How Can We Reduce Cardiovascular Risk in Women and Improve Risk Stratification?

Purpose Of Review: To explore sex-specific dimensions of cardiovascular disease (CVD) by addressing key questions: (1) What is the true burden of CVD in women, and how does it compare with that in men across diverse populations? (2) Do risk factors for CVD differ between sexes in prevalence, biological impact, and prognostic significance? (3) Should we adopt sex-specific cardiovascular risk stratification tools to improve diagnostic precision in women? (4) Is there a need for earlier or more aggressive preventive strategies in women, particularly for those with sex-specific or predominant risk factors?

Recent Findings: CVD remains the leading cause of morbidity and mortality among women worldwide. Despite advances in care, significant sex-based disparities persist in awareness, diagnosis, risk stratification, and treatment. Women often present with distinct biological and psychosocial risk factors that are underrecognized in standard assessments.

Breaking the Itch-Scratch Cycle: An Integrative Approach for Atopic Dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a significant psychological impact. The cardinal symptom of all phenotypes and severities is chronic pruritus with repetitive itching and scratching due to a vicious itch-scratch cycle that can be worsened or triggered by stress. Neuroimaging of brain areas responsible for itch processing in healthy subjects versus patients with AD has provided insights into the brain circuits involved in itch central perception.

Combination of sibutramine and topiramate for the treatment of obesity: the SIBAMATE retrospective cohort study : Sibutramine and topiramate for the treatment of obesity.

Background: Long-term treatment of obesity with lifestyle changes alone is unsustainable for most individuals. Antiobesity medications are recommended for individuals with a body mass index (BMI) ≥ 30 kg/m² or ≥ 27 kg/m² with one or more comorbidities. In Brazil, the prescription of combined sibutramine plus topiramate for obesity management is common in daily clinical practice.

Cardiovascular disease and cholesterol lowering therapy in women and men with molecularly defined heterozygous familial hypercholesterolemia from Brazil.

Background: Data on the epidemiology of familial hypercholesterolemia (FH) in developing regions based on contemporary, molecularly defined FH cohorts categorized by sex are scarce.

Objective: Evaluate the differences in cardiovascular disease (CVD) outcomes and lipid-lowering therapy (LLT) between men and women with molecularly defined heterozygous FH participating in a cascade screening program.

Methods: We included 794 adult FH patients (age 47 ± 15 years, 56.

Long-term experience with lomitapide treatment in patients with homozygous familial hypercholesterolemia: Over 10 years of efficacy and safety data.

Background: Homozygous familial hypercholesterolemia (HoFH) is a rare disease characterized by loss of low-density lipoprotein receptor (LDLR) function, an extreme elevation of circulating low-density lipoprotein cholesterol (LDL-C) from birth and substantially reduced life expectancy, if untreated. Patients with HoFH are frequently diagnosed late and have a markedly elevated risk of premature atherosclerotic cardiovascular disease (ASCVD).

Sources Of Material: The current European Atherosclerosis Society consensus statement on the treatment of HoFH recommends an LDL-C goal of <55 mg/dL for adults with ASCVD or major ASCVD risk factors, <70 mg/dL for adults without ASCVD risk factors, and <115 mg/dL for pediatric patients without ASCVD.

Global Variation in Lipoprotein(a) Levels Among Patients With Coronary Heart Disease: Insights From the INTERASPIRE Study and Implications for Emerging Lp(a)-Lowering Therapies.

Background: Lipoprotein(a) [Lp(a)] is a common risk factor for atherosclerotic cardiovascular disease, potentially more atherogenic per particle than low-density lipoprotein. An estimated 1.5 billion individuals globally have elevated levels ≥125 nmol/L, considered as a risk-enhancing threshold.

Angiopoietin-like protein inhibitors: Promising agents for the treatment of familial hypercholesterolemia and atherogenic dyslipidemia.

Background And Aims: This review examines the physiological functions of Angiopoietin-like proteins (ANGPTLs) in lipid metabolism and the epidemiology of atherosclerotic cardiovascular disease (ASCVD), while discussing their potential as therapies for dyslipidemias.

Methods: A review of contemporary literature on ANGPTLs was conducted.

Results: ANGPTLs comprise eight secreted proteins that share structural similarities with the angiopoietin family and serve as key regulators of various physiological and biochemical functions.

Frequency of residual combined dyslipidemia and hypertriglyceridemia in patients with coronary heart disease in 13 countries across 6 WHO Regions: Results from INTERASPIRE.

Background And Aims: Hypertriglyceridemia (HTG) is independently associated with risk of atherosclerotic events, even when LDL-cholesterol levels appear controlled. This INTERASPIRE study determined the frequency of HTG and residual combined dyslipidemia and their related factors in patients with coronary heart disease (CHD) from 13 countries across six World Health Organization (WHO) regions.

Methods: Participants with CHD underwent a standardized study interview and examination, including a centralized analysis of fasting blood samples.

Metabolic outcomes and safety of GLP-1 receptor agonists in children and adolescents with obesity: A systematic review and meta-analysis.

Background: Glucagon-like peptide 1 receptor agonists have been proven to be effective in adults with obesity. However, robust evidence on their effects on body weight, obesity-related metabolic changes, and safety in children and adolescents with obesity remains limited, making them a subpopulation with scant treatment options. Therefore, this meta-analysis aimed to determine more precise estimates of the efficacy and safety of glucagon-like peptide-1 agonists in pediatric obesity.

Ectopic GHRH production: revisiting a rare cause of acromegaly.

Growth Hormone-Releasing Hormone (GHRH) is a hypothalamic hormone that stimulates GH secretion by the anterior pituitary gland. Ectopic production of GHRH by neuroendocrine tumors (NETs) is a rare cause of acromegaly, with some clinical and biochemical features indistinguishable from pituitary adenoma origin. Some clues for this diagnosis include pituitary MRI harboring hyperplasia, increased serum GHRH and extra-pituitary tumor detected in whole body scans.

Low-density lipoprotein-cholesterol subfractions as predictors for coronary artery calcium incidence and progression - The Brazilian longitudinal study of Adult Health (ELSA - Brasil).

Background And Aims: Low-density lipoprotein-cholesterol (LDL-c) subfractions may play different roles in atherogenesis. Our objective was to evaluate the association between LDL-c subfractions and coronary artery calcium (CAC) incidence in individuals with a baseline CAC = 0 and CAC progression in those with CAC > 0 at baseline.

Methods: We include 2632 participants from the Brazilian Longitudinal Study of Adult Health cohort, all of whom underwent two repeated CAC score measurements and had LDL-c subfraction measurements.

Lipoprotein subfractions and carotid plaque: NMR analysis of triglyceride-rich vs LDL particle size concentrations (ELSA-Brasil study).

Background: This study analyzed the cross-sectional association of elevated concentrations of low-density lipoprotein particles (LDLp) and triglyceride-rich lipoprotein particles (TRLp) with carotid artery plaque (CAP) in the ELSA-Brasil cohort.

Methods: Data from 3801 participants (median age: 50.0 years [IQR 44.

Impact of Selective Peroxisome Proliferator-Activated Receptor (PPAR)-α Modulators and Fibrates on Microvascular Disease: Is There Still Room?

Purpose Of Review: This review examines the role of fibrates and the selective PPAR-alpha modulators (SPPARM-α), pemafibrate, in diabetic microvascular disease. It reviews their potential to mitigate residual risk in retinopathy, nephropathy, neuropathy and peripheral vascular disease.

Recent Findings: These pharmacotherapies, beyond their lipid-lowering effects, may exert anti-inflammatory, antioxidant, and endothelial-protective actions.

Non-linear associations of serum lipid levels with cognitive decline: Findings from the ELSA-Brasil cohort.

Background And Aims: Elevated low-density lipoprotein-cholesterol (LDL-C) is a modifiable risk factor for dementia, but evidence on other lipids is inconsistent, particularly in studies from low and middle-income countries. This study aimed to assess the association between lipid levels and cognitive decline in the ELSA-Brasil cohort.

Methods: In this prospective study, baseline serum lipid profile [total cholesterol (TC), LDL-C, high-density lipoprotein-cholesterol (HDL-C), triglycerides, and non-high-density lipoprotein-cholesterol (Non-HDL-C)] was analyzed.

Expanding the triglyceride range in clinical trials: therapeutic opportunities.

Background And Aims: Guidelines focus on individuals with triglycerides between 2.3 and 5.6 mmol/L (200 and 499 mg/dL).

Management of children with heterozygous familial hypercholesterolaemia worldwide: a meta-analysis.

Aims: Heterozygous familial hypercholesterolaemia (HeFH) is one of the most frequent monogenic disorders in the world, leading to premature atherosclerotic cardiovascular diseases. The aim of this meta-analysis was to evaluate the efficacy and safety of lipid-lowering therapy (LLT) and achievement of low density lipoprotein cholesterol (LDL-C) goal in children with HeFH.

Methods And Results: The main endpoint was efficacy of goal achievement for LDL-C and other lipid parameters: total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), apolipoprotein B, and lipoprotein(a), and the LLT safety [adverse events (AEs), including endocrine function, and growth indices].

Sheer drop ahead: reviewing sarcopenia outcomes in elderly patients undergoing bariatric surgery.

The global prevalence of obesity among elderly patients continues to rise. Despite the availability of new antiobesity medications, bariatric surgery remains an effective treatment option for carefully selected candidates. However, it is not risk-free, especially in a vulnerable population, predisposing to falls, fractures and sarcopenia.

Rationale, design and prerandomization data for a cluster randomized trial to assess the effect of a digitally enabled quality improvement intervention on LDL-C control in established atherosclerotic cardiovascular disease patients: The SAPPHIRE-LDL trial.

Background: Translating evidence into clinical practice in the management of established atherosclerotic cardiovascular disease patients is challenging. Few quality improvement interventions have successfully improved patient care.

Objectives: The main objectives are to evaluate the impact of a digitally enabled multifaceted quality improvement (QI) intervention on the control of LDL-cholesterol (LDL-C) in atherosclerotic cardiovascular disease (ASCVD).

Drugs for dyslipidaemia: the legacy effect of the Scandinavian Simvastatin Survival Study (4S).

Since the discovery of statins and the Scandinavian Simvastatin Survival Study (4S) results three decades ago, remarkable advances have been made in the treatment of dyslipidaemia, a major risk factor for atherosclerotic cardiovascular disease. Safe and effective statins remain the cornerstone of therapeutic approach for this indication, including for children with genetic dyslipidaemia, and are one of the most widely prescribed drugs in the world. However, despite the affordability of generic statins, they remain underutilised worldwide.