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LDL-Cholesterol-Lowering Therapy [chapter]

Angela Pirillo, Giuseppe D. Norata, Alberico L. Catapano
2020 Handbook of Experimental Pharmacology  
Indeed several clinical trials have shown that adding ezetimibe to statin therapy results in a further 15-20% LDL-C level reduction (Catapano et al. 2005 (Catapano et al. , 2006 Mikhailidis et al. 2007  ...  patients intolerant to statins, including the possibility to combine a low dose of a statin with another cholesterol-lowering drug which is acting by a complementary mechanism of action (Pirillo and Catapano  ... 
doi:10.1007/164_2020_361 pmid:32350699 fatcat:x6xvzrjaw5ethdlmwfbzrnscwm

Cardiovascular Disease Risk Prevention Across Europe

Richard Hobbs, Terry McCormack, Claudio Cricelli, Alberico L Catapano, Keith A Fox
2007 European Cardiology  
The interplay between risk factors, the variable influence of any one risk factor and the tendency for risk factors to cluster make the determination of cardiovascular disease (CVD) risk in apparently healthy individuals more complex 1 than assessing any single risk factor in isolation. For example, age factors heavily in a patient's CVD risk; however, a younger patient with multiple factors may also be at high lifetime CVD risk. Calculating that a younger patient has low 10-year CVD risk may
more » ... use the clinician to miss an opportunity to address modifiable risk factors prior to the onset of disease. Risk-factor clustering may also lead to an underestimation of CVD risk. One well-known, though controversial, example of risk-factor clustering is the metabolic syndrome. Metabolic syndrome increases the risk of CVD mortality in middle-aged men by as much as three-fold. 2 If the full spectrum of metabolic syndrome components -i.e. central obesity, hypertension, low high-density lipoprotein cholesterol (HDL-C), elevated triglycerides and increased blood sugar -were not assessed, the clinician would fail to recognise the severity of the patient's CVD risk. The concept of assessing multiple risk factors concurrently is referred to as total CVD risk, expressed as absolute risk within a defined time period. Total CVD risk assessment is useful in assisting clinicians in the prioritisation of treatment in patients who would derive the greatest benefit (i.e. high-risk patients), while reducing unnecessary drug exposure in low-risk patients. In addition, risk estimation provides a means of displaying total CVD risk in consultations between clinicians and patients in which lifestyle changes or other therapeutic interventions are recommended. The identification of coronary heart disease (CHD) and CHD risk equivalents can further simplify the CVD treatment algorithm for time-constrained practitioners and target intensive therapy appropriately in secondary prevention patients. The recent presentation comparing the results from the European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) surveys highlights a failure to address CVD risk factors such as hyperlipidaemia, hypertension, obesity, diabetes and smoking cessation in clinical practice. 3 These findings were in the context of the more clearly defined area of secondary prevention; the challenges are even greater in primary prevention. In an effort to simplify the process of total CVD risk assessment, a number of risk-assessment tools have been developed, several of which are available as online calculators or risk charts (see Table 1 ). Each riskassessment tool calculates risk according to a distinct algorithm, and may be used preferentially in various countries or when evaluating specific patient populations. The recent introduction of the new European guidelines on CVD prevention in clinical practice provides an ideal starting point from which to discuss total CVD risk and the similarities and differences in methodology employed for risk assessment throughout Europe. Methods of Risk Assessment -Comparisons Among Guidelines The first step in evaluating CVD risk is to identify patients who are candidates for total CVD risk assessment. In the new European guidelines, certain patients -such as those with established atherosclerotic disease, diabetes or marked increases in a single risk factor and end-organ damage -are automatically classified as 'high-risk' and require full preventative intervention. 4 These patients were traditionally considered to be eligible for secondary prevention. However, in individuals who do not meet these criteria the degree of CVD risk is less clear-cut. These individuals may also be at high risk of CVD because of an accumulation of multiple risk factors rather than the presence of a single high-risk attribute. The categories of patients who are recommended for total CVD risk assessment vary according to the CVD prevention guidelines used. The European guidelines on CVD prevention have established a hierarchy for prioritising CVD prevention in clinical practice. 4 Patients identified a priori as high-risk because of the presence of one or more of the above-mentioned risk factors are automatic candidates for therapeutic intervention. In patients without these risk factors, total CVD risk assessment is recommended if requested by the patient, in patients who are middle-aged smokers, in patients with one or more known risk factors, in patients with a positive family history and in patients with symptoms suggestive of CVD.
doi:10.15420/ecr.2007.0.2.14 fatcat:6vkikmgad5bflcjiarboibg3gi

Pitavastatin and HDL: Effects on plasma levels and function(s)

Angela Pirillo, Alberico L. Catapano
2017 Atherosclerosis Supplements  
The J-LIT study showed, in fact, that an increase of 10 mg/dL (0.26 mmol/L) of HDL-C levels translated into a 34.9% reduction in the risk of coronary events in patients with both hypercholesterolemia and  ... 
doi:10.1016/j.atherosclerosissup.2017.05.001 pmid:28716185 fatcat:s7w27oawn5g5fh737eocvqftjm

HDL in Immune-Inflammatory Responses: Implications beyond Cardiovascular Diseases

Fabrizia Bonacina, Angela Pirillo, Alberico L. Catapano, Giuseppe D. Norata
2021 Cells  
McMahon, M.; Skaggs, B.J.; Sahakian, L.; Grossman, J.; Fitzgerald, J.; Ragavendra, N.; Charles-Schoeman, C.; Chernishof, M.; Gorn, A.; Witztum, J.L.; et al.  ...  -L.; Capel, F. Alterations of HDL particle phospholipid composition and role of inflammation in rheumatoid arthritis. J. Physiol. Biochem. 2019, 75, 453-462. [CrossRef] 27.  ... 
doi:10.3390/cells10051061 pmid:33947039 fatcat:axl5jsdko5bfrag7qknzqmx52y

Strategies for the use of nonstatin therapies

Angela Pirillo, Giuseppe D. Norata, Alberico L. Catapano
2017 Current Opinion in Lipidology  
[61] ; no serious adverse events or adverse events leading to drug discontinuation were observed in patients achieving such very low LDL-C levels, thus suggesting that lower LDL-C levels (<0.5 mmol/L)  ...  [63, 64] . 3) Patients with hypertriglyceridaemia For the purpose of this review, we discuss exclusively data about patients with mild-to-moderate hypertriglyceridaemia (150-880 mg/dL, 1.7-10 mmol/L)  ...  Severe range for this topic: 3-10 mmol/l?  ... 
doi:10.1097/mol.0000000000000459 pmid:28914630 fatcat:wty4x3oigjaatcmzznenknxw5y

Targeting Two Sources of Cholesterol – An Advanced Treatment Approach to Lipid-lowering Management

Dr Alberico L Catapano
2005 European Cardiology  
Dr Alberico L Catapano is Professor of Pharmacology at the University of Milan in Italy.  ...  Dr Catapano has authored more than 150 scientific publications and edited 12 books on lipids and lipoproteins.  ... 
doi:10.15420/ecr.2005.16 fatcat:q66znksg7nafdexpjrwnul7fpa

Targeting Two Sources of Cholesterol – An Advanced Treatment Approach to Lipid-lowering Management

Dr Alberico L Catapano
2005 European Cardiology  
Dr Alberico L Catapano is Professor of Pharmacology at the University of Milan in Italy.  ...  Dr Catapano has authored more than 150 scientific publications and edited 12 books on lipids and lipoproteins.  ... 
doi:10.15420/ecr.2005.1b fatcat:3wcrv3nv35fafp2isgnxk4zdt4

HDL in Atherosclerotic Cardiovascular Disease: In Search of a Role

Manuela Casula, Ornella Colpani, Sining Xie, Alberico L. Catapano, Andrea Baragetti
2021 Cells  
common notion that HDL-C is inversely associated with the risk of cardiovascular events stems from several epidemiological studies [13] [14] [15] ; in observational studies, each 1 mg/dL (0.026 mmol/L)  ...  3.1 mg/dL ^ myocardial infarction - OR 0.81 (95%CI 0.44-1.46) ** ^ mean difference comparing top to bottom quintiles of each allele score; * per 1 SD increase in HDL-C due to SNP score; ** per 1 mmol/L  ...  AL Catapano reports grants from Amgen, Sanofi, and Regeneron, and personal fees from Merck, Sanofi, Regeneron, AstraZeneca, Amgen, and Novartis, outside the submitted work.  ... 
doi:10.3390/cells10081869 pmid:34440638 pmcid:PMC8394469 fatcat:433fe6lonfenpameptuqpcc4bi

Beyond LDL-C levels, does remnant cholesterol estimation matter?

Angela Pirillo, Giuseppe D Norata, Alberico L Catapano
2020 European Journal of Preventive Cardiology  
Clinical evidence suggests that the residual cardiovascular (CV) risk observed in patients with wellcontrolled low-density lipoprotein cholesterol (LDL-C) levels can be, in part, explained by residual lipid risk factors, among which the cholesterol content of remnants of triglyceride (TG)-rich lipoproteins (TRLs) appears to play a key role. 1 Observational and genetic studies have shown that remnant cholesterol (RC) is a causal risk factor for ischemic heart disease, 2 and more recently it has
more » ... een associated also with an increased risk of ischemic stroke. 3 Indeed, several studies have shown that non-high-density lipoprotein cholesterol (non-HDL-C) levels, which recapitulate the cholesterol content of all atherogenic apolipoprotein B (apoB)-containing lipoproteins including remnants, are a better predictor of CV risk than LDL-C levels alone. 4,5 In agreement with these observations, Mendelian randomization studies have suggested that the clinical benefit of lowering LDL-C may be better explained by the absolute reduction in apoB-containing lipoproteins. 6, 7 In their study, Elshazly et al. have evaluated whether RC associates with coronary atheroma progression and clinical events independently of LDL-C values in 5754 patients from 10 interventional trials. 8 Despite an overall effective treatment resulting in robust reductions of plasma lipids (including LDL-C, RC, TG, non-HDL-C) and apoB levels, a variability in the response for changes in the percent atheroma volume (PAV) was observed. 8 Of note, higher on-treatment RC levels were significantly associated with a greater progression of coronary atheroma, and also with an increased cumulative incidence of major adverse CV events at 24 months. 8 Atheroma progression occurred when ontreatment RC levels were higher than 25-30 mg/dL (depending on the method used for LDL-C level estimation), and was more strongly associated with changes in RC than LDL-C or apoB levels. 8 These results seem to be in agreement with a recent study demonstrating a relationship between RC and total coronary atherosclerotic plaque burden (evaluated by computed tomography coronary angiography) in a population of patients with optimal LDL-C levels (mostly treated with statins), in which RC levels remained an independent predictor of coronary atherosclerotic burden after adjusting for traditional risk factors. 9 In the GLAGOV study (included in the analysis of Elshazly et al.), only about two-thirds of Evolocumab-treated patients achieved plaque regression, despite reaching very low levels of LDL-C. 10 Although the possibility that the limited length of this trial (78 weeks) explains this result, as the reduction of plasma LDL-C levels does not immediately translate into an effective decrease of cholesterol load within the arteries, it also suggests that factors other than LDL-C might contribute to the disease (and to the residual CV risk), including RC. In addition, the composition of atherosclerotic plaque, and more specifically its lipid content, is a major determinant of the regression process potentially induced by a lipid-lowering treatment; indeed, a meta-analysis showed that high-intensity statin therapy promotes coronary plaque calcification rather than overall atheroma volume regression. 11 The mechanisms by which TRL remnants contribute to the atherogenic process are not fully understood. Due to their size, remnants can enter the subendothelial space, where they are retained; of note, remnant lipoproteins carry significantly more cholesterol per particle than LDL and do not require oxidation to be taken up by macrophages; within the subendothelial space, remnants induce a local low-grade inflammation,
doi:10.1177/2047487319899622 pmid:32013602 fatcat:lawsdq5z2rabvgppdkd7xe7kxu

Atherogenic markers in predicting cardiovascular risk and targeting residual cardiovascular risk

Alberico L. Catapano, Lale Tokgözoğlu, Alberto Mello e Silva, Eric Bruckert
2019 Atherosclerosis: X  
doi:10.1016/j.athx.2019.100001 fatcat:pj7qvi36djh7dclhdbc3do3dly

Current guidelines on prevention with a focus on dyslipidemias

Ian M. Graham, Alberico L. Catapano, Nathan D. Wong
2017 Cardiovascular Diagnosis and Therapy  
AL Catapano has received speaker/consulting fees from Aegerion, Abbot, Amgen, BMS, Eli Lilly, Genzyme, Kowa, Merck, Novartis, Pfizer, Recordati, Roche, Sanofi and Sigma-Tau.  ...  and 3.5 mmol/L (70-135 mg/dL).  ...  (190 mg/dL); (III) Diabetics subjects aged 40-75 without CVD with an LDL-C of 1.8 mmo/L (70 mg/dL) to 4.9 mmol/L (190 mg/dL); (IV) Apparently healthy subjects aged 40-75 with an ASCVD risk of ≥7.5%.  ... 
doi:10.21037/cdt.2017.04.04 pmid:28529917 pmcid:PMC5418212 fatcat:akd52gor65dexojpexqci3xcny

Pharmaceutical strategies for reducing LDL-C and risk of cardiovascular disease

Alberico L. Catapano, Lale Tokgözoğlu, Alberto Mello e Silva, Eric Bruckert
2019 Atherosclerosis: X  
doi:10.1016/j.athx.2019.100002 fatcat:o32uw7qxanfedfdtu5r2uw5o5u

Lifestyle interventions and nutraceuticals: Guideline-based approach to cardiovascular disease prevention

Alberico L. Catapano, Vivencio Barrios, Arrigo F.G. Cicero, Matteo Pirro
2019 Atherosclerosis: X  
Adapted from Catapano et al. 2016 [2].  ...  Adherence to lifestyle interventions (often dietary modifications and physical activity) can be disappointing in the long-term, particularly in view of the low persistence and modest reduction (0.16 mmol/L)  ... 
doi:10.1016/j.athx.2019.100003 fatcat:xggjab343vetlbs55o2wsg5tci

Understanding the Patient Perception of Statin Experience: A Qualitative Study

Michal Vrablik, Alberico L. Catapano, Olov Wiklund, Yi Qian, Pratik Rane, Alyson Grove, Mona L. Martin
2019 Advances in Therapy  
We would like to acknowledge the following clinicians for their assistance with this project: Jan Pitha (Czech Republic), Vladimir Blaha (Czech Republic), Maurizio Averna (Italy), Alberico Catapano (Italy  ...  Alberico Catapano has received grant support from Pfizer, Sanofi, Regeneron, Merck, and Mediolanum; consulting fees from Aegerion, Amgen, AstraZeneca, Genzyme, Bayer, SigmaTau, Menarini, Kowa, Eli Lilly  ...  Alberico Catapano contributed to study design, data acquisition, and analysis and interpretation of the data.  ... 
doi:10.1007/s12325-019-01073-7 pmid:31482507 pmcid:PMC6822972 fatcat:56rlqjz2evdwracjcpvb5jm66m

The Challenge of Lipid Management in Patients with Diabetes or Other Endocrine Disorders

Alberico L Catapano, Liliana Grigore, Angela Pirillo
2010 European Endocrinology  
Diabetes mellitus, a metabolic disorder defined by fasting glucose concentration ≥7.0 mmol/l or by glycated haemoglobin ≥6.5 %, 1 represents an established risk factor for coronary artery disease; 2,3  ...  A collaborative meta-analysis of 14 randomised trials of statin therapy showed that lowering LDL cholesterol by 1 mmol/l decreases the risk of cardiovascular events by about one-fifth, and that a greater  ... 
doi:10.17925/ee.2011.07.02.92 fatcat:rm6362epz5acfpvbdidtejxye4
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