA guidelines, more than half of them did not agree with lowering the low-density lipoprotein cholesterol levels to < 55 mg/dL, because its safety and efficacy have not yet been proven in Koreans. A substantial disparity exists between lipid management guidelines and current clinical practices, highlighting the necessity for clinical research that specifically targets East Asians and Koreans to bridge this gap.