The Lipid Accumulation Product and All-cause Mortality in Patients at High Cardiovascular Risk: A PreCIS Database Study

Hypercholesterolemia is a major risk factor for cardiovascular disease (CVD). Lowering low-density lipoproteins-cholesterol (LDL-C) has been shown to decrease the risk of CVD and of all-cause mortality. For appropriate management, estimation of each individual’s total cardiovascular risk is critical, as patients should receive treatment according to their cardiovascular risk category as well as their LDL-C level. However, available data indicate that a large proportion of patients fail to achieve lipid goals despite treatment, and a significant percentage of patients are not able to tolerate statin treatment. Researchers have therefore focused considerable attention on the development of novel LDL-C-lowering agents that act via different mechanisms. Among the most recent advances in clinical development are the proprotein convertase subtilisin/kexin 9 antibody inhibitors, including alirocumab and evolocumab, which appear particularly promising, with clinical trial data indicating these agents to be both well tolerated and highly efficacious in lowering LDL-C.

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Ankle-brachial index predicts renal outcomes and all-cause mortality in high cardiovascular risk population: a nationwide prospective cohort study in CORE project

International Urology and Nephrology ◽

10.1007/s11255-021-03049-5 ◽

2021 ◽

Author(s):

Noppawit Aiumtrakul ◽

Ouppatham Supasyndh ◽

Rungroj Krittayaphong ◽

Arintaya Phrommintikul ◽

Bancha Satirapoj

Keyword(s):

Cohort Study ◽

Cardiovascular Risk ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Ankle Brachial Index ◽

High Cardiovascular Risk ◽

Risk Population ◽

Renal Outcomes ◽

All Cause Mortality ◽

Core Project

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All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study

BMJ Open ◽

10.1136/bmjopen-2019-030034 ◽

2020 ◽

Vol 10 (1) ◽

pp. e030034 ◽

Cited By ~ 2

Author(s):

Yuejen Zhao ◽

Kanakamani Jeyaraman ◽

Paul Burgess ◽

Christine Connors ◽

Steven Guthridge ◽

...

Keyword(s):

Cardiovascular Risk ◽

Outcome Measures ◽

Low Dose ◽

Aboriginal People ◽

Univariate Analysis ◽

High Cardiovascular Risk ◽

Aboriginal Communities ◽

All Cause Mortality ◽

Benefit And Risk

ObjectivesTo evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia.DesignRetrospective cohort study using primary care and hospital data routinely used for healthcare. Aspirin users and non-users were compared before and after controlling confounders by matching. Marginal structural models (MSM) were applied to ascertain the benefit and risk.SettingThe benefit and harm of aspirin were investigated in patients aged ≥18 years from 54 remote Aboriginal communities.ParticipantsNone had a previous cardiovascular event or major bleeds. Patients on anticoagulants or other antiplatelets were excluded.InterventionAspirin at a dose of 75–162 mg/day.Outcome measuresEndpoints were all-cause, cardiovascular mortality and incidences of cardiovascular events and major bleeds.Results8167 predominantly Aboriginal adults were included and followed between July 2009 and June 2017 (aspirin users n=1865, non-users n=6302, mean follow-up 4 years with hospitalisations 6.4 per person). Univariate analysis found material differences in demographics, prevalence of chronic diseases and outcome measures between aspirin users and non-users before matching. After matching, aspirin was significantly associated with reduced all-cause mortality (HR=0.45: 95% CI 0.34 to 0.60; p<0.001), but not bleeding (HR=1.13: 95% CI 0.39 to 3.26; p=0.820). After using MSMs to eliminate the effects of confounders, loss of follow-up and time dependency of treatment, aspirin was associated with reduced all-cause mortality (HR=0.60: 95% CI 0.47 to 0.76; p<0.001), independent of age (HR=1.06; p<0.001), presence of diabetes (HR=1.42; p<0.001), hypertension (HR=1.61; p<0.001) and alcohol abuse (HR=1.81; p<0.001). No association between aspirin and major bleeding was found (HR=1.14: 95% CI 0.48 to 2.73; p=0.765). Sensitivity analysis suggested these findings were unlikely to have been the result of unmeasured confounding.ConclusionAspirin was associated with reduced all-cause mortality. Bleeding risk was less compared with survival benefits. Aspirin should be considered for primary prevention in Aboriginal people with high cardiovascular risk.

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Relation of Subclinical Hypothyroidism is Associated With Cardiovascular Events and All-Cause Mortality in Adults With High Cardiovascular Risk

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.03.371 ◽

2018 ◽

Vol 122 (4) ◽

pp. 571-577 ◽

Cited By ~ 10

Author(s):

Shinje Moon ◽

Sung Hye Kong ◽

Hoon Sung Choi ◽

Yul Hwangbo ◽

Moon-Kyu Lee ◽

...

Keyword(s):

Cardiovascular Risk ◽

Subclinical Hypothyroidism ◽

Cardiovascular Events ◽

High Cardiovascular Risk ◽

All Cause Mortality

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Adiposity Indexes as Phenotype-Specific Markers of Preclinical Metabolic Alterations and Cardiovascular Risk in Polycystic Ovary Syndrome: A Cross-Sectional Study

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0042-119524 ◽

2017 ◽

Vol 125 (05) ◽

pp. 307-315 ◽

Cited By ~ 5

Author(s):

Fernanda Mario ◽

Scheila Graff ◽

Poli Spritzer

Keyword(s):

Cardiovascular Risk ◽

Polycystic Ovary Syndrome ◽

Lipid Accumulation ◽

Polycystic Ovary ◽

Visceral Adiposity ◽

Visceral Adiposity Index ◽

Lipid Accumulation Product ◽

Ovary Syndrome ◽

Metabolic Alterations ◽

Adiposity Index

AbstractPolycystic ovary syndrome (PCOS) is a common condition in women of reproductive age. 2 PCOS phenotypes (classic and ovulatory) are currently recognized as the most prevalent, with important differences in terms of cardiometabolic features. We studied the performance of different adiposity indexes to predict preclinical metabolic alterations and cardiovascular risk in 234 women with PCOS (173 with classic and 61 with ovulatory PCOS) and 129 controls. Performance of waist circumference, waist-to-height ratio, conicity index, lipid accumulation product, and visceral adiposity index was assessed based on HOMA-IR ≥ 3.8 as reference standard for screening preclinical metabolic alterations and cardiovascular risk factors in each group. Lipid accumulation product had the best accuracy for classic PCOS, and visceral adiposity index had the best accuracy for ovulatory PCOS. By applying the cutoff point of lipid accumulation product<34, we identified a subgroup of patients without cardiometabolic alterations (P<0.05) in the group with classic PCOS, a population at higher risk for hypertension, dyslipidemia, and impaired glucose tolerance. In ovulatory PCOS, visceral adiposity index ≥ 1.32 was capable of detecting women with significantly higher blood pressure and less favorable glycemic and lipid variables as compared to ovulatory PCOS with lower visceral adiposity index (P<0.05). These results suggest LAP ≥ 34 as the best marker for classic PCOS, and VAI ≥ 1.32 for ovulatory PCOS women. Both indexes can be easily calculated with measures obtained in routine clinical practice and may be useful to detect cardiometabolic risk and secure early interventions.

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Lipid accumulation product index: a reliable marker of cardiovascular risk in polycystic ovary syndrome

Human Reproduction ◽

10.1093/humrep/dep072 ◽

2009 ◽

Vol 24 (7) ◽

pp. 1726-1731 ◽

Cited By ~ 56

Author(s):

D. Wiltgen ◽

I.G. Benedetto ◽

L.S. Mastella ◽

P.M. Spritzer

Keyword(s):

Cardiovascular Risk ◽

Polycystic Ovary Syndrome ◽

Lipid Accumulation ◽

Polycystic Ovary ◽

Lipid Accumulation Product ◽

Ovary Syndrome ◽

Reliable Marker ◽

Lipid Accumulation Product Index

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Role of colchicine in stroke prevention: an updated meta-analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2822 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L.M Lobo ◽

G Masson ◽

G Molinero ◽

G Masson ◽

A Lavalle Cobo ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Trials ◽

Cardiovascular Risk ◽

Cardiovascular Mortality ◽

Meta Analysis ◽

The Body ◽

High Cardiovascular Risk ◽

Stroke Incidence ◽

All Cause Mortality ◽

Colchicine Therapy

Abstract Background Colchicine is a microtubule inhibitor with anti-inflammatory proprieties. As the body and quality of evidence regarding the efficacy of colchicine for cardiovascular prevention is controversial, the aims of this study was to evaluate the effect of colchicine therapy on vascular events. Methods A meta-analysis was performed of randomized controlled clinical trials of colchicine on high cardiovascular risk populations, reporting data from stroke, myocardial infarction, cardiovascular mortality and all-cause mortality, after searching the PubMed/MEDLINE, Embase and Cochrane Controlled Trials databases. A random-effects meta-analysis model was then applied. Results Nine eligible trials of colchicine therapy, involving a total of 6630 patients, were considered eligible for analysis (3359 subjects were allocated to receive colchicine while 3271 subjects were allocated to the respective control arms). The stroke incidence was lower in the colchicine group compared with placebo arm (OR, 0.33; 95% CI, 0.15–0.70; six studies evaluated). We did not find a significant reduction in the incidence of myocardial infarction, cardiovascular mortality or all-cause mortality. Conclusion Our data suggest that in a population with high cardiovascular risk, the use of colchicine results in significantly reduction on stroke risk. Colchicine is an accessible drug that could be successfully utilized for the prevention of atherosclerotic cerebrovascular disease. The tolerability and benefits should be confirmed in ongoing clinical trials. Forest Plot Primary endpoint Funding Acknowledgement Type of funding source: None

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Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial

European Journal of Preventive Cardiology ◽

10.1177/2047487318819142 ◽

2018 ◽

Vol 26 (8) ◽

pp. 847-854 ◽

Cited By ~ 3

Author(s):

Anne Wang ◽

Stefan Arver ◽

Kurt Boman ◽

Hertzel C Gerstein ◽

Shun Fu Lee ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Events ◽

Free Testosterone ◽

Sex Hormone ◽

Sex Hormone Binding Globulin ◽

Hormone Binding ◽

High Cardiovascular Risk ◽

All Cause Mortality ◽

Low Levels

Aims: Testosterone and its binding protein sex hormone-binding globulin have been associated with cardiovascular disease and dysglycaemia. However, information on the prognostic implication in patients at high cardiovascular risk with dysglycaemia is inconsistent. The study objective was to determine whether testosterone and/or sex hormone-binding globulin predict cardiovascular events or death in dysglycaemic patients. Methods: Dysglycaemic males at high cardiovascular risk ( n = 5553) who participated in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial and provided baseline blood samples were studied. Testosterone and sex hormone-binding globulin were measured at baseline and used to estimate free testosterone. Low levels of total and free testosterone were defined as ≤300 ng/dl and ≤7 ng/dl, respectively. Patients were followed for six years for cardiovascular events (defined as the composite of cardiovascular death, non-fatal myocardial infarction or stroke) and all-cause mortality. Results: The mean total and free testosterone levels were 416.6 ng/dl and 8.4 ng/dl, and low levels were present in 13% and 37% of the patients. The median sex hormone-binding globulin level was 35 nmol/l. In Cox regression models adjusted for age, previous diseases and pharmacological treatment, neither total nor free testosterone predicted cardiovascular events. However, a one-standard-deviation increase in sex hormone-binding globulin predicted both cardiovascular events (hazard ratio 1.07; 95% confidence interval 1.00–1.14; p = 0.03) and all-cause mortality (hazard ratio 1.13; 95% confidence interval 1.06–1.21; p < 0.01). Conclusion: Sex hormone-binding globulin, but not total testosterone, predicts cardiovascular disease and all-cause mortality in dysglycaemic males at high cardiovascular risk.

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