Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The ...aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (LLT) in FH patients recruited in SAFEHEART.
A cross-sectional analysis of cases recruited in the Spanish FH cohort at inclusion was performed. Demographic, lifestyle, medical and therapeutic data were collected by specific surveys. Blood samples for lipid profile and DNA were obtained. Genetic test for FH was performed through DNA-microarray. Data from 1852 subjects (47.5% males) over 19 years old were analyzed: 1262 (68.1%, mean age 45.6 years) had genetic diagnosis of FH and 590 (31.9%, mean age 41.3 years) were non-FH. Cardiovascular disease was present in 14% of FH and in 3.2% of non-FH subjects (P < 0.001), and was significantly higher in patients carrying a null mutation compared with those carrying a defective mutation (14.87% vs. 10.6%, respectively, P < 0.05). Prevalence of current smokers was 28.4% in FH subjects. Most FH cases were receiving LLT (84%). Although 51.5% were receiving treatment expected to reduce LDL-c levels at least 50%, only 13.6% were on maximum statin dose combined with ezetimibe. Mean LDL-c level in treated FH cases was 186.5 mg/dl (SD: 65.6) and only 3.4% of patients reached and LDL-c under 100 mg/dl. The best predictor for LDL-c goal attainment was the use of combined therapy with statin and ezetimibe.
Although most of this high risk population is receiving LLT, prevalence of cardiovascular disease and LDL-c levels are still high and far from the optimum LDL-c therapeutic goal. However, LDL-c levels could be reduced by using more intensive LLT such as combined therapy with maximum statin dose and ezetimibe.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Familial hypercholesterolemia (FH) is the most common genetic disorder associated with premature atherosclerotic cardiovascular disease (ASCVD). There are sparse data on attainment of treatment ...targets; large registries that reflect real-life clinical practice can uniquely provide this information.
We sought to evaluate the achievement of low-density lipoprotein cholesterol (LDL-C) treatment goals in FH patients enrolled in a large national registry.
The SAFEHEART study (Spanish Familial Hypercholesterolemia Cohort Study) is a large, ongoing registry of molecularly defined patients with heterozygous FH treated in Spain. The attainment of guideline-recommended plasma LDL-C goals at entry and follow-up was investigated in relation to use of lipid-lowering therapy (LLT).
The study recruited 4,132 individuals (3,745 of whom were ≥18 years of age); 2,752 of those enrolled were molecularly diagnosed FH cases. Mean follow-up was 5.1 ± 3.1 years; 71.8% of FH cases were on maximal LLT, and an LDL-C treatment target <100 mg/dl was reached by only 11.2% of patients. At follow-up, there was a significant increase in the use of ezetimibe, drug combinations with statins, and maximal LLT. The presence of type 2 diabetes mellitus, a defective allele mutation, ezetimibe use, and the absence of previous ASCVD were predictors of the attainment of LDL-C goals.
Despite the use of intensified LLT, many FH patients continue to experience high plasma LDL-C levels and, consequently, do not achieve recommended treatment targets. Type of LDL-receptor mutation, use of ezetimibe, coexistent diabetes, and ASCVD status can bear significantly on the likelihood of attaining LDL-C treatment goals.
A patogênese e os achados clínicos, hematológicos e anatomopatológicos da infecção natural pelo protozoário Rangelia vitalii (rangeliose canina) foram estudados em 35 cães que morreram em ...consequência dessa condição. Os resultados obtidos permitem o seguinte conjunto de conclusões: (1) causa doença hemolítica exclusivamente extravascular e de origem imunomediada; (2) cursa invariavelmente com algum grau de hemorragia à necropsia, mas nem sempre clinicamente perceptível; (3) os principais sinais que devem chamar a atenção para a suspeita clínica são anemia, icterícia e esplenomegalia; (4) o principal achado hematológico e que deve chamar a atenção para a suspeita clínica é a ocorrência de anemia com sinais de intensa regeneração eritroide; (5) os três principais diagnósticos diferenciais são leptospirose, babesiose e erliquiose monocitotrópica aguda; (6) a principal lesão observada é uma associação de hiperplasia linfoide com inflamação mononuclear, predominantemente plasmocitária, mas por vezes granulomatosa; (7) outras lesões frequentes são secundárias à marcada anemia regenerativa; (8) o agente etiológico pode ser facilmente encontrado, pois ocorre em grande quantidade na maioria dos tecidos, principalmente nos linfonodos, no baço, na medula óssea, no coração e nas tonsilas.
The pathogenesis, clinical, hematological and pathological features of the natural infection by the protozoan organism Rangelia vitalii (canine rangeliosis) was studied in 35 dogs that died due this condition. The results allow for the following set of conclusions on canine rangeliosis: (1) causes an exclusively extravascular immune mediated hemolysis; (2) is invariably associated with some degree of hemorrhage observed at necropsy, but no always clinically apparent; (3) the clinical signs that are the hallmark of the disease are anemia, icterus and splenomegaly; (4) the main hematological aspect that establishes a clinical suspect is the development of anemia with signs of intense erythroid regeneration; (5) the three main differential diagnosis are leptospirosis, babesiosis and e acute monocytotropic ehrlichiosis; (6) the main observed histopathological lesion is an association of lymphoid hyperplasia with mononuclear inflammatory reaction, predominantly plasmacytic, but occasionally granulomatous; (7) other frequently found lesions are secondary to a marked regenerative anemia; (8) large numbers of the etiologic agent can be easily demonstrate in most tissues, mainly in lymph nodes, spleen, bone marrow, heart, and tonsils.
Resumen La hipercolesterolemia familiar (HF) es un trastorno genético frecuente que se manifiesta desde el nacimiento y que causa un aumento en los niveles plasmáticos de colesterol-LDL (cLDL), ...xantomas y enfermedad coronaria prematura. Su detección y tratamiento precoz reduce la morbimortalidad coronaria. A pesar de la disponibilidad de un tratamiento eficaz, la HF está poco diagnosticada y tratada. La identificación de los casos índices y la posterior detección en cascada familiar utilizando los niveles de cLDL y la detección genética es la estrategia más coste-efectiva para la detección de nuevos casos. El tratamiento crónico con estatinas ha disminuido el riesgo cardiovascular a los niveles de la población general. Los objetivos en cLDL son < 130 mg/dl en los niños y adultos jóvenes, < 100 mg/dl en los adultos y < 70 mg/dl en los adultos con enfermedad coronaria conocida o diabetes. En la mayoría de los pacientes es difícil conseguir estos objetivos, por lo que puede ser necesario el tratamiento combinado con ezetimiba u otros fármacos. Cuando no se alcanzan los objetivos con el máximo tratamiento farmacológico tolerado, una reducción de cLDL ≥ 50% puede ser aceptable. La LDL-aféresis es útil en los pacientes homocigotos y en los heterocigotos graves resistentes al tratamiento. Este documento proporciona recomendaciones para el diagnóstico, cribado y tratamiento de la HF en niños y adultos, así como consejos específicos para los especialistas clínicos y médicos de atención primaria con el objetivo de mejorar el cuidado de los pacientes y reducir su carga de enfermedad cardiovascular.
Prior to the release of their cargoes into the vacuolar lumen, sorting endosomes mature into multivesicular bodies (MVBs) through the action of ENDOSOMAL COMPLEX REQUIRED FOR TRANSPORT (ESCRT) ...protein complexes. MVB-mediated sorting of high-affinity phosphate transporters (PHT1) to the vacuole limits their plasma membrane levels under phosphate-sufficient conditions, a process that allows plants to maintain phosphate homeostasis. Here, we describe ALIX, a cytosolic protein that associates with MVB by interacting with ESCRT-III subunit SNF7 and mediates PHT1;1 trafficking to the vacuole in Arabidopsis thaliana. We show that the partial loss-of-function mutant alix-1 displays reduced vacuolar degradation of PHT1;1. ALIX derivatives containing the alix-1 mutation showed reduced interaction with SNF7, providing a simple molecular explanation for impaired cargo trafficking in alix-1 mutants. In fact, the alix-1 mutation also hampered vacuolar sorting of the brassinosteroid receptor BRI1. We also show that alix-1 displays altered vacuole morphogenesis, implying a new role for ALIX proteins in vacuolar biogenesis, likely acting as part of ESCRT-III complexes. In line with a presumed broad target spectrum, the alix-1 mutation is pleiotropic, leading to reduced plant growth and late flowering, with stronger alix mutations being lethal, indicating that ALIX participates in diverse processes in plants essential for their life.
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