Sex differences in the treatment with PCSK9 monoclonal antibodies- real world experience from a dedicated preventive cardiology clinic.

Purpose: Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9 mAb) lower low-density lipoprotein cholesterol (LDL-C) levels and reduce atherosclerotic cardiovascular disease (ASCVD). Data regarding sex differences in PCSK9 mAb treatment remain lacking. This study examines sex differences in patients' characteristics, indications, efficacy, and safety of PCSK9 mAb treatment.

Digenic Overlap Syndrome Masquerading as Homozygous Familial Hypercholesterolemia.

Background: The development of tendinous xanthomas in childhood with a low-density lipoprotein (LDL) cholesterol level >400 mg/dL is characteristic of homozygous familial hypercholesterolemia (FH).

Case Summary: We present the case of a patient with a severely elevated LDL cholesterol level and childhood-onset xanthomas who fulfilled clinical criteria for homozygous FH. However, genetic and absorption testing clarified his phenotype to be a unique digenic overlap of both heterozygous FH and heterozygous sitosterolemia with marked elevations in cholesterol absorption indices.

Gene therapy and genome editing for lipoprotein disorders.

Genetic factors play a critical role in the development of lipoprotein disorders, which significantly contribute to atherosclerotic cardiovascular disease (ASCVD). Traditional management of these conditions has relied on lipid-lowering therapies, which require lifelong adherence. Recent advancements in gene addition and editing technologies offer novel and potentially transformative approaches for treating lipoprotein disorders by targeting the relevant genetic pathways for each disease.

LpX and LpZ associated hypercholesterolemia in a patient with primary sclerosing cholangitis - A case report.

This case report highlights the complex interplay between cholestatic liver disease and lipoproteins in a 45-year-old male with primary sclerosing cholangitis who presents with severe hyper-cholesterolemia. Nuclear magnetic resonance lipoprofile revealed marked elevations in lipoprotein X and lipoprotein Z (LpZ), with LpZ being the predominant abnormal lipoprotein. Treatment with evolocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibody, effectively reduced LpZ levels, with a consequent decrease in low-density lipoprotein particle concentration.

Metabolic Dysfunction-Associated Steatotic Liver Disease, Hypertriglyceridemia and Cardiovascular Risk.

Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum of liver conditions ranging from simple steatosis to the more severe metabolic dysfunction-associated steatohepatitis (MASH). MASLD is strongly linked to insulin resistance disorders, with a high prevalence among patients with type 2 diabetes. Long-term complications include liver cirrhosis, liver cancer, and cardiovascular disease.

Circulating Endothelial Progenitor Cells in Patients with Established Cardiovascular Disease Treated with PCSK9 Monoclonal Antibodies.

Background: The role of circulating endothelial progenitor cells (cEPCs) in vascular repair and their association to cardiovascular protection is well established.

Objectives: We examined the effect of proprotein convertase subtilisin kexin type 9 monoclonal antibodies (PCSK9 mAb) on cEPCs in adults with hypercholesterolemia and cardiovascular disease, aiming to establish a pleotropic class effect.

Methods: Non-interventional prospective study in patients with cardiovascular disease treated with either evolocumab or alirocumab.

Hypertriglyceridemia-induced acute pancreatitis in pregnancy associated with CREB3L3 mutation.

A 40-year-old woman at 35 weeks of gestation presented with abdominal pain and hypertriglyceridemia of above 5000 mg/dL. Following lab tests and imaging studies, she was diagnosed with hypertriglyceridemia-related acute pancreatitis in pregnancy. She was managed with nil per os (NPO), intravenous insulin, and peripheral parenteral nutrition, but her condition further complicated with preeclampsia, and she was induced and delivered at 36 weeks of gestation.

Anti PCSK9 Monoclonal Antibody Treatment in Elderly Patients: A Real-world Clinical Experience.

Background: The use of proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9 mAbs) is emerging for lowering low-density lipoprotein cholesterol (LDL-C). However, real-world data is lacking for their use among elderly patients.

Objectives: To define the characteristics of elderly patients treated with PCSK9 mAbs and to evaluate the efficacy and tolerability compared with younger patients.

The obesity paradox in patients with acute coronary syndromes over 2 decades - the ACSIS registry 2000-2018.

Background: Obesity is a worldwide epidemic which is associated with major cardiovascular (CV) risk factors. Nevertheless, substantial distant data, mostly published more than a decade ago, have demonstrated an obesity paradox, where obese patients generally have a better short- and long-term prognosis than do their leaner counterparts with the same CV profile. Nonetheless, it is not fully elucidated whether the obesity paradox is still relevant in the contemporary cardiology era among patients with acute coronary syndrome (ACS).

An unusual case report of transcatheter aortic valve implantation-related actinomycosis endocarditis.

Background: Actinomycosis is a chronic invasive infection caused by species. Actinomycosis endocarditis has been described, yet considered rare. We present the first reported transcatheter aortic valve implantation (TAVI)-related actinomycosis endocarditis.

The Association between Low Levels of Low Density Lipoprotein Cholesterol and Intracerebral Hemorrhage: Cause for Concern?

Excessive levels of low-density lipoprotein cholesterol (LDL-C) in the blood are a known risk factor for atherosclerosis, and a common target of treatment for primary and secondary prevention of cerebrocardiovascular disease. As lipid lowering agents including statins, ezetimibe and anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have shown good therapeutic results, the guidelines are constantly lowering the "optimal" LDL-C goals. However, old and new data point towards an association between low LDL-C and total cholesterol and intracerebral hemorrhage (ICH).

Comparison of Low and Full Dose Apixaban Versus Warfarin in Patients With Atrial Fibrillation and Renal Dysfunction (from a National Registry).

The use of direct oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) is robust. However, the efficacy and safety of different dosage in patients with renal dysfunction is still a clinical challenge. We aimed to evaluate the clinical characteristics and outcomes of patients treated with apixaban in its different doses.

Apixaban in Patients with Atrial Fibrillation and Severe Renal Dysfunction: Findings from a National Registry.

Background: Real-world information regarding the use of direct oral anticoagulants therapy and the outcome in patients with renal dysfunction is limited.

Objectives: To evaluate the clinical characteristics and outcomes of patients with atrial fibrillation (AF) and severe renal dysfunction who are treated with apixaban.

Methods: A sub-analysis was conducted within a multicenter prospective cohort study.

Thrombin Generation in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

Background: The optimal antithrombotic treatment for patients with atrial fibrillation (AF) that undergo percutaneous coronary intervention (PCI) is controversial. Dual therapy (clopidogrel and a direct oral anticoagulant [DOAC]) is safer than triple therapy (warfarin, aspirin, and clopidogrel), while efficacy is unclear. We aimed to evaluate thrombin generation (TG) under dual and triple therapy.

Prognosis of STEMI Patients with Multi-Vessel Disease Undergoing Culprit-Only PCI without Significant Residual Ischemia on Non-Invasive Stress Testing.

Aims: In about 50-80% of ST-segment elevation myocardial infarction (STEMI) patients there is significant atherosclerotic disease in other coronary arteries in addition to the culprit vessel. There is substantial controversy as to the optimal revascularization approach in these patients. We sought to compare the outcomes of STEMI patients with multi-vessel disease (MVD) treated with culprit-only primary percutaneous coronary intervention (PPCI) without significant ischemia on subsequent non-invasive testing, to those of STEMI patients with single-vessel disease (SVD).