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Ciccarone Center Research
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- Antiplatelet Therapy
- ASCVD (Atherosclerotic Cardiovascular Disease)
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- Cholesterol / Lipids / Statins
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- Family History of CVD
- Gender / Cardiovascular Disease in Women
- Heart Failure
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- Markers of Thrombosis, Myocardial Injury, Wall Stress
- Mobile Health
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- Quality of Care
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- Sleep Disorders
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View by Journal
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- Meet the Authors
Cholesterol / Lipids / Statins
To facilitate the guideline-based implementation of treatment recommendations in the ambulatory setting and to encourage participation in the multiple preventive health efforts that exist, we have organized several recent guideline updates into a simple ABCDEF approach. We would remind clinicians that evidence-based medicine is meant to inform recommendations but that synthesis of patient-specific data and use of appropriate clinical judgment in each individual situation is ultimately preferred.Published in: Journal of the American Heart AssociationRead on Pubmed
This is a state-of-art review on the possible effects of statin therapy on organs not in the cardiovascular system.Published in: British Medical JournalRead on Pubmed
Headed in the right direction but at risk for miscalculation: a critical appraisal of the 2013 ACC/AHA risk assessment guideline.
The newly released 2013 ACC/AHA Guideline for Assessing Cardiovascular Risk was a major advance over prior guidelines, but the new risk equations do not appear to lead to significantly better discrimination than older models. Since the same risk factors are incorporated, using the new risk estimators may lead to inaccurate assessment of atherosclerotic cardiovascular risk in certain groups of patients. There also is likely an overestimation of risk when applied to modern populations. Future guidelines could provide clearer direction on which individuals would benefit from additional testing for more personalized preventive therapies.Published in: Journal of the American College of CardiologyRead on Pubmed
Concepts and controversies: the 2013 American College of Cardiology/American Heart Association risk assessment and cholesterol treatment guidelines.
This editorial discusses the strengths and limitations of the new prevention guidelines.Published in: Annals of Internal MedicineRead on Pubmed
Dyslipidemia, coronary artery calcium, and incident atherosclerotic cardiovascular disease: implications for statin therapy from the multi-ethnic study of atherosclerosis.
CAC scoring can help match statin therapy to absolute atherosclerotic CVD risk.Published in: CirculationRead on Pubmed
Statins and cognition: a systematic review and meta-analysis of short- and long-term cognitive effects.
In this study of patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data supports a beneficial role for statins in the prevention of dementia.Published in: Mayo Clinic ProceedingsRead on Pubmed
What role does genetics play in the variability in response to statin therapy?
We examine the role of certain genetic polymorphisms in affecting the response to statin therapy.
Discordance in lipid measurements: Can we capitalize to better personalize cardiovascular risk assessment and treatment?
Lipid measurement is one of the cornerstones of cardiovascular risk assessment and treatment. It is widely accepted that reduction of atherogenic lipids reduces risk of atherosclerotic cardiovascular disease. As the study of lipids has yielded deeper understanding of the pathophysiology of lipid metabolism, it has become clear that different techniques to quantify atherogenic lipids and lipoproteins could be complementary. For example, low-density lipoprotein cholesterol can exist in a range of forms from small, dense to large, buoyant, and therefore, discordance may arise between measures of its cholesterol content and particle concentration. In this article, we review the most recent literature on discordance in lipid measurements. We emphasize interesting and important new findings, and aim to bring the reader up-to-date on the topic. We submit that lipid discordances create an opportunity to better personalize the risk assessed for atherogenic cardiovascular disease and the care we give patients with dyslipidemia. We note that while prior research has often examined one lipid measure vs another in their abilities to predict the average risk in a population, recent studies are increasingly asking what lipid discordance in individual patients can tell us about risk. We propose that this latter approach asks the more clinically important question. The message from these studies is consistent: discordance matters. As the field moves forward, we propose standardization of methods for discordance research. In our view, this will best enable us to further clarify the clinical implications of the principle of discordance and best inform personalized cardiovascular care.
How do statins work?: Changing paradigms with implications for statin allocation.
Derivation and validation of a novel method for more accurate estimation of LDL-C from the standard lipid profile.
Low-density lipoprotein cholesterol (LDL-C) is of longstanding clinical and research interest and the primary target in national and international clinical practice guidelines. Conventionally, LDL-C is estimated by the Friedewald equation which assumes a fixed ratio of TG:VLDL-C of 5:1. Applying a factor of 5 to every individual patient is problematic given variance in the TG:VLDL-C ratio across the range of triglyceride and nonHDL-C levels. Rather than a fixed conversion factor, we have developed a method that uses a sliding scale factor to estimate VLDL-C with high precision from triglycerides and non-HDL cholesterol levels.
Effect of statin treatment on coronary plaque progression — a serial coronary CT angiography study.
Statin therapy resulted in significantly lower progression of low attenuation plaque and noncalcified plaques compared to nonstatin users.
APOE modulates the correlation between triglycerides, cholesterol, and CHD through pleiotropy, and gene-by-gene interactions.
The relationship between total cholesterol and triglycerides varies by apolipoprotein E isoform genotype in African-American and European-American populations.
Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile.
This study sought to develop a new method for calculating low-density lipoprotein cholesterol, the so-called “bad” form of blood fat that can lead to hardening of the arteries, that would be more accurate than the standard profile for measuring a person’s risk for heart attack and stroke.
Non-high-density lipoprotein cholesterol, guideline targets, and population percentiles for secondary prevention in 1.3 million adults: the VLDL-2 study (very large database of lipids).
There is a significant patient-level discordance between non-HDL-C and LDL-C percentiles at lower LDL-C and higher triglyceride levels, which has implications for the treatment of high-risk patients.
Ratio of dense to buoyant LDL subclass is associated with LDL density phenotype (VLDL-5).
Dense LDL phenotypes are associated with increased atherogenicity, and are commonly evaluated for the purposes of atherosclerosis research and cardiovascular risk discrimination. In this study we examined the ability of LDL subclasses, expressed as a ratio of dense-to-buoyant subclass (LLDR), to predict LDL density phenotype. Further research is needed to investigate the relationship between lipoprotein density and size, and whether LLDR provides more cardiovascular risk discrimination than LDL density phenotype.