Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

O’Malley, Patrick G.; Arnold, Michael J; Kelley, Cathy; Spacek, Lance; Buelt, Andrew; Natarajan, Sundar; Donahue, Mark; Vagichev, Elena; Ballard-Hernandez, Jennifer; Logan, Amanda L.; Thomas, Lauren E.; Ritter, Joan; Neubauer, Brian; Downs, John R.

doi:10.7326/m20-4648

Cited by 48 publications

(38 citation statements)

References 36 publications

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“…Hyperlipidemia is a well-established strong risk factor for atherosclerosis and cardiovascular diseases. Lipid-modifying drugs, which primarily lower plasma levels of LDL cholesterol, substantially reduce the risk of cardiovascular diseases [35,36]. Drugs from natural products have distinct advantages, such as extensive resources and fewer adverse effects as well as the lipids-lowering action [37,38].…”

Section: Discussionmentioning

confidence: 99%

Rosmarinic Acid Exhibits a Lipid-Lowering Effect by Modulating the Expression of Reverse Cholesterol Transporters and Lipid Metabolism in High-Fat Diet-Fed Mice

Nyandwi

Jin

et al. 2021

Biomolecules

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Hyperlipidemia is a potent risk factor for the development of cardiovascular diseases. The reverse cholesterol transport (RCT) process has been shown to alleviate hyperlipidemia and protect against cardiovascular diseases. Recently, rosmarinic acid was reported to exhibit lipid-lowering effects. However, the underlying mechanism is still unclear. This study aims to investigate whether rosmarinic acid lowers lipids by modulating the RCT process in high-fat diet (HFD)-induced hyperlipidemic C57BL/6J mice. Our results indicated that rosmarinic acid treatment significantly decreased body weight, blood glucose, and plasma total cholesterol and triglyceride levels in HFD-fed mice. Rosmarinic acid increased the expression levels of cholesterol uptake-associated receptors in liver tissues, including scavenger receptor B type 1 (SR-B1) and low-density lipoprotein receptor (LDL-R). Furthermore, rosmarinic acid treatment notably increased the expression of cholesterol excretion molecules, ATP-binding cassette G5 (ABCG5) and G8 (ABCG8) transporters, and cholesterol 7 alpha-hydroxylase A1 (CYP7A1) as well as markedly reduced cholesterol and triglyceride levels in liver tissues. In addition, rosmarinic acid facilitated fatty acid oxidation through AMP-activated protein kinase (AMPK)-mediated carnitine palmitoyltransferase 1A (CPT1A) induction. In conclusion, rosmarinic acid exhibited a lipid-lowering effect by modulating the expression of RCT-related proteins and lipid metabolism-associated molecules, confirming its potential for the prevention or treatment of hyperlipidemia-derived diseases.

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Section: Discussionmentioning

confidence: 99%

Rosmarinic Acid Exhibits a Lipid-Lowering Effect by Modulating the Expression of Reverse Cholesterol Transporters and Lipid Metabolism in High-Fat Diet-Fed Mice

Nyandwi

Jin

et al. 2021

Biomolecules

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“…The primary finding from this study is that participating in RE was associated with 20%–30% reduced risk of developing obesity defined by BMI, WC, or PBF. A 20%–30% risk reduction is comparable to the 20%–30% reduced risk of cardiovascular disease observed when adults from the general population with average cholesterol levels are prescribed short-term statin therapy [ 32 ]. The associations between RE and obesity were consistent among various subgroups (e.g., men/women, older/younger participants) and persisted after adjusting for several potential confounders, including AE.…”

Section: Discussionmentioning

confidence: 99%

Resistance exercise, alone and in combination with aerobic exercise, and obesity in Dallas, Texas, US: A prospective cohort study

et al. 2021

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Background Obesity is a significant and growing public health problem in high-income countries. Little is known about the relationship between resistance exercise (RE), alone and in combination with aerobic exercise (AE), and the risk of developing obesity. The purpose of this prospective cohort study was to examine the associations between different amounts and frequencies of RE, independent of AE, and incident obesity. Methods and findings Participants were 11,938 healthy adults ages 18–89 years with a BMI < 30 kg/m2 at baseline who completed at least 2 clinical examinations during 1987–2005 as part of the Aerobics Center Longitudinal Study. Self-reported RE participation in minutes/week and days/week was collected from a standardized questionnaire. Incident obesity was defined as a BMI ≥ 30 kg/m2 at follow-up. Incident obesity was also defined by waist circumference (WC) > 102/88 cm for men/women and percent body fat (PBF) ≥ 25%/30% for men/women at follow-up in participants who were not obese by WC (n = 9,490) or PBF (n = 8,733) at baseline. During the average 6-year follow-up, 874 (7%), 726 (8%), and 1,683 (19%) developed obesity defined by BMI, WC, or PBF, respectively. Compared with no RE, 60–119 min/wk of RE was associated with 30%, 41%, and 31% reduced risk of obesity defined by BMI (hazard ratio [95% CI], 0.70 [0.54–0.92], p = 0.008), WC (0.59 [0.44–0.81], p < 0.001), and PBF (0.69 [0.57–0.83], p < 0.001), respectively, after adjusting for confounders including age, sex, examination year, smoking status, heavy alcohol consumption, hypertension, hypercholesterolemia, diabetes, and AE. Compared with not meeting the RE guidelines of ≥2 d/wk, meeting the RE guidelines was associated with 18%, 30%, and 30% reduced risk of obesity defined by BMI (hazard ratio [95% CI], 0.82 [0.69–0.97], p = 0.02), WC (0.70 [0.57–0.85], p < 0.001), and PBF (0.70 [0.62–0.79], p < 0.001), respectively. Compared with meeting neither guideline, meeting both the AE and RE guidelines was associated with the smallest hazard ratios for obesity. Limitations of this study include limited generalizability as participants were predominantly white men from middle to upper socioeconomic strata, use of self-reported RE, and lack of detailed diet data for the majority of participants. Conclusions In this study, we observed that RE was associated with a significantly reduced risk of obesity even after considering AE. However, meeting both the RE and AE guidelines was associated with the lowest risk of obesity.

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“…1 Some investigators advocate initiating statin therapy with a moderate-intensity agent and, if well-tolerated, up-titrating to a higher dose. 39,40 However, because most patients tolerate a high-intensity statin, [34][35][36]38 there is no compelling reason other than patient preference to start with a low-to moderate-intensity statin followed by uptitration. If a patient who has begun taking a high-intensity statin convincingly demonstrates statin-associated adverse effects, however, a moderate-intensity statin should be tried.…”

Section: High-intensity Statins Generally Well Toleratedmentioning

confidence: 99%

High-Intensity Statins Benefit High-Risk Patients: Why and How to Do Better

Grundy

Stone

Blumenthal

et al. 2021

Mayo Clinic Proceedings

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Review of the US and European literature indicates that most patients at high risk for atherosclerotic cardiovascular disease (ASCVD are not treated with high-intensity statins, despite strong clinical-trial evidence of maximal statin benefit. High-intensity statins are recommended for 2 categories of patients: those with ASCVD (secondary prevention) and high-risk patients without clinical ASCVD. Most patients with ASCVD are candidates for high-intensity statins, with a goal for low-density lipoprotein cholesterol reduction of 50% or greater. A subgroup of patients with ASCVD are at very high risk and can benefit by the addition of nonstatin drugs (ezetimibe with or without bile acid sequestrant or bempedoic acid and/or a proprotein convertase subtilisin/kexin type 9 inhibitor). High-risk primary prevention patients are those with severe hypercholesterolemia, diabetes with associated risk factors, and patients aged 40 to 75 years with a 10-year risk for ASCVD of 20% or greater. In patients with a 10-year risk of 7.5% to less than 20%, coronary artery calcium scoring is an option; if the coronary artery calcium score is 300 or more Agatston units, the patient can be up-classified to high risk. If high-intensity statin treatment is not tolerated in high-risk patients, a reasonable approach is to combine a moderate-intensity statin with ezetimibe. In very high-risk patients, proprotein convertase subtilisin/kexin type 9 inhibitors lower low-density lipoprotein cholesterol levels substantially and hence reduce risk as well.

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Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Cited by 48 publications

References 36 publications

Rosmarinic Acid Exhibits a Lipid-Lowering Effect by Modulating the Expression of Reverse Cholesterol Transporters and Lipid Metabolism in High-Fat Diet-Fed Mice

Rosmarinic Acid Exhibits a Lipid-Lowering Effect by Modulating the Expression of Reverse Cholesterol Transporters and Lipid Metabolism in High-Fat Diet-Fed Mice

Resistance exercise, alone and in combination with aerobic exercise, and obesity in Dallas, Texas, US: A prospective cohort study

High-Intensity Statins Benefit High-Risk Patients: Why and How to Do Better

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