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Proteins play a crucial role in metabolism, in maintaining fluid and acid-base balance and antibody synthesis. Dietary proteins are important nutrients and are classified into: 1) animal proteins (meat, fish, poultry, eggs and dairy), and, 2) plant proteins (legumes, nuts and soy). Dietary modification is one of the most important lifestyle changes that has been shown to significantly decrease the risk of cardiovascular (CV) disease (CVD) by attenuating related risk factors. The CVD burden is reduced by optimum diet through replacement of unprocessed meat with low saturated fat, animal proteins and plant proteins. In view of the available evidence, it has become acceptable to emphasize the role of optimum nutrition to maintain arterial and CV health. Such healthy diets are thought to increase satiety, facilitate weight loss, and improve CV risk. Different studies have compared the benefits of omnivorous and vegetarian diets. Animal protein related risk has been suggested to be greater with red or processed meat over and above poultry, fish and nuts, which carry a lower risk for CVD. In contrast, others have shown no association of red meat intake with CVD. The aim of this expert opinion recommendation was to elucidate the different impact of animal vs vegetable protein on modifying cardiometabolic risk factors. Many observational and interventional studies confirmed that increasing protein intake, especially plant-based proteins and certain animal-based proteins (poultry, fish, unprocessed red meat low in saturated fats and low-fat dairy products) have a positive effect in modifying cardiometabolic risk factors. Red meat intake correlates with increased CVD risk, mainly because of its non-protein ingredients (saturated fats). However, the way red meat is cooked and preserved matters. Thus, it is recommended to substitute red meat with poultry or fish in order to lower CVD risk. Specific amino acids have favourable results in modifying major risk factors for CVD, such as hypertension. Apart from meat, other animal-source proteins, like those found in dairy products (especially whey protein) are inversely correlated to hypertension, obesity and insulin resistance.

Background Bempedoic acid is a first-in-class lipid-lowering drug recommended by guidelines for the treatment of hypercholesterolemia. Our objective was to estimate its average effect on plasma lipids in humans and its safety profile. Methods and findings We carried out a systematic review and meta-analysis of phase II and III randomized controlled trials on bempedoic acid (PROSPERO: CRD42019129687). PubMed (Medline), Scopus, Google Scholar, and Web of Science databases were searched, with no language restriction, from inception to 5 August 2019. We included 10 RCTs (n = 3,788) comprising 26 arms (active arm [n = 2,460]; control arm [n = 1,328]). Effect sizes for changes in lipids and high-sensitivity C-reactive protein (hsCRP) serum concentration were expressed as mean differences (MDs) and 95% confidence intervals (CIs). For safety analyses, odds ratios (ORs) and 95% CIs were calculated using the Mantel–Haenszel method. Bempedoic acid significantly reduced total cholesterol (MD −14.94%; 95% CI −17.31%, −12.57%; p < 0.001), non-high-density lipoprotein cholesterol (MD −18.17%; 95% CI −21.14%, −15.19%; p < 0.001), low-density lipoprotein cholesterol (MD −22.94%; 95% CI −26.63%, −19.25%; p < 0.001), low-density lipoprotein particle number (MD −20.67%; 95% CI −23.84%, −17.48%; p < 0.001), apolipoprotein B (MD −15.18%; 95% CI −17.41%, −12.95%; p < 0.001), high-density lipoprotein cholesterol (MD −5.83%; 95% CI −6.14%, −5.52%; p < 0.001), high-density lipoprotein particle number (MD −3.21%; 95% CI −6.40%, −0.02%; p = 0.049), and hsCRP (MD −27.03%; 95% CI −31.42%, −22.64%; p < 0.001). Bempedoic acid did not significantly modify triglyceride level (MD −1.51%; 95% CI −3.75%, 0.74%; p = 0.189), very-low-density lipoprotein particle number (MD 3.79%; 95% CI −9.81%, 17.39%; p = 0.585), and apolipoprotein A-1 (MD −1.83%; 95% CI −5.23%, 1.56%; p = 0.290). Treatment with bempedoic acid was positively associated with an increased risk of discontinuation of treatment (OR 1.37; 95% CI 1.06, 1.76; p = 0.015), elevated serum uric acid (OR 3.55; 95% CI 1.03, 12.27; p = 0.045), elevated liver enzymes (OR 4.28; 95% CI 1.34, 13.71; p = 0.014), and elevated creatine kinase (OR 3.79; 95% CI 1.06, 13.51; p = 0.04), though it was strongly associated with a decreased risk of new onset or worsening diabetes (OR 0.59; 95% CI 0.39, 0.90; p = 0.01). The main limitation of this meta-analysis is related to the relatively small number of individuals involved in the studies, which were often short or middle term in length. Conclusions Our results show that bempedoic acid has favorable effects on lipid profile and hsCRP levels and an acceptable safety profile. Further well-designed studies are needed to explore its longer-term safety., Maciej Banach and colleagues discuss the efficacy and safety of bempedoic acid, a drug that designed to lower LDL-C levels., Author summary Why was this study done? Lowering low-density lipoprotein cholesterol (LDL-C) is effective for reducing cardiovascular events over time. A number of phase II and phase III randomized controlled trials (RCTs) are already available showing encouraging results of bempedoic acid treatment on LDL-C. We aimed to perform a systematic review and meta-analysis on the clinical evidence available to date to better define the efficacy and tolerability profile of treatment with bempedoic acid. What did the researchers do and find? In this analysis of bempedoic acid that included 10 randomized clinical trials (n = 3,788 patients) comprising 26 arms (active arm [n = 2,460]; control arm [n = 1,328]), we confirmed that bempedoic acid significantly reduced total cholesterol (by 15%), non-high-density lipoprotein cholesterol (by 18.2%), LDL-C (by 22.9%), low-density lipoprotein particle number (by 20.7%), apolipoprotein B (by 15.2%), and high-sensitivity C-reactive protein (hsCRP) (by 27%), while negatively affecting serum levels of high-density lipoprotein cholesterol (−5.8%) and high-density lipoprotein particle number (−3.2%). Our results also confirmed that the therapy is overall safe and well tolerated, with no significant increase of serious adverse effects. What do these findings mean? The current meta-analysis demonstrates the multiple positive effects of bempedoic acid on lipid profile and hsCRP serum levels, as well as acceptable safety profile. This could be relevant in a setting where statin intolerance is very frequent and the LDL-C target suggested by international guidelines for dyslipidemia management is hard to achieve with standard therapies. An ongoing long-term cardiovascular outcomes trial will answer questions on the effect of bempedoic acid on cardiovascular events and mortality as well as on the drug’s safety issues.

Statins are the most common drugs administered for patients with cardiovascular disease. However, due to statin-associated muscle symptoms, adherence to statin therapy is challenging in clinical practice. Certain nutraceuticals, such as red yeast rice, bergamot, berberine, artichoke, soluble fiber, and plant sterols and stanols alone or in combination with each other, as well as with ezetimibe, might be considered as an alternative or add-on therapy to statins, although there is still insufficient evidence available with respect to long-term safety and effectiveness on cardiovascular disease prevention and treatment. These nutraceuticals could exert significant lipid-lowering activity and might present multiple non–lipid-lowering actions, including improvement of endothelial dysfunction and arterial stiffness, as well as anti-inflammatory and antioxidative properties. The aim of this expert opinion paper is to provide the first attempt at recommendation on the management of statin intolerance through the use of nutraceuticals with particular attention on those with effective low-density lipoprotein cholesterol reduction. © 2018 American College of Cardiology Foundation

Background and aims: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Methods: Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. Results: 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in ∼2/3 countries. Lipoprotein-apheresis is offered in ∼60% countries, although access is limited. Conclusions: FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed. © 2018 Elsevier B.V.

In recent years, there has been growing interest in the possible use of nutraceuticals to improve and optimize dyslipidemia control and therapy. Based on the data from available studies, nutraceuticals might help patients obtain theraputic lipid goals and reduce cardiovascular residual risk. Some nutraceuticals have essential lipidlowering properties confirmed in studies; some might also have possible positive effects on nonlipid cardiovascular risk factors and have been shown to improve early markers of vascular health such as endothelial function and pulse wave velocity. However, the clinical evidence supporting the use of a single lipid-lowering nutraceutical or a combination of them is largely variable and, for many of the nutraceuticals, the evidence is very limited and, therefore, often debatable. The purpose of this position paper is to provide consensus-based recommendations for the optimal use of lipid-lowering nutraceuticals to manage dyslipidemia in patients who are still not on statin therapy, patients who are on statin or combination therapy but have not achieved lipid goals, and patients with statin intolerance. This statement is intended for physicians and other healthcare professionals engaged in the diagnosis and management of patients with lipid disorders, especially in the primary care setting. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved.

The aim of the research was to estimate the occurrence of cardio-vascular risk among patients with rheumatoid arthritis depending on age, status of menopause, dyslipidemia and clinical and laboratory features.Materials and methods. 50 female patients with confirmed diagnosis of rheumatoid arthritis were examined. Cardio-vascular risk was defined according to mSCORE with the following gradation: low, middle, high, very high level among women aged >45 years old. Laboratory diagnostics consisted of clinical and biochemistry blood analysis, determination of CRP, RF and ACCP. DAS28 was used for activity characteristic. Cholesterol, HDL, LDL, thyroglobulin, apoliprotein A1, apoliproteinB, uric acid, ATE, microalbuminuria were tested.Results. Estimation of cardio-vascular risk occurrence among patients older than 45 years old showed that the majority had a middle level of cardio-vascular risk whereas almost every fifth patient has a high level. Analysis of cardio-vascular risk occurrence according to mSCORE depending on patients’ age showed its significant elevation among patients elder than 45 years old and substantial differences in quantitative indices in group of patients aged 46 - 60 and >60. 83.3 % of reproductive age female patients did not show cardio-vascular risk, 11.1 % showed middle level and 5.6 % - low level of cardio-vascular risk. Only 3.9 % of postmenopausal women did not have a cardio-vascular risk, the majority (64.7 %) showed middle level, 25.5 % – high level and 3.9 % – very high level. The analysis revealed the presence of significant differences in patients older than 60 years old and the most of them demonstrated cardio-vascular risk more than 5 %. The majority of patients, who received immunobiological therapy (methotrexat), had cardio-vascular risk less than 5 %.Conclusions. Occurrence of cardio-vascular risk among women older than 45 years old with rheumatoid arthritis made 96% whereas its grater part was registered in patients older than 60 years old. Significantly higher quantitative indices of cardio-vascular risk according to mSCORE scale were observed in patients with high activity level of inflammatory process (CRP, TJC, SJC and DAS28 levels). Analysis of cardio-vascular risk occurrence indicated its increasing trend among women who did not receive immunobiological therapy. The tested group of patients with cardio-vascular risk of more than 5% showed dyslipidemia which was characterized by higher levels of cholesterol, LDL, apoliproteinB and significantly lower HDL concentration., Цель работы – оценить распространённость сердечно-сосудистого риска у больных ревматоидным артритом в зависимости от возраста, наличия или отсутствия менопаузы, дислипидемии и клинико-лабораторных характеристик заболевания.Материалы и методы. Обследовано 50 больных, все – женщины с установленным диагнозом ревматоидного артрита. Сердечно-сосудистый риск определяли по шкале mSCORE, по градации низкий, средний, высокий, очень высокий у женщин возрастом старше 45 лет. Лабораторное обследование пациентов включало общий и биохимический анализ крови, определение уровней СРП, РФ, АЦЦП. Для характеристики активности использовали DAS28. Определяли содержание холестерина, ЛПВП, ЛПНП, ТГ, аполипопротеина А1, аполипопротеина В, мочевой кислоты, АПФ, микроальбуминурию.Результаты. Оценка распространённости сердечно-сосудистого риска среди обследованных возрастом более 45 лет показала, что наибольшая часть имела средний, а почти каждая пятая – высокий сердечно-сосудистый риск. Анализ распределения сердечно-сосудистого риска по mSCORE в зависимости от возраста свидетельствовал о достоверных признаках повышения его распространённости после 45 лет и существенные различия по количественным показателям между пациентами в когорте от 46 до 60 и более 60 лет. У 83,3 % женщин с сохранённой репродуктивной функцией не отмечался сердечно-сосудистый риск, 11,1 % демонстрировали средний и 5,6 % – низкий. У женщин в постменопаузе лишь 3,9 % не имели сердечно-сосудистого риска, у большинства (64,7 %) отмечался средний, 25,5 % – высокий и у 3,9 % – очень высокий. Анализ свидетельствовал о достоверных отличиях у пациенток возрастом старше 60 лет, большая часть которых демонстрировала сердечно-сосудистый риск более 5 %. Большинство больных, которые получали иммунобиологическую терапию, метотрексат, имели сердечно-сосудистый риск менее 5 %.Выводы. Распространённость сердечно-сосудистого риска среди женщин с ревматоидным артритом после 45 лет составляет 96 %, причём значительно большая его часть регистрировалась у пациенток возрастом старше 60 лет. Достоверно более высокие количественные показатели сердечно-сосудистого риска по шкале mSCORE наблюдались у больных с высокой степенью активности воспалительного процесса (СРП, КБС, КПС, показателя DAS28). Анализ распространённости сердечно-сосудистого риска свидетельствовал о тенденции увеличения у женщин, которые не получали иммунобиологическую терапию. В группе обследованных с сердечно-сосудистым риском более 5 % констатированы явления дислипидемии, что характеризовались более высокими уровнями холестерина, ЛПНП, аполипопротеина В и достоверно низкими концентрациями ЛПВП., Мета роботи – оцінити поширеність серцево-судинного ризику у хворих на ревматоїдний артрит залежно від віку, наявності чи відсутності постменопаузи, дисліпідемії та клініко-лабораторних характеристик захворювання.Матеріали та методи. Обстежили 50 хворих жінок зі встановленим діагнозом ревматоїдного артриту. Серцево-судинний ризик визначали за шкалою mSCORE, з градацією на низький, середній, високий, дуже високий у жінок віком понад 45 років. Лабораторне обстеження пацієнтів включало загальний, біохімічний аналізи крові, визначення рівнів СРП, РФ, АЦЦП. Для характеристики активності використовували DAS28. Визначали вміст холестерину, ЛПВЩ, ЛПНЩ, ТГ, аполіпопротеїну А1, аполіпопротеїну B, сечової кислоти, мікроальбумінурію.Результати. Оцінювання поширеності серцево-судинного ризику серед обстежених віком старші за 45 років показало, що найбільша частка мала середній, а майже кожна п’ята – високий серцево-судинний ризик. Аналіз розподілу серцево-судинного ризику за mSCORE залежно від віку свідчив про вірогідні ознаки збільшення його поширеності після 45 років і суттєві відмінності за кількісним показником між пацієнтками в когорті від 46 до 60 і більше ніж 60 років. У 83,3 % жінок зі збереженою репродуктивною функцією не спостерігали серцево-судинного ризику, 11,1 % демонстрували середній і 5,6 % – низький. У жінок у постменопаузі лише 3,9 % не мали серцево-судинного ризику, у більшості (64,7 %) спостерігали середній, 25,5 % – високий та у 3,9 % – дуже високий. Аналіз свідчив про наявність вірогідних відмінностей у пацієнток старше за 60 років, більшість з них демонстрували серцево-судинний ризик понад 5 %. Більшість хворих, які отримували імунобіологічну терапію, метотрексат, мали тенденцію до нижчого серцево-судинного ризику. За кількісними показниками у групі пацієнтів, що постійно отримували імунобіологічну терапію, серцево-судинний ризик був вірогідно нижчим.Висновки. Поширеність серцево-судинного ризику серед жінок із ревматоїдним артритом після 45 років становить 96 %, причому суттєво вищу його частоту реєстрували в пацієнток старше за 60 років. Вірогідно вищі кількісні показники серцево-судинного ризику за шкалою mSCORE спостерігали у хворих із високим ступенем активності запального процесу (СРП, КБС, КПС, показника DAS28). Аналіз поширеності серцево-судинного ризику свідчив про тенденцію до його збільшення в жінок, які не отримували імунобіологічну терапію. У групі обстежених із серцево-судинним ризиком понад 5 % констатовані явища дисліпідемії, що характеризувалися вищими рівнями холестерину, ЛПНЩ, аполіпопротеїну В і вірогідно нижчими концентраціями ЛПВЩ.