R3i SYMPOSIUM
23-25 April 2015
Merida, Yucatan
1a Cumbre Internacional de Aterosclerosis
del Mayab
Friday April 24, 2015

10:00 - 10:15 R3i importance in Latinoamerica Dr Cesar Rodriguez Gilabert, Mexico
 
10:15 - 10:30 Remnant Particles as markers of cardiovascular risk Dr Carlos Calvo, Chile
 
10:30 - 10:45 Residual risk in atherogenic dyslipidemia Dr Ruben Yza, Mexico
 
10:45 - 11:00 Discussion
LATEST
Landmark study
Elevated nonfasting remnant cholesterol associated with increased mortality
Focus on...
Hint of outcomes benefit with PCSK9 inhibition
LINKS
The National Lipid Association (NLA)
The National Lipid Association (NLA) is a nonprofit, multidisciplinary medical society focused on enhancing the practice of lipid management in clinical medicine.
EDITORIAL
13 April 2015
The Residual Risk Debate Hots Up: Lowering LDL-C or lowering remnant cholesterol?
Prof. Jean Charles Fruchart, Prof. Jean Davignon, Prof. Michel Hermans, Prof. Pierre Amarenco
Prof. Jean Charles Fruchart, Prof. Jean Davignon, Prof. Michel Hermans, Prof. Pierre Amarenco
An Editorial from the R3i Trustees

Has PCSK9 inhibition clouded other considerations? This month’s editorial brings together both sides of the debate surrounding the optimal approach for targeting residual cardiovascular risk. One the one hand, two recent publications discussed in this month’s Focus, have heightened anticipation of the potential for PCSK9 inhibition for reducing residual cardiovascular risk. Both show that treatment with monoclonal antibody therapy targeting PCSK9, in addition to maximally tolerated statin therapy, results in remarkably consistent LDL-C reduction of about 60%...
R3i Education Channel
      MSDA 2014 - Experts interviews - Part 3 / 3

Pr Peter Libby

Pr Jean-Pierre Deprés

Pr Liping Zhao

What is inflammation relevant to the pathogenesis of insulin resistance?
Peter Libby
What is the mechanistic link between inflammation and the metabolic cluster?
Peter Libby
What are the criteria for overweight and obesity in Japan?
Jean-Pierre Després
What is the level of cardiovascular residual risk in Asian population?
Jean-Pierre Després
What is the value of BMI as a marker of risk?
Jean-Pierre Després
Gut microbiota is a complex ecological system how does it interact with our metabolism?
Liping Zhao
RECENT PUBLICATIONS
Genetic variants of APOA5 predispose to atherogenic dyslipidaemia and subclinical atherosclerosis
Elevated triglycerides are a marker of elevated remnant cholesterol and a component of atherogenic dyslipidaemia. Atherogenic dyslipidaemia is a key driver of atherosclerosis especially in individuals with cardiometabolic disease. It has been proposed that variation at the APOA5 gene locus, encoding apoAV, a key regulator of triglyceride levels, modulates lipoprotein subclass distributions toward a more atherogenic pattern in dyslipidaemic patients.
 
In this study of 422 treatment-naïve subjects, two APOA5 variants, rs662799 (-1131T>C) and rs3135506 (S19W), were genotyped. Circulating lipoproteins were determined by nuclear magnetic resonance, and intima-media thickness (IMT) was evaluated using B-mode ultrasonography. Carriers of the rs662799 and rs3135506 variants had a proatherogenic lipid profile based on remnant (very low-density lipoprotein [VLDL] and intermediate density lipoprotein [IDL] subclasses), resulting in an increase in large VLDL (+133%, p < 0.001) and small LDL (+34%, p = 0.014). This atherogenic subclass distribution was significantly associated with increased carotid IMT, especially in patients with increased body mass index (?25 kg/m2). These findings add to the evidence supporting a link between remnant cholesterol, atherogenic lipoprotein profile and IMT-defined subclinical atherosclerosis.
APOA5 variants predispose hyperlipidemic patients to atherogenic dyslipidemia and subclinical atherosclerosis.
Guardiola M, Cofán M, de Castro-Oros I et al.
Elevated serum remnant-like cholesterol linked to coronary plaque development
Increasingly, evidence supports elevated remnant cholesterol, for which serum triglycerides are a marker, with residual cardiovascular disease risk in patients with well controlled levels of low-density lipoprotein cholesterol (LDL-C). New data suggest that remnant cholesterol may contribute to formation of coronary plaque.
 
In this study, 40 Japanese men with stable angina (mean 71 years, mean baseline LDL-C 107 mg/dL or 2.8 mmol/L) underwent intravascular ultrasound and coronary angiography to evaluate the severity of coronary artery disease, and plaque morphology and composition. Blood samples were taken to measure serum levels of adiponectin, omentin-1 and serum remnant cholesterol. The cross-sectional area at the most stenotic site of the plaque of target lesions correlated strongly with body mass index (r5=0.53, p<0.001) and negatively with serum adiponectin levels (r5=-0.34, p=0.03). Serum remnant cholesterol was the strongest positive factor for necrotic tissue and a negative determinant for fibrotic tissue in the plaques. Furthermore, the remnant cholesterol/triglyceride ratio was significantly correlated with the proportion of lipid in plaques, whereas serum LDL-C or high-density lipoprotein cholesterol levels were not. In conclusion, this study supports the concept that increased serum remnant-like cholesterol levels may contribute to the development of coronary plaques in patients with stable angina with well controlled LDL-C levels on statin therapy. Measurement of remnant cholesterol may aid evaluation of residual cardiovascular risk in this setting.
Impact of remnant lipoprotein on coronary plaque components.
Matsuo N, Matsuoka T, Onishi S et al.
Much to be done to improve awareness and control of dyslipidaemia in China
A new study from China highlights differences in the awareness, treatment and control of hypertension and dyslipidaemia in previously-diagnosed and newly-diagnosed subjects with diabetes. In total, 98,658 adults aged at least 18 years were identified from the China Noncommunicable Disease Surveillance 2010 study. Glycaemia was defined according to the 2010 American Diabetes Association criteria; hypertension was diagnosed according to the 7th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; and dyslipidaemia was diagnosed according to the 2004 National Cholesterol Education Program Adult Treatment Panel III. The prevalence of dyslipidaemia increased from 47% in subjects with normal glucose levels to 63% in subjects with newly-diagnosed diabetes and 70% in those with previously-diagnosed diabetes. Compared with subjects with newly-diagnosed diabetes, those with previously diagnosed diabetes were more likely to aware of dyslipidaemia (34% versus 13%), and were receiving pharmacotherapy (19% versus 5%). Among subjects with previously diagnosed diabetes, low-density lipoprotein cholesterol levels were controlled in 87%; however, management of triglycerides and high-density lipoprotein levels lagged behind (50% and 27% had controlled levels). These findings show that detection and control of dyslipidaemia remains far from optimal in Chinese adults.
Treatment and control of cardiometabolic disorders in Chinese adults with diabetes: a national representative population study.
Wang T, Xu Y, Xu M et al. Awareness
Presence of diabetic retinopathy may increase risk of future CV events
There has been support for the concept that the presence of microvascular complications is predictive of an increased risk of cardiovascular events. This study tested this concept in patients with type 2 diabetes and diabetic retinopathy (DR) compared with those without DR. A total of 312 people with diabetes (mean age 57 years, 51% male) were included in the study, of whom 153 (49%) had DR. All participants underwent carotid ultrasound imaging to assess carotid intima-media thickness and the presence of carotid plaques. A higher percentage of patients with DR had carotid plaques than those without DR (68% vs 52%, p=0.0045). Patients with DR also had a higher prevalence of ?2 carotid plaques (44.4% vs 21.4%, p<0.0001). However there were no differences in the cIMT measured at different carotid regions between the two groups. Using multivariate logistic regression (with adjustment for major risk factors for atherosclerosis), DR was independently associated with mean-internal cIMT (p = 0.0176), the presence of carotid plaques (p = 0.0366) and carotid plaque burden (?2 plaques; p < 0.0001).
 
DR in patients with type 2 diabetes is associated with a higher atherosclerotic burden in the carotid arteries than seen in patients with type 2 diabetes and no DR. As patients with increased atherosclerotic burden have a higher risk of cardiovascular events, the authors recommended that patients with type 2 diabetes and DR should be considered for carotid ultrasound imaging to ensure a more individualised and careful cardiovascular assessment.
Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy.
Alonso N, Traveset A, Rubinat E et al.
Jackson Heart Study: metabolic syndrome, diabetes and subclinical atherosclerosis in African Americans
While the presence of subclinical disease measures has been directly associated with the development of cardiovascular disease in whites, there are less data for African Americans. This analysis from the Jackson Heart Study showed a moderately high prevalence of subclinical disease in this group, which in turn translated to higher cardiovascular risk, especially with concomitant metabolic syndrome and diabetes.
 
The analysis included 4,416 subjects (mean age 54 years; 64% women) who attended the first examination of the Jackson Heart Study. In total, 1,155 (26%) subjects had subclinical disease, defined as the presence of peripheral arterial disease, left ventricular hypertrophy (LVH), microalbuminuria, high coronary artery calcium (CAC) score, and/or low left ventricular ejection fraction. Cross-sectional multivariable-adjusted logistic regression analysis showed that subjects with metabolic syndrome or diabetes were at high risk of subclinical disease compared with those without these conditions (odds ratios 1.55 [95% CI 1.30–1.85] and 2.86 [95% CI 2.32–3.53], respectively). Furthermore, having either condition significantly increased the hazard of incident cardiovascular disease, independent of the presence of subclinical disease (P < 0.001).
Relations Between Subclinical Disease Markers and Type 2 Diabetes, Metabolic Syndrome, and Incident Cardiovascular Disease: The Jackson Heart Study.
Xanthakis V, Sung JH, Samdarshi TE et al.