Pathophysiologic Peculiarities of Different Factors’ Influence on Development and Course of IHD Complicated with Atrial Fibrillation

Over the last years, mortality because of cardiovascular diseases (CVD) increased significantly in Ukraine. If we speak about atrial fibrillation (AF) itself, the number of recurrent arrhythmias cases as the main cause of hospitalization of patients with AF increased at 66% over the last 20 years. Independent development factors of AF are heart failure, aortic and mitral valve diseases, arterial hypertension, left atrial enlargement, and also obesity and obstructive sleep apnea, etc. In 2013 A.A. Novykov from Kherson region and several other researchers proved the influence of chaotic changes of meteofactors in cases of overt or hidden functional cardiovascular disorders (CVD) that can significantly influence its hemodynamic stability, functional ability, particularly its rhythmic activity. The main problem in the treatment of one or another nosological entity of CVD today is not the adjustment of a medication for its treatment, but the finding of pathogenetic links in the development of the disease itself. Especially this occurs, when the patient gets several organs or systems disabled simultaneously. Several scientists and practicing physicians are interested in the development of new approaches to diagnosis and treatment of AF in patients with ischemic heart disease (IHD) considering the peculiarities of clinical course and comorbidity. After all, the finding of complications’ causes in comorbid pathology in patients with IHD will contribute to treatment optimization and prevention of other complications, especially those resulting from the anticoagulant therapy, for example when a functional liver state or metabolic processes are impaired

Evinacumab for Homozygous Familial Hypercholesterolemia

BACKGROUND Homozygous familial hypercholesterolemia is characterized by premature cardiovascular disease caused by markedly elevated levels of low-density lipoprotein (LDL) cholesterol. This disorder is associated with genetic variants that result in virtually absent (null–null) or impaired (non-null) LDL-receptor activity. Loss-offunction variants in the gene encoding angiopoietin-like 3 (ANGPTL3) are associated with hypolipidemia and protection against atherosclerotic cardiovascular disease. Evinacumab, a monoclonal antibody against ANGPTL3, has shown potential benefit in patients with homozygous familial hypercholesterolemia. METHODS In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned in a 2:1 ratio 65 patients with homozygous familial hypercholesterolemia who were receiving stable lipid-lowering therapy to receive an intravenous infusion of evinacumab (at a dose of 15 mg per kilogram of body weight) every 4 weeks or placebo. The primary outcome was the percent change from baseline in the LDL cholesterol level at week 24. RESULTS The mean baseline LDL cholesterol level in the two groups was 255.1 mg per deciliter, despite the receipt of maximum doses of background lipid-lowering therapy. At week 24, patients in the evinacumab group had a relative reduction from baseline in the LDL cholesterol level of 47.1%, as compared with an increase of 1.9% in the placebo group, for a between-group least-squares mean difference of –49.0 percentage points (95% confidence interval [CI], –65.0 to –33.1; P 0.001); the between-group least-squares mean absolute difference in the LDL cholesterol level was –132.1 mg per deciliter (95% CI, –175.3 to –88.9; P 0.001). The LDL cholesterol level was lower in the evinacumab group than in the placebo group in patients with null–null variants (–43.4% vs. +16.2%) and in those with non-null variants (–49.1% vs. –3.8%). Adverse events were similar in the two groups. CONCLUSIONS In patients with homozygous familial hypercholesterolemia receiving maximum doses of lipid-lowering therapy, the reduction from baseline in the LDL cholesterol level in the evinacumab group, as compared with the small increase in the placebo group, resulted in a between-group difference of 49.0 percentage points at 24 weeks. (Funded by Regeneron Pharmaceuticals; ELIPSE HoFH ClinicalTrials.gov number, NCT03399786.