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A nationwide cohort study conducted in Taiwan has found that lipid‐modifying agents, particularly statins and fibrates, reduce mortality risk in patients with schizophrenia. The reduced risk was apparent for both all‐cause and natural‐cause mortality, the investigators reported. Study results were published online May 16, 2024, in The British Journal of Psychiatry. [ABSTRACT FROM AUTHOR]

Numerous studies have shown that a low level of high-density lipoprotein cholesterol (HDL-C) is an independent biomarker of cardiovascular disease. High-density lipoprotein (HDL) is considered to be a protective factor for atherosclerosis (AS). Therefore, raising HDL-C has been widely recognized as a promising strategy to treat atherosclerotic cardiovascular diseases (ASCVD). However, several studies have found that increasing HDL-C levels does not necessarily reduce the risk of ASCVD. HDL particles are highly heterogeneous in structure, composition, and biological function. Moreover, HDL particles from atherosclerotic patients exhibit impaired anti-atherogenic functions and these dysfunctional HDL particles might even promote ASCVD. This makes it uncertain that HDL-raising therapy will prevent and treat ASCVD. It is necessary to comprehensively analyze the structure and function of HDL subfractions. We review current advances related to HDL subfractions remodeling and highlight how current lipid-modifying drugs such as niacin, statins, fibrates, and cholesteryl ester transfer protein inhibitors regulate cholesterol concentration of HDL and specific HDL subfractions. [ABSTRACT FROM AUTHOR]

Mn3O4/ZnO-Al2O3-CeO2 catalyst was synthesized through a solid-state process from a 3% Mn-doped Zn-(Al/Ce) layered double hydroxide structure. Detailed structural and optical characterization using XRD, FTIR, UV–visible DRS, and TEM was conducted. By investigating clofibric acid (CA) degradation in aqueous solution, Mn3O4/ZnO-Al2O3-CeO2 photocatalytic activity was evaluated. The results show that the heterostructure mixed oxide catalyst has excellent CA photodegradation performance. Further, the characterization reveals that such photocatalytic efficiency can be attributed to two facts that are summarized in the optical properties and the synergic effect between Mn and Ce elements. The sample demonstrated a narrow band gap of 2.34 eV based on DRS. According to the experimental results of the photodegradation, after 120 min of irradiation, the photocatalyst exhibited the highest photocatalytic activity, with a degradation efficiency of 93.6%. Optimization outcomes indicated that maximum degradation efficiency was attained under the following optimum conditions: catalyst dose of 0.3 g/L, initial dye concentration of 20 mg/L, pH 3.86, and 120 min of reaction time. The quenching test demonstrates that photogenerated electrons and superoxide radicals are the most powerful reactive species. The catalyst could be useful in decreasing the photogenerated charges recombination, which offers more redox cycles simultaneously during the catalytic process. The strong Ce-Mn interaction and the formation of their different oxidation states offer a high degradation efficiency by facilitating electron–hole transfer. The introduction of Mn3O4 in the catalyst can effectively improve the visible absorption properties, which are beneficial in the photocatalytic process by reaching a high catalytic efficiency at a low cost. [ABSTRACT FROM AUTHOR]

Lipodystrophies involve the loss of subcutaneous adipose tissue, resulting in severe metabolic issues such as insulin resistance and challenging diabetes management. This case series aims to assess bromocriptine treatment response in lipodystrophy patients, offering insights into its antidiabetic effects. This retrospective analysis focused on four female lipodystrophy patients with poor glycemic control who were undergoing bromocriptine treatment. Statistical analysis used nonparametric tests. Metabolic parameters were assessed before and 3 months post-bromocriptine treatment, revealing a modest reduction in median daily insulin dose and decreased hemoglobin A1c and fasting glucose levels. Body weight remained constant, while triglyceride levels increased. Dopamine receptor expression in pancreatic ß-cells and adipocytes suggests a direct impact on glucose homeostasis. While this case series hints at bromocriptine's positive influence on glycemic control and insulin requirements in lipodystrophy patients, larger studies are essential for establishing efficacy and safety. [ABSTRACT FROM AUTHOR]

Lipoprotein(a) exhibits proatherogenic properties, thus promoting the development of atherosclerotic cardiovascular disease. Lp(a) levels are genetically determined and relatively constant at the turn of a patient's life. Even a single measurement could be an important screening test to distinguish a group of patients with increased cardiovascular risk. Despite the lack of specific therapies, drugs with potential effects on reducing Lp(a) levels include ezetimibe, PCSK-9 inhibitors, fibrates, inclisiran, olparisan, aspirin, tocilizumab or mipomersen. Although ezetimibe has shown a moderate effect on lowering Lp(a) in monotherapy, its combination with statins does not provide a significant additional benefit in reducing Lp(a). PCSK-9 inhibitors contribute to a significant reduction in cardiovascular risk in patients in whom maximum-dose statin therapy fails to achieve lipoprotein targets. Patients with baseline higher Lp(a) levels receive greater benefit from PCSK9 inhibitor therapy. The use of aspirin to reduce Lp(a) levels could be most significant in rs3798220 carriers, but the European Atherosclerosis Society does not support the advisability of such a drug. Studies involving tocilizumab are promising, but data on non-RA groups are lacking. Mipomersen, on the other hand, has shown significant lipoprotein(a)-lowering effects, but is only used to treat familial hypercholesterolemia due to the risk of side effects. The aim of this systematic review was to discuss lipoprotein(a)'s potential as an independent cardiovascular risk factor and summarize pharmacological approaches available to lower its levels according to currently available knowledge based on the main findings of randomized clinical studies, review studies and meta-analyses. [ABSTRACT FROM AUTHOR]

A range of novel lipid‐lowering agents are now available, providing options for patients unable to achieve sufficient control on older drugs such as statins. This article gives an overview of the main lipid‐lowering agents, their indications and usage, with a focus on the newer therapies targeting PCSK9. [ABSTRACT FROM AUTHOR]

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death among urban and rural residents in China, and elevated low-density lipoprotein cholesterol (LDL-C) is a risk factor for ASCVD. Considering the increasing burden of ASCVD, lipid management is of the utmost importance. In recent years, research on blood lipids has made breakthroughs around the world, hence a revision of China guidelines for lipid management is imperative, especially since the target lipid levels in the general population vary in respect to the risk of ASCVD. The level of LDL-C, which can be regarded as appropriate in a population without frisk factors, can be considered abnormal in people at high risk of developing ASCVD. As a result, the "Guidelines for the prevention and treatment of dyslipidemia" were adapted into the "China Guidelines for Lipid Management" (henceforth referred to as the new guidelines) by an Experts' committee after careful deliberation. The new guidelines still recommend LDL-C as the primary target for lipid control, with CVD risk stratification to determine its target value. These guidelines recommend that moderate intensity statin therapy in adjunct with a heart-healthy lifestyle, be used as an initial line of treatment, followed by cholesterol absorption inhibitors or/and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, as necessary. The new guidelines provide guidance for lipid management across various age groups, from children to the elderly. The aim of these guidelines is to comprehensively improve the management of lipids and promote the prevention and treatment of ASCVD by guiding clinical practice. [ABSTRACT FROM AUTHOR]

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In this study, ZnO-Zn2TiO4 (ZTM) material was prepared through a novel synthesis method based on a ultrasound-assisted polyol-mediated process followed by calcination at a different temperature. Physical features of the samples were studied by using various analysis techniques including XRD, FT-IR, SEM/EDX, pHPZC, and UV–Vis DRS. Subsequently, the materials were employed as catalysts for the photocatalytic degradation of clofibric acid as a model pharmaceutical contaminant. The photocatalytic performance was evaluated under different conditions of calcination temperature, catalyst dosage, starting concentration, and initial pH of clofibric acid solution. The finding results revealed that hexagonal-tetragonal phases of ZnO-Zn2TiO4 calcined at 600 °C (ZTM-600) with an average crystallite size of 97.8 Å exhibited the best degradation efficiency (99%). The primary bands characteristic of ZnO and Zn2TiO4 were displayed by FT-IR analysis and the UV–visible DRS confirms the larger absorption capacity in UV–visible regions. The photogenerated electrons are the powerful reactive species involved in clofibric acid photodegradation process. This study shows a promising photocatalyst and provides new sight to rational design the facets of photocatalysis process for enhanced photocatalytic performances and effective wastewater treatment. [ABSTRACT FROM AUTHOR]

Introduction: Jaundice is one of the most common problems during infancy. It is believed that breast milk jaundice is one of the reasons for the persistence of jaundice after 14 days of prolonged jaundice. This study evaluates the effect of Clofibrate and phototherapy on prolonged jaundice originating from breast milk in term and healthy neonates. Materials And Methods: This double-blind clinical trial study was performed on 100 randomly divided neonates in the neonatal ward of Besat Hospital. In addition to phototherapy, the case group received a single dose of edible Clofibrate (50 mg/kg) dissolved in 2 CCs of distilled water. The control group received the same amount of distilled water as the phototherapy group. After treatment, bilirubin change rate, duration of hospitalization, and any association with gender, gestational age, hemoglobin, blood type, and Rh of neonates were determined and compared throughout the 2 groups. Results: Data analysis showed that the bilirubin reduction rate was statistically significantly higher in the case group than in the control group (P <.05). The mean duration of hospitalization and phototherapy in the case group was significantly lower than in the control group (P =.005). The bilirubin reduction rate was not affected significantly by gestational age, blood type, or Rh. Conclusion: This study's results demonstrated that Clofibrate effectively decreased bilirubin levels and shortened the duration of phototherapy and hospitalization in infants with probable breast milk jaundice. Registration: IRCT2012092910933N1 [ABSTRACT FROM AUTHOR]

Effective management of dyslipidemia is of paramount importance to prevent cardiovascular (CV) complications. Using current clinical practice guidelines is recommended to correct lipid levels and prevent further pathologic processes. This article presents an overview of treatment options for patients with dyslipidemia and CV disease, with a special focus on the following drug classes: HMG-CoA reductase inhibitors (also called statins), cholesterol absorption inhibitors (ezetimibe), bile acid sequestrants, fibrates, icosapent ethyl, and PCSK9 inhibitors. [ABSTRACT FROM AUTHOR]

The increase in production and consumption of pharmaceuticals and personal care products causes environmental problems. In this study, naproxen and clofibric acid adsorption were studied using Fe3O4-supported UiO-66 (Zr) metal–organic framework (Mag-UiO-66). The adsorption processes were carried out in batch mode at pH value 3.0. The optimum adsorbent quantities, equilibrium periods, pseudo-first-order (PFO), pseudo-second-order (PSO), and intra-particles diffusion kinetic models were calculated. Non-linear Langmuir, Freundlich, Dubinin-Radushkevich (D-R), and Sips isotherm equations were applied to experimental data. Thermodynamic analyses of naproxen and clofibric acid adsorption were also carried out in this study. The Langmuir isotherm qm values were found as 14.15 mg/g for naproxen at 308 K and 41.87 mg/g for clofibric acid at 298 K. Both of the adsorption processes were exothermic. MISO (multi-input single-output) fuzzy logic models for removal of both naproxen and clofibric acid adsorptions were designed based on the experimental data to estimate the removal uptake values. It is noteworthy that the results obtained through designed fuzzy logic models matched well with the experimental data and the findings of this study emphasize the validity of designed fuzzy logic models. [ABSTRACT FROM AUTHOR]

This study is the first report on the synthesis, characterization and application of amine-functionalized mesoporous nanocomposites based on natural rubber (NR) and wormhole-like mesostructured silica (WMS). In comparison with amine-functionalized WMS (WMS-NH2), a series of NR/WMS-NH2 composites were synthesized via an in situ sol-gel method in which the organo-amine group was grafted onto the nanocomposite surface via co-condensation with 3-aminopropyltrimethoxysilane (APS) as the amine-functional group precursor. The NR/WMS-NH2 materials had a high specific surface area (115–492 m2 g−1) and total pore volume (0.14–1.34 cm3 g−1) with uniform wormhole-like mesoporous frameworks. The amine concentration of NR/WMS-NH2 (0.43–1.84 mmol g−1) was increased with an increase in the APS concentration, corresponding to high levels of functionalization with the amine groups of 53–84%. The H2O adsorption–desorption measurement revealed that NR/WMS-NH2 possessed higher hydrophobicity than WMS-NH2. The removal of clofibric acid (CFA), a xenobiotic metabolite of the lipid-lowering drug clofibrate, from the aqueous solution using WMS-NH2 and NR/WMS-NH2 materials was investigated using a batch adsorption experiment. The adsorption was a chemical process in which the pseudo-second order kinetic model expressed the sorption kinetic data better than the pseudo first-order and Ritchie-second kinetic order model. In addition, the CFA adsorption sorption equilibrium data of the NR/WMS-NH2 materials were fitted to the Langmuir isotherm model. The NR/WMS-NH2 with 5% amine loading had the highest CFA adsorption capacity (6.29 mg g−1). [ABSTRACT FROM AUTHOR]

The consumption of pharmaceuticals has increased worldwide and new compounds are continually being introduced in the market. Studies on the occurrence of pharmaceuticals show that the widely used pharmaceuticals acid clofibric are present in relevant concentrations in the environment. This molecule is recognized as highly resistant to biodegradation (WWTP biomass or bacteria) and has high persistence in the environment. Hence, to date, the elimination of this molecule continues to be a subject of interest. This study employs a viable alternative for micropollutant removal. The aim of the present study was to investigate the potential of selected strain to degrade CLA and their adaptability in multiple cultures with activated sludge. Additionally, the possibility of biostimulation of the activity of microorganisms from the consortium by optimizing their functionality in the biodegradation process of pharmaceutical compound was also examined. The results showed a removal efficiency of CLA of 58.5% when the wet biomass ratio Streptomyces MIUG 4.89: activated sludge was 1:1. This work represents the first study of the ability of multiple cultures Streptomyces MIUG 4.89 and activated sludge to remove this refractory compound. [ABSTRACT FROM AUTHOR]

In this study, a commercial magnetic ion exchange (MIEX) resin was used for the removal of clofibric acid (CA), one of the most persistent pharmaceutical active compounds (PhACs) in the environment, from aqueous solutions. As a result of batch experiments, optimum conditions were determined as pH = 4–7, equilibrium time = 240 min., and resin dosage = 26 mL/L for the removal of CA with MIEX resin. Freundlich isotherm model and pseudo-second order kinetic model showed the best fit for the sorption data with correlation coefficients higher than 0.99. Thermodynamic calculations indicated that the ion exchange process betweenMIEX resin and CA was a thermodynamically feasible and spontaneous process. Regeneration studies showed that the repeated use of MIEX resin is possible. The effect of all coexistent anions (chloride, carbonate and sulphate) was found to be close to each other for molar ratios of CA:coexisting anion = 1–3. Fourier transform infrared (FTIR) spectrum and environmental scanning electron microscopy (ESEM) images were used to examine the interactions of resins with CA and to see the changes that could occur in the resins after regeneration. The most obvious changes in MIEX resin due to CA sorption are found in the 1712 cm−1, 1480 cm−1, 1238 cm−1and 963 cm−1 bands. This study revealed that the mechanism of removal of the CA by MIEX resin is ion exchange and is reversible. [ABSTRACT FROM AUTHOR]

$\mathrm{TiO}_2$_Pd prepared by the incipient wet impregnation (IWI) method was successfully used as a photocatalyst for the degradation of an emerging water pollutant, clofibric acid (CA). It exhibits an improved photoactivity in comparison with different commercial titania in the degradation of CA (25 ppm). The irradiation intensity, photocatalyst dose, CA concentration and influence of water quality and of some salts in the reaction medium were systematically examined to understand their effects on the process efficiency. A total pollutant decomposition and a high mineralization yield (78%) were achieved in 50 and 190 min, respectively, in the optimal conditions, which is very promising for practical applications.

Hospitals played vital role in the maintenance and sustenance of human health. However, hospital activities generate high volume of toxic solid and liquid containing diverse inorganic, organic and microbial wastes released untreated into the ecosystem. The management of hospital wastewater in particular has been a major source of concern due to the presence of unregulated emerging micro-pollutants at concentrations in the range of ng/L to μg/L. These pollutants at low concentration exert different potential health effects on human and aquatic species. In this review, the formation, composition, properties and ecotoxicology effects of selected emerging micro-pollutants (Norfloxacin, Ofloxacin, Ciprofloxacin, Clofibric acid and Carbamazepine) at different concentrations in hospital wastewater were reviewed. The review also elucidates on detection and quantification of concentration of different emerging micropollutants in hospital wastewater by Spectrophotometry techniques, Gas Chromatography, Ion Chromatography, Gas Chromatography-Mass spectrometry, and High-Performance Liquid Chromatography. Furthermore, treatment of hospital wastewater through physical, biological, chemical, adsorption and advanced oxidation processes such as photocatalysis and photo-Fenton including their operational mechanism were provided. The chemistry and mechanism of degradation of the selected emerging micropollutants into several intermediates were reviewed. It was found that conventional wastewater treatment methods are not designed for effective removal of these unregulated pollutants in hospital wastewater because they exist as mixtures at very high concentrations and exerts different toxicological effects. The review also reveals that no single technology can effectively detoxify the wastewater, instead combination of methods such as (phototcatalytic/adsorption or photo-fenton/adsorption) was found most appropriate for hospital wastewater treatment. Finally, regular monitoring and determination of physicochemical and ecotoxicological parameters and treatment of hospital wastewater are recommended.

TiO2_Pd prepared by the incipient wet impregnation (IWI) method was successfully used as a photocatalyst for the degradation of an emerging water pollutant, clofibric acid (CA). It exhibits an improved photoactivity in comparison with different commercial titania in the degradation of CA (25 ppm). The irradiation intensity, photocatalyst dose, CA concentration and influence of water quality and of some salts in the reaction medium were systematically examined to understand their effects on the process efficiency. A total pollutant decomposition and a high mineralization yield (78%) were achieved in 50 and 190 min, respectively, in the optimal conditions, which is very promising for practical applications. [ABSTRACT FROM AUTHOR]

This study is the first report on the synthesis, characterization and application of amine-functionalized mesoporous nanocomposites based on natural rubber (NR) and wormhole-like mesostructured silica (WMS). In comparison with amine-functionalized WMS (WMS-NH2), a series of NR/WMS-NH2 composites were synthesized via an in situ sol-gel method in which the organo-amine group was grafted onto the nanocomposite surface via co-condensation with 3-aminopropyltrimethoxysilane (APS) as the amine-functional group precursor. The NR/WMS-NH2 materials had a high specific surface area (115–492 m2 g−1) and total pore volume (0.14–1.34 cm3 g−1) with uniform wormhole-like mesoporous frameworks. The amine concentration of NR/WMS-NH2 (0.43–1.84 mmol g−1) was increased with an increase in the APS concentration, corresponding to high levels of functionalization with the amine groups of 53–84%. The H2O adsorption–desorption measurement revealed that NR/WMS-NH2 possessed higher hydrophobicity than WMS-NH2. The removal of clofibric acid (CFA), a xenobiotic metabolite of the lipid-lowering drug clofibrate, from the aqueous solution using WMS-NH2 and NR/WMS-NH2 materials was investigated using a batch adsorption experiment. The adsorption was a chemical process in which the pseudo-second order kinetic model expressed the sorption kinetic data better than the pseudo first-order and Ritchie-second kinetic order model. In addition, the CFA adsorption sorption equilibrium data of the NR/WMS-NH2 materials were fitted to the Langmuir isotherm model. The NR/WMS-NH2 with 5% amine loading had the highest CFA adsorption capacity (6.29 mg g−1).

The treatment of dyslipidemia continues to be a dynamic and controversial topic. Even the most appropriate therapeutic range for lipid levels—including that of triglycerides and low-density lipoprotein cholesterol—remain actively debated. Furthermore, with ever-increasing options and available treatment modalities, the management of dyslipidemia has progressed in both depth and complexity. An understanding of appropriate lipid-lowering therapy remains an essential topic of review for practitioners across medical specialties. The goal of this review is to provide an overview of recent research developments and recommendations for patients with dyslipidemia as a means of better informing the clinical practice of lipid management. By utilizing a guideline-directed approach, we provide a reference point on optimal lipid-lowering therapies across the spectrum of dyslipidemia. Special attention is paid to long-term adherence to lipid-lowering therapies, and the benefits derived from instituting appropriate medications in a structured manner alongside monitoring. Novel therapies and their impact on lipid lowering are discussed in detail, as well as potential avenues for research going forward. The prevention of cardiovascular disease remains paramount, and this review provides a roadmap for instituting appropriate therapies in cardiovascular disease prevention. [ABSTRACT FROM AUTHOR]

Objective: High plasma triglyceride (TG) is an independent risk factor for cardiovascular disease. Fibrates lower TG levels through peroxisome proliferator-activated receptor α (PPARα) agonism. Currently available fibrates, however, have relatively low selectivity for PPARα. The aim of this trial was to assess the safety, tolerability, and efficacy of K-877 (pemafibrate), a selective PPARα modulator, in statin-treated European patients with hypertriglyceridemia.Research Design and Methods: A total of 408 statin-treated adults were recruited from 68 European sites for this phase 2, randomized, double-blind, placebo-controlled trial. They had fasting TG between 175 and 500 mg/dL and HDL-cholesterol (HDL-C) ≤50 mg/dL for men and ≤55 mg/dL for women. Participants were randomly assigned to receive placebo or one of six pemafibrate regimens: 0.05 mg twice a day, 0.1 mg twice a day, 0.2 mg twice a day, 0.1 mg once daily, 0.2 mg once daily, or 0.4 mg once daily. The primary end points were TG and non-HDL-C level lowering at week 12.Results: Pemafibrate reduced TG at all doses (adjusted P value <0.001), with the greatest placebo-corrected reduction from baseline to week 12 observed in the 0.2-mg twice a day treatment group (54.4%). Reductions in non-HDL-C did not reach statistical significance. Reductions in TG were associated with improvements in other markers for TG-rich lipoprotein metabolism, including reductions in apoB48, apoCIII, and remnant cholesterol and an increase in HDL-C levels. Pemafibrate increased LDL-cholesterol levels, whereas apoB100 was unchanged. Pemafibrate was safe and well-tolerated, with only minor increases in serum creatinine and homocysteine concentrations.Conclusions: Pemafibrate is effective, safe, and well-tolerated for the reduction of TG in European populations with hypertriglyceridemia despite statin treatment. [ABSTRACT FROM AUTHOR]

The occurrence of a wide range of micropollutants in natural aquatic environment has been reported in different parts of the world. These compounds are harmful for the aquatic life and human beings. Diclofenac and clofibric acid are the two common toxic micropollutants due to very large production and high consumption by humans. The present communication addresses the removal of diclofenac and clofibric acid from aqueous solutions using the hybrid material obtained by incorporating 3-aminopropyltriethoxysilane (APTES) onto the activated sericite clay. Initially, sericte clay was treated for activation and further modified with organosilane to obtain hybrid material. The materials were characterized using SEM, BET surface area, XRD, and FT-IR analyses. SEM and BET surface area analyses showed that the textural property of sericite clay was greatly changed after activation and the surface area was immensely increased from 3.65 to 62.92 m2/g. The organosilane was anchored on the activated clay and confirmed with FTIR analysis. Batch adsorption experiments showed that the diclofenac and clofibric acid removal is maximum at pH 6.0 to 7.0 and the adsorption of these two micropollutants were observed to be very fast and the time dependent adsorption data were best fitted to pseudo-second order kinetic model. The maximum adsorption capacity of diclofenac and clofibric acid using APTES-sericite hybrid material was found to be 1.868 and 1.749 mg/g, respectively. Furthermore, the loading capacities of the column packed with APTES-sericite hybrid material were found to be 0.789 and 1.095 mg/g. Therefore, this study indicated that the APTES-sericite hybrid material must be an useful material for the effective removal of diclofenac and clofibric acid from aqueous waste. [ABSTRACT FROM AUTHOR]

Clofibric acid (CA) is widely used as regulator of lipid levels in blood; it is considered one of the residual drugs that have a high persistence in the aquatic environment. After wastewater treatment, only a small amount of CA can be removed. The aim of this work was to investigate the reduction of CA in contaminated wastewater using calcinedanionic clay ZnAl-CO3, which was chosen for its higher adsorption capacity, recyclability, and non-regeneration of sludge. The maximum retention amount, Qm, exceeded 2220 mg g–1, and the value of DH° suggested a physical process. The removal rate achieved 90 %, and the remaining quantity was widely below the tolerance thresholds. Retention was achieved by hydrogen bonds and electrostatic interactions between the adsorbate molecules. Recycling tests clearly suggested that this material is recyclable, promising, and very effective compared to other adsorbents. This retention contributes to the attenuation of persistent lipid regulator.

Objective: To describe physicians' variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence.Data Sources: We analyzed 2007-2015 claims data from OptumLabs® Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data.Study Design: We modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial, which found statins and fibrates were no more effective than statins alone in reducing cardiovascular events among type 2 diabetic patients. We modeled fibrate use trends with physician random effects and physician characteristics such as age and specialty.Data Extraction: We identified patient-year-quarters with one year of continuous insurance enrollment, type 2 diabetes diagnoses, and fibrate use. We designated the physician most responsible for patients' diabetes care based on evaluation and management visits and prescriptions of glucose-lowering drugs.Principal Findings: Fibrate use increased by 0.12 percentage points per quarter among commercial patients (95% CI, 0.10 to 0.14) and 0.17 percentage points per quarter among Medicare Advantage patients (95% CI, 0.13 to 0.20) before the trial and then decreased by 0.16 percentage points per quarter among commercial patients (95% CI, -0.18 to -0.15) and 0.05 percentage points per quarter among Medicare Advantage patients (95% CI, -0.06 to -0.03) after the trial. However, 45% of physicians treating commercial patients and 48% of physicians treating Medicare Advantage patients had positive trends in prescribing following the trial. Physicians' characteristics did not explain their variation (pseudo R2  = 0.000).Conclusion: On average, physicians decreased fibrate prescribing following the ACCORD lipid trial. However, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing. Future research should examine whether physicians vary similarly in other de-adoption settings. [ABSTRACT FROM AUTHOR]

Dyslipidemia is a condition characterized by abnormal levels of one or more plasma lipids or lipoproteins. It is a major cause of cardiovascular diseases (CVDs) around the world. Pediatric dyslipidemias can lead to atherosclerosis and extrapolate to premature CVDs. Atherosclerotic lesions begin during childhood and act as the major risk factor for atherosclerotic CVD (ASCVD). Dyslipidemias can be caused by primary genetic disorders or by secondary causes, the most common of which is obesity. In order to diagnose and manage dyslipidemias early, it is important to know the screening guidelines, lifestyle changes, and treatment for childhood dyslipidemias. The appropriate identification and management of dyslipidemia in childhood can lead to decreased risk factors for future CVDs. One of the best ways to manage childhood dyslipidemias is through appropriate lifestyle changes where parents play a vital role, through healthy home environment. Pharmacological interventions include statins and fibrates that play a major role. This article reviews pediatric dyslipidemia and reemphasizes on the importance of lifestyle changes modeled by parents as well as appropriate selection of treatment by health-care providers. The aim of this review article is to draw attention toward the importance of screening, identification, and timely management of dyslipidemias in children which can prevent future risks and complications that may even be life threatening. [ABSTRACT FROM AUTHOR]

Purpose: Drug-induced hyponatremia is common, with medications from many drug-classes implicated. Lipid-lowering agents are among the most prescribed drugs. Limited evidence suggests an inverse association between statins and hyponatremia, while data on other lipid-lowering agents is absent. The objective of this investigation was to study the association between lipid-lowering drugs and hospitalization due to hyponatremia. Methods: This was a register-based case–control study of the general Swedish population. Those hospitalized with a main diagnosis of hyponatremia (n = 11,213) were compared with matched controls (n = 44,801). Multivariable logistic regression adjusting for co-medication, diseases, previous hospitalizations, and socioeconomic factors was used to explore the association between severe hyponatremia and the use of lipid-lowering drugs. Results: Unadjusted ORs (95% CI) for hospitalization due to hyponatremia were 1.28 (1.22–1.35) for statins, 1.09 (0.79–1.47) for ezetimibe, 1.38 (0.88–2.12) for fibrates, and 2.12 (1.31–3.35) for resins. After adjustment for confounding factors the adjusted odds ratios (95% CI) compared with controls were 0.69 (0.64–0.74) for statins, 0.60 (0.41–0.86) for ezetimibe, 0.87 (0.51–1.42) for fibrates, and 1.21 (0.69–2.06) for resins. Conclusions: Use of statins and ezetimibe was inversely correlated with severe hyponatremia. Consequently, these drugs are unlikely culprits in patients with hyponatremia, and they appear safe to initiate in hyponatremic patients. A potential protective effect warrants further studies on how statins and other lipid-lowering drugs are linked to dysnatremias. [ABSTRACT FROM AUTHOR]

Lipoprotein(a) is a unique form of low-density lipoprotein. It is associated with a high incidence of premature atherosclerotic disease such as coronary artery disease, myocardial infarction, and stroke. Plasma levels of this lipoprotein and its activities are highly variable. This is because of a wide variability in the size of the apolipoprotein A moiety, which is determined by the number of repeats of cysteine-rich domains known as "kringles." Although the exact mechanism of lipoprotein(a)-induced atherogenicity is unknown, the lipoprotein has been found in the arterial walls of atherosclerotic plaques. It has been implicated in the formation of foam cells and lipid deposition in these plaques. Pharmacologic management of elevated levels of lipoprotein(a) with statins, fibrates, or bile acid sequestrants is ineffective. The newer and emerging lipid-lowering agents, such as the second-generation antisense oligonucleotides, cholesteryl ester transfer protein inhibitors, and proprotein convertase subtilisin/kexin type 9 inhibitors offer the most effective pharmacologic therapy. [ABSTRACT FROM AUTHOR]

[Display omitted] Clofibric acid, the main pharmacologically-active metabolite of pharmaceutical products used as antilipaemic agent has received, in last years, an increased interest because of its well-known recalcitrance to biodegradation and its high persistence in the aquatic environment. This molecule passes unchanged or poorly transformed in wastewater treatment plants. An indigenous strain of Streptomyces , named MIUG 4.89 was previously selected, exhibited the ability to favor clofibric acid biodegradation within submerged cultivation in controlled biotechnological conditions. Thus, in order to enhance the biodegradation of this refractory molecule, mathematical modeling and statistical optimization designs associated to Plackett-Burman Design and Response Surface Methodology were used to evaluate and optimize the effects of different major culture conditions of this bacterial isolate. According to the results, under optimized culture conditions (5 g L−1 glucose, inoculation level 4.7 %, 27.5 °C and 20 days of incubation) the strain Streptomyces MIUG 4.89 exhibited a successful removal of clofibric acid with a biodegradation yield of 54 %, which is in agreement with model prediction. Thus, under optimized conditions, the removal yield was enhanced, which is very promising accounting for the refractory character of this water pollutant. [ABSTRACT FROM AUTHOR]

Clofibric acid (CA) is widely used as regulator of lipid levels in blood; it is considered one of the residual drugs that have a high persistence in the aquatic environment. After wastewater treatment, only a small amount of CA can be removed. The aim of this work was to investigate the reduction of CA in contaminated wastewater using calcined anionic clay ZnAl-CO3, which was chosen for its higher adsorption capacity, recyclability, and non-regeneration of sludge. The maximum retention amount, Qm, exceeded 2220 mg g-1, and the value of DH° suggested a physical process. The removal rate achieved 90%, and the remaining quantity was widely below the tolerance thresholds. Retention was achieved by hydrogen bonds and electrostatic interactions between the adsorbate molecules. Recycling tests clearly suggested that this material is recyclable, promising, and very effective compared to other adsorbents. This retention contributes to the attenuation of persistent lipid regulator. [ABSTRACT FROM AUTHOR]

Clofibric acid (CA) is widely used as regulator of lipid levels in blood; it is considered one of the residual drugs that have a high persistence in the aquatic environment. After wastewater treatment, only a small amount of CA can be removed. The aim of this work was to investigate the reduction of CA in contaminated wastewater using calcined anionic clay ZnAl-CO3, which was chosen for its higher adsorption capacity, recyclability, and non-regeneration of sludge. The maximum retention amount, Qm, exceeded 2220 mg g-1, and the value of DH° suggested a physical process. The removal rate achieved 90%, and the remaining quantity was widely below the tolerance thresholds. Retention was achieved by hydrogen bonds and electrostatic interactions between the adsorbate molecules. Recycling tests clearly suggested that this material is recyclable, promising, and very effective compared to other adsorbents. This retention contributes to the attenuation of persistent lipid regulator. [ABSTRACT FROM AUTHOR]

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are autoimmune cholestatic liver diseases that commonly result in the need for liver transplantation. The lack of an effective therapy for PSC remains a largely unmet need in hepatology, and although the majority of patients with PBC will have an adequate response to ursodeoxycholic acid and/or obeticholic acid, there is a need for treatment among patients who do not respond completely to these therapies. Investigations of statins, fibrates, and other peroxisome proliferator-activated receptor (PPAR) agonists suggest clinical benefit with some of these agents. Statins have recently been suggested to improve outcomes in patients with PSC but have not demonstrated benefit in patients with PBC, whereas fibrates and newer PPAR agonists appear to improve biochemical markers linked to better clinical outcomes in patients with PBC. Further research is needed to fully understand the clinical efficacy of these agents in the treatment of PBC and PSC. [ABSTRACT FROM AUTHOR]

Diabetes can lead to a myriad of microvascular and macrovascular complications – with the leading cause of mortality in diabetes being cardiovascular disease. Low‐density lipoprotein cholesterol, along with non‐high‐density lipoprotein cholesterol and triglycerides are proven, modifiable risk factors for cardiovascular disease. This article will focus on lipid‐lowering agents in individuals with diabetes. It will summarise relevant changes in the latest guidelines for dyslipidaemia and will also review the mechanisms of action of lipid‐lowering agents along with the latest cardiovascular outcomes data specific to individuals with diabetes. Older agents such as statins, ezetimibe, fibrates and nicotinic acid will be reviewed with a focus on new diabetes‐specific evidence. Similarly, a relatively novel agent proprotein‐convertase subtilisin‐kexin type 9 will be reviewed and details around the Pharmaceutical Benefits Scheme criteria governing its usage in Australia will be reported. Finally, this review will touch on agents still on the horizon such as icosapent ethyl, high‐density lipoprotein mimetics, bempedoic acid, omega‐3 free fatty acids, bromodomain and extra‐terminal protein inhibitors and inclisiran – a long‐acting ribonucleic acid interference agent. In the appropriately selected population of individuals with diabetes, these agents can assist to improve further lipid profile and reduce cardiovascular events. [ABSTRACT FROM AUTHOR]