scholarly journals Circulating Proprotein Convertase Subtilisin/Kexin Type 9 Levels Predict Future Cardiovascular Event Risks in Hemodialyzed Black African Patients

2021 ◽  
Vol 12 (3) ◽  
pp. e0020
Author(s):  
François-Pantaléon Musungayi Kajingulu ◽  
◽  
François Bompeka Lepira ◽  
Aliocha Natuhoyila Nkodila ◽  
Jean-Robert Rissassy Makulo ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Density Lipoprotein ◽  
Hemodialysis Patients ◽  
Lipoprotein Cholesterol ◽  
Atherogenic Dyslipidemia ◽  
Proprotein Convertase ◽  
Black African ◽  
Increased Risk ◽  
Future Risk

Context and Objective: Cardiovascular diseases are the leading cause of mortality in patients. In this context, proprotein convertase subtilisin/kexin type 9 (PCSK9) appears to be the new biomarker identified as interfering in lipid homeostasis. This study aimed to investigate the association between PCSK9, dyslipidemia, and future risk of cardiovascular events in a population of black Africans. Methods: A cross-sectional study was conducted between August 2016 and July 2020 in six hemodialysis centers in the city of Kinshasa, Democratic Republic of the Congo. Serum PCSK9 was measured by ELISA; lipid levels of 251 chronic kidney disease grade 5 (CKD G5) hemodialysis patients and the Framingham predictive instrument were used for predicting cardiac events. Results: Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were significantly increased in the tertile with the highest PCSK9. By contrast, high-density lipoprotein cholesterol (HDL-c) was significantly decreased in the same tertile. A strong positive and significant correlation was found between PCSK9 and TC, TG, and LDL-c. Negative and significant correlation was observed between PCSK9 and HDL-c. The levels of PCSK9, smoking, overweight, and atherogenic dyslipidemia were associated with future risks for cardiovascular events in univariate analysis. After adjustment, all these variables persisted as independent determinants of future risk for cardiovascular events. The probability of having a cardiovascular event in this population was independently associated with PCSK9 levels. Compared to the patients in the lowest PCSK9 tertile, patients with PCSK9 levels in the middle (aOR 5.9, 95% CI 2.06–17.3, P<0.001) and highest tertiles (aOR 8.9, 95% CI 3.02–25.08, P<0.001) presented a greater risk of cardiac event. Conclusion: Increased PCSK9 serum levels are associated with higher levels of TC, LDL-c, and TG and lower levels of HDL-c in black African hemodialysis patients. Serum PCSK9 levels in these patients predict increased risk of cardiovascular events, independent of traditional potential confounders.

Cardiovascular event rates increase after each recurrence and associate with poor statin adherence

2020 ◽  
pp. 204748732090433 ◽  
Author(s):  
Mariann I Lassenius ◽  
Iiro Toppila ◽  
Susanne Bergius ◽  
Julia Perttilä ◽  
KE Juhani Airaksinen ◽  
...  
Keyword(s):  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Increased Risk ◽  
Event Rates

Aims The study evaluated the quality of cardiovascular prevention in real-world clinical practice. The recurrence of up to five cardiovascular events was assessed, as data on recurrence beyond the first event and interindividual variations in event rates past the second event have been sparse. Low-density lipoprotein cholesterol concentrations and lipid-lowering therapy use were investigated. Methods This retrospective register-based study included adult patients with an incident cardiovascular event between 2004 and 2016 treated in the hospital district of southwest Finland. Patients were followed for consecutive cardiovascular events or cardiovascular death, low-density lipoprotein cholesterol and statin purchases. The timing of event recurrence was evaluated, and predictive factors were assessed. Results A wide interindividual variation in cardiovascular event recurrence was observed, each additional event caused an increased risk, the median time of recurrence decreased from 7 to one year for the second and fifth event. Event rates increased correspondingly from 12 to 43/100 patient-years and were most pronounced in the first years following the previous event. The low-density lipoprotein cholesterol goal (<1.8 mmol/l) was reached by 18% in the year after the event and statin underuse was associated with an increased risk of recurrence. Six months after the index event high intensity statins were used by only 22% of the cohort. Conclusion The study provides new perspectives on individual risk assessment showing that event rates are not stable for all patients but increase 1.2–1.9-fold per consecutive event. The underuse of statins and poor adherence support the identification of these patients for intensified multifactorial preventive measures.

Familial Hypercholesterolemia-Risk-Score: A New Score Predicting Cardiovascular Events and Cardiovascular Mortality in Familial Hypercholesterolemia

2021 ◽  
Vol 41 (10) ◽  
pp. 2632-2640 ◽  
Author(s):  
Martine Paquette ◽  
Sophie Bernard ◽  
Bertrand Cariou ◽  
Robert A. Hegele ◽  
Jacques Genest ◽  
...  
Keyword(s):  
Familial Hypercholesterolemia ◽  
Risk Score ◽  
Cardiovascular Event ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Free Survival

Objective: Familial hypercholesterolemia (FH) is associated with a high risk of premature atherosclerotic cardiovascular disease (ASCVD). However, this risk is highly heterogeneous and current risk prediction algorithms for FH suffer from limitations. The primary objective of this study was to develop a score predicting incident ASCVD events over 10 years in a large multinational FH cohort. The secondary objective was to investigate the prediction of major adverse cardiovascular events and cardiovascular mortality using this score. Approach and Results: We prospectively followed 3881 patients with adult heterozygous FH with no prior history of ASCVD (32 361 person-years of follow-up) from 5 registries in Europe and North America. The FH-Risk-Score incorporates 7 clinical variables: sex, age, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, hypertension, smoking, and lipoprotein (a) (Lp(a)) with a Harrell C-index for 10-year ASCVD event of 0.75, which was superior to the SAFEHEART-RE (Spanish Familial Hypercholesterolemia Cohort; 0.69). Subjects with an elevated FH-Risk-Score had decreases in 10-year ASCVD-free survival, 10-year major adverse cardiovascular event-free survival, and 30-year survival for CV mortality compared with the low-risk group, with hazard ratios of 5.52 (3.94–7.73), 4.64 (2.66–8.11), and 10.73 (2.51–45.79), respectively. The FH-Risk-Score showed a similar performance in subjects with and without an FH-causing mutation. Conclusions: The FH-Risk-Score is a stronger predictor of future ASCVD than the SAFEHEART-RE and was developed in FH subjects with no prior cardiovascular event. Furthermore, the FH-Risk-Score is the first score to predict CV death and could offer personalized cardiovascular risk assessment and treatment for patients with FH. Future studies are required to validate the FH-Risk-Score in different ethnic groups.

scholarly journals Predictive Value of Small Dense Low-density Lipoprotein Cholesterol and Remnant-like Particle Cholesterol for Cardiovascular Events in Chinese Elder Diabetes Mellitus Patients

2020 ◽  
Author(s):  
Li Xu ◽  
Feifei Lu ◽  
Jingfen Lu ◽  
Yan Xu ◽  
Nuoer Chen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Predictive Value ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Cox Regression Analysis ◽  
Type 2 Dm ◽  
Increased Risk

Abstract BackgroundAs a subcomponent of lipoprotein cholesterol (LDL-C), small dense LDL-C (sdLDL-C) have been suggested to be a better predictor of cardiovascular diseases(CVD). This research was to evaluate the predictive of the sdLDL-C in cardiovascular events (CVs) in Chinese elder type 2 diabetes mellitus(DM) patients.MethodsSerum sdLDL-C measured by homogeneous method was compared in 386 consecutive type 2 DM patients between December 2014 and December 2016. Finally, 92 type 2 DM patients had CVs during the 48-month follow-up period. Receiver operating characteristic (ROC) curves were used for assess the predictive value of baseline parameters to major CVs.ResultsNinety-two CVs occurred during the study period.The ROC curve manifested that sdLDL-C in the study population had a matchable discriminatory power (AUC for sdLDL-C was 0.7366, P = 0.003). In addition, kaplan-Meier event-free survival curves displayed a obvious increase of CVs risk for sdLDL-C ≧ 26 mg/dL (log-rank = 9.10,P = 0.003). This phenomenon had analogousresultsin patients who received statins at baseline (log rank = 7.336༌P = 0.007).The study discovered that the increase in HbA1c, glucose, LDL-C, sdLDL-C, non-HDL-C and ApoB and the decrease in ApoA1 were obviously interrelated with heightened CVs risk through Cox regression analysis. Multivariate analysis demonstrated that the increase of sdLDL-C and HbA1c was obviously correlated with CVs. The results of the study indicated that sdLDL-C (per 10 mg/dL) was a increased risk for CVs in the multivariate model (HR 1.281, 95% CI 1.225–16.032; P < 0.01).ConclusionThe consequences demonstrated that sdLDL-C was more effective than RLP-C in predicting the future CVs of Chinese elder type 2 DM patients

Abstract 15089: Relationship between Paradoxical Decrease in High-Density Lipoprotein Cholesterol Levels Following Statin Therapy and Severe Cardiovascular Event in Patients with Acute Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tomoyuki Ota ◽  
Hideki Ishii ◽  
Susumu Suzuki ◽  
Akihito Tanaka ◽  
Naohiro Osugi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
High Density Lipoprotein ◽  
Statin Therapy ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Independent Predictor ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol

Introduction: Low levels of high-density lipoprotein-cholesterol (HDL-C) are well known as an important risk factor for cardiovascular disease. In addition to lowering low-density lipoprotein-cholesterol (LDL-C), statin therapy increase HDL-C moderately. Contrary to this expectation, we sometimes have experience to paradoxical decrease in HDL-C following statin therapy. The purpose of our study was to analyze the relation between the paradoxical HDL-C decrease following statin therapy and adverse cardiovascular event in patients with acute myocardial infarction (AMI). Methods: Total of 724 AMI patients who started statins newly after initial coronary intervention were analyzed. Change in HDL-C levels (ΔHDL) was calculated as HDL-C levels at follow-up coronary angiography minus baseline HDL-C levels. These patients were divided into two groups according toΔHDL; 620 patients with ΔHDL≥0 (increase HDL group) and 104 patients with ΔHDL<0 (decrease HDL group). Severe cardiovascular events were defined as all cause death, myocardial infarction and stroke. Results: Change in lipid profile and clinical outcomes were shown in table. Event-free survival curves for severe cardiovascular events appeared in figure. Multivariate analysis showed that decrease HDL and reperfusion time per hour were the independent predictor of severe cardiovascular event (hazard ratio [HR]: 2.138; 95% confidence interval [CI]: 1.106 - 4.132 and HR: 1.070; 95% CI: 1.026 - 1.117, respectively). Conclusions: Paradoxical decrease in serum HDL-C levels following statin therapy might be an independent predictor of long-term severe cardiovascular disease in patients with AMI.

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