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Lipid-lowering medication is effective in reducing the risk of cardiovascular disease in several clinical scenarios. However, the evidence in patients with familial hypercholesterolemia (FH) and severe primary hypercholesterolemia is less robust.The main objective of the present systematic review was to analyze the association between lipid-lowering medication and cardiovascular risk reduction in patients with FH or severe primary hypercholesterolemia.This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect studies that evaluated the association between lipid-lowering medication and cardiovascular events in FH patients. The diagnosis of FH varied in the studies analyzed. Genetic and clinical criteria or a combination of both were used. Likewise, we considered patients with severe primary hypercholesterolemia.Fourteen studies including 21059 patients were considered eligible for this research. This systematic review showed that the vast majority of the studies with statins reported a significant cardiovascular risk reduction. Statin use was associated with a lower risk of major adverse cardiovascular events (3 studies), coronary heart disease (2 studies), cardiovascular death (4 studies), all-cause mortality (4 studies) and combined endpoint of coronary heart disease and mortality (1 study). When analyzing the association between non-statin lipid-lowering medications and the incidence of cardiovascular events, the results were conflicting.Despite the low level of evidence, this systematic review showed that statins reduce cardiovascular events in patients with HeFH. Evidence for other lipid-lowering drugs is not conclusive.

Resumen Introduccion Las estatinas son la primera linea de tratamiento en pacientes con hipercolesterolemia severa (HS). A pesar de la evidencia disponible sobre su eficacia y seguridad para prevenir eventos cardiovasculares, el correcto tratamiento sigue siendo un desafio. Materiales y metodos Estudio observacional prospectivo disenado para determinar mediante entrevista telefonica la presencia de factores de riesgo, seguimiento clinico anual, persistencia/uso de estatinas y aparicion de nuevos eventos cardiovasculares (ECV) despues de 5 anos, en pacientes con HS incluidos en un programa de Deteccion de Hipercolesterolemia Familiar. Resultados Se evaluo a 115 participantes, la edad media fue de 56 ± 10, siendo el 74% mujeres. El 63,4% de las mujeres y el 43% de los hombres refirio estar en seguimiento y control clinico en el ultimo ano. El 38,8% de las mujeres recibio estatinas vs. el 26,7% de los hombres y solo 22 participantes (31,8%) fueron persistentes con el tratamiento desde 2015. El 15,5% de los participantes presento un ECV no fatal y el 3,4% fatal. En el analisis multivariado no se detectaron predictores para presentar un ECV. Conclusiones En nuestra poblacion con HS encontramos un alto riesgo de presentar un ECV y una dramatica baja tasa de uso y persistencia al tratamiento con estatinas.

Familial chylomicronemia syndrome (FCS) is a rare genetic disorder characterized by extremely high triglyceride levels due to impaired clearance of chylomicrons from plasma. This paper is the result of a panel discussion with Latin American specialists who raised the main issues on diagnosis and management of FCS in their countries. Overall FCS is diagnosed late on the course of the disease, is characterized by heterogeneity on the occurrence of pancreatitis, and remains a long time in care of different specialists until reaching a lipidologist. Pancreatitis and secondary diabetes are frequently seen, often due to late diagnosis and inadequate care. Molecular diagnosis is unusual; however, loss of function variants on the lipoprotein lipase gene are apparently the most frequent etiology. A founder effect of the glycosylphosphatidylinositol anchored high density lipoprotein binding protein 1 gene has been described in the northeast of Brazil. Low awareness of the disease amongst health professionals contributes to inadequate care and an inadequate patient journey.

Elevated lipoprotein(a) [Lp(a)] levels are independently associated with atherosclerotic cardiovascular disease, although this association is less explored in postmenopausal women. The main objective of this systematic review was to analyze the association between elevated Lp(a) levels and cardiovascular outcomes in posmenopausal women. Studies that evaluated this association were searched in the current literature. Ten studies including 157.690 women were considered eligible for this study. In total, 4 prospective cohorts, 3 cross-sectional studies, 2 nested case-control studies, and one post-hoc analysis from a randomized clinical trial were analyzed. The included studies showed different results regarding the association between Lp(a) levels and cardiovascular outcomes: a positive association (4 studies), no association (2 studies), or different results depending on the subgroups or outcomes evaluated (4 studies). The results were robust when evaluating coronary events. The reduction in coronary events attributed to a hormone replacement therapy-associated decrease in Lp(a) levels was controversial.

Atherosclerosis and its clinical manifestation as ischaemic heart disease remains a considerable health burden. Given that many factors contribute to ischaemic heart disease, a multifactorial approach to prevention is recommended, starting with lifestyle advice, smoking cessation, and control of known cardiovascular risk factors, such as blood pressure and lipids. Within the lipid profile, the principal target is lowering LDL cholesterol, firstly with lifestyle interventions and subsequently with pharmacological therapy. Statins are the recommended first-line pharmacological treatment. Some individuals might require further lowering of LDL cholesterol or be unable to tolerate statins. Additional therapies targeting different pathways in cholesterol metabolism are now available, ranging from small molecules taken orally, to injectable therapies. Examples include ezetimibe, which targets Niemann-Pick C1-like protein, and monoclonal antibodies that target PCSK9. Phase 3 trials have also been completed for bempedoic acid (targeting ATP-citrate lyase) and inclisiran (an interference RNA-based therapeutic targeting hepatic PCSK9 synthesis). In addition to LDL cholesterol, mendelian randomisation studies support a causal role for lipoprotein(a) and triglycerides in ischaemic heart disease. In this Series paper, we appraise currently available and emerging therapies for lowering LDL cholesterol, lipoprotein(a), and triglycerides for prevention of ischaemic heart disease.

We report the photodegradation of optically trapped oleic acid droplets by visible light in the absence of additional reactive gaseous species. The temporal evolution of the droplet's chemical composition and size is monitored by Raman spectroscopy and elastic light scattering, respectively. The dependencies on the oxygen amount in the surrounding gas phase (~0–20%), the droplet size (~500–3000 nm in radius), and the laser power and wavelength are investigated. The oxygen amount and the droplet size have only a very minor influence on the reaction rate, if at all. By contrast, the reaction becomes substantially faster at higher laser power and shorter wavelength. The experimental observations indicate that mechanisms involving the photoexcitation of oleic acid are the dominant pathways. Our study reveals that direct photodegradation has to be accounted for when using optical traps or applying spectroscopic and light scattering characterization methods to study aerosol particles that contain fatty acids. © 2020 Elsevier Ltd, Journal of Aerosol Science, 151, ISSN:0021-8502, ISSN:1879-1964

Resumen Introduccion Se estudio la alteracion en la distensibilidad de las paredes arteriales producidas por la dislipidemia dependiente de c-LDL a lo largo de las distintas decadas de la vida, utilizando el analisis de onda de pulso radial. Metodos Se efectuo el registro de onda de pulso en la arteria radial mediante un transductor de movimiento apoyado sobre la zona de palpacion, sobre un conjunto de 100 varones dislipidemicos sin otros factores de riesgo, de edades comprendidas entre la 3.a y la 6.a decadas de la vida. Se calculo en cada caso el indice de aumentacion. Tambien se identifico en los registros la onda reflejada y se definio un coeficiente de velocidad como el cociente entre la talla del individuo y el tiempo transcurrido entre el maximo de la onda sistolica y el instante de llegada de dicha onda. Los resultados se compararon con los de un conjunto de 161 voluntarios sanos. Resultados Se hallo que los dislipidemicos presentaron valores del indice de aumentacion similares a los controles hasta la 4.a decada, aumentando a partir de entonces, con diferencias significativas a partir de la 6.a decada. No se hallaron diferencias significativas en el indice de velocidad en ninguna de las edades estudiadas. Conclusiones Se concluye que las alteraciones producidas por la dislipidemia requieren decadas para manifestarse, y comienzan afectando al mecanismo de vasodilatacion de las arterias distales con mayor proporcion de musculo liso, sin alterar las arterias de conduccion proximales con mayor contenido de elastina.

After almost a decade, finally Guidelines for the management of hypercholesterolemia in adults by the AHA/ACC were published. The substantial change in the paradigm of this new recommendation is the treatment decision basically statin, based on a recalculation of cardiovascular risk. Four groups were identified and based on them different statins indication, according to the power applied. As is apparent, have been used only randomized clinical trials (RCT) as the sole basis for the drafting of these new guidelines. Two basic issues are reviewed and revised in the following article: leaving aside other types of evidence to generate the recommendation and on the other hand the attempt to simplify the interpretation and management of this condition. We stress the need for any recommendation to clinical reasoning to interpret different scenarios involved in each patient.

A history and review of cholesterol ester transfer protein inhibitors and their contribution to the understanding of the physiology and pathophysiology of high density lipoprotein Abstract There is irrefutable evidence that statins reduce the risk of cardiovascular events in a magnitude proportional to the intensity of the decrease in cholesterol transport by the low density lipoproteins. Despite this great advance there is still a residual risk of cardiovascular events. For this reason, an increase in the levels of high density lipoprotein is considered in order to boost the main action of this lipoprotein, which is reverse cholesterol transport.

JR Chora was funded by FCT: SFRH/BD/108503/2015; AM Medeiros was funded by FCT: SFRH/BD/113017/2015.