scholarly journals Hypertriglyceridaemia: Contemporary management of a neglected cardiovascular risk factor

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Tina Z Khan ◽  
Ulrike Schatz ◽  
Stefan R Bornstein ◽  
Mahmoud Barbir
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
High Dose ◽  
Omega 3 ◽  
Icosapent Ethyl ◽  
Uncontrolled Diabetes ◽  
Contemporary Management ◽  
Lipid Abnormalities

Hypertriglyceridaemia represents one of the most prevalent lipid abnormalities, however it is often eclipsed by focus on LDL cholesterol and is frequently overlooked by clinicians, despite it being an important cardiovascular risk factor. For most patients, hypertriglyceridaemia arises from a combination of environmental factors and multiple genetic variations with small effects. Even in cases with apparent familial clustering of hypertriglyceridaemia, a monogenetic cause is rarely identified. Common secondary causes include obesity, uncontrolled diabetes, alcohol, and various commonly used drugs. Correction of these factors, along with lifestyle optimisation, should be prioritised prior to commencing medication.The goal of drug treatment is to reduce the risk of cardiovascular disease in those with moderate hypertriglyceridaemia and the risk of pancreatitis in those with severe hypertriglyceridaemia.Recent and ongoing trials demonstrate the important role of triglycerides (TG) in determining residual risk in patients with cardiovascular disease (CVD) already established on statin therapy. Novel and emerging data on omega-3 fatty acids (high-dose icosapent ethyl) and the selective PPAR modulator pemafibrate are eagerly awaited and may provide further clarity for clinicians in determining which patients will benefit from TG lowering and help inform clinical guidelines. There are numerous novel therapies on the horizon that reduce TG by decreasing the activity of proteins that inhibit lipoprotein lipase such as apolipoprotein C-III (including Volanesorsen which was recently approved in Germany) and ANGPTL 3/4 which may offer promise for the future.

scholarly journals Lipoprotein(a): the underutilized risk factor for cardiovascular disease

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
T Z Khan ◽  
S R Bornstein ◽  
M Barbir
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
Cardiovascular Events ◽  
Adverse Outcomes ◽  
Lipoprotein A ◽  
Diagnosis And Management ◽  
Randomised Controlled

Raised lipoprotein(a) [Lp(a)] is an important independent cardiovascular risk factor and predictor of adverse outcomes. Challenges remain with regards to the screening, diagnosis and management of this condition. Although further prospective randomised controlled data is required, there is growing evidence suggesting that lowering Lp(a) may reduce the risk of cardiovascular events and ameliorate symptoms.

Abstract P368: Risk Factor Interventions are Effective for Preventing Cardiovascular Events in HIV-Infected Patients on Antiretroviral Therapy: A Systematic Review and Meta-analysis

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Chidozie Nduka ◽  
Kandala Ngianga-Bakwin ◽  
Gaurav Suri ◽  
Saverio Stranges
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
Cardiovascular Events ◽  
Antiretroviral Treatment ◽  
Clinical Effectiveness ◽  
Lipid Lowering ◽  
Hiv Positive

Introduction: The declining rate of HIV-related deaths has become rather slow in recent times, largely because of the rising incidence of cardiovascular events associated with the disease and its long-term treatment with anti-retroviral drugs. While conclusive evidences support the effectiveness of cardiovascular risk factor interventions in the general population, there is a dearth of such evidence of clinical effectiveness in certain high-risk subgroups, particularly HIV-infected patients on antiretroviral treatment. Objective: To evaluate the clinical effectiveness of risk factor interventions in preventing cardiovascular disease in HIV-positive patients on antiretroviral treatment (ART) and summarize the effect size. Design and methods: Systematic review of randomized controlled trials investigating the effects of interventions in modifying ART-associated risk factors for cardiovascular disease. Trials were eligible for inclusion if they were published in the last 12 years [2000 to June 2012] and participants were HIV-positive, on ART and having more than one ART-associated cardiovascular risk factor. Results: In total, 2,071 HIV-positive participants from 10 randomized trials were included in the review. The interventions evaluated comprised lifestyle modification, lipid-lowering treatment and smoking cessation. Overall, the main results showed significant improvements in total cholesterol [P<0.0001], LDL cholesterol [P<0.0001], HDL cholesterol [P<0.002], triglycerides [P<0.001], apolipoprotein B levels [P=0.036], adiposity [<0.001], anthropometry [P<0.001], insulin sensitivity [P<0.05], HbA1c levels [P<0.001], FBG levels [P=0.017], adiponectin levels [P<0.05], dietary intake [P<0.001], smoking abstinence [P<0.0001] and Framingham score [P=0.03]. The results also showed improvements in systolic [from 145.6±14.5 mmHg to 122.8±5.2 mmHg] and diastolic blood pressure [from 84.7±1.7 mmHg to 80.1±3.8 mmHg]; however, there was no improvement in carotid intima-media thickness [P=0.61] or inflammatory biomarkers [P=0.973 to 0.110]. Conclusion: In conclusion, this review presents evidence suggesting that cardiovascular risk factor interventions are effective in HIV-infected persons on ART. However, cardiovascular screening programs targeting people living with HIV and primary studies assessing the effectiveness (clinical and cost) of multiple risk factor interventions in this sub-group are needed.

scholarly journals Cardiovascular risk factors in chronic renal failure patient at Soavinandriana Hospital Antananarivo

2020 ◽  
Vol 8 (7) ◽  
pp. 2622
Author(s):  
Lucas Z. Randimbinirina ◽  
Fanomezantsoa H. Randrianandrianina ◽  
Tsirimalala Rajaobelison ◽  
Jean Claude A. Rakotoarisoa ◽  
Agnes M. L. Ravalisoa
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Renal Failure ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Chronic Renal Failure ◽  
Cardiovascular Diseases ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Risk Factor ◽  
High Cardiovascular Risk

Background: Cardiovascular disease (CVD) is the primary cause of morbidity and premature mortality in chronic kidney disease (CKD). The aim of this study was to assess the frequency of cardiovascular disease and cardiovascular risk in haemodialysis population for chronic kidney disease.Methods: This was a retrospective and descriptive study for a period of 4 years from January 2016 to December 2019, performed at hemodialysis unit in Soavinandriana Hospital Center Antananarivo, including all patients, following regular hemodialysis for chronic renal failure. Demographic data, cardiovascular disease, cardiovascular risk factors, aetiology of nephropathy, haemoglobin <11 g/dl, phosphocalcic metabolism disorders and uricemia were analyzed.Results: Seventy-six patients were recorded, including 46 males (60.52%) and were women (39.47%). The average age was 59.98 years old. The risk factors of cardiovascular disease were smoking (22.36%), diabetes mellitus (46.05%), high blood pressure (71.05%), dyslipidemia (47.36%) and obesity (11.84%). Fifty-eight patients (76.31%) had a high cardiovascular risk factor. Seventy patients (22.36%) had had a history of cardiovascular diseases. Fifty-nine patients had a haemoglobin concentration under 11 g/dl (77.63%). There were 23 cases of hypocalcemia (30.26%), 22 cases of hyperphosphatemia (28.94%) and 37 cases of hyperuricemia (48.68%).Conclusions: There was a high cardiovascular risk factor in this study population. Early detection of cardiovascular diseases should be done in patients who have a high-risk factor of cardiovascular disease to decrease the mortality rate in chronic kidney diseases population. The appropriate management of modifiable risk factors is important to improve the survival of this study patients.

scholarly journals Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications

2019 ◽  
Vol 26 (2_suppl) ◽  
pp. 25-32 ◽  
Author(s):  
Elisa Dal Canto ◽  
Antonio Ceriello ◽  
Lars Rydén ◽  
Marc Ferrini ◽  
Tina B Hansen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factor ◽  
Low Income ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Population Based ◽  
Overweight And Obesity ◽  
Low Income Countries

The global prevalence of diabetes is predicted to increase dramatically in the coming decades as the population grows and ages, in parallel with the rising burden of overweight and obesity, in both developed and developing countries. Cardiovascular disease represents the principal cause of death and morbidity among people with diabetes, especially in those with type 2 diabetes mellitus. Adults with diabetes have 2–4 times increased cardiovascular risk compared with adults without diabetes, and the risk rises with worsening glycaemic control. Diabetes has been associated with 75% increase in mortality rate in adults, and cardiovascular disease accounts for a large part of the excess mortality. Diabetes-related macrovascular and microvascular complications, including coronary heart disease, cerebrovascular disease, heart failure, peripheral vascular disease, chronic renal disease, diabetic retinopathy and cardiovascular autonomic neuropathy are responsible for the impaired quality of life, disability and premature death associated with diabetes. Given the substantial clinical impact of diabetes as a cardiovascular risk factor, there has been a growing focus on diabetes-related complications. While some population-based studies suggest that the epidemiology of such complications is changing and that rates of all-cause and cardiovascular mortality among individuals with diabetes are decreasing in high-income countries, the economic and social burden of diabetes is expected to rise due to changing demographics and lifestyle especially in middle- and low-income countries. In this review we outline data from population-based studies on recent and long-term trends in diabetes-related complications.

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