450 research outputs found
Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid - a position paper developed by the European Consensus Panel on HDL-C
No full textReduction of low-density lipoprotein cholesterol (LDL-C) is presently the primary focus of lipid-lowering therapy for prevention and treatment of coronary heart disease (CHD). However, the high level of residual risk among statin-treated patients in recent coronary prevention studies indicates the need for modification of other major components of the atherogenic lipid profile. There is overwhelming evidence that a low plasma level of high-density lipoprotein cholesterol (HDL-C) is an important independent risk factor for CHD. Moreover, a substantial proportion of patients with or at risk of developing premature CHD typically exhibit distinct lipid abnormalities, including low HDL-C levels. Thus, therapeutic intervention aimed at raising HDL-C, within the context of reducing global cardiovascular risk, would benefit such patients, a viewpoint increasingly adopted by international treatment guidelines. Therapeutic options for patients with low HDL-C include treatment with statins, fibrates and nicotinic acid, either as monotherapy or in combination. Of these options, nicotinic acid is not only the most potent agent for raising HDL-C but is also effective in reducing key atherogenic lipid components including triglyceride-rich lipoproteins (mainly very low-density lipoproteins [VLDL] and VLDL remnants), LDL-C, and lipoprotein(a). The principal features of the atherogenic lipid profile in type 2 diabetes and the metabolic syndrome make them logical targets for nicotinic acid therapy, either alone or in combination with a statin. The lack of comprehensive European data on the prevalence of low HDL-C levels highlights a critical need for education on the importance of raising HDL-C in CHD prevention and treatment. The development of a reliable and accurate assay for HDL-C, as well as clarification of criteria for low and optimal levels of HDL-C in both men and women, constitute critical factors in the reliable identification and treatment of patients at elevated risk of CHD due to low HDL-C. Based on the available evidence, the European Consensus Panel recommends that the minimum target for HDL-C should be 40 mg/dL (1.03 mmol/L) in patients with CHD or with a high level of risk for CHD, including patients at high global risk with type 2 diabetes or the metabolic syndrome
Residual macrovascular risk in 2013: What have we learned?
No full textCardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk. © 2014 Fruchart et al.; licensee BioMed Central Ltd
Lessons from PROMINENT and prospects for pemafibrate
No full textThe neutral result of the PROMINENT trial has led to questions about the future for pemafibrate. This commentary discusses possible reasons for the lack of benefit observed in the trial. There were, however, indicators suggesting therapeutic potential in microvascular ischaemic complications associated with peripheral artery disease, with subsequent analysis showing reduction in the incidence of lower extremity ischaemic ulceration or gangrene. Reassurance about the safety of pemafibrate, together with emerging data from PROMINENT and experimental studies, also suggest benefit with pemafibrate in non-alcoholic fatty liver disease (alternatively referred to as metabolic dysfunction-associated steatotic liver disease) and microangiopathy associated with diabetes, which merit further study
1.1. Le cadre environnemental et son évolution à l'échelle microrégionale
No full textBarral (Coord.), Billoin (D.), Blin (S.), Bossuet (G.), Cramatte (C.), Fruchart (C.) Laplaige (C.), Mamie (A.), Monnier (J.), Mougin (P.), Nouvel (P.), Piningre (J.-F.), Thivet (M.), Nouvelles données sur l’agglomération antique d’Epomanduodurum (Mandeure et Mathay, Doubs)International audienc
1.4. Dynamique du peuplement et formes de l’habitat dans le secteur de Mandeure, entre la fin de l’âge du Fer et le début du Moyen-Âge
No full textBarral (Coord.), Billoin (D.), Blin (S.), Bossuet (G.), Cramatte (C.), Fruchart (C.) Laplaige (C.), Mamie (A.), Monnier (J.), Mougin (P.), Nouvel (P.), Piningre (J.-F.), Thivet (M.), Nouvelles données sur l’agglomération antique d’Epomanduodurum (Mandeure et Mathay, Doubs)International audienc
2.2.2. La trame viaire de l'agglomération Antique et son intégration aux axes de communication
No full textBarral (Coord.), Billoin (D.), Blin (S.), Bossuet (G.), Cramatte (C.), Fruchart (C.) Laplaige (C.), Mamie (A.), Monnier (J.), Mougin (P.), Nouvel (P.), Piningre (J.-F.), Thivet (M.), Nouvelles données sur l’agglomération antique d’Epomanduodurum (Mandeure et Mathay, Doubs)International audienc
Juan Bartolomé: In the footsteps of B. Cabrera, C. J. Gorter, and L. Néel
No full textInternational audienceInterestingly, in the proceedings of the “Institut International de Cooperation Intellectuelle” the meeting “Réunion d’Etudes sur le Magnétisme” helded in Strasbourg, 21–25 May 1939,1 one can find the successive contributions of C. J. Gorter (p. 57), L. Néel (p. 58), and B. Cabrera (p. 59). The Dutch scientist is known having contributed merely on paramagnetism and relaxation, the French scientist, having focused on the molecular field, sending out the basis of antiferromagnetism and the Spanish, the oldest, was of the pioneers and productive scientists in terms of magnetic properties. Indeed, the main concern of those physicists and their distinguished colleagues was to better understand the behavior of magnetic materials versus temperature, pressure, alloying combinations. So they aimed to introduce the necessary thermodynamic considerations in stabilizing magnetic couplings
2.2.1. L’occupation de l’agglomération antique de Mandeure / Mathay : phases de développement du tissu urbain
No full textBarral (Coord.), Billoin (D.), Blin (S.), Bossuet (G.), Cramatte (C.), Fruchart (C.) Laplaige (C.), Mamie (A.), Monnier (J.), Mougin (P.), Nouvel (P.), Piningre (J.-F.), Thivet (M.), Nouvelles données sur l’agglomération antique d’Epomanduodurum (Mandeure et Mathay, Doubs)International audienc
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