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  • Inconsistent Guideline Recommendations for Cardiovascular Prevention and the Debate About Zeroing in on and Zeroing LDL-C Levels With PCSK9 Inhibitors

    Abstract Full Text
    JAMA. 2017; 318(5):419-420. doi: 10.1001/jama.2017.6765

    This Viewpoint discusses variances in cardiovascular prevention guidelines from the United States, Europe, and Canada and the debate surrounding low-density lipoprotein levels as the primary focus.

  • Therapies That Target PCSK9 Effective at Reducing LDL Cholesterol

    Abstract Full Text
    JAMA. 2017; 317(20):2054-2054. doi: 10.1001/jama.2017.5656
  • JAMA May 23, 2017

    Figure: Therapies That Target PCSK9 Effective at Reducing LDL Cholesterol

    In patients with high LDL cholesterol despite statin therapy, targeting PCSK9 effectively reduces LDL.
  • JAMA March 7, 2017

    Figure 1: Association of Damaging Lipoprotein Lipase Gene (LPL) Mutations With Circulating Lipid Concentrations

    Beta coefficients reflective of the difference in lipid concentrations between carriers of a damaging LPL mutation and noncarriers were derived from linear regression models that included adjustment for age, age squared, sex, cohort, and the first 5 principal components of ancestry. Principal components of ancestry were based on observed genotypic differences across subpopulations (eg, race or ethnicity) in the overall study. Inclusion of principal components as covariates in linear regression analyses increases statistical power for true relationships and minimizes confounding by ancestry. Fixed-effects meta-analysis was used to combine results across cohorts (P for heterogeneity > .50 for each lipid phenotype). The number of participants from each study cohort with lipid fraction values available is displayed. HDL indicates high-density lipoprotein; IQR, interquartile range; and LDL, low-density lipoprotein. To convert cholesterol to millimoles per liter, multiply by 0.0259; triglycerides to millimoles per liter, multiply by 0.0113.
  • Thyroid-Stimulating Hormone in the Evaluation of Subclinical Hypothyroidism

    Abstract Full Text
    JAMA. 2016; 316(15):1592-1593. doi: 10.1001/jama.2016.9534

    A 62-year-old woman presented with a 6-month history of hair thinning, itchy scalp, and cold sensitivity, has a mild elevation of her thyroid-stimulating hormone level (4.88 mIU/L) and elevated levels of low-density lipoprotein (155 mg/dL) and total cholesterol (257 mg/dL). How do you interpret the test results?

  • Association Between Low-Density Lipoprotein Cholesterol–Lowering Genetic Variants and Risk of Type 2 Diabetes: A Meta-analysis

    Abstract Full Text
    free access
    JAMA. 2016; 316(13):1383-1391. doi: 10.1001/jama.2016.14568

    This meta-analysis of genetic association studies summarizes associations between molecular targets of lipid-lowering therapy and risk of type 2 diabetes and coronary artery disease.

  • JAMA August 9, 2016

    Figure 2: RCTs Showing Effect of Statins on Mean Percent Change in LDL, Total, and HDL Cholesterol Levels (Key Question 6)

    LDL indicates low-density lipoprotein; HDL, high-density lipoprotein.
  • JAMA August 9, 2016

    Figure 1: Analytic Framework

    MI indicates myocardial infarction. Evidence reviews for the US Preventive Services Task Force (USPSTF) use an analytic framework to visually display the key questions that the review will address to allow the USPSTF to evaluate the effectiveness and safety of a preventive service. The questions are depicted by linkages that relate interventions and outcomes. Dashed line indicates an association between an intermediate outcome and a health outcome. Further details are available from the USPSTF procedure manual.aIntermediate outcomes include lipid levels (total, low-density lipoprotein, high-density lipoprotein, and non–high-density lipoprotein cholesterol; triglycerides) and atherosclerosis markers (carotid intima-medial thickness, calcium score, pathological findings).
  • Predicting the Overuse of PCSK-9 Inhibitors

    Abstract Full Text
    JAMA. 2015; 314(18):1909-1910. doi: 10.1001/jama.2015.13414

    This Viewpoint anticipates widespread premature use of proprotein convertase subtilisin-kexin type 9 (PCSK-9) inhibitors in response to the challenges some patients experience taking statins and urges caution until trials and experience demonstrate the new drugs are safe.

  • JAMA January 20, 2015

    Figure 3: Adjusted Failure Plots to Show the Magnitude of Risk Increase for Cardiovascular Disease That Was Associated With Hospitalization for Pneumonia in CHS and ARIC

    ARIC indicates Atherosclerosis Risk in Communities study; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); CHS, Cardiovascular Health Study; CVD, cardiovascular disease; LDL, low-density lipoprotein. The failure plots are adjusted for demographics and cardiovascular risk factors (see Methods for additional details). The plots in brown represent participants with pneumonia and the plots in blue represent controls with a covariate pattern in the 25th, 50th, and 75th percentiles in CHS and ARIC. The shaded areas around each curve represent 95% CIs.
  • JAMA December 17, 2014

    Figure 3: Effect of Study Diets on Main Outcomes

    The primary outcomes were systolic blood pressure, insulin sensitivity, and levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. Diastolic blood pressure was a secondary outcome. Additional data related to these outcomes are presented in Table 3 and eTable 3 in Supplement 2. Apolipoproteins and other lipid outcomes are in eTable 4. Carb indicates carbohydrate; GI, glycemic index. To convert cholesterol to mmol/L, multiply by 0.0259; triglycerides to mmol/L, multiply by 0.0113.aFor the 5 primary outcomes on the primary diet contrast (insulin sensitivity, triglycerides, HDL cholesterol, LDL cholesterol, and systolic blood pressure), we plot and tabulate 99% CI to achieve nominal 95% coverage.
  • Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Japanese Patients 60 Years or Older With Atherosclerotic Risk Factors: A Randomized Clinical Trial

    Abstract Full Text
    free access
    JAMA. 2014; 312(23):2510-2520. doi: 10.1001/jama.2014.15690

    Ikeda and coauthors determine whether daily, low-dose aspirin reduces the incidence of cardiovascular (CV) events compared with no aspirin in older Japanese patients with multiple atherosclerotic risk factors.

  • Evolocumab Lowers LDL in Genetic High Cholesterol Disorder

    Abstract Full Text
    JAMA. 2014; 312(20):2083-2083. doi: 10.1001/jama.2014.15519
  • JAMA April 16, 2014

    Figure 3: Mean Change in Glycated Hemoglobin, High- and Low-Density Lipoprotein Cholesterol, and Triglyceride Levels From Baseline Through 36 Months

    Mean value at baseline: A, 7.8% for both placebo and aleglitazar; B, 41.8 mg/dL for placebo and 42.2 mg/dL for aleglitazar; C, 154 mg/dL for placebo and 152 mg/dL for aleglitazar; and D, 79.7 mg/dL for placebo and 78.9 mg/dL for aleglitazar. To convert high-density lipoprotein and low-density lipoprotein to millimoles per liter, multiply by 0.0259; triglycerides to millimoles per liter, multiply by 0.0113. Error bars indicate 95% CIs.
  • JAMA January 15, 2014

    Figure 2: Median Levels of Lipid Parameters and Log CRP in Patients Treated With Placebo and Varespladib

    CRP indicates C-reactive protein; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein. Error bars for LDL-C and HDL-C represent standard errors. Error bars for triglycerides and log CRP represent interquartile ranges. P values for LDL-C, HDL-C, and CRP are by t test. P value for triglycerides is by Wilcoxon rank sum test for percentage change.
  • JAMA June 5, 2013

    Figure 2: Outcomes Over Time

    Error bars indicate 95% CIs; LDL, low-density lipoprotein (to convert from mg/dL to mmol/L, multiply by 0.0259). * P value for difference is <.01.
  • JAMA March 28, 2012

    Figure 3: Risk of Major Cardiovascular Events by LDL and non-HDL Cholesterol Categories

    Data markers indicate hazard ratios (HRs) and 95% CIs for risk of major cardiovascular events. Results are shown for 4 categories of statin-treated patients based on whether or not they reached the low-density lipoprotein cholesterol (LDL-C) target of 100 mg/dL and the non–high-density lipoprotein cholesterol (non–HDL-C) target of 130 mg/dL. HRs were adjusted for sex, age, smoking, diabetes, systolic blood pressure, and trial.
  • JAMA November 16, 2011

    Figure 2: Proposed Mechanism of Evacetrapib on Lipid Exchange Between Lipoprotein Particles

    The left panel illustrates exchange of cholesteryl ester and triglycerides (TG) between high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) particles. The right panel illustrates the proposed effects of evacetrapib, which inhibits lipid exchange via the CETP (cholesteryl ester transfer protein) pathway. This mechanism theoretically results in HDL particles that contain greater amounts of cholesterol, and LDL particles that contain lesser amounts of cholesterol, resulting in an increase in circulating levels of HDL cholesterol and a decrease in LDL cholesterol.
  • JAMA June 15, 2011

    Figure 2: Stratified Analyses of Risk of Death by Fibroblast Growth Factor 23 Levels

    The multivariable-adjusted hazard ratio (95% confidence intervals) of death per unit increment in standard deviation of natural log-transformed fibroblast growth factor 23 (FGF-23) is plotted for the entire cohort and according to strata of baseline covariates. See Figure 1 legend for adjusted variables. To covert calcium from mg/dL to mmol/L, multiply by 0.25; low-density lipoprotein from mg/dL to mmol/L, multiply by 0.0259; and parathyroid hormone from pg/mL to ng/L, multiply by 0.1053.
  • JAMA June 15, 2011

    Figure 1: Multivariable-Adjusted Hazard Function for Death According to Measured (Untransformed) Levels of Fibroblast Growth Factor 23

    The median fibroblast growth factor 23 (FGF-23) level within the lowest FGF-23 quartile (74 RU/mL) served as the referent value (hazard = 1.0). The model was stratified by center and adjusted for age; sex; race; ethnicity; estimated glomerular filtration rate; natural log-transformed urine albumin-to-creatinine ratio; hemoglobin; serum albumin; systolic blood pressure; body mass index; diabetes; smoking status; low-density lipoprotein; history of coronary artery disease, congestive heart failure, stroke, and peripheral vascular disease; use of aspirin, β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers; and serum calcium, phosphate, and natural log-transformed parathyroid hormone. Tick marks on the x-axis indicate individual observations at corresponding levels of FGF-23. The solid black line represents the multivariable-adjusted hazard of mortality as a function of the measured (nontransformed) FGF-23 level. The dashed lines indicate the 95% confidence intervals.