scholarly journals Role of Lipoprotein Apheresis in Cardiovascular Disease Risk Reduction

2019 ◽  
Vol 47 (4) ◽  
pp. 301-316 ◽  
Author(s):  
Rupesh Raina ◽  
Claire Young ◽  
Vinod Krishnappa ◽  
Rahul Chanchlani
Keyword(s):  
Cardiovascular Disease ◽  
Disease Risk ◽  
Therapeutic Option ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Serum Lipoprotein ◽  
Lipid Lowering ◽  
Lipoprotein Apheresis ◽  
Prevention Methods

Background and Aim: Elevated low-density lipoprotein cholesterol and/or lipoprotein(a) are established risk factors for cardiovascular disease (CVD). Management of hypercholesterolemia consists of drug therapies, including statins and proprotein convertase subtilisin/kexin type 9 inhibitors. In patients with familial hypercholesterolemia (FH), lipoprotein apheresis (LA) is utilized to control lipid levels. However, LA is not currently a standard therapy for non-FH. This review summarizes the literature regarding LA therapy in CVD prevention. Methods: PubMed/MEDLINE databases were searched using the keywords “LA” and “CVD”. Citations were individually reviewed for relevance. Results: The efficacy of LA was clearly demonstrated, largely based on evidence from observational studies. In patients who are unresponsive to traditional lipid-lowering medications, LA effectively reduced serum lipoprotein levels and adverse cardiovascular events. Conclusion: It was concluded that LA is a safe and effective technique that could be considered in the management of hypercholesterolemia and future risk. Randomized control trials would further support a role for LA as a therapeutic option.

Should we Consider Lipoprotein (a) in Cardiovascular Disease Risk Assessment in Patients with Familial Hypercholesterolaemia?

2019 ◽  
Vol 24 (31) ◽  
pp. 3665-3671 ◽  
Author(s):  
Panagiotis Anagnostis ◽  
Pavlos Siolos ◽  
Dimitrios Krikidis ◽  
Dimitrios G. Goulis ◽  
John C. Stevenson
Keyword(s):  
Cardiovascular Disease ◽  
Familial Hypercholesterolaemia ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Pcsk9 Inhibitors ◽  
Cvd Risk ◽  
Lipoprotein A ◽  
Increased Risk

Background: Familial hypercholesterolaemia (FH) is a genetically determined lipid disorder, affecting 1 per 200-500 individuals in the general population. It is significantly and independently associated with an increased risk of Cardiovascular Disease (CVD), although it remains still an underrecognized and undertreated disease. Lipoprotein (a) [Lp(a)] is a low-density-lipoprotein (LDL)-like molecule, containing an additional protein, apolipoprotein (a). Objective: This review aims to present and discuss available data on the role of Lp(a) in patients with FH, in terms of its potential augmentation of CVD risk. Methods: A comprehensive search of the literature was performed to identify studies evaluating the CV effects of Lp(a) in patients with FH. Results: Lp(a) has been recognised as an independent risk factor for CVD, mainly coronary artery disease (CAD). Most, but not all, studies show increased Lp(a) concentrations in adults and children with FH. There is also evidence of an independent association between Lp(a) and CVD (mainly CAD) risk in these patients. Conclusion: Some therapeutic modalities, such as niacin, oestrogens, tibolone and proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors may effectively reduce Lp(a) concentrations by 25-30%, although their clinical benefit of this effect remains to be established.

scholarly journals Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association

Circulation ◽  
2020 ◽  
Vol 141 (3) ◽  
Author(s):  
Jo Ann S. Carson ◽  
Alice H. Lichtenstein ◽  
Cheryl A.M. Anderson ◽  
Lawrence J. Appel ◽  
Penny M. Kris-Etherton ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Dietary Patterns ◽  
Cardiovascular Health ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Dietary Cholesterol ◽  
Density Lipoprotein ◽  
Heart Association ◽  
Meta Analyses

The elimination of specific dietary cholesterol target recommendations in recent guidelines has raised questions about its role with respect to cardiovascular disease. This advisory was developed after a review of human studies on the relationship of dietary cholesterol with blood lipids, lipoproteins, and cardiovascular disease risk to address questions about the relevance of dietary cholesterol guidance for heart health. Evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk. Although meta-analyses of intervention studies differ in their findings, most associate intakes of cholesterol that exceed current average levels with elevated total or low-density lipoprotein cholesterol concentrations. Dietary guidance should focus on healthy dietary patterns (eg, Mediterranean-style and DASH [Dietary Approaches to Stop Hypertension]–style diets) that are inherently relatively low in cholesterol with typical levels similar to the current US intake. These patterns emphasize fruits, vegetables, whole grains, low-fat or fat-free dairy products, lean protein sources, nuts, seeds, and liquid vegetable oils. A recommendation that gives a specific dietary cholesterol target within the context of food-based advice is challenging for clinicians and consumers to implement; hence, guidance focused on dietary patterns is more likely to improve diet quality and to promote cardiovascular health.

scholarly journals Association of Fitness and Fatness with Clustered Cardiovascular Disease Risk Factors in Nigerian Adolescents

2020 ◽  
Vol 17 (16) ◽  
pp. 5861
Author(s):  
Danladi I. Musa ◽  
Abel L. Toriola ◽  
Daniel T. Goon ◽  
Sunday U. Jonathan
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Cvd Risk ◽  
Standardized Residuals

Purpose: This study examinedthe independent and joint association of fitness and fatness with clustered cardiovascular disease risk (CVDrs) in 11–18 year-old Nigerian adolescents. Methods: A hundred and ninety seven adolescents (100 girls and 97 boys) were evaluated forfitness, fatness and CVDrs. Fitness was evaluated with the progressive aerobic cardiovascular endurance run test while fatness was assessed using body mass index. A clustered CVDrs was computed from the standardized residuals of total cholesterol, high density lipoprotein cholesterol, Low density lipoprotein cholesterol, triglycerides, plasma glucose, systolic blood pressure, and diastolic blood pressure. Regression models controlling for waist circumference assessed the association of fitness and fatness with CVDrs. Results: Prevalence of clustered CVD risk was 7.1% (girls = 3.0%; boys = 4.1%). Based on risk factor abnormalities, 52.8% of participants had one or more CVD risk factor abnormalities with more boys (27.4%) affected. Low fitness was associated with clustered CVDrs in both girls (R2 = 9.8%, β = −0.287, p = 0.05) and boys (R2 = 17%, β = −0.406, p < 0.0005). Fatness was not associated with the CVDrs in both sexes. After controlling for all the variables in the model, only fitness (R2 = 10.4%) and abdominal fat (R2 = 19.5%) were associated with CVDrs respectively. Unfit girls were 3.2 (95% CI = 1.31–7.91, p = 0.011) times likely to develop CVD risk abnormality compared to their fit counterparts. The likelihood of unfit boys developing CVD risk abnormality was 3.9 (95% CI = 1.15–10.08, p = 0.005) times compared to their fit peers. Conclusions: Fitness but not fatness was a better predictor of CVDrs in Nigerian boys and girls. The result of this study suggests that any public health strategies aimed at preventing or reversing the increasing trends of CVD risk in adolescents should emphasize promotion of aerobic fitness.

scholarly journals Study of cardiovascular disease risk factors among rural schoolchildren in Sousse,Tunisia

2001 ◽  
Vol 7 (4-5) ◽  
pp. 617-624
Author(s):  
H. Ghannem
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Epidemiological Survey ◽  
Cardiovascular Disease Risk Factors ◽  
Cardiovascular Disease Risk Factor ◽  
Significant Difference

We undertook an epidemiological survey based on a representative sample of 793 rural schoolchildren in Sousse, Tunisia to assess the prevalence of certain cardiovascular disease risk factors. The prevalence of hypertension [11.2%], hypercholesterolaemia [2.9%], hypertriglyceridaemia [1.0%], high levels of low-density lipoprotein cholesterol [0.6%] and obesity [4.0%] showed no statistically significant difference based on sex. However, smoking [4%] showed a significant gender difference [boys: 7.3%; girls 1.2%]. The relatively low cardiovascular disease risk factor profile of Tunisian children needs to be encouraged through to adulthood. Thus a school programme of heart health promotion should be established.

Exercise, Postprandial Triacylglyceridemia, and Cardiovascular Disease Risk

2004 ◽  
Vol 29 (6) ◽  
pp. 781-799 ◽  
Author(s):  
Terry E. Graham
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Dietary Fats ◽  
Low Density ◽  
Key Words Atherosclerosis

An elevation of plasma triacylglycerides (TAG) is a well recognized cardiovascular risk factor. Less appreciated is that high and prolonged elevations in TAG in the postprandial (PP) phase is also a risk factor. Given that we spend approximately 18 hrs a day in the PP state, this is particularly critical. The elevation is due to both cylomicron and very low density lipoprotein TAG. It is thought that enhancing the concentrations of these lipoproprotein fractions increases the production of smaller, more dense low density lipoprotein and that this leads to increased cardiovascular disease risk. The PP TAG response is greater in men, in obese individuals, and in type 2 diabetics. It has been reported repeatedly that exercise the day before ingestion of a high fat meal is associated with a marked dampening of the PP TAG rise. The mechanisms for this are not clear and do not appear to be due to changes in the exercised muscle itself. There is some speculation that the production of plasma TAG may be decreased. The exercise benefits are lost within 3 days. The minimum exercise required has not been determined, but even 30 min of intermittent aerobic exercise or mild resistance exercise has a positive effect. This demonstrates a clear benefit from an active lifestyle and one that does not require intense exercise or months of training. Key words: atherosclerosis, type 2 diabetes, dietary fats, carbohydrates, VLDL, LDL, triglycerides, sex differences

scholarly journals Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices

2009 ◽  
Vol 55 (3) ◽  
pp. 407-419 ◽  
Author(s):  
John H Contois ◽  
Joseph P McConnell ◽  
Amar A Sethi ◽  
Gyorgy Csako ◽  
Sridevi Devaraj ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Apolipoprotein B ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Vascular Diseases ◽  
Position Statement ◽  
Apo B ◽  
Lipid Panel

Abstract Background: Low-density lipoprotein cholesterol (LDL-C) has been the cornerstone measurement for assessing cardiovascular risk for nearly 20 years. Content: Recent data demonstrate that apolipoprotein B (apo B) is a better measure of circulating LDL particle number (LDL-P) concentration and is a more reliable indicator of risk than LDL-C, and there is growing support for the idea that addition of apo B measurement to the routine lipid panel for assessing and monitoring patients at risk for cardiovascular disease (CVD) would enhance patient management. In this report, we review the studies of apo B and LDL-P reported to date, discuss potential advantages of their measurement over that of LDL-C, and present information related to standardization. Conclusions: In line with recently adopted Canadian guidelines, the addition of apo B represents a logical next step to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) and other guidelines in the US. Considering that it has taken years to educate physicians and patients regarding the use of LDL-C, changing perceptions and practices will not be easy. Thus, it appears prudent to consider using apo B along with LDL-C to assess LDL-related risk for an interim period until the superiority of apo B is generally recognized.

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