Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.
- MeSH
- akutní koronární syndrom * krev farmakoterapie etiologie MeSH
- anticholesteremika terapeutické užití MeSH
- ateroskleróza * krev komplikace farmakoterapie MeSH
- hypolipidemika * terapeutické užití MeSH
- LDL-cholesterol krev MeSH
- lidé MeSH
- přehledová literatura jako téma MeSH
- statiny terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
Atherosclerotic cardiovascular disease (ASCVD) is accelerated in people with diabetes. Dyslipidemia, hyperglycemia, oxidative stress, and inflammation play a role via a variety of mechanisms operative in the artery wall. In addition, some unique features predispose people with type 1 diabetes to accelerated atherosclerosis. Various organizations have created guidelines that provide advice regarding screening, risk assessment, and roadmaps for treatment to prevent ASCVD in diabetes. Management of dyslipidemia, especially with statins, has proven to be of immense benefit in the prevention of clinical CVD. However, since many patients fail to attain the low levels of low-density lipoproteins (LDL) recommended in these guidelines, supplemental therapy, such as the addition of ezetimibe, bempedoic acid or PCSK9 inhibitors, is often required to reach LDL goals. As a result, the upfront use of combination therapies, particularly a statin plus ezetimibe, is a rational initial approach. The addition to statins of drugs that specifically lower triglyceride levels has not proven beneficial, although the addition of icosapent-ethyl has been shown to be of value, likely by mechanisms independent of triglyceride lowering. Newer treatments in development, including apoC-III and ANGPTL3 inhibitors, seem promising in further reducing apoB-containing lipoproteins.
- MeSH
- anticholesteremika terapeutické užití MeSH
- ateroskleróza farmakoterapie krev prevence a kontrola MeSH
- biologické markery krev MeSH
- diabetes mellitus 1. typu farmakoterapie diagnóza krev komplikace MeSH
- dyslipidemie * farmakoterapie krev diagnóza MeSH
- ezetimib terapeutické užití MeSH
- hypolipidemika terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- statiny terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- aortální stenóza krev prevence a kontrola MeSH
- ateroskleróza krev prevence a kontrola MeSH
- kardiovaskulární nemoci * krev prevence a kontrola MeSH
- lidé MeSH
- lipoprotein (a) * krev škodlivé účinky účinky léků MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
V diagnostice a stanovování prognózy kardiovaskulárních onemocnění (KVO) již byla použita řada ukazatelů. Aterogenní index plazmy (AIP) se vypočítává jako logaritmus molárních koncentrací triglyceridu (TG) a lipoproteinů o vysoké hustotě (high-density lipoprotein, HDL). Vynikající predikční hodnota AIP je výsledkem těsného vztahu mezi AIP a velikostí lipoproteinových částic. AIP lze jednoduše vypočítat pomocí typického lipidového profilu. Jedná se o přesnější prediktor velikosti lipoproteinových částic než velikosti částic jednotlivých lipidů nebo poměru TG a HDL.
Numerous indicators have been used to diagnose and prognosticate cardiovascular disease (CVD). The atherogenic index of plasma (AIP) is a logarithmic conversion of triglyceride (TG) to high-density lipoprotein (HDL) molar concentrations. The close association between AIP and the size of lipoprotein particles may account for its excellent predictive value. AIP may be computed simply using a typical lipid profile. It is a bet- ter predictor of lipoprotein particle size than that of individual lipids or the ratio of TG to HDL.
- MeSH
- algoritmy MeSH
- ateroskleróza etiologie krev MeSH
- biologické markery * analýza MeSH
- kardiovaskulární nemoci * diagnóza etiologie krev MeSH
- krevní plazma MeSH
- lidé MeSH
- lipoproteiny HDL analýza MeSH
- prognóza MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- triglyceridy analýza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- Klíčová slova
- hsCRP,
- MeSH
- ateroskleróza krev metabolismus patofyziologie prevence a kontrola MeSH
- C-reaktivní protein * analýza MeSH
- kardiovaskulární nemoci klasifikace krev MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- zánět krev MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), "lower is better for longer", and the recent data have strongly emphasized the need of also "the earlier the better". In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an 'Extremely High Risk' group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients.
- MeSH
- akutní koronární syndrom krev farmakoterapie MeSH
- anticholesteremika škodlivé účinky terapeutické užití MeSH
- ateroskleróza krev farmakoterapie MeSH
- ezetimib škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- lipidy krev MeSH
- management nemoci MeSH
- PCSK9 inhibitory škodlivé účinky terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The term arterial stiffness (ArSt) describes structural changes in arterial wall related to the loss of elasticity and is known as an independent predictor of cardiovascular diseases (CVD). The evidence relating to ArSt and triglycerides (TG) shows contradictory results. This paper means to survey the association between high TG and ArSt, utilizing the cardio-ankle vascular index (CAVI). METHODS: Subjects aged between 25 and 64 years from a random population-based sample were evaluated between 2013 and 2016. Data from questionnaires, blood pressure, anthropometric measures, and blood samples were collected and analyzed. CAVI was measured using VaSera VS-1500 N devise. Subjects with a history of CVD or chronic renal disease were excluded. RESULTS: One thousand nine hundred thirty-four participants, 44.7% of males, were included. The median age was 48 (Interquartile Range [IQR] 19) years, TG levels were 1.05 (0.793) mmol/L, and CAVI 7.24 (1.43) points. Prevalence of high CAVI was 10.0% (14.5% in males and 6.4% in females; P < 0.001) and prevalence of hypertriglyceridemia was 20.2% (29.2% in males and 13% in females, P < 0.001). The correlation between TG and CAVI was 0.136 (P < 0.001). High CAVI values were more prevalent among participants with metabolic syndrome (MetS), high blood pressure, dysglycemia, abdominal obesity, high LDL-cholesterol (LDL-c), and high total cholesterol. Using binary regression analysis, high TG were associated with high CAVI, even after adjustment for other MetS components, age, gender, smoking status, LDL-c, and statin treatment (β = 0.474, OR = 1.607, 95% CI = 1.063-2.429, P = 0.024). CONCLUSION: TG levels were correlated with ArSt, measured as CAVI. High TG was associated with high CAVI independent of multiple cardiometabolic risk factors. Awareness of the risks and targeted treatment of hypertriglyceridemia could further benefit in reducing the prevalence of CVD and events.
- MeSH
- ateroskleróza krev patofyziologie MeSH
- dospělí MeSH
- hypertriglyceridemie krev patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metabolický syndrom krev patofyziologie MeSH
- regresní analýza MeSH
- rizikové faktory MeSH
- triglyceridy krev MeSH
- tuhost cévní stěny fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- apolipoproteiny B krev MeSH
- ateroskleróza * krev terapie MeSH
- LDL-cholesterol krev MeSH
- lidé MeSH
- lipoproteiny HDL krev MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
OBJECTIVE: Atherosclerosis is a major contributor to cardiovascular disease, with a higher burden on men than women during the occupational age. Intake of individual dietary antioxidants is inversely associated with risk of atherosclerosis development. We aimed to understand the relationship between dietary composite antioxidant intake and the carotid intima media thickness (cIMT), which is a proxy of atherosclerosis progression. APPROACH AND RESULTS: We performed a cross-sectional analysis that included 894 members of the Kardiovize cohort, a random urban sample population. Nutrient intakes were derived by 24-h recall. We constructed a composite dietary antioxidant index (CDAI), based on zinc, selenium, vitamin A, vitamin C, vitamin E and carotenoids. We considered the CDAI as the exposure variable and primary outcomes were the following cardio-metabolic parameters: body mass index (BMI), waist-to-hip ratio (WHR), body fat mass (BFM), systolic and diastolic blood pressure, triglycerides, HDL and LDL cholesterol, and cIMT. Associations and interactions between variables were evaluated using linear regression analyses. In women, a 1 mg increase in dietary intake of zinc or vitamin E decreased the cIMT by 3.36 and 1.48 µm, respectively, after adjusting for covariates. Similarly, the cIMT decreased by 4.72 µm for each one-unit increase in CDAI (p = 0.018). Beyond CDAI, age (β = 3.61; SE=0.89; p = 0.001), systolic blood pressure (β = 1.30; SE=0.59; p = 0.029) and triglycerides (β = 22.94; SE=10.09; p = 0.024) were significant predictors of cIMT in women. By contrast, we found no association between CDAI and cIMT in men. CONCLUSIONS: CDAI negatively associates with cIMT in women. These findings indicate that combined intake of nutrients with anti-oxidant properties might prevent the initiation and progression of arterial lesions in a sex-specific manner.
- MeSH
- antioxidancia aplikace a dávkování MeSH
- ateroskleróza krev diagnóza dietoterapie patofyziologie MeSH
- dospělí MeSH
- HDL-cholesterol krev MeSH
- index tělesné hmotnosti MeSH
- intimomediální šíře tepenné stěny * MeSH
- karotenoidy aplikace a dávkování MeSH
- kyselina askorbová aplikace a dávkování MeSH
- LDL-cholesterol krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- poměr pasu a boků MeSH
- potravní doplňky * MeSH
- progrese nemoci MeSH
- průřezové studie MeSH
- selen aplikace a dávkování MeSH
- sexuální faktory MeSH
- triglyceridy krev MeSH
- tuková tkáň účinky léků MeSH
- vitamin A aplikace a dávkování MeSH
- vitamin E aplikace a dávkování MeSH
- zinek aplikace a dávkování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- MeSH
- asymptomatické nemoci MeSH
- ateroskleróza * diagnóza farmakoterapie komplikace krev MeSH
- dvojitá slepá metoda MeSH
- hormonální substituční terapie MeSH
- hormony štítné žlázy krev MeSH
- hypotyreóza * farmakoterapie komplikace krev MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- testy funkce štítné žlázy MeSH
- thyreotropin krev MeSH
- thyroxin * terapeutické užití MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- souhrny MeSH
