BACKGROUND
Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk.
OBJECTIVES
In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels.
METHODS
ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3–74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2–111.0 mg/dL).
RESULTS
In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [Cl]: 0.52–0.90) and 1.11 (95% Cl: 0.83–1.49), with treatment-lipoprotein(a) interaction on MACE (
P
interaction
= 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% Cl: 0.72–0.92) and 0.89 (95% Cl: 0.75–1.06), with
P
interaction
= 0.43.
CONCLUSIONS
In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab;
NCT01663402
)
Our results suggest protective effect of apolipoprotein E epsilon2 allele on susceptibility for carotid plaque presence as well as low density lipoprotein cholesterol lowering effect in Serbian patients with carotid atherosclerosis. Further research of multiple gene and environmental factors that contribute to the appearance and the progression of atherosclerosis should be continued with respect to different populations.
Background/Aim. Overweight/obesity has become important health problem in developed countries. It may be related to a presence of low-grade inflammation in white adipose tissue. The aim of this study was to investigate the levels of inflammatory marker C-reactive protein (CRP) and its relation to anthropometric parameters in overweight and obese females. Methods. This study included 200 apparently healthy, overweight and obese women (18-45 years). Their standard and alternative anthropometric parameters [body mass index (BMI), percentage of fat (%F), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI)] were determined and correlated to serum CRP concentration. Results. Average CRP level was 5.56 ± 2.43 mg/L, and it significantly positively correlated to all investigated anthropometric parameters. There was significant difference between overweight and obese group in all investigated anthropometric parameters, as well as in CRP values. When investigated separately, according to BMI, values regarding obese females showed significant correlation between CRP and every investigated anthropometric parameter. In overweight subjects, no such correlation was recorded. In the obese group, all investigated parameters were significantly related to F. In overweight subjects, body weight (BW), BMI, WC and WHtR showed significant relation to F. Conclusion. The significant difference between the overweight and obese group in all parameters of central obesity was found as well as in the CRP levels. In the obese group, we found strong correlation between adiposity measured by fat percentage and parameters of central obesity, while in the overweight group WHR and BAI did not correlate to fat percentage. Our results confirmed that CRP is a valuable marker of metabolic risk in obese females, and BMI, although not so new, is still reliable parameter of adiposity.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.