Peter E. Penson

Liverpool John Moores University | LJMU · School of Pharmacy and Biomolecular Sciences

Muscle wasting is one of the main causes for exercise intolerance and ventilatory inefficiency in patients with heart failure and a strong predictor of frailty and reduced survival. The prevalence of sarcopenia is at least 20% in patients with heart failure. Patients with heart failure often have subclinical systemic inflammation, which may exert s...

Background: There is good evidence showing that inactivity and walking minimal steps per day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps, and their role in health is however still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause...

Lipid disorders are the most common risk factor for atherosclerotic cardiovascular disease (ASCVD). Statins are the gold standard in the treatment of lipid disorders. These drugs significantly improve the prognosis of patients, both in primary and secondary ASCVD prevention. Statins have a good safety profile, yet they are often not used in the hig...

Muscle wasting is one of the main causes for exercise intolerance and ventilatory inefficiency in patients with heart failure and a strong predictor of frailty and reduced survival. The prevalence of sarcopenia is at least 20% in patients with heart failure. Patients with heart failure often have subclinical systemic inflammation, which may exert s...

Aims: We aimed to evaluate the association between metabolic syndrome (MetS) and longterm all-cause mortality. Methods: The LIPIDOGRAM studies were carried out in the primary care in Poland in 2004, 2006 and 2015. MetS was diagnosed based on the National Cholesterol Education Program, Adult Treatment Panel III (NCEP/ATP III) and Joint Interim Stat...

Cardiovascular disease (CVD) is a chronic non-communicable disease (NCD) and the predominant cause of morbidity and mortality worldwide. Substantial reductions in the CVD prevalence have been achieved in recent years by the attenuation of risk factors (particularly hypertension and dyslipidaemias) in primary and secondary prevention. Despite the re...

Non-Alcoholic Fatty Liver Disease (NAFLD) is a common condition affecting around 10-25% of the general adult population, 15% of children, and even >50% of individuals who have type 2 diabetes mellitus. It is a major cause of liver-related morbidity, and cardiovascular (CV) mortality is a common cause of death. In addition to being the initial step...

Introduction Older people in care homes with atrial fibrillation (AF) have complex health needs and would benefit from taking part in research. This study assessed the feasibility of pharmacist implementation of the Atrial Fibrillation Better Care (ABC: Anticoagulation; Better symptoms; Cardiovascular comorbidity management) pathway, and collection...

COVID-19 is primarily associated with acute infection, however, its presentation and degree of severity varies in individuals. Individuals at the greatest risk of long-COVID include those who experience severe symptoms of their initial infection and those who are aged >65 years, female, obese or smoke tobacco. Long-COVID presents anything up to 1-y...

Objective To determine atrial fibrillation (AF) prevalence and temporal trends, and examine associations between AF and risk of adverse health outcomes in older care home residents. Methods Retrospective cohort study using anonymised linked data from the Secure Anonymised Information Linkage Databank on CARE home residents in Wales with AF (SAIL C...

Dyslipidemia in patients with type 2 diabetes (DMT2) is one of the worst controlled worldwide, with only about 1/4 of patients being on the low-density lipoprotein cholesterol (LDL-C) target. There are many reasons of this, including physicians’ inertia, including diabetologists and cardiologists, therapy nonadherence, but also underusage and under...

Background: Treatment decisions about oral anticoagulants (OACs) for atrial fibrillation (AF) are complex in older care home residents. Aim: To explore factors associated with OAC prescription. Design and setting: Retrospective cohort study set in care homes in Wales, UK, listed in the Care Inspectorate Wales Registry 2017/18. Method: Analys...

Invited Editorial on the largest achievements in cardiovascular disease area in 2022.

Invited Editorial on the paper entitled: "Gaps and discontinuation of statin treatment in Norway: potential for optimizing management of lipid lowering drugs" European Heart Journal Open, 2022;, oeac070, https://doi.org/10.1093/ehjopen/oeac070

Background Prescription of oral anticoagulants (OAC) is paramount for stroke prevention in people with atrial fibrillation (AF), but treatment decisions in older care home residents are complicated by frailty, multi-morbidity and heightened stroke and bleeding risk. There is a paucity of data on factors influencing the decision to prescribe OAC in...

Background Older care home residents are a high-risk group of people with atrial fibrillation (AF) who are under-represented in clinical trials. Improved understanding of AF epidemiology and management in this population is paramount for health and social care organisations to strategically plan services. Purpose To determine the trends in AF prev...

Individualised and patient-centric care is essential in the effective management of statin intolerance to enable the patient to initiate a therapy which they are willing to take, and which will allow them to reach (as far as possible) risk-reduction targets for CVD. This requires careful history taking, and careful selection from the ever-widening...

Background Around 36,000 cardiac operations are undertaken in the United Kingdom annually, with most procedures undertaken via median sternotomy. Wound complications occur in up to 8% of operations, with an associated mortality rate of around 47% in late or undetected cases. Objective To undertake a systematised literature review to identify pre-o...

Aims • Capture community pharmacists’ views regarding the practicalities of dispensing EPS paediatric prescriptions• Identify any gaps in specialist paediatric knowledge and training needs required to implement the service fully • Determine the most feasible methods for efficient and effective service delivery Methods University ethical approval w...

Within Europe and the Asia-Pacific, the Atrial Fibrillation Better Care (ABC) pathway is the gold standard integrated care strategy for atrial fibrillation management. Atrial fibrillation diagnosis should be Confirmed and Characterized (CC) before implementation of ABC pathway components: (1) ‘A’- Anticoagulation/Avoid stroke; (2) ‘B’- Better sympt...

The risk of atherosclerotic cardiovascular disease (ASCVD) is strongly related to lifetime exposure to low-density lipoprotein (LDL)-cholesterol in longitudinal studies. Lipid-lowering therapy (using statins, ezetimibe and PCSK9 inhibitors) substantially ameliorates the risk and is associated with long-term reduction in cardiovascular (CV) events....

Solid oral dosage forms (SODFs), (often called pills by patients) are the default formulation to treat medical ailments. Beneficial therapeutic outcomes rely on patients taking them as directed. Up to 40% of the population experience difficulties swallowing SODFs, resulting in reduced adherence and impaired therapeutic efficacy. Often associated wi...

This study aimed to assess asthma management in a sample of adult patients in a general practice. A retrospective case-note review was conducted, involving 27 asthma patients in a general practice in England. The Asthma Quality Improvement tool informed the development of the data collection tool. The data were analysed statistically by the res...

Despite continuous advances in pharmacotherapy, atherosclerotic cardiovascular disease remains the world's leading killer. Atherosclerosis relates not only to an increased level of cholesterol, but involves the development of atherosclerotic plaques, which are formed as a result of processes including inflammation and oxidative stress. Therefore, i...

Aims: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a key risk factor for ischaemic stroke. Following AF detection, treatment with oral anticoagulation can significantly lower mortality and morbidity rates associated with this risk. The availability of several hand-held devices which can detect AF may enable trained...

Clinical trials have suggested that increased 25-hydroxyvitamin D (25(OH)D) has positive effect on hand grip strength. This Mendelian randomisation (MR) was implemented using summary-level data from the largest genome-wide association studies on vitamin D (n = 73,699) and hand grip strength. Inverse variance weighted method (IVW) was used to estima...

Statin intolerance is a clinical syndrome whereby adverse effects associated with statin therapy (most commonly statin-associated muscle symptoms [SAMS]) result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated pati...

This editorial refers to: Major Adverse Cardiovascular Events in Homozygous Familial Hypercholesterolemia: a systematic review and meta-analysis By Kramer et al. European Journal of Preventative Cardiology (2021) https://doi.org/10.1093/eurjpc/zwab224

The detection of antinuclear autoantibody (ANA) is dependent on many factors and varies between the populations. The aim of the study was first to assess the prevalence of ANA in the Polish adult population depending on age, sex and the cutoff threshold used for the results obtained. Second, we estimated the occurrence of individual types of ANA-st...

Background The anti-DFS70 autoantibodies are one of the most commonly and widely described agent of unknown clinical significance, frequently detected in healthy individuals. It is not known whether the DFS70 autoantibodies are protective or pathogenic. One of the factors suspected of inducing the formation of anti-DFS70 antibodies is increased oxi...

Aims: Statin intolerance (SI) represents a significant public health problem for which precise estimates of prevalence are needed. Statin intolerance remains an important clinical challenge, and it is associated with an increased risk of cardiovascular events. This meta-analysis estimates the overall prevalence of SI, the prevalence according to d...

Background: The anti-DFS70 autoantibodies are one of the most commonly and widely described agent of unknown clinical significance, frequently detected in healthy individuals. It is not known whether the DFS70 autoantibodies are protective or pathogenic. One of the factors suspected of inducing the formation of anti-DFS70 antibodies is increased ox...

Barriers to care home research have always existed, but have been thrown into sharp relief by the COVID-19 pandemic. Existing infrastructure failed to deliver the research, or outcomes, which care home residents deserved and we need to look, again, at how these barriers can be taken down. Barriers can be categorised as procedural (encountered befor...

Elevated circulating concentrations of low-density lipoprotein cholesterol (LDL-C) have been conclusively demonstrated in epidemiological and intervention studies to be causally associated with the development of atherosclerotic cardiovascular disease. Enormous advances in LDL-C reduction have been achieved through the use of statins, and in recent...

A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the years 2015 and 2016. A total of 438 primary care physicians enrolled 13,724 adult patients that sought medical care in primary health care practices. The prevalence of hypertension, diabetes mellitus, dyslipidaemia, and CVD were similar in urban and rural areas (49...

Across multiple sectors, including food, cosmetics and pharmaceutical industries, there is a need to predict the potential effects of xenobiotics. These effects are determined by the intrinsic ability of the substance, or its derivatives, to interact with the biological system, and its concentration–time profile at the target site. Physiologically...

The detection of antinuclear autoantibody (ANA) is dependent on many factors and varies between the populations. The aim of the study was first to assess the prevalence of ANA in the Polish adult population depending on age, sex and the cutoff threshold used for the results obtained. Second, we estimated the occurrence of individual types of ANA-st...

Purpose of Review Remarkable reductions in cardiovascular morbidity and mortality have been achieved in recent decades through the widespread use of ‘small-molecule’ hypolipidaemic drugs such as statins and ezetimibe. An alternative approach is to perturb the production of proteins through ribonucleic acid (RNA) silencing, leading to long-lasting k...

Cardiovascular disease (CVD) remains the most common cause of death worldwide. Low-density lipoprotein cholesterol (LDL-C) is the most important risk factor for atherosclerosis and plays a significant role in the development of atherosclerotic CVD (ASCVD). To estimate the risk of death in patients with established CVD or atherosclerotic risk factor...

Background The efficacy of statins in the prevention and treatment of cardiovascular disease is well established. Despite their large benefit, statin intolerance (SI) is still an important clinical challenge. In this meta-analysis, we aimed to estimate the overall prevalence of SI, the prevalence based on different diagnostic criteria and different...

Background Ankle-brachial index (ABI) is a non-invasive and accessible indicator of peripheral arterial disease (PAD) which shares pathophysiological mechanisms with coronary and cerebral atherosclerosis. Purpose This study investigated associations between ABI and cardiovascular (CV) mortality in a longitudinal cohort study. Methods Ankle-brachi...

Background Abdominal aortic calcification (AAC) has recently been recognised as a risk factor for cardiovascular disease, as it shares pathophysiological mechanisms with coronary artery disease. Purpose We investigated relationships between AAC and traditional cardiovascular risk factors in a cross-sectional epidemiological cohort from the USA Me...

Background: The purpose of the study was to evaluate secondary stroke prevention in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. Material and methods: From all patients in LIPIDOGRAM2015 Study (n = 13,724), 268 subjects had a history of ischaemic stroke and were includ...

Background: Familial hypercholesterolemia (FH) is a genetic autosomal co-dominant metabolic disorder leading to elevated circulating concentrations of low-density lipoprotein cholesterol (LDL-C). Early development of atherosclerotic cardiovascular disease (ASCVD) is common in affected patients. We aimed to evaluate the characteristics and differen...

Dyslipidemia has been globally recognized, for almost seven decades, as one of the most important risk factors for the development and complications of atherosclerotic cardiovascular disease (ASCVD) [...]

Introduction: Risk-factor identification and risk stratification are prerequisites to the effective primary and secondary prevention of cardiovascular disease (CVD). Patients at the highest risk benefit the most from the intensive risk-factor reduction. However, high-risk patients’ group is heterogeneous, and it is increasingly recognised that ther...

Gastric cancer is the fourth most common cause of cancer-linked deaths in the world. Gastric tumor cells have biological characteristics such as rapid proliferation, high invasiveness, and drug resistance, which result in recurrence and poor survival. Helicobacter pylori (H. pylori) has been proposed as a first‐class carcinogen for gastric cancer a...

Background: Inflammation plays a central role in the pathogenesis and clinical manifestations of atherosclerosis. Randomized controlled trials (RCTs) have investigated the potential benefit of colchicine in reducing cardiovascular events (CE) in patients with coronary artery disease (CAD) but produced conflicting results. The aim of this meta-anal...

Introduction Pyroptosis is a regulated form of cell death, which is often a consequence of the activation of inflammatory caspases. Material and methods Appropriate inflammatory responses and the induction of pyroptosis enhance the clearance of pathogens and increase innate immunity. Results However, excessive pyroptosis contributes to a hyperinf...

Dyslipidaemias result in the deposition of cholesterol and lipids in the walls of blood vessels , chronic inflammation and the formation of atherosclerotic plaques, which impede blood flow and (when they rupture) result in acute ischaemic episodes. Whilst recent years have seen enormous success in the reduction of cardiovascular risk using conventi...

Background: Sleep disorders are associated with increased incidence of cardiovascular disease (CVD), but the causal mechanisms are not clear. We aimed to study associations between sleep duration and cardiovascular risk factors. Materials and Methods: Participants in the National Health and Nutrition Examination Survey (NHANES 2005-2008) reported...

Introduction Oxidative stress is one of many factors suspected to promote antinuclear autoantibody (ANA) formation. Reactive oxygen species can induce changes in the antigenic structure of macromolecules, causing the immune system to treat them as “neo-antigens” and start production of autoantibodies. This study was designed to evaluate the relatio...

Purpose of Review: Recent studies have demonstrated an important role for inflammation in the pathogenesis of atherosclerotic cardiovascular disease. Several studies have investigated the efficacy of colchicine (a widely used and safe anti-inflammatory drug) in patients with atherosclerosis. This review explains the rationale for the use of colchic...

In the field of cardiovascular disease prevention, much recent attention has naturally focused on the remarkable opportunities afforded by novel lipid-lowering drugs, including monoclonal antibody inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9). and inclisiran. Equally important are efforts to optimize the use of existing therap...

Background Abdominal aortic aneurysms (AAAs) is an important cause of death in older adults due to aortic rupture. There are currently no effective medical therapies for AAA, with surgery being the only acceptable treatment. There is frequently an extended period between AAA diagnosis and treatment by corrective surgery, during which an effective d...

Inflammation is a marker of arterial disease stemming from cholesterol-dependent to -independent molecular mechanisms. In recent years, the role of inflammation in atherogenesis has been underpinned by pharmacological approaches targeting systemic inflammation that have led to a significant reduction in cardiovascular disease (CVD) risk. Although t...

Background General Pharmaceutical Council standards (UK) state ‘pharmacy professionals have the right to practise in line with their religion, personal values or beliefs as long as they …make sure that person-centred care is not compromised’, indicating a potential conflict for pharmacists who wish to exercise their right to conscientious objection...

Abstract Background: Asthma poses a public health concern, with an estimated 235 million people currently living with the condition globally. The provision of evidence-based, patient-centred services for adult asthma patients in community pharmacy which involves collaboration across the multidisciplinary team could improve their asthma control. Ob...

Objectives: Diagnosis of Systemic Autoimmune Rheumatic Diseases using antinuclear autoantibodies (ANA) is dependent on many factors and varies between populations, such that the screening dilution used for indirect immunofluorescence assay (IIFA) should be defined locally for each population. The aim of the study was firstly, to assess the prevalen...

Background Asthma poses a public health concern, with an estimated 235 million people currently living with the condition globally. The provision of evidence-based, patient-centred services for adult asthma patients in community pharmacy which involves collaboration across the multidisciplinary team could improve their asthma control. Objectives A...

Introduction: In the absence of a European standardized postmarketing food supplement surveillance system (nutrivigilance), some member states and companies have developed their own approaches to monitoring potential adverse reactions to secure a high level of product safety. This paper describes the use of a nutrivigilance system in monitoring the...

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein...

Myocarditis refers to the clinical and histological characteristics of a diverse range of inflammatory cellular pathophysiological conditions which result in cardiac dysfunction. Myocarditis is a major cause of mortality in individuals less than 40 years of age and accounts for approximately 20% of cardiovascular disease (CVD) events. Myocarditis c...

This Editorial refers to the paper: "Combination of bempedoic acid, ezetimibe, and atorvastatin in patients with hypercholesterolemia: A randomized clinical trial" by John Rubino, Diane E. MacDougall, Lulu R.Sterling, Jeffrey C.Hanselman, and Stephen J.Nicholls.

Commentary on: N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects (Wood et al. NEJM 2020).

Statins reduce circulating concentrations of low-density lipoprotein cholesterol (LDL-C) and thereby are effective at reducing cardiovascular (CV) events and mortality in primary and secondary prevention. As with all drugs, statins cause adverse effects in some patients. Statin intolerance occurs when adverse effects limit the maximum dose of stati...

This editorial refers to ‘Genetically determined hyperchol-esterolaemia results into premature leukocyte telomere length shortening and reduced haematopoietic precursors’, by A. Baragetti et al., doi: 10.1093/eurjpc/zwaa115.

There is a strong evidence that more marked lowering of low-density lipoprotein cholesterol (LDL-C) leads to progressively lower risk of cardiovascular disease (CVD) events. The evidence on validity of this hypothesis comes from epidemiological, genetic and clinical studies. The hypothesis “the lower the better” has been recently strongly supported...

Disorders of the central nervous system (CNS) and tumors of the brain are challenging to treat, and they rank amongst the most common causes of death worldwide. The delivery of drugs to the brain is problematic because the blood-brain barrier (BBB) effectively arrests the transport of large molecules (including drugs) from the blood to the CNS. Nan...

Atherosclerosis, a chronic progressive inflammatory condition characterized by the formation of lipid-laden lesions in arterial walls, is associated with substantial morbidity (including ischaemic stroke and myocardial infarction) and mortality. Risk factors for atherosclerosis are well understood and can be ameliorated by evidence-based and guidel...

Elevated circulating concentrations of low-density lipoproteins have been definitively demonstrated to be a cause of atherosclerotic cardiovascular disease (ASCVD). Increasing recognition is given to the importance of reducing lifetime exposure to low-density lipoprotein cholesterol (LDL-C) according to the rule of "the lower the better," but also...