Atorvastatin in the Treatment of Dyslipidemic Patients with Very High Cardiovascular Risk and Nonalcoholic Fatty Liver Disease

2019 ◽  
Vol 70 (6) ◽  
pp. 2159-2161
Author(s):  
Irina Iuliana Costache ◽  
Irina Garleanu ◽  
Viviana Aursulesei ◽  
Razan Al Namat ◽  
Adriana Ion ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Liver Disease ◽  
Liver Function ◽  
Fatty Liver Disease ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
High Cardiovascular Risk ◽  
Nonalcoholic Fatty Liver ◽  
Very High

Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of hepatic fat accumulation after ruling out other causes of hepatic steatosis. The aim of the study is to identify the role of statin therapy in dyslipidemic patients with very high cardiovascular risk and NAFLD in achieving low density lipoprotein (LDL) cholesterol targets while also evaluating the changes in liver enzymes levels. This prospective study included 140 patients with NAFLD, hyperlipidemia and elevated cardiovascular risk. Serum lipids were assessed and liver function tests were performed at baseline and at 6 months follow up in 10 mg/ 20 mg daily atorvastatin treatment schedule. The results showed that total cholesterol, LDL cholesterol and triglycerides were significantly reduced at 6 months follow-up, while high density lipoprotein (HDL) cholesterol has not undergone important changes. Statin treatment significantly improved alanine aminotransferase serum levels, whereas aspartate aminotransferase levels were not significantly reduced between baseline and follow-up. Although statin therapy appears to be safe and effective for use in patients with NAFLD, an insufficient treatment is commonly observed in clinical practice, in order to avoid liver damage . NAFLD is not only a major cause of liver related morbidity and mortality, but also an independent cardiovascular risk factor, with cardiovascular mortality being the most important cause of death. Therefore, detecting and modifying risk factors without impairing liver function is desirable.

scholarly journals Remnant Lipoprotein Cholesterol and Cardiovascular and Cerebrovascular Events in Patients with Non-Alcoholic Fatty Liver Disease

2018 ◽  
Vol 7 (11) ◽  
pp. 378 ◽  
Author(s):  
Daniele Pastori ◽  
Francesco Baratta ◽  
Marta Novo ◽  
Nicholas Cocomello ◽  
Francesco Violi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Density Lipoprotein ◽  
Alcoholic Fatty Liver ◽  
Remnant Lipoprotein ◽  
Cerebrovascular Events ◽  
Alcoholic Fatty Liver Disease

: Non-alcoholic fatty liver disease (NAFLD) is characterized by an atherogenic dyslipidaemia and an increased cardiovascular risk. Remnant lipoprotein cholesterol (RLP-C) is emerging as a novel cardiovascular risk factor, but its predictive value in patients with NAFLD is unknown. We investigated factors affecting RLP-C levels, and the association with major adverse cardiovascular and cerebrovascular events (MACCE) in NAFLD. A prospective observational cohort study was carried out including 798 unselected patients with cardio-metabolic diseases screened by ultrasound for the presence of NAFLD. Fasting RLP-C (mg/dL) was calculated as total cholesterol—(HDL (high-density lipoprotein) + LDL (low-density-lipoprotein)). Primary endpoint of the follow-up study was a combined endpoint of MACCE. Patients with NAFLD (79.2%) had higher median fasting RLP-C in comparison to those without (27.0 vs. 20.0 mg/ dL, respectively p < 0.001). Metabolic syndrome, NAFLD, age above median, and female sex were independently associated to fasting RLP-C above the median. In patients with NAFLD, values of RLP-C were associated with liver disease severity, as shown by the increasing value of RLP-C across tertiles of aspartate aminotransferase (AST) (p = 0.002) and gamma-glutamyl transpeptidase (GGT) (p < 0.001). Furthermore, levels of RLP-C and Hamaguchi score, were significantly correlated (r = 0.193, p < 0.001). During a median follow-up of 32 months (interquartile range: 14.2–51.7, 1700 person-years), 41 MACCE (2.41%/year) were registered in 596 NAFLD patients. The rate of events was higher in NAFLD patients with RLP-C above the median compared to those below (log-rank test p = 0.040). Age (hazard ratio (HR) 1.039, 95% confidence interval (CI), 1.005–1.074, p = 0.024), previous cardiovascular events (HR 2.210, 95% CI, 1.052–4.643, p = 0.036), female sex (HR 0.454, 95% CI, 0.208–0.989, p = 0.047) and RLP-C above the median (HR 2.202, 95% CI, 1.132–4.285, p = 0.020) were associated with MACCE. In conclusion, we found that NAFLD was independently associated with higher circulating RLP-C, and that high RLP-C levels were predictive of MACCE in patients with NAFLD.

scholarly journals Effect of Sodium Glucose Cotransporter 2 Inhibitors on Renal Function in Patients with Nonalcoholic Fatty Liver Disease and Type 2 Diabetes in Japan

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 86
Author(s):  
Kota Yano ◽  
Yuya Seko ◽  
Aya Takahashi ◽  
Shinya Okishio ◽  
Seita Kataoka ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
Liver Disease ◽  
Liver Function ◽  
Protective Effect ◽  
Fatty Liver Disease ◽  
Nonalcoholic Fatty Liver ◽  
Sodium Glucose Cotransporter

Sodium-glucose cotransporter-2 inhibitors (SGLT2I) have been reported to have renal-protective effects in patients with type 2 diabetes (T2DM). This a retrospective study aimed to evaluate the effect of SGLT2I on renal function in patients with nonalcoholic fatty liver disease (NAFLD) and T2DM. We analyzed 69 consecutive patients with a biopsy-proven NAFLD and T2DM with an estimated glomerular filtration rate (eGFR) >60 mL/min. Of these 69 patients, 22 received SGLT2I and 47 were treated without SGLT2I. Liver function and eGFR were analyzed at baseline and after three years. Body mass index, liver function and HbA1c improved significantly in both groups. In the total population, the median eGFR declined from 80.7 mL/min at the baseline to 74.9 mL/min at the end of follow-up. The median eGFR at the baseline/end of follow-up was 81.2/80.4 mL/min in patients treated with SGLT2I and 80.2/70.8 mL/min in patients treated without SGLT2I. Multivariate analysis identified an increased FIB-4 index with an odds ratio (OR) of 4.721, (p = 0.045) and SGLT2I treatment (OR 0.263, p = 0.033) as predictive factors for decreased eGFR. SGLT2I treatment has a protective effect on the renal function for NAFLD with T2DM. A long-term, randomized, controlled trial is warranted to confirm the renal protective effect of SGLT2I in NAFLD patients with T2DM.

scholarly journals Alirocumab effectiveness and rapidity in achieving and maintaining target LDL, HDL cholesterol and triglyceride values in patients at very high cardiovascular risk

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Cavarra ◽  
E Salerno ◽  
G Chiaranda"
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Case Studies ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
High Cardiovascular Risk ◽  
Target Value ◽  
Target Values ◽  
Very High

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Still too few patients after an acute cardiocerebrovascular event reach C-LDL values recommended by guidelines even in therapy with statins and ezetimibe, thus maintaining a high risk of new cardiovascular episodes. Purpose To evaluate, in a long follow-up, the effectiveness and the rapidity of alirocumab in the attainment and maintenance of LDL-cholesterol target values in patients at very high risk and intolerant to statins. Methods Our case studies consist of 72 patients, 80% males (58) and 20% females (14), with an average age of 61.9. 90.2% of patients were hypertensive. 5.5% had chronic kidney disease (CKD stage III). 65.2% had an ACS and the 34.7% had CeVD. 84.7% of the patients were in therapy only with ezetimibe while 15.3% in association with PUFA N-3. The average value of C-LDL was 169.2 mg/dl. The follow up was 24 months with clinical checks and C-LDL at 3,6,12 and 24 months. The dosage of alirocumab was both 75 and 150 mg Results At 3 months the reduction of C-LDL was 52.24%; at 6 months of 51.18%; at 12 months of 51.36% and at 24 months of 52.47%. The 37 patients who had started with 150 mg, had a very high average C-LDL base, 183.0 mg/dl, and showed a reduction of C-LDL to 3 months of 59.04%, to 6 months of 58.45%, to 12 months of 65.05%, to 24 months of 55.76%. The target value of C-LDL recommended by the ESC guidelines was reached for 42.10% at 3 months; for 52.63% at 6 months; for 63.15% at 12 months and for 73.68% at 24 months. 5.5% of patients with a CKD showed a 73.68% reduction in C-LDL values to 3 months, 65.22% to 6 months, 57.49% to 12 months and 53.95% to 24 months. The follow-up to the Tg study showed a reduction of 3.55% to 3 months, an increase of 8.75% to 6 months, a reduction of 1.65% to 12 months and 7.95% to 24 months. C-HDL values showed an increase of 4.55% at 3 months, 3.69% at 6 months, 10.97% at 12 months and 7.82% at 24 months.  Conclusions Our case studies have confirmed the effectiveness of alirocumab in reducing C-LDL values in patients at very high cardiovascular risk and the rapidity in reaching the target value set by guidelines for the management of cardiovascular risk. Our study also confirmed the its effectiveness in increasing the values of C-HDL while it was not possible to confirm the reduction of Tg values. % Alirocumab Efficacy C-LDL TGs C-HDL 3 MONTHS -52,24% -3,55% +4,55% 6 MONTHS -51,18% +8,75% +3,69% 12 MONTHS -51,36% -1,65% +10,97% 24 MONTHS -52,47% -7,95% +7,82% C-LDL: LDL-CHOLESTEROL TGs TRIGLYCERIDES C-HDL: HDL-CHOLESTEROL Abstract Figure. % Alirocumab Efficacy

scholarly journals Atherogenic index of plasma is an independent predictor of ultrasound-proven nonalcoholic fatty liver disease among non-obese populations

2021 ◽  
Author(s):  
Hua-Jun Ye ◽  
Xu-Yan Chen ◽  
XiXi He
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Atherogenic Index ◽  
Alcoholic Fatty Liver ◽  
Atherogenic Index Of Plasma ◽  
Nonalcoholic Fatty Liver

Abstract Background & AimsEvidence regarding the association between atherogenic index of plasma (AIP) and the risk of non-alcoholic fatty liver disease (NAFLD) in non-obese populations is limited. Our study aimed to investigate whether AIP predicts NAFLD in non-obese Chinese populations.MethodsThe present study was a population-based longitudinal study, including 16 173 non-obese participants who underwent health examinations in a tertiary hospital from January 2010 to December 2014. The primary outcome was developing NAFLD during the follow-up period. AIP was calculated as Log (Triglycerides/ high-density lipoprotein cholesterol).ResultsThe mean age of the included participants was 43.2 ± 15.0 years old, and about 52.5% of them were male. During the follow-up period, 2 322 of 16 173 (14.3%) participants developed NAFLD. In the fully-adjusted model, for every one standard deviation increased in AIP levels, the incidence of NAFLD increased by 52% (1.52, 95%CI 1.43, 1.60). The optimal cut-off point of AIP for incident NAFLD was 0.00 (receiver operator characteristic 0.76 [95% CI 0.75–0.77], sensitivity 0.68, specificity 0.72). Individuals with AIP values in the positive range had two-fold increased odds of developing NALFD compared with those with values in the negative range. After propensity score matching, for every one-SD increased in AIP levels, the incidence of NAFLD increased by 34% (HR 1.34, 95%CI 1.27, 1.41).ConclusionAIP is an independent predictor of incident NAFLD among Chinese non-obese populations.

scholarly journals Possibilities of combined hypolipidemic therapy in different categories of high and very high cardiovascular risk patients (a pilot study)

2022 ◽  
Vol 17 (4) ◽  
pp. 66-73
Author(s):  
O. V. Tsygankova ◽  
O. V. Timoshchenko ◽  
L. D. Latyntseva
Keyword(s):  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Total Cholesterol Level ◽  
Low Density Lipoprotein ◽  
Randomized Study ◽  
Density Lipoprotein ◽  
High Cardiovascular Risk ◽  
Very High

Aim of the study was to evaluate the efficacy and safety of the combined use of statins with ezetimibe in patients of various nosological groups of high and very high cardiovascular risk. Material and methods. A prospective interventional non-randomized study included 40 people, mean age 60.7±9.5 years, high and very high cardiovascular risk, who did not receive statin therapy or took statins without reaching the target low density lipoprotein (LDL) cholesterol values. Patients were recommended to receive high-intensity statin therapy in combination with ezetimibe for 3 months. Biochemical parameters were determined by standard enzymatic methods and the beginning of combined lipid-correcting therapy and after 3 months. Results. In patients with high cardiovascular risk, the level of total cholesterol decreased by 39.7 % 3 months after treatment (6.8 ± 2.5 and 4.7 ± 2.5 mmol/L; p = 0.0001), the level of LDL cholesterol by 52.2 % (4.6 ± 2.4 and 2.8 ± 2.2 mmol/L; p = 0.0001), the TG level by 26 % (2.7 ± 1.1 and 2.0 ± 1.0 mmol/L; p = 0.008). In the group of patients with very high cardiovascular risk, we also noted a decrease in the total cholesterol level by 39.1 % (6.4 ± 1.4 and 4.4 ± 1.2 mmol/L; p = 0.0001), the level of LDL cholesterol by 45.5 % (4.4 ± 1.4 and 2.5 ± 0.9 mmol/L; p = 0.0001). We did not find statistically significant changes in the remaining lipid parameters. LDL cholesterol targets were achieved in 64 % of patients with high and 52 % of very high cardiovascular risk. There were no significant changes in activity of alanine and aspartate amino transferases, content creatine phosphokinase, glucose and glycated hemoglobin, glomerular filtration rate. Conclusions. Initial combination therapy with statin and ezetimibe is well tolerated and can reduce LDL cholesterol levels by 2 times within 3 months in various categories of patients with high and very high cardiovascular risk.

scholarly journals Cardiovascular events and effectiveness of hypolipidemic therapy in patients with familial hypercholesterolemia and patients of very high cardiovascular risk: 3-year follow-up of the RENAISSANCE Registry

2020 ◽  
pp. 27-36
Author(s):  
У.В. Чубыкина ◽  
М.В. Ежов
Keyword(s):  
Cardiovascular Risk ◽  
Familial Hypercholesterolemia ◽  
Cardiovascular Events ◽  
Density Lipoprotein ◽  
High Cardiovascular Risk ◽  
Lipoprotein A ◽  
History Of ◽  
Male Sex ◽  
Very High

Цель. Целью исследования явилась оценка эффективности и приверженности гиполипидемической терапии, частоты развития сердечно<со< судистых осложнений в течение 3<летнего периода наблюдения в рамках регистра РЕНЕССАНС (Регистр пациентов с СГХС и пациентов очень высокого сЕрдечно<Сосудистого риска с недоСтАточной эффективНоСтью проводимой гиполипидемической терапии). Материал и методы. РЕНЕССАНС является открытым национальным наблюдательным исследованием и включает больных с семейной ги< перхолестеринемией (СГХС), а также пациентов очень высокого сердечно<сосудистого риска (ОВССР). Учитывали наличие факторов риска атеросклероза, анамнез сердечно<сосудистых заболеваний, гиполипидемическую терапию. В каждом центре выполняли определение концен< трации: общего холестерина (ОХС), триглицеридов (ТГ), холестерина липопротеидов высокой плотности (ХС ЛВП) в сыворотке крови. Содер< жание холестерина липопротеидов низкой плотности (ХС ЛНП) рассчитывали по формуле Фридвальда. Уровень липопротеида(а) измеряли методом иммуноферментного анализа в некоторых центрах. При оценке частоты конечной точки, включавшей фатальные и нефатальные сердечно<сосудистых осложнения (ССО), проводили анализ Каплана — Майера. Результаты. В регистр включено 1570 (средний возраст 54,0±14,6 лет) пациентов с СГХС и 121 (63,5±10,9 лет) больной с ОВССР. В группе СГХС динамическое наблюдение проведено у 594 пациентов (38%) в течение 23,6±14,6 месяцев, конечная точка зарегистрирована у 9% больных. Мужской пол (относительный риск 2,1; 95% доверительный интервал 1,13–3,66; p<0,01), гипертония (2,8; 1,4–5,2; p<0,01), ишеми< ческая болезнь сердца (6,8; 3,5–13,2; p<0,0001), отягощенный анамнез по сердечно<сосудистым заболеваниям (ССЗ) (2,1; 1,1–3,9; p<0,05) и концентрация липопротеида(а) ≥ 30 мг/дл (2,8; 1,1–7,7; p<0,05) явились предикторами развития ССО. В группе СГХС отмечено снижение уровня ОХС от исходного на 19%, ХС ЛНП на 25% (р<0,001 для обоих), целевых значений ХС ЛНП достигли 2% больных. В группе ОВССР динамическое наблюдение проведено у 72 (60%) пациентов в течение 19,7±5,8 месяцев. Ни один больной не достиг целевого уровня ХС ЛНП менее 1,4 ммоль/л. Заключение. Трехлетнее наблюдение за участниками регистра РЕНЕССАНС демонстрирует усиление приверженности гиполипидемической терапии. С увеличением риска развития сердечно<сосудистых осложнений при СГХС ассоциированы мужской пол, наличие гипертонии, ише< мической болезни сердца, отягощенного анамнеза по ССЗ и высокий уровень липопротеида(а). The aim of the study was to evaluate the effectiveness and adherence to hypolipidemic therapy, the frequency of cardiovascular events (CVE) during the 3!year follow!up in the RENAISSANCE registry (Registry of patients with familial hypercholesterolemia and very high cardiovascular risk with insufficient effect of hypolipidemic therapy). Methods. The RENAISSANCE registry is an open, national, observational study and includes patients with familial hypercholesterolemia (FH), as well as patients of very high cardiovascular risk (VHR). We took into consideration atherosclerosis risk factors and history of cardiovascular diseases (CVD), adherence to hypolipidemic therapy. Concentrations of total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL!C) were measured in blood serum in all centers. Low density lipoprotein cholesterol (LDL!C) level was defined according to Friedewald formula. The concentration of lipoprotein(a) was measured by enzyme!linked immunosorbent assay in serum in some centers. Kaplan!Mayer analysis was performed to assess the frequency of fatal and nonfatal CVE. Results. The Registry consisted of 1570 (mean age 54.0±14.6 years) FH patients and 121 (63.5±10.9 years) VHR patients. Data of 594 patients (38%) who had follow!up visits were obtained in FH patients, follow!up duration 23.6±14.6 months, 54 (9%) patients experienced CVE. Male sex (hazard ratio 2.1; 95% confidence interval 1.13!3.66, p<0.01), hypertension (2.8;1.4–5.2; p<0.01), ischemic heart disease (6.8;3.5!13.2; p<0.0001), family history of CVD (2.1;1.1–3.9, p<0.05) and lipoprotein(a) level ≥30 mg/dl (2.8;1.1–7.7; p<0.05) were predictors of CVE. In FH patients the level of TC decreased by 19%, LDL!C by 25% (p<0.001 for both). Data on 72 VHR patients (60%) were obtained with follow!up duration of 19.7±5.8 months. No patient achieved the target LDL!C level of less than 1.4 mmol/L. Conclusion. Three!year follow!up of participants in the RENAISSANCE registry shows an enhanced adherence to hypolipidemic therapy. In FH patients the increased risk of new CVE is associated with male sex, hypertension, CHD, family history of CVD and lipoprotein(a) level ≥30 mg/dl

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