Certain nutraceuticals, mainly containing red yeast rice, might be considered as an alternative therapy to statins in patients with dyslipidemia, although there is still insufficient evidence available with respect to long-term safety and effectiveness on cardiovascular disease prevention and treatment. The aim of this study was to assess the lipid-lowering activity and safety of a dietary supplement containing a low dose of monacolin K combined with coenzyme Q10, grape seed and olive tree leaf extracts in patients with mild hypercholesterolemia. In total, 105 subjects with mild hypercholesterolemia (low-density lipoprotein cholesterol LDL-C levels 140–180 mg/dL) and low CV risk were randomly assigned into three treatment groups: lifestyle modification (LM), LM plus a low dosage of monacolin K (3 mg), and LM plus a high dosage of monacolin K (10 mg) and treated for 8 weeks. The primary endpoint was the reduction of LDL-C and total cholesterol (TC). LDL-C decreased by 26.46% on average (p < 0.001) during treatment with 10 mg of monacolin and by 16.77% on average during treatment with 3 mg of monacolin (p < 0.001). We observed a slight but significant reduction of the triglyceride levels only in the high-dose-treated group (mean −4.25%; 95% CI of mean −11.11 to 2.61). No severe adverse events occurred during the study. Our results confirm the LDL-C-lowering properties of monacolin are clinically meaningful even in lower doses of 3 mg/day.

Purpose: This study aimed to evaluate various therapeutic approaches, identify potential predictive factors for the recurrence and development of hypothyroidism, and examine specific clinical and laboratory characteristics of patients with subacute thyroiditis (SAT) due to SARS-CoV-2 infection. Methods: We retrospectively analyzed the medical records of 226 patients with confirmed SAT diagnosed from January 2020 to November 2022. Results: The mean age was 48.01 ± 0.75 years, and the F/M ratio was 2.3/1. At the end of the follow-up period, 69 patients (32.1%) had developed hypothyroidism. Treatment duration was significantly shorter with nonsteroidal anti-inflammatory drugs (NSAIDs) (17.40 ± 2.56 days), while time-to-symptom relief was shorter with glucocorticoids (CGs). Recurrence was observed only in those treated with corticosteroid preparations (14.1%). C-reactive protein levels at treatment discontinuation were higher in patients who experienced SAT recurrence, while the coexistence of Hashimoto’s thyroiditis was a significant predictive factor for the development of hypothyroidism. The TSH value at the time of treatment withdrawal >4.12 μIU/mL showed optimal sensitivity and specificity for the prediction of permanent hypothyroidism. Regarding COVID-19, 34 patients (15%) experienced related SAT, with similar clinical manifestations of the disease but a higher BMI and shorter time-to-symptom relief. Conclusion: In conclusion, GCs administration alleviated acute symptoms earlier during the onset of SAT, whereas NSAIDs had a shorter treatment duration, and both regimens could not prevent the development of delayed hypothyroidism. The clinical characteristics of SAT due to COVID-19 infections were similar to those of typical SAT disease.

The objective of the present study was to assess the lipid-lowering efficacy and safety of a novel dietary supplement containing monacolin K combined with the coenzyme Q10 and grape seed and olive tree leaf extracts (Arichol^®®) on the lipid profile of adults with moderate cholesterol elevations and an absence of concomitant risk factors. We recruited patients from our Endocrinology Clinics in Greece who had low-density lipoprotein cholesterol (LDL-C) 140–180 mg/dL, were on no medications affecting serum lipid concentrations, and consented to participate in the present study. All subjects received 8-weeks supplementation with Arichol^®® once daily. We measured total cholesterol (TC), high-density lipoprotein cholesterol (HDL), LDL-C, triglycerides (TG), and liver enzymes with enzymatic colorimetric assays at baseline and at the end of the study, and documented complaints potentially attributable to muscle injury. We recruited a total of 37 subjects, 33 females and 4 males (with a mean age of 55.89 ± 1.50 [mean ± standard error mean, SEM]). The treatment resulted in a statistically significant reduction in TC (from 258.9 ± 4.0 mg/dL to 212.7 ± 4.5 mg/dL, p < 0.001), LDL-C (from 173.8 ± 3.5 to 129.0 ± 4.5 mg/dL, p < 0.001), and TG (from 127.0 ± 12.2 to 117.0 ± 9.2, mg/dL, p = 0.012) concentrations, while HDL-C concentrations remained unchanged. There were no alterations in liver enzymes or symptoms of muscle pain in any subject. These promising results suggest that supplementation with this nutraceutical mixture favorably influences lipid concentrations during a short period of administration while exhibiting an excellent safety profile. Larger controlled studies are required to assess the potential for cardiovascular risk reduction with the above compound.

Background/Objectives: Vitamins D and B12 play a crucial role in maintaining bone health, immune function, and neurological integrity. Combined deficiencies in these vitamins can lead to severe health consequences. Current treatment approaches, such as dietary changes and single-vitamin supplementation, often fail to address these deficiencies comprehensively. This study evaluates the effectiveness of concurrent vitamin D and B12 supplementation to correct these insufficiencies. Methods: A prospective, multicenter, randomized controlled trial was conducted in Greece from October 2024 to December 2024. Participants aged 20 to 80 years, with insufficient levels of 25-hydroxyvitamin D (serum < 20 ng/mL) and B12 (serum < 250 ng/L), were eligible for inclusion. Results: A total of 124 patients were randomized into three groups: one receiving vitamins B12 and D in a single supplement (2500 IU + 1000 mcg), one receiving separate doses of each vitamin (2000 IU + 1000 mcg), and a control group receiving no supplementation. The results demonstrated a significant increase in B12 and 25-hydroxyvitamin D levels among the supplemented groups. Particularly, participants in the combined supplementation group showed higher average serum levels of both vitamins. By the end of this study, 37.1% of those in the combined supplement group achieved adequate vitamin levels, compared to 29.4% in the separate supplementation group. Conclusions: In conclusion, combined supplementation may improve patient adherence and compliance, leading to better health outcomes for individuals with combined vitamins D and B12 deficiencies.

Purpose: Lipid lowering treatments (LLTs) can reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Despite the availability of potent LLTs, our clinical observations suggest an inadequate use of such agents. To evaluate this treatment deficit, we designed the present study. Methods: We reviewed the charts of all patients with a history of ASCVD (coronary artery disease—CAD; carotid stenosis—CS; or peripheral artery disease—PAD) diagnosed prior to their first visit to one of our clinics. We recorded their gender, age, ASCVD risk factors (diabetes, hypertension, tobacco use, body mass index), lipid values during that visit and the LLT used. We estimated the rates of the attainment of guideline-specific lipid goals by year, and assessed factors influencing the likelihood of treatment success. Results: Overall, n = 1003 subjects were recruited: CAD n = 703 (70.1%), PAD n = 168 (16.8%), CS n = 325 (32.4%); age 64.7 ± 11.2 years; n = 376 (37.5%) females; n = 642 (64.0%) had diabetes; n = 740 (73.8%) had hypertension; n = 299 (29.8%) were former and n = 367 (36.6%) were current smokers. An appropriate LLT was used in 361 (36.0%) subjects, n = 159 (15.9%) were on no treatment, n = 483 (48.2%) were receiving inadequate therapy, n = 434 (43.3%) were on a high-intensity LLT and n = 361 (36.0%) had achieved the year-specific LDL goals. Success rates ranged from 5.7% to 81.5%, with the lowest being 2020–2023 (5.7–14.5%), p < 0.001. The use of a combination of LLTs and PCSK9 inhibitors led to higher rates of LDL-C goals achievement (p < 0.001). Discussion: Recent secondary ASCVD risk prevention guidelines’ goals are rarely achieved in daily clinical practice, producing a major treatment deficit in this population. Newer systematic interventions are needed to curb this public health issue.

Disclosure: R.D. Paparodis: None. I. Androulakis: None. D.P. Askitis: None. I. Perogamvros: None. N. Angelopoulos: None. A. Rizoulis: None. S. Livadas: None. A. Boniakos: None. Background: The increasing availability of aggressive lipid lowering therapies (LLTs) worldwide is expected to produce a significant decline in cholesterol concentrations worldwide and a more successful attainment of LDL lowering goals (LLGs), especially in those who need them most: patients with established atherosclerotic cardiovascular disease (ASCVD). Aims: To assess the long-term changes in the rate of attainment of LGs according to the European Society of Cardiology Guidelines nationwide, with the use of different LLTs during 12 consecutive years. Methods: We reviewed the charts of all patients initially seen between 2010-2022 who returned for care follow up at our 8 busy Endocrinology clinics, located in 6 cities in Greece, between Sep-1-2022 and Nov-30-2022. We enrolled those with recorded diagnosis of ASCVD [coronary artery disease (CAD), peripheral arterial disease (PAD) or carotid stenosis >50% (CS)] prior to our initial visit. For the present work, we reviewed data on tobacco use, intake of LLTs, and LDL-cholesterol concentrations as recorded during our initial clinic visit. We excluded all patients referred to our clinics for lipids management. Data are presented as means ± standard deviation. Means are compared with Kruskal Wallis test and p<0.05 is deemed significant. Results: We enrolled n=890 consecutive patients, age 63.9 ± 11.4 years, n=339 were women (38.1%), n=529 (59.4%) had diabetes, n=672 (75.5%) had hypertensions and all had ≥1 forms of established ASCVD: n=630 with CAD, n=279 with CS and n=151 with PAD. Out of these, n=144 (16.2%) were on no LLTs, n=334 (37.5%) continued to smoke, n=381 (42.8%) were on guidelines-based appropriate LLT strategy, n=248 (27.9%) reached LLGs and n=318 (35.7%) fulfilled the year-specific guidelines requirements. Of note is, that this rate dropped to 2.4-20.4% in the years 2019-2022. The likelihood of achieving LDL goals was not statistically significantly different among patients with different forms of ASCVD (p=0.42). Overall, the mean LDL was 88.2 ± 32.1mg/dl, and was not different between patients with different forms of ASCVD (p=0.75). Mean LDL concentrations have only started to drop between 2020-2022 as compared to 2019 (p<0.001), but are not different compared to those seen in the years 2010-2018. The mean LDL dropped to 82.3 ± 30.5mg/dl in 2022 as compared to 102.2 ± 38.8mg/dl in 2019. Conclusions: Our study reveals a large care gap in patients with established ASCVD, which did not seem to improve significantly over the past 12 years, despite the excellent availability of aggressive LLT strategies in Greece. Intervention studies are urgently needed to enhance adherence to updated international guidelines and reduce the extremely high ASCVD risk in this fragile population. Presentation: Friday, June 16, 2023