Role of redox reactions in the vascular phenotype of hyperhomocysteinemic animals

Hyperhomocysteinemia is a risk factor for cardiovascular disease, stroke, and thrombosis. Several animal models of hyperhomocysteinemia have been developed by using both dietary and genetic approaches. These animal models have provided considerable insight into the mechanisms underlying the adverse vascular effects of hyperhomocysteinemia. Accumulating evidence suggests a significant role of altered cellular redox reactions in the vascular phenotype of hyperhomocysteinemia. Redox effects of hyperhomocysteinemia are particularly important in mediating the adverse effects of hyperhomocysteinemia on the endothelium, leading to loss of endothelium-derived nitric oxide and vasomotor dysfunction. Redox reactions also may be key factors in the development of vascular hypertrophy, thrombosis, and atherosclerosis in hyperhomocysteinemic animals. In this review, we summarize the metabolic relations between homocysteine and the cellular redox state, the vascular phenotypes that have been observed in hyperhomocysteinemic animals, the evidence for altered redox reactions in vascular tissue, and the specific redox reactions that may mediate the vascular effects of hyperhomocysteinemia.

Influence of ALA54THR polymorphism of fatty acid-binding protein 2 on obesity and cardiovascular risk factors

A transition of G to A at codon 54 of FABP2 results in an amino acid substitution (Ala54 to Thr54). This polymorphism was associated with some cardiovascular risk factors. The aim of our study was to investigate the influence of Thr54 polymorphism in the FABP2 gene on obesity anthropometric parameters and cardiovascular risk factors. A population of 226 obesity (body mass index >30) nondiabetic outpatients were analyzed. An indirect calorimetry, tetrapolar electrical bioimpedance, blood pressure, a serial assessment of nutritional intake with 3 days of written food records, and biochemical analysis (lipid profile, adipocytokines, insulin, CRP, and lipoprotein-a) were performed. The statistical analysis was performed for the combined ALA54/THR54 and THR54/THR54 as a mutant group and wild type ALA54/ALA54 as a second group. Two-hundred and twenty-six patients gave informed consent and were enrolled in the study. The mean age was 44.2+/-16 years and the mean BMI 35.1+/-5.1, with 63 males (28.3%) and 163 females (71.7%). One-hundred and thirteen patients (50%) had the genotype ALA54/ALA54 (wild group) and 113 (50%) patients had the genotype ALA54/THR54 (91 patients, 40.2%) or THR54/THR54 (22 patients, 9.8%) (mutant group). The ANOVA analysis of the three groups ( ALA54/THR54, THR54/THR54 and ALA54/ALA54) shows a higher levels of fat mass in Thr54/Thr54 group (45.6+/-14.6 kg) than Ala54/Ala54 (37.5+/-11.2 kg: p<0.05), without differences with Ala54/Thr54 group (41.2+/-13.5 kg). CRP, IL-6, and lipoprotein-a were higher in mutant group ( ALA54/THR54, THR54/THR54) than in wild group ( ALA54/ALA54). The novel finding of this study is the association of the Thr54/Ala54 and Thr54/Thr54 FABP2 phenotypes with higher levels of C reactive protein, IL6, and lipoprotein-a. Further studies are needed to explain the role of this polymorphism in different populations.

Relationship of glycaemic index with cardiovascular risk factors: analysis of the National Diet and Nutrition Survey for people aged 65 and older

Objective

To identify associations between dietary glycaemic index (GI) and weight, body mass index and other risk factors for cardiovascular disease (CVD) – waist-to-hip ratio (WHR), lipoprotein fractions, triacylglycerols (TAG) and blood pressure (BP) – in an older British population.

Design

Cross-sectional dietary, anthropometric and biochemical data from the National Diet and Nutritional Survey for adults aged over 65 years were reanalysed using a hierarchical regression model. Associations between body weight, CVD risk factors, and dietary factors including GI and fibre intakes were explored among 1152 healthy older people living in the UK between 1994 and 1995.

Results

In the unadjusted model, GI was significantly and directly associated with TAG (β = 0.008 ± 0.003) and diastolic BP (β = 0.325 ± 0.164) in males. These relationships were attenuated and non-significant after adjustment for potential confounding factors. WHR (β = 0.003 ± 0.001) and TAG (β = 0.005 ± 0.002) were significantly predicted by GI in males and females combined. The association with WHR was attenuated by adjustment for sex, age, region and social class; the relationship with TAG was non-significant after adjustment for other potential dietary confounders.

Conclusion

After controlling for potential confounders, no clear links were detected between GI and body weight or other CVD risk factors. This study provides little evidence for advising the consumption of a low-GI diet in the elderly to prevent weight gain or improve other CVD risk factors.

Intima-media thickness of common carotid as cardiovascular risk factor in rheumatoid arthritis and metabolic disorders

OBJECTIVES

To study the intima-media thickness (IMT) of the common carotid artery and the lipid profile in patients with rheumatoid arthritis (RA), type 1 diabetes mellitus T1DM), and obesity (Ob), against a control group of normal subjects (NS), in order to determine the relationship between cardiovascular risks and pro-atherosclerosis conditions in various inflammatory and metabolic disorders.

MATERIALS AND METHODS

147 subjects, with written consent, were divided into the following categories: 38 patients with RA (6m/32f; average age 51.7+/-4.4 years, range 42-71); 42 patients with T1DM (20m/22f; average age 52.1+/-6.2 years, range 45-65); 37 patients with obesity (20m/17f; average age 53.8+/-5.3 years, range 46-70); 30 normal subjects, age and sex matched, that make up the control group (14m/16f; average age 52.5+/-4.6, range 40-62). The IMT and the plaques were measured (values expressed in mm) according to the guidelines of the GIUV (Gruppo Italiano Ultrasonologia Vascolare, Italian Group of Vascular Ultrasonology).

RESULTS

Our research has revealed the presence of a thickening of the intima-media complex in patients suffering from RA, highlighting, at the same time, that the atherosclerotic risk factor in these patients manifested regardless of the activity of the disease or the serum level.

CONCLUSIONS

The presence of an inflammatory systemic chronic disease such as rheumatoid arthritis, seems to constitute a significant and independent atherosclerosis risk in itself, which apparently does not correlate with the lipid profile.

Effect of vitamin C on blood glucose, serum lipids & serum insulin in type 2 diabetes patients

BACKGROUND & OBJECTIVE

Diabetes mellitus is one of the most common metabolic disorders that causes micro- and macro-vascular complications. Because of additive effects of hyperglycaemia and hyperlipidaemia for cardiovascular diseases, lipid abnormalities should be evaluated in diabetes. As vitamin C is known for its beneficial effects on serum lipids and glycated haemoglobin (HbA1c), we evaluated the effect of different doses of vitamin C on blood glucose, serum lipids and serum insulin in individuals with type 2 diabetes mellitus.

METHODS

A total of 84 patients with type 2 diabetes referred to Yazd Diabetes Research Center, Iran, were included in the study. They received randomly either 500 mg or 1000 mg daily of vitamin C for six weeks. Fasting blood sugar (FBS), triglyceride (TG), total cholesterol (TC), low and high density lipoprotein (LDL, HDL), glycated haemoglobin HbA(Ic) and serum insulin were measured before and after vitamin C consumption and the results were analyzed.

RESULTS

A significant decrease in FBS, TG, LDL, HbA1c and serum insulin was seen in the group supplemented with 1000 mg vitamin C. The dose of 500 mg vitamin C, however, did not produce any significant change in any of the parameters studied.

INTERPRETATION & CONCLUSION

Our results indicate that daily consumption of 1000 mg supplementary vitamin C may be beneficial in decreasing blood glucose and lipids in patients with type 2 diabetes and thus reducing the risk of complications.

Severe periodontitis is associated with systemic inflammation and a dysmetabolic status: a case–control study

BACKGROUND AND AIM

A cluster of metabolic factors defines a syndrome that predisposes to diabetes and cardiovascular disease. Chronic infections such as periodontitis might alter these individual metabolic factors and the systemic inflammatory burden. The aim of this study was to investigate the association between severe periodontitis and increase in inflammatory and metabolic risk factors for cardiovascular disease.

MATERIALS AND METHODS

We examined 302 patients with severe periodontitis and 183 healthy controls, and we collected a blood sample from each subject in order to investigate differences in inflammatory (leukocyte numbers and differential counts) and metabolic markers (lipids and glucose).

RESULTS

After correcting for differences in age, gender, smoking and ethnicity, periodontitis subjects exhibited a low-grade systemic inflammation (increased white cell counts, 1.10+/-1.02 x 10(9)/l, 95%CI 1.05-1.15, p=0.0001), dyslipidemia [lower high-density lipoprotein cholesterol, 1.14+/-1.03 mmol/l, 95%CI 1.08-1.20, p<0.0001 and higher low-density lipoprotein cholesterol, 1.12+/-1.03, 95%CI 1.05-1.19, p<0.0001) and increased non-fasting serum glucose levels (1.04+/-1.01 mmol/l, 95%CI 1.02-1.06, p=0.01) when compared with controls. The associations were confirmed in a subpopulation of Caucasian non-smokers. A trend for a dose dependent effect of the number of periodontal pockets on the tested inflammatory and metabolic markers was observed.

CONCLUSIONS

These data suggest a possible link between severe generalized periodontitis, systemic inflammation and a dysmetabolic state in otherwise healthy individuals.

Short-term effects of smoking cessation on blood antioxidant parameters and paraoxonase activity in healthy asymptomatic long-term cigarette smokers

The aim of this study was to compare short-term effects of smoking cessation on blood oxidant/antioxidant status, cholesterol levels, and paraoxonase activity. Sixteen healthy, asymptomatic long-term cigarette smokers (mean age: 35 +/- 9 yr) participated in the study in the smoking cessation program. After and before smoking cessation, subjects were examined for oxidant/antioxidant status, cholesterol level, paraoxonase activity, breath carbon monoxide levels, and blood carboxyhemoglobin values. When compared to previous values, subjects were revealed statistically significant decreases in malondialdehyde and carbon monoxide levels 4 wk after smoking cessation. The ratio of high-density lipoprotein (HDL) low-density lipoprotein (LDL) cholesterol was found to be increased. Significantly increased to paraoxonase activity was also observed in the blood samples obtained after cigarette cessation period. It was concluded that all these changes observed after smoking cessation might be of importance in the reduction of cardiovascular risk parameters in the smokers.

Associations of plasma fibrinogen levels with established cardiovascular disease risk factors, inflammatory markers, and other characteristics: individual participant meta-analysis of 154,211 adults in 31 prospective studies: the fibrinogen studies collaboration

Long-term increases in plasma fibrinogen levels of 1 g/liter are associated with an approximate doubling of risk of major cardiovascular disease outcomes, but causality remains uncertain. To quantify cross-sectional associations of fibrinogen levels with established risk factors and other characteristics, the investigators combined individual data on 154,211 apparently healthy adults from 31 prospective studies conducted between 1967 and 2003, using a linear mixed model that included random effects at the cohort level. Fibrinogen levels increased with age and showed continuous, approximately linear relations with several risk markers and slightly curvilinear associations with log triglycerides, albumin, and tobacco and alcohol consumption. Female sex, Black ethnicity, lower socioeconomic status, and alcohol abstinence were each associated with modestly higher fibrinogen levels. Approximately one third of the variation in fibrinogen levels was explained by cohort, age, and sex. An additional 7% was explained by established risk factors (notably, positive associations with smoking and body mass index and an inverse association with high density lipoprotein cholesterol), and a further 10% was explained by inflammatory markers (notably, a positive association with C-reactive protein). The association with body mass index was twice as strong in women as in men, whereas the association with smoking was much stronger in men. These findings substantially advance understanding of the correlates and possible determinants of fibrinogen levels.

Exploring patient demographic and clinical characteristics associated with lipid-lowering pharmacotherapy use in primary care

BACKGROUND

Lipid-lowering therapeutics, particularly HMG Co-A reductase inhibitors, can be beneficial in primary and secondary cardiovascular prevention. The Canadian population frequently uses these medications but the manner in which they are used in community-based practice is unknown.

OBJECTIVES

To assess the patient characteristics associated with lipid lowering drug use in community-based clinical practice across four geographic regions in Canada. To assess amongst lipid-lowering drugs users the proportion of patients that would meet accepted dyslipidemia management guidelines. To assess the community-based effectiveness of anti-hyperlipidemic drugs.

METHODS

Patients filling a prescription for any anti-hyperlipidemia therapy in selected pharmacies in Ontario (ON), Quebec (PQ), British Columbia (BC) and Nova Scotia (NS). All eligible patients were interviewed over the telephone. Physicians who were providing healthcare to the participating patients were requested to provide information from the patient's medical record.

RESULTS

The mean patient age was > 60 yr in all four provinces. There were some differences amongst the four provinces pertaining to patient characteristics, prescription patterns and therapeutic indicators, but not to outcomes. Anti-hyperlipidemia therapy was associated with a 1.81 mmol/L decrease in LDL-Cholesterol (P < 0.001); however only 73% of patients achieved target LDL-Cholesterol concentrations. A lag time of 1.96 yr (P < 0.0001) was observed from the diagnosis of dyslipidemia until the drug treatment was initiated. Patients had an average of 2.8 cardiovascular (CV) risk factors and 86% of patients had at two or more CV risk factors. Thirty-nine percent (95% CI, 36% - 42%) of the patients were being treated for secondary prevention. Thirteen percent (11-16%) of patients who were being treated for primary prevention had diabetes. Metabolic syndrome was observed in 32% (29-35%) of patients.

CONCLUSION

Almost all patients fulfilled guideline requirements for the use of anti-hyperlipidemic therapy. Although the use of pharmacotherapy was associated with a lowering of LDL cholesterol more aggressive management is required to attain target LDL cholesterol concentrations.

Data mining tools for genotype-phenotype correlation

Single Nucleotide Polymorphisms (SNPs) may be the key to diagnosing and treating certain diseases. A preliminary study was conducted at The Ohio State University Medical Center Information Warehouse to correlate such SNPs with a selected group of lab values for cardiology patients. Early results show that data mining tools can be valuable for understanding such correlations, but further refinement of the methodology and data preparation is needed to fully realize such value.

Influence of antiretroviral therapy on oxidative stress and cardiovascular risk: a prospective cross-sectional study in HIV-infected patients

BACKGROUND

Oxidative stress (OS) results from excessive free radical production, exceeding endogenous antioxidant defense mechanisms, which can damage a wide variety of cellular components. One of the main consequences is the attack of free radicals on polyunsaturated fatty acids contained in low-density lipoprotein (LDL) lipids, causing lipid peroxidation and subsequent elevated concentrations of lipid peroxides and their metabolites, which are strongly suggestive of oxidative damage. OS is increased among HIV-infected patients, but whether it implicates a higher risk for cardiovascular disease or the influence of antiretroviral therapy (ART) on OS remains unknown.

OBJECTIVE

The aim of this study was to assess the relationship of OS with established cardiovascular risk factors and with ART as measured by total peroxide concentration.

METHODS

A prospective cross-sectional study was conducted in 245 consecutive HIV-infected patients during a 2-month period (September 15, 2003-November 15, 2003) at the HIV clinic of the Infectious Disease Unit, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Spain. Laboratory measurements included total peroxide concentrations, C-reactive protein (CRP) levels, fasting lipid levels, white blood cell type CD4(+) T-lymphocyte counts, plasma HIV RNA, and routine blood tests. To measure OS, total peroxide concentration was determined quantitatively with a colorimetric assay. The association of peroxide concentrations with HIV-related variables and cardiovascular risk factors was examined using univariate and multivariate analyses.

RESULTS

Two hundred forty-five patients were screened and enrolled in the study; no patients refused enrollment. Median (interquartile range [IQR]) age of the patients was 40.2 (35.4-46.2) years; 194 (79.2%) were male, and 238 (97.1%) white. Median (IQR) weight was 67.5 (60.4-76.0). Ninety-five (38.8%) patients were receiving a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen at the time of enrollment; 52 (21.2%) were on a protease inhibitor (PI)-based regimen. Peroxide concentrations were above reference values (< 400 micromol/L) in 121 (49.4%) patients. Peroxide levels correlated positively with CRP (P < 0.001) and LDL-cholesterol (LDL-C) (P = 0.003), and negatively with age (P = 0.002) and body mass index (P < 0.001). Among patients on ART, peroxide concentrations were significantly lower in those treated with NNRTI-based regimens than in those receiving PIs (median [IQR], 331.2 [196.2-495.7] vs 472.8 [302.5-586.5] micromol/L; P = 0.003). In multivariate analysis, when peroxide concentration was dichotomized according to reference values (< 400 micromol/L), age (odds ratio [OR], 0.96; 95% CI, 0.93-0.99; P = 0.007) and ART including NNRTI (OR, 0.52; 95% CI, 0.28-0.95; P = 0.03) were associated with low peroxide concentrations, while LDL-C (OR, 1.01; 95% CI, 1.00-1.02; P = 0.03) predicted the highest values.

CONCLUSIONS

The results from this study suggest that, among this cohort of HIV-infected patients, peroxide concentration used as a marker of OS was associated with other established cardiovascular risk factors. Antiretroviral regimens based on NNRTIs were associated with low peroxide concentrations. In contrast, high peroxide levels were found in patients receiving PI-based regimens.

Lipid-modifying therapy and attainment of cholesterol goals in Hungary: the return on expenditure achieved for lipid therapy (REALITY) study

BACKGROUND AND OBJECTIVE

Cardiovascular disease is a leading cause of death in Eastern Europe. Few studies on cholesterol goal achievement have been conducted in Hungarian clinical settings. This study set out to evaluate lipid-modifying therapy practices and their effects on total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) goal attainment in Hungarian patients with coronary heart disease (CHD), CHD risk equivalents, or >or=2 coronary risk factors.

METHODS

This multicentre observational study involved patients receiving lipid-modifying therapy who were under the care of general practitioners (n = 300) or specialists (n = 140). Physician questionnaires were used to collect data on baseline patient characteristics, including laboratory parameters. Using validated cardiovascular risk assessment measures, patients were stratified into high-risk (10-year absolute coronary risk >20%; n = 367) and lower risk groups (n = 73). Cholesterol goals were TC <4.5 mmol/L (<175 mg/dL) and LDL-C <2.5 mmol/L (<100 mg/dL) for the high-risk group and TC <5.0 mmol/L (<193 mg/dL) and LDL-C <3.0 mmol/L (<117 mg/dL) for those at lower risk.

RESULTS

Among 440 patients (n = 312 with CHD or CHD risk equivalents), 374 (85%) were initiated on HMG-CoA reductase inhibitors (statin monotherapy), 44 (10%) received fibric acid derivatives and 22 (5%) received combination regimens. Although >50% of patients needed >35% TC lowering to reach goal, <10% of patients received high or very high potency lipid-modifying regimens or combination regimens initially. A total of 116 (26.4%) patients achieved their TC goals after >/=1 year of treatment, including 27.9% of patients with CHD/risk equivalents and 22.7% of those with risk factors only. Sixty-six (15%) patients achieved goal on initial lipid-modifying regimens, while a further 50 (11.4%) achieved goal following treatment changes, including upward dosage adjustments.

CONCLUSION

Approximately 74% of Hungarian patients receiving lipid-modifying therapy in our study did not achieve cholesterol goals. The proportion of patients realising their TC goals was higher in those treated by specialists but still did not exceed one-third.

Do Turkish adults really have lower serum levels of high-density lipoprotein cholesterol?

BACKGROUND

Coronary heart disease is the leading cause of death in Turkey. The Turkish Heart Study and TEKHARF study have been carried out at various times and in different parts of Turkey and have suggested that the Turkish population has a low high-density lipoprotein-cholesterol (HDL-C) level. However, in our daily practice, mean HDL-C levels were not as low as previously reported. Here, we investigated the lipid profile, especially the HDL-C level, in the population of the Duzce region of northwest Turkey.

METHODS

Serum triglyceride, total cholesterol, and HDL-C levels were measured in 674 healthy volunteers (398 women and 276 men); low-density lipoprotein cholesterol (LDL-C) levels were calculated using the Friedewald equation.

RESULTS

The mean serum HDL-C level was 46.1 +/- 9.8 mg/dl in men and 53.2 +/- 10.7 mg/dl in women; these values are higher than expected based on the Turkish Heart Study. The mean serum total cholesterol level was 196.7 +/- 43.2 mg/dL in men and 198.4 +/- 43.9 mg/dL in women; the mean LDL-C level was 119.6 +/- 34.9 mg/dL in men and 118.7 +/- 34.1 mg/dL in women; and the mean serum triglyceride level was 151.4 +/- 80.9 mg/dL in men and 132.1 +/- 68.9 mg/dL in women.

CONCLUSIONS

Our finding that the HDL-C level in this population was higher than the previously reported levels in Turkey indicates that HDL-C levels may not be as low as previously thought. We believe that lower HDL-C levels that were previously reported might be due to the difference between techniques of analysis, nutritional status, and percent of subjects who were fasting in the day of analysis or improper subject inclusion which did not reflect the Turkish population causing selection bias.

Low plasma levels of adiponectin are associated with low risk for future cardiovascular events in patients with clinical evident vascular disease

BACKGROUND

Adiponectin is considered to have anti-inflammatory, insulin-sensitizing, and antiatherosclerotic properties. In the present prospective study, the relationship between metabolic syndrome (Adult Treatment Panel III) and adiponectin plasma levels and the relationship between plasma adiponectin levels and future cardiovascular events were investigated.

METHODS

A case-cohort study of 431 patients with clinical evident vascular disease from the Second Manifestations of ARTerial Disease study. The relationship between adiponectin plasma levels and new vascular events was investigated with Cox regression, adjusted for potential confounders and effect modifiers (age, sex, renal function [modification of diet in renal disease], body mass index, high sensitive C-reactive protein, use of angiotensin converting enzyme-inhibition and/or AII antagonists, and presence of metabolic syndrome or impaired renal function).

RESULTS

Plasma adiponectin levels were lower in patients with metabolic syndrome as compared with patients without (7.9 +/- 0.3 vs 5.2 +/- 0.3 microg/mL) and decreased with the number of components. During a mean follow-up of 2.3 years, 216 patients had a new cardiovascular event. Lower adiponectin plasma levels were associated with a lower risk for future cardiovascular events (hazard ratio 0.50, 95% confidence interval 0.25-0.99). This relationship was not influenced by renal function, body mass index, and renin-angiotensin system-blocking agents or modified by metabolic syndrome and impaired renal function.

CONCLUSION

In patients with clinical evident vascular disease, lower adiponectin levels were associated with a lower cardiovascular risk. Therefore, it may be hypothesized that the potential antiatherosclerotic properties of adiponectin do not apply for patients with already established vascular disease.

Variants in the CRP gene as a measure of lifelong differences in average C-reactive protein levels: the Cardiovascular Risk in Young Finns Study, 1980-2001

Genetic association studies have used variants in the C-reactive protein (CRP) gene to estimate causal effects of lifelong circulating CRP levels on disease endpoints. However, the extent to which the genetic variants are actually associated with lifelong circulating CRP levels has not been demonstrated empirically. In a population-based prospective cohort study (1980-2001) of 1,609 young Finns (768 men and 841 women), the authors genotyped five single nucleotide polymorphisms in the CRP gene (-717A/G, -286C/T/A, +1059G/C, +1444T/C, and +1846G/A) and assessed circulating CRP levels at ages 3-18 years and 24-39 years. The haplotypes from the five single nucleotide polymorphisms were associated with circulating CRP levels in childhood and adulthood, with the strongest effect being found for average CRP level across these two measures taken at two time points in the life course. In combination, the haplotype pairs accounted for 3.9%, 3.3%, and 5.0% of the variation in circulating CRP levels in childhood, in adulthood, and for the mean of CRP levels at both time points, respectively. These findings support the assumption that the above genetic variants define groups with long-term differences in circulating CRP levels.

Pasta naturally enriched with isoflavone aglycons from soy germ reduces serum lipids and improves markers of cardiovascular risk

Most studies of soy and cholesterol have tested foods made from purified soy proteins containing mainly isoflavone glycosides. Fermented soy foods have mainly isoflavone aglycons and account for a high proportion of the soy protein source in Asia, where there is an inverse relationship between soy intake and serum cholesterol. The aim of this study was to compare a novel soy germ pasta, naturally enriched in isoflavone aglycons as a result of the manufacturing process, with conventional pasta for effects on serum lipids and other cardiovascular risk markers. In this randomized, controlled, parallel study design of 62 adults with hypercholesterolemia who consumed a Step II diet that included one 80-g serving/d of pasta, we measured serum lipids, high sensitivity C-reactive protein (hsCRP), urinary isoprostanes, and brachial artery flow-mediated vasodilatation at baseline and after 4 and 8 wk. The pasta delivered 33 mg of isoflavones and negligible soy protein and led to a serum isoflavone concentration of 222 +/- 21 nmol/L; 69% of subjects were equol producers. Soy germ pasta reduced serum total and LDL cholesterol by 0.47 +/- 0.13 mmol/L (P = 0.001) and 0.36 +/- 0.10 mmol/L (P = 0.002) more than conventional pasta, representing reductions from baseline of 7.3% (P = 0.001) and 8.6% (P = 0.002), respectively. Arterial stiffness (P = 0.003) and hsCRP (P = 0.03) decreased and improvements in all the above risk markers were greatest in equol producers. All measures returned to baseline when patients were switched to conventional pasta. In conclusion, pasta naturally enriched with isoflavone aglycons and lacking soy protein had a significant hypocholesterolemic effect beyond a Step II diet and improved other cardiovascular risk markers.

Single oral challenge by advanced glycation end products acutely impairs endothelial function in diabetic and nondiabetic subjects

OBJECTIVE

The current study was designed to test the acute effects of dietary advanced glycation end products (AGEs) on endothelial function of diabetic and nondiabetic subjects.

RESEARCH DESIGN AND METHODS

Flow-mediated dilation (FMD) of the brachial artery and serum levels of AGEs, plasminogen activator inhibitor 1 (PAI-1), vascular cell adhesion molecule 1 (VCAM-1), and glucose were assessed before and after a single oral AGE challenge (approximately 1.8 x 10(6) AGE units) in 44 diabetic and 10 nondiabetic subjects.

RESULTS

The diabetic patients had higher baseline levels of serum AGEs (P = 0.020), PAI-1 (NS), and VCAM-1 (P = 0.033) and lower baseline values of FMD compared with nondiabetic subjects (P = 0.032). Ninety minutes after a single oral AGE challenge, serum AGEs and PAI-1 levels increased and FMD decreased significantly in both healthy subjects (AGEs: 7.2 +/- 0.5 to 9.3 +/- 1 units/ml, P = 0.014; PAI-1: 5.4 +/- 0.4 to 6.8 +/- 0.4 ng/ml, P = 0.007; and FMD: 9.9 +/- 0.7 to 7.4 +/- 0.9%, P = 0.019) and diabetic subjects (AGEs: 10.5 +/- 0.7 to 14.2 +/- 1 units/ml, P = 0.020; PAI-1: 6.5 +/- 1 to 10 +/- 2 ng/ml, P = 0.030; and FMD: 5.4 +/- 0.4 to 4.0 +/- 0.3%, P = 0.032). Serum glucose and VCAM-1 levels remained unchanged.

CONCLUSIONS

Significant increases in serum AGEs can occur together with altered clinical measures of endothelial function in diabetic and nondiabetic subjects after a single modest AGE-rich beverage. Thus, repeated or chronic exposure to high AGE diets could over time lead to and/or accelerate vascular disease.

Comparison of cationic propyl gallate and adenosine diphosphate for the measurement of aspirin effectivity with optical aggregometry

To compare the newer inductor of platelet aggregation cationic propyl gallate (CPG) with adenosine diphosphate (ADP) for the examination of aspirin (ASA) effectivity with optical aggregometry. In total,116 patients were prospectively enrolled with a stable cardiovascular disease, taking ASA 100 mg/day for >or=1 month. The control group consisted of 62 healthy volunteers. A platelet aggregation was investigated by optical aggregometry (aggregometer LASER 4x; BIO ART, Sint-Katelijne-Waver, Belgium). CPG and ADP were added as aggregating agents. The measured parameters were CPG-slope (%/min) and ADP max (%). Using the CPG-slope values from the control group, the CPG-slope cut-off value was determined to define a laboratory ASA-noneffectively treated patient. The values from control group followed a normal distribution (Shapiro-Wilk test). We calculated the cut-off value using the 1-tailed 95% confidence interval. The CPG-slope cut-off value was 79 %/min for an ASA-effectively treated patient. We marked the patients as laboratory ASA-noneffective treated when the CPG-slope was >79%/min. In the same way we defined the cut-off value for ADP-max. We identified the aspirin treatment as ineffective when the value of ADP-max was >62%. The values of CPG-slope and ADP-max were in close correlation in the group of patients treated with aspirin with a highly significant correlation index (r=0.671, P<0.001). By CPG-induced optical aggregation, 33,6% were ASA-noneffectively treated patients. When using both inductors, the proportion of ASA-noneffectively treated patients was 25%. Using both tests, 72.4% of patients were equally divided. ASA-noneffectively treated patients were commonly more obese (46.2%), had hypertension (94.9%) and hypercholesterolemia (73.7%), and were less commonly treated with statins (30.8%) than the aspirin effectively treated patients (42%, 88.2%, 59.2%, and 42.1%, respectively). The detected differences were not statistically significant. Cationic propyl gallate is an optimal inductor for optical aggregometry to monitor laboratory effectiveness of aspirin therapy in routine clinical pratice. The determined high prevalence of laboratory aspirin ineffectiveness highlights the clinical importance of the problem. This study brings attention to the importance of controlling cardiovascular risk factors.