Editorial Are we getting to lipid targets in real life?

Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London, London, United Kingdom.
Archives of medical science : AMS 10/2010; 6(5):639-41. DOI: 10.5114/aoms.2010.17073
Source: PubMed


Available from: Maciej Banach, Jun 14, 2015
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    ABSTRACT: The year 2012 has been extremely interesting concerning new findings on diagnosis, management and therapy of dyslipidaemia, hypertension and kidney disease. Looking at recent lipid disorders studies, two issues have seemed to be especially important-searching for new potent biomarkers of lipid disorders (including studies on dysfunctional High Density Lipoprotein [HDL] cholesterol, as well as subfractions/subpopulations of HDL/Low Density Lipoprotein [LDL] cholesterol) and research on new lipid disorders drugs, especially concerning proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, which seem to be very potent in LDL-C lowering. Within the past year, there has been also growing clinical and research progress in hypertension management, especially concerning Resistant Hypertension (RH). In 2012, many important studies on Renal denervation (RDN), as a method of RH therapy have been published, including the ones with patients with different concomitant diseases (e.g., Chronic Kidney Disease (CKD)), as well as with longer follow-up. On the basis of the available data RDN has gained an important role in RH treatment and has recently been introduced to clinical practice. November 2012 has been critical for new nephrology data, as the most important trails were presented during American Society of Nephrology (ASN) Congress in San Diego. They concerned among others, the problems of secondary hyperparathyroidism management in CKD patients, new data on transplantations (e.g., glucocorticoid avoidance strategy), nephro cardiology (stepped pharmacotherapy algorithm vs. ultrafiltration in heart failure patients with CKD), as well as acute kidney injury and diabetic nephropathy (new data on bardoxolone methyl).
    International Journal of Pharmacology 08/2012; 8(8):659-678. DOI:10.3923/ijp.2012.659.678 · 0.98 Impact Factor
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    ABSTRACT: Proprotein convertase subtilisin/kexin 9 (PCSK9) is part of the proteinase K subfamily of subtilases and plays a key role in lipid metabolism. It increases degradation of the low-density lipoprotein receptor (LDL-R), modulates cholesterol metabolism and transport, and contributes to the production of apolipoprotein B (apoB) in intestinal cells. Exogenous PCSK9 modifies the activity of 3-hydroxy-3-methylglutaryl-coenzyme A reductase and acyl coenzyme A:cholesterol acyltransferase and enhances secretion of chylomicrons by modulating production of lipids and apoB-48. Statins increase PCSK9 messenger RNA expression and attenuate the capacity to increase LDL-R levels. Therefore, the inhibition of PCSK9 in combination with statins provides a promising approach for lowering low-density lipoprotein cholesterol (LDL-C) concentrations. This review will address new therapeutic strategies targeting PCSK9, including monoclonal antibodies, antisense oligonucleotides, small interfering RNAs, and other small molecule inhibitors. Further studies are still needed to determine the efficacy and safety of the PCSK9 inhibitors not only to decrease LDL-C but also to investigate the potential underlying mechanisms involved and to test whether these compounds actually reduce cardiovascular end points and mortality.
    Journal of Cardiovascular Pharmacology and Therapeutics 06/2014; 20(2). DOI:10.1177/1074248414539562 · 3.07 Impact Factor
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    ABSTRACT: Despite the continuous improvement of the quality of lipid lowering therapy the achievement of target values is still not satisfactory, mainly in the very high cardiovascular risk category patients, where the goal of low density lipoprotein cholesterol (LDL-C) is 1.80 mmol/l. The trends in lipid lowering treatment of 17420 patients from different studies conducted between 2004 and 2010 were compared to that of 1626 patients of MULTI GAP (MULTI Goal Attainment Problem) 2011 treated by general practitioners (GPs) and specialists. In MULTI GAP 2011 the mean LDL-C level ± SD) of patients treated by GPs was found to be 2.87 ±1.01 mmol/l, the target value of 2.50 was achieved by 40% of them, in the specialists' patients the mean LDL-C level proved to be 2.77 ±1.10 mmol/l and the achievement rate was 45%. In the 2.50 mmol/l achievement rate of GPs' patients a satisfactory improvement was observed in the studied years, but the 1.80 mmol/l LDL-C goal in 2011 was attained only in 11% of very high risk cases. There was a linear correlation between the patient compliance estimated by the physicians and the LDL-C achievement rate. As the number of very high risk category patients has been increased according to the new European dyslipidemia guidelines, growing attention needs to be placed on attainment of the 1.80 mmol/l LDL-C level. Based on the results of the MULTI GAP studies, improving patients' adherence and the continuous training of physicians are necessary.
    09/2012; 8(4):608-13. DOI:10.5114/aoms.2012.30283