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Table of Contents
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 99-100

Journal scan

Editors, JCSR

Date of Web Publication26-Mar-2019

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JCSR.JCSR_38_18

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How to cite this article:
Suresh V, Bitla A R. Journal scan. J Clin Sci Res 2018;7:99-100

How to cite this URL:
Suresh V, Bitla A R. Journal scan. J Clin Sci Res [serial online] 2018 [cited 2020 Jul 10];7:99-100. Available from: http://www.jcsr.co.in/text.asp?2018/7/2/99/254980

Odyssey outcomes committees and investigators: Alirocumab and cardiovascular outcomes after the acute coronary syndrome

This study involved 18,924 patients who suffered an acute coronary even while on therapy with high-intensity statin or on maximally tolerated doses of statins. The other stipulation was that their low-density lipoprotein cholesterol (LDLc) levels were >70 mg/dL, non-high-density lipoprotein cholesterol (HDLc) was >100 mg/dL and/or their apolipoprotein B was >80 mg/dL, even after the treatment with statins as above.

These patients were randomised after their presentation to receive either alirocumab (75 mg every 2 weeks) or matching placebo. The dose of alirocumab was titrated to achieve an LDLc between 25 and 50 mg/dL.

After a median follow-up of 2.8 years mortality in the alirocumab group was lower than that of the placebo group (3.5% vs. 4.1%, respectively). Similarly, the composite endpoint of death from coronary heart disease, non-fatal myocardial infarction, fatal or non-fatal ischaemic stroke or unstable angina requiring hospitalisation was lower in the alirocumab group (9.5% in alirocumab group vs. 11.1% in the placebo group; P < 0.001). Better benefits were obtained in the subset of patients with an LDLc >100 mg/dL.

  Comment Top

Alirocumab is a monoclonal antibody directed against the protease that degrades the LDL receptor (proprotein convertase subtilisin/kexin type 9) mainly on hepatocytes. Inhibition of this protease will prolong the expression of LDL receptors on hepatocytes, thereby increasing the uptake of LDLc. This can lower the LDLc by as much as 70%. In accordance with the “cholesterol hypothesis” in the pathogenesis and progression of atherosclerosis, lowering of LDLc should lower clinical events-and it does! This new drug is an effective addition to our existing armamentarium to tackle hypercholesterolaemia, particularly in lowering residual cholesterol levels after the use of statins.

Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med 2018;379:2097-107.

Angiotensin-converting enzyme inhibitors and risk of lung cancer: population-based cohort study

In this study, 992,061 patients newly treated with antihypertensive drugs were followed for a mean of 6.4 (standard deviation 4.7) years, in this period, there were 7952 new lung cancers in this cohort. When compared to angiotensin receptor blockers (ARBs), an angiotensin-converting-enzyme inhibitors (ACE I) use was associated with an increased risk of lung cancer (incidence rate 1.6 vs. 1.2/1000 person-years) with hazard ratios (HRs) increasing with time and peaking at 10 years (HR - 1.31 at 10 years of use). The association between ACE I use and lung cancer was particularly evident after 5 years of use.

  Comment Top

Angiotensin-converting-enzyme not only activates angiotensin I to angiotensin II but also responsible for the degradation of bradykinin. Thus, its blockade leads to the accumulation of bradykinin, which has been thought to be responsible for ACE I-induced cough. Bradykinin has additionally been shown to stimulate the growth of lung cancer, though its role in initiating cancer has yet to be worked out. The present study raises concerns about the long-term use of ACE I and favours the use of ARBs instead, particularly in those at high risk for carcinoma lung such as smokers, uranium miners, asbestos workers or those with a family history of carcinoma lung.

Hicks BM, Filion KB, Yin H, Sakr L, Udell JA, Azoulay L, et al. Angiotensin converting-enzyme-inhibitors and risk of lung cancer: Population based cohort study. BMJ 2018;363:k4209.

Association of plasma procalcitonin with various components of metabolic syndrome and insulin resistance in the urban Indian population: A novel biomarker

This was a case-control study in which plasma procalcitonin levels were compared between participants with and without the metabolic syndrome. Procalcitonin was higher (mean 0.55 ± 0.60 ng/mL) in 53 patients with metabolic syndrome as compared to that of the 26 healthy controls (P < 0.001). Further, it correlated positively with insulin resistance (P < 0.01), waist circumference, triglycerides, very LDLc (P < 0.05) and fasting blood glucose (P < 0.01) and inversely with HDLc (P < 0.05). It was also higher in patients with cardiovascular complications and those with microalbuminuria.

  Comment Top

Procalcitonin (which can be measured even in the non-fasting state) is a marker of systemic inflammation. Increasingly, it has been recognised that metabolic syndrome is an inflammatory state. However, before procalcitonin can be recommended as a diagnostic test for metabolic syndrome, the above study has to be replicated in a larger population, and further diagnostic validation with determination of reproducibility, sensitivity, specificity, positive and negative predictive values has to be determined using the current clinical diagnostic criteria for metabolic syndrome as the gold standard. This is an area for further research.

Bajpai D, Pednekar S, Pandey D, Moulick MD, Humane D, Bedmutha K. Association of plasma procalcitonin with various components of metabolic syndrome and insulin resistance in urban Indian population: A novel biomarker. J Assoc Phys Indian 2018;66:35-8.

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