Journal Of Clinical Lipidology[JOURNAL]
Sun
200 papers
Predictive value of lipoprotein(a) in patients undergoing percutaneous coronary intervention with drug-eluting stent: A meta-analysis.
Chuanchai W, Pajareya P, Siranart N … +4 more , Phutinart S, Sowalertrat W, Laojindapun P, Techasatian W
J Clin Lipidol · 2026 Apr · PMID 42002380 · Publisher ↗
BACKGROUND: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis. Drug-eluting stents (DES) were developed to delay the progression of atherosclerosis. However, the diagnostic and prognostic value of...
BACKGROUND: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis. Drug-eluting stents (DES) were developed to delay the progression of atherosclerosis. However, the diagnostic and prognostic value of Lp(a) in patients undergoing percutaneous coronary intervention (PCI) with DES remains unknown. OBJECTIVE: We aim to evaluate the prognostic impact of serum Lp(a) level on cardiovascular outcomes and predictive value on repeat revascularization in patients undergoing PCI with DES. METHODS: We conducted a literature search from the inception of PubMed to May 2025. Eligible studies include adult patients, with the majority (>90%) undergoing PCI with DES. Primary outcomes were the prognostic value of Lp(a) in predicting major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, cardiovascular (CV) mortality, and all-cause mortality. Secondary outcomes were the diagnostic value of Lp(a) for repeat revascularization, target vessel revascularization (TVR), and target lesion revascularization (TLR) evaluated in terms of sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). RESULTS: Eleven cohorts were included, comprising a total of 27,618 patients (mean age 61 ± 10.2 years, mean follow-up 4.5 ± 1.98 years). For primary outcomes, high Lp(a) level was associated with increased risks of MACE (odds ratio [OR] 1.25, 95% CI 1.09-1.42), MI (OR 1.75, 95% CI 1.08-2.83), stroke (OR 1.28, 95% CI 1.04-1.59), CV mortality (OR 1.37, 95% CI 1.02-1.83), and all-cause mortality (OR 1.29, 95% CI 1.04-1.59). For secondary outcomes, high Lp(a) level showed sensitivity of 46%, 35%, and 39% and specificity of 64%, 74%, and 79% in predicting repeat revascularization, TLR, and TVR, respectively. The AUROC for repeat revascularization, TLR, and TVR were 0.527, 0.536, and 0.537, respectively. CONCLUSION: High Lp(a) level in patients who underwent PCI with DES was associated with poor prognosis; however, the predictive value of Lp(a) in this population remains inconclusive.
From the Editors: New 2026 guideline for management of dyslipidemia.
Barton Duell P, Maki KC
J Clin Lipidol · 2026 Apr · PMID 42002379 · Publisher ↗
Abstract loading — click title to view on PubMed.
Elevated LDL-C and non-HDL-C in U.S. adults with normal total serum cholesterol.
Essa M, Zhang Z, Martin SS … +5 more , Michos ED, Jones SR, Spatz ES, Blumenthal RS, Faridi KF
J Clin Lipidol · 2026 Jun · PMID 42000209 · Publisher ↗
BACKGROUND: Serum total cholesterol (TC) <200 mg/dL is considered normal for adults in laboratory reporting and public health messaging, although low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprote...
BACKGROUND: Serum total cholesterol (TC) <200 mg/dL is considered normal for adults in laboratory reporting and public health messaging, although low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) may be elevated within this range. OBJECTIVE: Determine the prevalence of elevated LDL-C and non-HDL-C among adults with normal TC. METHODS: We used 2011-2020 National Health and Nutrition Examination Survey data to determine survey-weighted prevalence of elevated LDL-C, non-HDL-C, and statin eligibility among adults without atherosclerotic cardiovascular disease (ASCVD) who had TC <200 mg/dL without lipid-lowering therapy. RESULTS: Among 9163 participants representing 82.6 million adults, 47.5% (95% CI, 45.2%-49.8%) had LDL-C ≥100 mg/dL and 30.8% (29.4%-32.1%) had non-HDL-C ≥130 mg/dL. Elevated LDL-C or non-HDL-C was highest among adults with elevated triglycerides or metabolic syndrome. Prevalence decreased with lower TC, and no participants with TC <150 mg/dL had LDL-C ≥100 mg/dL or non-HDL-C ≥130 mg/dL. Among adults aged 40 to 75 years, 43.3% were statin-eligible based on 2018 U.S. CONCLUSION: Nearly half of ASCVD-free U.S. adults with 'normal' TC have elevated LDL-C or non-HDL-C, supporting greater emphasis on atherogenic cholesterol measures for public health and individual risk stratification.
Novel MFN2 compound heterozygote genotype in a patient with multiple symmetric lipomatosis and metabolic dysfunction.
Lefebvre FA, Paquette M, Baass A
J Clin Lipidol · 2026 Jun · PMID 41991472 · Publisher ↗
Inherited lipodystrophy syndromes are rare disorders of energy metabolism. Patients exhibit adipose tissue atrophy with metabolic dysregulation linked to ectopic fat deposition. Here, we describe the case of a 67-year-ol...
Inherited lipodystrophy syndromes are rare disorders of energy metabolism. Patients exhibit adipose tissue atrophy with metabolic dysregulation linked to ectopic fat deposition. Here, we describe the case of a 67-year-old woman presenting with partial adipose tissue atrophy, multiple symmetric lipomatosis, and muscle pseudohypertrophy. Metabolically, she had long-lasting diabetes mellitus with severe insulin resistance and hypertriglyceridemia. She developed hepatomegaly with steatosis, neuropathy, proteinuria, and coronary artery disease. In accordance with an inherited etiology, the patient's family history was positive for lipomatosis and premature heart disease. Targeted sequencing identified a variant in the MFN2 gene, previously linked to lipomatosis and Charcot-Marie-Tooth neuropathy. Copy number variation analysis revealed a novel 5.4 kb duplication in the MFN2 gene. Hence, we describe a novel compound heterozygote MFN2 genotype in this patient, which we believe accounts for her metabolic phenotype. Raising awareness of lipodystrophy syndromes is important because treatment with recombinant leptin, when available, can improve metabolic outcomes.
Commentary on reduction of major adverse cardiovascular events in primary prevention trials (meta-analysis by Kalra et al.).
Goldberg AC, Soffer DE
J Clin Lipidol · 2026 May · PMID 41986181 · Publisher ↗
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Clinical outcomes of lipid apheresis in hypertriglyceridemia-induced acute pancreatitis: A 10-year triglyceride-stratified retrospective study.
Qi S, Wang S, Chen W … +7 more , Chen W, Ni T, Xu D, Yang Z, Mao E, Chen E, Chen Y
J Clin Lipidol · 2026 Jun · PMID 41963121 · Publisher ↗
BACKGROUND: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has become the second leading cause of acute pancreatitis in China, accounting for approximately 20% of cases. Although lipid apheresis (LA) reduces tr...
BACKGROUND: Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) has become the second leading cause of acute pancreatitis in China, accounting for approximately 20% of cases. Although lipid apheresis (LA) reduces triglyceride (TG) levels, its clinical utility and patient selection criteria remain unclear. OBJECTIVE: This study aimed to evaluate LA outcomes in patients with HTG-AP, comparing outcomes between those with baseline TG levels of 22.4 to 56.5 mmol/L and >56.5 mmol/L. METHODS: This was a single-center retrospective cohort study utilizing data from the electronic medical records of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (from January 2014 to August 2024). RESULTS: A total of 608 patients with HTG-AP were included, of whom 123 underwent LA. After propensity score matching, 65 matched pairs were included. Generalized linear model analysis showed that LA was significantly associated with higher odds of intensive care unit (ICU) admission (β = 2.49, P < .01). The LA group had higher TG levels (β = 0.48, P < .01) and higher Acute Physiology and Chronic Health Evaluation II scores on day 3 (β = 0.16, P = .047). No significant differences were observed in C-reactive protein, systemic inflammatory response syndrome, computed tomography severity index, or sequential organ failure assessment scores. Among LA-treated patients, those with baseline TG >56.5 mmol/L had a significantly higher likelihood of prolonged hospitalization (length of stay >14 days) compared with the 22.4 to 56.5 mmol/L group (β = 1.43, P < .01). Sensitivity analyses supported the robustness of the primary results. CONCLUSION: LA therapy was associated with higher odds of ICU admission in patients with HTG-AP. Among LA-treated patients, baseline TG >56.5 mmol/L predicted prolonged hospitalization, which was supported by sensitivity analysis.
Early metabolic alterations in pediatric obesity: Depot-specific insights from untargeted adipose tissue metabolomics.
López-Gonzálvez Á, Muñoz-San Martín C, Soria-Gondek A … +13 more , Requena B, Fernández-García P, González L, Reyes-Farias M, Murillo M, Valls A, Corrales P, Villarroya F, Cereijo R, Herrero L, Barbas C, Sánchez-Infantes D, Gonzalez-Riano C
J Clin Lipidol · 2026 Jun · PMID 41963120 · Publisher ↗
BACKGROUND: Childhood obesity is associated with lifelong metabolic risk, yet depot-specific alterations in adipose tissue metabolism during early life remain poorly understood. OBJECTIVE: This study aimed to characteriz...
BACKGROUND: Childhood obesity is associated with lifelong metabolic risk, yet depot-specific alterations in adipose tissue metabolism during early life remain poorly understood. OBJECTIVE: This study aimed to characterize the metabolic differences between subcutaneous (sWAT) and visceral white adipose tissue (vWAT) in pediatric obesity using untargeted metabolomics. METHODS: Adipose tissue samples were collected from 12 children with overweight/obesity (OW/OB) and 18 who were of normal weight (NW). Untargeted metabolomics was performed using capillary electrophoresis-mass spectrometry to profile polar metabolites in sWAT and vWAT, and free fatty acids (FFAs) were analyzed using liquid chromatography-mass spectrometry. RESULTS: Comparison of children with OW/OB vs NW revealed pronounced depot-specific heterogeneity. vWAT in children with OW/OB exhibited 24 significantly altered metabolites compared with NW controls. This visceral profile was characterized by elevated ketone bodies (3-hydroxybutyrate and acetoacetic acid), tricarboxylic acid cycle intermediates (citric and pyruvic acids), and long-chain FFAs (palmitic and oleic acids). Concurrently, amino acid imbalances, specifically elevated leucine and arginine but reduced histidine and carnosine, suggested heightened mitochondrial stress and inflammation. In contrast, sWAT from children with OW/OB showed fewer variations (12 metabolites), defined primarily by elevated glutamate, leucine, and short-chain FFAs, reflecting a milder metabolic disruption. Direct comparison between depots revealed that vWAT was enriched in amino acids and carnitine, while sWAT showed relatively higher levels of glycolytic and ketone body intermediates in NW conditions. CONCLUSION: Depot-specific metabolic differences are evident in pediatric obesity. vWAT in children with OW/OB displays a metabolic profile consistent with heightened lipotoxicity and mitochondrial stress, whereas sWAT exhibits fewer, less pronounced metabolic differences.
Dyslipidemia and its risk factors among adolescents: A population-based analysis from the Comprehensive National Nutrition Survey of India, 2016-2018.
Kalaivani M, Amudhan S, Hemraj C … +7 more , Bharti R, Rana G, Abraham RA, Varhlunchhungi, Sachdev HS, Ramakrishnan S, Lakshmy R
J Clin Lipidol · 2026 Jun · PMID 41951469 · Publisher ↗
BACKGROUND: Despite the rising prevalence of dyslipidemia in adolescents from socioeconomic and lifestyle transitions, nationally representative data on dyslipidemia and its risk factors among Indian adolescents remain l...
BACKGROUND: Despite the rising prevalence of dyslipidemia in adolescents from socioeconomic and lifestyle transitions, nationally representative data on dyslipidemia and its risk factors among Indian adolescents remain limited. OBJECTIVE: This study aimed to estimate the prevalence and risk factors of dyslipidemia among Indian adolescents using nationally representative survey data. METHODS: Using the Comprehensive National Nutrition Survey (CNNS) data (2016-2018), we estimated the prevalence and risk factors of dyslipidemia among adolescents aged 10 to 19 years (n = 11,960). Overall dyslipidemia (≥1 lipid abnormality) prevalence was estimated at the national and state levels, accounting for sampling design. Prevalence of each lipid abnormality was stratified by age, gender, and residence. Binomial logistic regression examined associated risk factors and interactions between lifestyle factors and comorbidities. RESULTS: In CNNS, overall dyslipidemia prevalence was 39.9% (95% CI: 37.4-42.4), higher in boys (41.9%), late-adolescents (42.5%), and rural residents (41.1%). Prevalence varied widely across states. Low high-density lipoprotein cholesterol (HDL-C) (28.0%) was the most prevalent lipid abnormality, followed by high triglycerides (TGs) (15.8%). Low HDL-C was more prevalent in boys, and high TG was more prevalent in girls, whereas both abnormalities were more prevalent in late adolescents and rural areas. Besides male gender and late adolescence, lower wealth index, Muslims or Christians, overweight/obesity, alcohol use, and low physical activity had higher odds of dyslipidemia. Belonging to other socio-educationally disadvantaged communities or being ovovegetarian was protective. Alcohol use, diet, and obesity showed significant interactions. CONCLUSION: In India, nearly two-fifths of the adolescents have dyslipidemia, posing a substantial future cardiovascular disease burden and premature mortality. These findings emphasize the need for school-based early screening and lifestyle interventions.
Guideline-based lipid-lowering therapy in acute coronary syndromes: A simulation of population-level impact on cardiovascular events and LDL-C goal achievement.
Steen DL, Ray KK, Khan I … +5 more , Catapano AL, Bhatt DL, Koumas A, Pol K, Giugliano RP
J Clin Lipidol · 2026 May · PMID 41935912 · Publisher ↗
BACKGROUND: Despite high cardiovascular risk, many patients with acute coronary syndrome (ACS) do not receive timely intensification of lipid-lowering therapy (LLT). OBJECTIVE: To predict the impact of LLT intensificatio...
BACKGROUND: Despite high cardiovascular risk, many patients with acute coronary syndrome (ACS) do not receive timely intensification of lipid-lowering therapy (LLT). OBJECTIVE: To predict the impact of LLT intensification on cardiovascular events and attainment of low-density lipoprotein cholesterol (LDL-C) goals in this population. METHODS: A Monte Carlo simulation was conducted using data from 54,154 patients with ACS to estimate 5-year rates of a composite endpoint of myocardial infarction, ischemic stroke, or cardiovascular death. Three immediate LLT strategies were modeled: (1) high-intensity statin (HIS) + ezetimibe (EZE), (2) HIS + alirocumab (ALI), and (3) HIS + EZE + ALI (triple LLT). Two delayed strategies were also assessed: (1) HIS + EZE at baseline with ALI added at 6 months if LDL-C goals were unmet, and (2) HIS alone at baseline with sequential addition of EZE at 6 months and ALI at 12 months if goals were unmet. LDL-C goals included <55 mg/dL and <40 mg/dL, each with and without ≥50% reduction. Subgroups included patients with prior ischemic stroke or without revascularization during ACS hospitalization. RESULTS: Triple LLT reduced the predicted 5-year event rate from 22.2% (95% CI: 21.8-22.6) with HIS alone to 14.3% (95% CI: 14.0-14.6), yielding an absolute risk reduction of 8.0% (95% CI: 7.6-8.3) and a relative reduction of 35.8% (95% CI: 34.4-37.2). Predicted benefit was greater in patients with prior ischemic stroke or no revascularization, with LDL-C goals achieved in nearly all patients. CONCLUSIONS: Triple LLT initiated at ACS hospitalization may markedly reduce cardiovascular events through earlier and more complete achievement of LDL-C targets.
Association of LDL-C between parents and younger offspring: A cross-sectional study using the Korea National Health and Nutrition Examination Survey.
Kay HY, Kim HI, Jang HY
J Clin Lipidol · 2026 May · PMID 41935911 · Publisher ↗
BACKGROUND: Atherosclerotic cardiovascular disease develops in adulthood, but its metabolic precursors, such as dyslipidemia, often emerge during childhood. OBJECTIVE: This study aimed to evaluate the associations of par...
BACKGROUND: Atherosclerotic cardiovascular disease develops in adulthood, but its metabolic precursors, such as dyslipidemia, often emerge during childhood. OBJECTIVE: This study aimed to evaluate the associations of parental low-density lipoprotein cholesterol (LDL-C) levels with their offspring's LDL-C levels and dyslipidemia risk. METHODS: This study examined the intergenerational association between parental dyslipidemia (LDL-C-defined) and offspring LDL-C levels using nationally representative data from the Korea National Health and Nutrition Examination Survey (2017-2023). RESULTS: A total of 2702 first-born children aged 7 to 18 years with available parental lipid data were included. Offspring hypercholesterolemia was defined as LDL-C ≥130 mg/dL, and parental dyslipidemia as a diagnosis of dyslipidemia (ie, total cholesterol ≥240 mg/dL, LDL-C ≥160 mg/dL, or use of lipid-lowering medication). Linear regression was used to assess associations between parental and offspring LDL-C, and logistic regression to estimate odds ratios (ORs) for offspring hypercholesterolemia (high LDL-C levels) according to parental dyslipidemia (LDL-C-defined). Statistical interaction terms between maternal LDL-C and offspring biological sex or age group (7-12 vs 13-18 years) were tested. Both maternal and paternal LDL-C were significantly associated with offspring LDL-C (β = 0.214 and 0.113, respectively; both P < .001). Offspring hypercholesterolemia (high LDL-C levels) risk increased with parental dyslipidemia (LDL-C-defined) (OR = 2.12 for father only, 4.03 for mother only, and 3.83 for both parents; all P < .01). CONCLUSION: These findings highlight maternal LDL-C as a predominant determinant of offspring lipid levels and emphasize the importance of family-based early screening and preventive strategies.
The effect of sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors on the lipid profiles of patients with type II diabetes and coronary artery disease: A retrospective study.
Theertham A, Low GK, Thondup T … +7 more , Upadhyay J, Leung AN, Yao W, Grover J, Nawaz S, Samson E, Tan TC
J Clin Lipidol · 2026 May · PMID 41935910 · Publisher ↗
BACKGROUND: Patients with type 2 diabetes mellitus and established coronary artery disease (CAD) carry a very high cardiovascular risk, requiring aggressive lipid management. Sodium-glucose cotransporter-2 inhibitors (SG...
BACKGROUND: Patients with type 2 diabetes mellitus and established coronary artery disease (CAD) carry a very high cardiovascular risk, requiring aggressive lipid management. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) are widely used for glycemic control, but their effects on lipid profiles in high-risk patients remain unclear. OBJECTIVE: To evaluate the association between SGLT2i and DPP4i therapies with low-density lipoprotein cholesterol (LDL-C), additional lipid parameters, and clinical outcomes in patients with type 2 diabetes and established CAD. METHODS: We retrospectively analyzed diabetic inpatients with angiographically confirmed CAD, stratified by use of SGLT2i, DPP4i, combination therapy, or neither at admission. The primary outcome was the difference in LDL-C, assessed using multivariable linear regression adjusted for statin use and cardiometabolic comorbidities. Secondary lipid parameters were analyzed similarly. Clinical outcomes included a composite of all-cause mortality and major adverse cardiovascular events (MACE), analyzed using Cox regression, with Fine-Gray competing risk models for individual components. RESULTS: A total of 423 patients (74% male, median age 65) were included: 68 on SGLT2i, 76 on DPP4i, 31 on combination therapy, and 248 on neither. After adjustment, SGLT2i use was associated with reduced LDL-C (β = -0.39 mmol/L; 95% CI -0.67 to -0.10), as was combination therapy (β = -0.38 mmol/L; 95% CI -0.75 to -0.02), with no change observed in the DPP4i group. SGLT2i monotherapy was also associated with lower total cholesterol and non-high-density lipoprotein cholesterol. Over 2.8 years, SGLT2i monotherapy was linked to reduced risk of the composite outcome (hazard ratio 0.55; 95% CI 0.31 to 0.97), whereas DPP4i and combination therapy showed no association. CONCLUSION: SGLT2i use in patients with diabetes and CAD was associated with modest LDL-C reductions and lower risk of mortality/MACE, supporting further evaluation of their potential lipid-modifying role in secondary prevention.
Lipoprotein lipase DNA methylation in the adipose tissue of patients with persistent chylomicronemia.
Larouche M, Brisson D, Laprise C … +1 more , Gaudet D
J Clin Lipidol · 2026 May · PMID 41934047 · Publisher ↗
BACKGROUND: Persistent chylomicronemia (PC) is a rare condition characterized by plasma triglyceride concentration persistently >10 mmol/L despite treatment, reflecting a lack of lipoprotein lipase (LPL) bioavailability....
BACKGROUND: Persistent chylomicronemia (PC) is a rare condition characterized by plasma triglyceride concentration persistently >10 mmol/L despite treatment, reflecting a lack of lipoprotein lipase (LPL) bioavailability. PC encompasses patients with the familial chylomicronemia syndrome (FCS) and patients with multifactorial PC. Life habits and environmental factors are known modulators of DNA methylation (DNAme), which can influence access to the LPL gene and possibly contribute to the expression of PC. OBJECTIVE: To compare LPL DNAme in blood and adipose tissue of patients with PC or other causes of hypertriglyceridemia (HTG) and normotriglyceridemic controls. METHODS: DNA was extracted from blood and adipose tissue in 186 participants: 31 with PC (21 FCS, 10 multifactorial PC), 125 with HTG, and 30 controls. DNAme was measured using pyrosequencing at 22 cytosine-phosphate-guanine sites (CpGs) located in the promoter and between the first exons of the LPL gene. Differences in LPL DNAme were assessed according to the genotype and severity of HTG. RESULTS: No difference in LPL DNAme was observed in blood samples. In adipose tissues, patients with FCS were significantly less methylated at 2 CpGs located in the LPL gene body compared with other genotypes (Δϐ = 2.85% and 3.78%, P = .011). When DNAme was analyzed according to HTG severity, the same CpGs were less methylated in patients with PC of any cause compared with other groups (Δϐ = 4.55%, P = .002; Δϐ = 7.70%, P < .001). CONCLUSION: In this study, the LPL DNAme signature in adipose tissue differed in patients with PC compared with others, highlighting that different factors might contribute to PC and its associated risks.
Changes in lipoprotein(a) and their association with LDL-C in patients with ACS treated with triple oral lipid-lowering therapy.
Mahajan K, Mahajan N, Sharma JB … +3 more , Himral S, Bhatia T, Dutta D
J Clin Lipidol · 2026 Mar · PMID 41925481 · Publisher ↗
BACKGROUND: Lipoprotein(a) [Lp(a)] is a well-established, genetically determined risk factor for atherosclerotic cardiovascular disease, but its short-term response to aggressive lipid-lowering therapy after acute corona...
BACKGROUND: Lipoprotein(a) [Lp(a)] is a well-established, genetically determined risk factor for atherosclerotic cardiovascular disease, but its short-term response to aggressive lipid-lowering therapy after acute coronary syndrome (ACS) remains unclear. OBJECTIVE: To evaluate 1-month changes in Lp(a) and assess whether baseline Lp(a) levels are associated with low-density lipoprotein cholesterol (LDL-C) goal achievement in statin-naive ACS patients undergoing triple oral lipid-lowering therapy. METHODS: We retrospectively analyzed 345 patients with ACS treated with rosuvastatin (20-40 mg), ezetimibe (10 mg), and bempedoic acid (180 mg) for 1 month after percutaneous coronary intervention. Lp(a) and LDL-C were measured at baseline and 1 month. Multivariable logistic regression identified predictors of achieving the LDL-C goal (<50 mg/dL). RESULTS: Despite a 59.1 ± 17.3% reduction in the mean LDL-C, the average Lp(a) increased by 91% (from 42.2 ± 39.2 mg/dL to 80.5 ± 66.3 mg/dL, P < .001). LDL-C targets of <50 mg/dL and <55 mg/dL were achieved in 68.9% and 78.6% patients, respectively. Baseline Lp(a) independently predicted failure to reach LDL-C goals (adjusted odds ratio [OR] 0.97; 95% CI 0.96-0.98; P < 0.001), while diabetes mellitus increased the likelihood of achieving targets (adjusted OR 2.69; 95% CI 1.36-5.61; P = .006). A strong inverse relationship was observed between Lp(a) change and LDL-C goal achievement (ρ = -0.38, P < 10⁻¹²). CONCLUSION: In Indian patients with ACS, aggressive triple oral lipid-lowering therapy quickly reduces LDL-C, while being accompanied by a substantial rise in Lp(a) levels, likely reflecting an acute-phase response. Baseline Lp(a) may independently limit LDL-C target attainment. Early Lp(a) testing may improve residual risk assessment and help guide the use of emerging Lp(a)-focused treatments.
C-reactive protein-triglyceride-glucose index is an independent predictor of cardiovascular mortality in patients with metabolic syndrome.
Ghay S, Elajami MK, Kaur B … +6 more , Abushamat LA, Urina-Jassir D, Bahmad HF, Welty FK, Mihos CG, Elajami TK
J Clin Lipidol · 2026 May · PMID 41881698 · Publisher ↗
BACKGROUND: Metabolic syndrome (MetS) is characterized by an interplay of risk factors mediated by chronic inflammation and is strongly linked to increased cardiovascular (CV) mortality. C-reactive protein-triglyceride-g...
BACKGROUND: Metabolic syndrome (MetS) is characterized by an interplay of risk factors mediated by chronic inflammation and is strongly linked to increased cardiovascular (CV) mortality. C-reactive protein-triglyceride-glucose index (CTI) has emerged as a marker for both insulin resistance and systemic inflammation, both established CV risk factors. This study examines whether CTI predicts CV mortality among adults with MetS. METHODS: The National Health and Nutrition Examination Survey database was queried from 1999 to 2010, and data on mortality follow-up through December 31, 2019, were analyzed. Patients with MetS were identified by stratifying individuals aged ≥20 years who met ≥3 of the 5 MetS criteria. CTI was derived using the formula 0.412 × ln(C-reactive protein [mg/L]) + ln(Triglycerides [mg/dL] × Fasting Glucose [mg/dL]/2). Cox proportional hazards models were used to assess the association between CTI and CV mortality. Restricted cubic splines assessed for nonlinearity in this association. RESULTS: A total of 10,421 patients with MetS were identified. In a fully adjusted survey-weighted model, each 1-unit increase in CTI was associated with a 32% higher risk of CV mortality (hazard ratio [HR] = 1.32; 95% CI: 1.07-1.62; P = .010). Quartile-based analysis revealed no significant association for Quartiles 2 and 3 compared with Quartile 1. However, Quartile 4 had significantly higher CV mortality (HR = 1.60; 95% CI: 1.13-2.25; P = .007). Spline analysis supported a linear relationship. CONCLUSION: Higher CTI, particularly values in the highest quartile, was independently associated with increased CV mortality in adults with MetS. These findings suggest that CTI may help identify high-risk individuals for early prevention.
Dyslipidemia and therapies after heart transplantation: Current evidence and future directions.
Yadalam AK, Gold ME, Patel KJ … +13 more , Razavi AC, Flowers A, Seo G, Britt WM, Eisenberg S, Book WM, Brett Rollins J, van Beuningen A, Vega JD, Butler J, Givertz MM, Quyyumi AA, Sperling LS
J Clin Lipidol · 2026 May · PMID 41876350 · Publisher ↗
BACKGROUND: Dyslipidemia following orthotopic heart transplantation (OHT) affects up to 80% of transplant recipients, contributing to both atherosclerotic cardiovascular disease and cardiac allograft vasculopathy (CAV),...
BACKGROUND: Dyslipidemia following orthotopic heart transplantation (OHT) affects up to 80% of transplant recipients, contributing to both atherosclerotic cardiovascular disease and cardiac allograft vasculopathy (CAV), a leading cause of late graft failure and mortality. As transplant rates and post-OHT survival continue to rise, understanding and managing dyslipidemia in this population is of increasing clinical importance. SOURCES OF MATERIAL: This state-of-the-art review draws upon clinical trials, retrospective analyses, observational studies, pharmacokinetic studies, and leading international cardiovascular and transplant society guidelines. ABSTRACT OF FINDINGS: Post-OHT dyslipidemia arises from traditional risk factors, including diet, obesity, diabetes, and genetic predisposition such as familial hypercholesterolemia, and is compounded by transplant-specific factors, most notably immunosuppressive (IS) medications. IS medications further contribute to lipid abnormalities through low-density lipoprotein cholesterol (LDL-C) receptor downregulation, lipoprotein lipase inhibition, and insulin resistance induction. Statins remain the cornerstone of therapy, reducing CAV incidence, rejection, and mortality through both lipid-lowering and pleiotropic immunomodulatory mechanisms, though drug interactions necessitate careful selection and dose limitation. Nonstatin adjunct therapies vary in their suitability, with select agents demonstrating favorable efficacy and safety profiles, while others carry significant interaction risks with IS medications. Emerging therapies, including bempedoic acid, siRNA therapeutics, and LDL-C apheresis show promise but require further study. CONCLUSION: Effective post-OHT dyslipidemia management requires individualized strategies accounting for transplant-specific pharmacology, drug interactions, and long-term graft outcomes. Future research should define optimal LDL-C targets and evaluate novel lipid-lowering agents in this population.
Long-term prognostic value of apolipoprotein B levels in patients with very premature (≤40 years) acute coronary syndrome.
Rallidis LS, Giannakopoulou SP, Armylagos S … +4 more , Kotakos C, Rallidis SL, Stathopoulou EP, Panagiotakos D
J Clin Lipidol · 2026 May · PMID 41864845 · Publisher ↗
BACKGROUND: Apolipoprotein B (apoB) is a recognized risk factor for acute coronary syndrome (ACS); however, its prognostic value in secondary prevention and superiority over other lipid biomarkers, especially in younger...
BACKGROUND: Apolipoprotein B (apoB) is a recognized risk factor for acute coronary syndrome (ACS); however, its prognostic value in secondary prevention and superiority over other lipid biomarkers, especially in younger populations, remains uncertain. OBJECTIVE: To investigate whether elevated baseline apoB predicts recurrent cardiovascular events in patients who experienced an ACS at ≤40 years of age and compare its incremental predictive value with that of other lipid biomarkers. METHODS: We recruited 405 consecutive patients who survived an ACS at ≤40 years of age. Clinical endpoints included major adverse cardiovascular events (MACE): cardiac death, readmission for ACS or ventricular arrhythmias, ischemic stroke, and coronary revascularization due to clinical deterioration. The association between baseline lipid biomarkers and recurrent MACE risk was assessed using multivariable Cox regression. Model performance was evaluated based on discrimination and reclassification. RESULTS: Of 378 young ACS survivors (33.7 ± 4.3 years) with follow-up data, 139 (36.8%) experienced a MACE over a median 8-year (5.2-12.5 years) follow-up. Elevated baseline apoB was independently associated with a higher risk of recurrent MACE (hazard ratio per 10 mg/dL: 1.082, P= .007). This association remained significant even after additionally accounting for low-density lipoprotein cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C). Conversely, apoB adjustment attenuated the LDL-C and non-HDL-C associations. Compared with LDL-C and non-HDL-C, apoB was associated with greater risk of recurrent MACE, and upon addition to conventional cardiovascular risk factors, yielded the greatest improvement in discrimination and reclassification. CONCLUSION: Baseline apoB may act as a driver for long-term recurrence of MACE in very young ACS survivors, highlighting its potential clinical utility to improve risk stratification beyond traditional lipid measurements.
From the Editors: Dietary Guidelines for Americans, an update on statin safety, and an upcoming meta-analysis of MACE reduction in primary prevention CVOTs.
Maki KC, Barton Duell P
J Clin Lipidol · 2026 Mar · PMID 41864750 · Publisher ↗
Abstract loading — click title to view on PubMed.
Association between remnant cholesterol and stroke among patients with atrial fibrillation: A population-based cohort study.
Li Y, Ling Y, Wu H … +8 more , Luo S, Luo J, Tang X, Li S, Zhuang X, Wu B, Xiong Z, Huang Z
J Clin Lipidol · 2026 May · PMID 41856850 · Publisher ↗
BACKGROUND: Remnant cholesterol (RC) is a modifiable risk factor for stroke in the general population; however, its role in stroke risk among patients with atrial fibrillation (AF) remains unclear. OBJECTIVE: This study...
BACKGROUND: Remnant cholesterol (RC) is a modifiable risk factor for stroke in the general population; however, its role in stroke risk among patients with atrial fibrillation (AF) remains unclear. OBJECTIVE: This study aimed to examine the associations between key RC metrics, including baseline levels, cumulative measures, average real variability (ARV), and RC/low-density lipoprotein cholesterol (LDL-C) discordance, and stroke risk in patients with AF. METHODS: A total of 2154 patients with AF from the Atherosclerosis Risk in Communities database were analyzed. RC was calculated as total cholesterol minus LDL-C and high-density lipoprotein cholesterol. Cox proportional hazards models were used to assess the associations of 4 key RC metrics with stroke risk, adjusting for potential confounders. RESULTS: Higher baseline RC levels were significantly associated with an increased risk of stroke, with an adjusted hazard ratio (HR) of 1.41 (95% CI: 1.02-1.94, P = .039). This association was linear (P overall = .008). Each 1-SD increase in RC corresponded to a 11% higher stroke risk (HR = 1.11, P = .039). Similar associations were observed for ARV (HR = 2.06, P = .041) and cumulative RC levels (HR = 1.11, P = .002). Additionally, the concordant high RC/LDL-C group was linked to a higher stroke risk (HR = 1.93, P = .01). CONCLUSION: Elevated RC baseline levels, variability, and cumulative exposure are independently associated with an increased risk of stroke in patients with AF, highlighting the need for lipid-lowering interventions targeting RC levels to mitigate stroke risk in this high-risk population.
Preoperative triglyceride-glucose index in the prediction of 1-year mortality after isolated coronary artery bypass grafting surgery.
Hançer H, Hançer H, Yiğit F … +3 more , Özgür MM, Gürel B, Kırali K
J Clin Lipidol · 2026 May · PMID 41850915 · Publisher ↗
BACKGROUND: Insulin resistance (IR) is a key contributor to poor cardiovascular outcomes following surgery but remains underrepresented in conventional cardiac risk models. The triglyceride-glucose index (TGI), a surroga...
BACKGROUND: Insulin resistance (IR) is a key contributor to poor cardiovascular outcomes following surgery but remains underrepresented in conventional cardiac risk models. The triglyceride-glucose index (TGI), a surrogate marker of IR, has emerged as a promising metabolic risk indicator. OBJECTIVE: To evaluate the prognostic value of preoperative TGI in predicting 1-year mortality among patients undergoing isolated coronary artery bypass grafting (CABG). METHODS: In this single-center retrospective cohort study, 705 adult patients who underwent isolated CABG between January 2022 and December 2023 were analyzed. TGI was calculated as ln[(fasting triglyceride × fasting glucose)/2]. Patients were stratified based on median TGI values. Multivariable logistic regression was performed to identify independent predictors of 1-year mortality, adjusting for age, gender, and diabetes mellitus. RESULTS: The cohort had a median age of 62 years; 21.3% were female. Diabetes and hypertension were present in 49.9% and 58.3% of patients, respectively. Higher TGI levels were observed in patients who died within 1 year (P = .016). TGI independently predicted 1-year mortality (odds ratio: 4.304; 95% CI: 1.30-14.24; P = .018). Elevated TGI was also associated with increased incidence of acute kidney injury (P = .011), longer intensive care unit stays, and prolonged intubation times (both P < .05). CONCLUSION: Preoperative TGI is an independent predictor of 1-year mortality after CABG and may enhance current risk stratification tools. Integrating TGI into preoperative assessment could guide individualized perioperative management, particularly in metabolically high-risk patients. Prospective studies are warranted to validate these findings and evaluate the impact of TGI-based interventions.
Effects of pemafibrate on liver fibrosis in patients with MASLD and hypertriglyceridemia: A 2-year retrospective observational study using MR elastography.
Noritake H, Inoue T, Yonekura T … +9 more , Tamakoshi H, Ida Y, Matsumoto M, Hanaoka T, Yamashita M, Umemura M, Ohta K, Chida T, Kawata K
J Clin Lipidol · 2026 May · PMID 41833465 · Publisher ↗
BACKGROUND: Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, has shown potent triglyceride-lowering effects. However, evidence regarding its long-term effects on liver fibrosis in metaboli...
BACKGROUND: Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, has shown potent triglyceride-lowering effects. However, evidence regarding its long-term effects on liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD) remains limited. OBJECTIVE: Using magnetic resonance elastography (MRE), we evaluated the effects of 2-year pemafibrate treatment on liver fibrosis in patients with MASLD and hypertriglyceridemia. METHODS: This single-center retrospective study included 25 patients with MASLD and hypertriglyceridemia who received pemafibrate for ≥2 years and underwent MRE-based liver stiffness measurements (MRE-LSMs) before and after treatment. The primary endpoint was the change in MRE-LSMs over 2 years. Secondary endpoints included changes in lipid parameters, liver enzyme levels, liver function parameters, serum fibrosis markers, and the proton density fat fraction. Responders were defined as those showing ≥19% reduction in MRE-LSMs. RESULTS: The median MRE-LSM decreased significantly from 3.05 to 2.52 kPa (P < .001), with 92% of the patients showing improvement and 36% meeting the responder criteria. The proportion of patients showing significant fibrosis decreased from 44.0% to 28.0%. The triglyceride levels decreased from 231 to 125 mg/dL (P < .001). The liver enzyme levels, liver function parameters, and serum fibrosis markers improved significantly. These improvements occurred without changes in body weight, glycemic control, or hepatic fat content. No treatment discontinuations occurred due to adverse events. CONCLUSION: Two-year pemafibrate treatment significantly improved liver stiffness and hepatic parameters independent of weight loss or fat reduction, indicating potential antifibrotic mechanisms. These real-world findings support the hepatoprotective role of pemafibrate and warrant validation in prospective trials.
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