Lipoprotein heterogeneity at birth: influence of gestational age and race on lipoprotein subclasses and Lp (a) lipoprotein

OBJECTIVE

To determine the influence of gestational age, gender, and race, on lipoprotein heterogeneity at birth.

DESIGN

Prospective study of representative sample of infants.

SETTING

The Johns Hopkins Hospital.

PARTICIPANTS

163 infants (70 White and 93 Black) >28 weeks gestational age.

INTERVENTION

None.

MAIN OUTCOME MEASURES

Lipids, lipoprotein subclasses, apolipoproteins, Lp (a) lipoprotein.

RESULTS

The number of low-density lipoprotein (LDL) particles, large LDL subclass, and LDL cholesterol level, were all significantly higher in the younger infants. The large high-density lipoprotein (HDL) subclass was significantly higher, while the small HDL subclass was significantly lower in the younger infants. Female infants had a greater HDL size than did males (P=.03). There were no differences between the age groups for HDL cholesterol, very low-density lipoprotein subclasses, or levels of triglycerides, or apolipoproteins B and A-I. White infants had a notably higher mean (SD) level (nmol/L) of total LDL particles (476 [251]), compared to the Black infants (372 [177]) (P=.009). The Black infants had a significantly (P=.02) higher mean (SD) Lp (a) lipoprotein level (mg/dL), compared to the White infants, 2.8 (3.2) vs 1.7 (2.4). Black small-for-gestational age infants had significantly higher levels of very low and intermediate density lipoproteins and apolipoprotein B, compared to appropriate-for-gestational age infants.

CONCLUSIONS

Gestational age has a significant effect on both LDL and HDL subclasses. Differences in LDL particle number and Lp (a) between White and Black infants mirror those seen later in life.

Lipid and apolipoproteins (ApoAI, ApoB, Apo CIII, ApoE) disturbance in hemodialysis (HD) and renal transplant (Tx) patients

The aim of the study was to evaluate the serum lipid and apolipoprotein profiles among patients after renal transplantation (Tx) and to compare them with the profiles obtained for permanently hemodialysed patients (HD). The investigations were performed at 15 Tx, 40 HD patients and the control group of 40 healthy subjects. There were significantly increased TG, ApoAIII, ApoE, TC/ HDL-C, ApoCIII non B, ApoCIII:B and decreased HDL-C, ApoAI, HDL-C/ApoAI, ApoAI/ApoCIII, ApoB/ApoCIII ratios comparing HD patients to the control group. There were increased TG, ApoCIII, ApoCIII non B, ApoB/ApoCIII ratios and decreased ApoAI/ApoCIII ratios in Tx patients as compared to the control subjects. Moreover, there were significantly higher HDL, ApoAI, HDL/ApoAI, ApoCIII non B and lower ApoE, ApoE/ApoB, ApoCIII:B ratios in Tx patients as compared to these of HD patients. Significant inverse correlation of the time which passed from executed Tx and ApoCIII:B ratio (r = -0.67; p < 0.01) at renal transplant patients were observed, which means the diminished risk of development of atherosclerosis.

Effects of Glucosyl Hesperidin on Serum Lipids in Hyperlipidemic Subjects: Preferential Reduction in Elevated Serum Triglyceride Level

Although hesperidin lowers serum total cholesterol (TC) or triglyceride (TG) in animal models, its effect in humans remains unclear. Using a soluble hesperidin derivative, glucosyl hesperidin (G-hesperidin), as a hesperidin source, we examined the efficacy on hyperlipidemic subjects. G-Hesperidin was administered to the subjects at 100 or 500 mg/d for 6 wk. The percentage of subjects who had a change in serum cholesterol levels was less than 20%. However, 45-55% of the total subjects showed a reduction in serum TG level. The subjects were classified into normal (TC<230mg/dL, TG<150mg/dL), high-TC (TC>230 mg/dL, TG<150 mg/dL) and high-TG (TG>150 mg/dL) types. While serum cholesterol levels scarcely changed in any phenotype, TG level was significantly reduced by administration in the high-TG type. In this phenotype, serum apolipoprotein (apo) C-II and E levels decreased by the administration, but non-apo B. G-Hesperidin also raised low-density lipoprotein (LDL)-cholesterol/apo B in the high-TG type. These results indicate that G-hesperidin preferentially lowers serum TG in hypertriglyceridemic subjects and that this effect is possibly caused by the facilitation of catabolism of TG-rich lipoproteins and may contribute to the reduction of small dense LDL.

Dietary restriction in aged mice can partially restore impaired metabolism of apolipoprotein A-IV and C-III

Dietary restriction (DR) is only one well-established non-genetic experimental means to retard aging in various species of animals. Here we demonstrated that DR in mice for 3 months initiated late in life, at the age of 22 months, partially restores age-related decline of serum apolipoprotein A-IV (apo A-IV) level and the gene expression found in the liver of ad libitum fed young animals as revealed by fasting. In contrast, increase in gene expression of apo C-III by fasting was higher in the aged than that in the young, but it was reduced to the level of young animals in DR counterparts of the aged. In view of the implication that apo A-IV and C-III are involved in the activation and inhibition of lipoprotein lipase, respectively, the adult onset DR can conceivably upregulate the activity of this enzyme that is likely reduced in aged animals and thus improve the lipid metabolism. The present findings suggest that DR initiated even relatively late in life may reduce risk of age-related diseases associated with impaired lipid metabolism.

Apolipoprotein C-III, metabolic syndrome, and risk of coronary artery disease

Apolipoprotein C-III (apoC-III) is a marker of triglyceride (TG)-rich lipoproteins, which are often increased in metabolic syndrome (MS). The T-455C polymorphism in the insulin-responsive element of the APOC3 gene influences TG and apoC-III levels. To evaluate the contribution of apoC-III levels and T-455C polymorphisms in the coronary artery disease (CAD) risk of MS patients, we studied 873 patients, 549 with CAD and 251 with normal coronary arteries. Patients were classified also as having or not having MS (MS, n = 270; MS-free, n = 603). Lipids, insulin, apolipoprotein levels, and APOC3 T-455C genotypes were evaluated. ApoC-III levels were significantly increased in MS patients, and the probability of having MS was correlated with increasing quartiles of apoC-III levels. MS patients with CAD had significantly higher apoC-III levels than did CAD-free MS patients. The carriership for the -455C variant multiplied the probability of CAD in MS in an allele-specific way and was associated with increased apoC-III and TG levels. Obesity was less frequent in MS carriers of the -455C allele than in MS noncarriers (21.6% vs. 34.8%, P < 0.05). In conclusion, apoC-III-rich lipoprotein metabolism and the APOC3 polymorphism have relevant impacts on the CAD risk of MS patents.

Plasma turnover of HDL apoC-I, apoC-III, and apoE in humans: in vivo evidence for a link between HDL apoC-III and apoA-I metabolism

Numerous factors are known to affect the plasma metabolism of HDL, including lipoprotein receptors, lipid transfer protein, lipolytic enzymes and HDL apolipoproteins. In order to better define the role of HDL apolipoproteins in determining plasma HDL concentrations, the aims of the present study were: a) to compare the in vivo rate of plasma turnover of HDL apolipoproteins [i.e., apolipoprotein A-I (apoA-I), apoC-I, apoC-III, and apoE], and b) to investigate to what extent these metabolic parameters are related to plasma HDL levels. We thus studied 16 individuals with HDL cholesterol levels ranging from 0.56-1.66 mmol/l and HDL apoA-I levels ranging from 89-149 mg/dl. Plasma kinetics of HDL apolipoproteins were investigated using a primed constant (12 h) infusion of deuterated leucine. Plasma HDL apolipoprotein levels were 41.8 +/- 1.5, 9.7 +/- 0.5, 4.9 +/- 0.5, and 0.7 +/- 0.1 micromol/l for apoA-I, apoC-I, apoC-III and apoE. Plasma transport rates (TRs) were 388.6 +/- 24.7, 131.5 +/- 12.5, 66.5 +/- 9.1, and 31.4 +/- 3.3 nmol.kg-1.day-1; and residence times (RTs) were 5.1 +/- 0.4, 3.7 +/- 0.3, 3.6 +/- 0.3, and 1.1 +/- 0.1 days, respectively. HDL cholesterol and apoA-I levels were significantly correlated with HDL apoA-I RT (r = 0.69 and r = 0.56), and were not significantly correlated with HDL apoA-I TR. In contrast, HDL apoC-I, apoC-III, and apoB levels were all positively related to their TRs and not their RTs. HDL apoC-III TR was positively correlated with levels of HDL apoC-III (r = 0.73, P < 0.01), and with those of HDL cholesterol and apoA-I (r = 0.54 and r = 0.53, P < 0.05, respectively). HDL apoC-III TR was in turn related to HDL apoA-I RT (r = 0.51, P < 0.05). Together, these results provide in vivo evidence for a link between the metabolism of HDL apoC-III and apoA-I, and suggest a role for apoC-III in the regulation of plasma HDL levels.

Genetic study of common variants at the Apo E, Apo AI, Apo CIII, Apo B, lipoprotein lipase (LPL) and hepatic lipase (LIPC) genes and coronary artery disease (CAD): variation in LIPC gene associates with clinical outcomes in patients with established CAD

BACKGROUND

Current evidence demonstrates that positive family history and several alterations in lipid metabolism are all important risk factors for coronary artery disease (CAD). All lipid abnormalities themselves have genetic determinants. Thus, objective of this study was to determine whether 6 genetic variants potentially related to altered lipid metabolism were associated with CAD and with lipid abnormalities in an Italian population. These genetic variables were: apolipoprotein E (Apo E), Apo AI, Apo CIII, Apo B, lipoprotein lipase (LPL) and the hepatic lipase (LIPC) genes. Furthermore, an 8 years prospective analysis of clinical cardiovascular events was related to the various genetic markers.

METHODS

102 subjects with established coronary artery disease and 104 unrelated normal subjects were studied. CAD Patients were followed up for 8 years, and clinical CAD outcomes (a second coronary angioplasty (PTCA), myocardial infarction, coronary artery by-pass graft (CABG), cardiovascular deaths), available from 60 subjects, were related to the genetic variants by multiple regression analysis. Results. Of the six lipid loci studied (for a total of 11 polymorphisms) only the apolipoprotein E, Apo B and LIPC polymorphisms distinguished between case and controls. However, multivariate analysis accounting for clinical and metabolic predictors of CAD showed that only the ApoB Xba1 and ApoE4 polymorphism associated with CAD in this Italian population. When lipid parameters were related to genotypes, the ApoE, ApoB, and LIPC gene polymorphisms were associated to various markers of dyslipidaemia in the CAD patients, confirming previous reports. When the occurrence of a second cardiovascular event was related to genotypes, an independent role was observed for the LIPC gene T202T variant.

CONCLUSIONS

variation in LIPC (hepatic lipase) gene associates with clinical outcomes in Italian patients with established CAD. Further studies on the LIPC gene in CAD patients are warranted, in particular looking at the possible influences on clinical outcomes.

Effectiveness and tolerability of a new lipid-altering agent, gemcabene, in patients with low levels of high-density lipoprotein cholesterol

This study evaluated the efficacy and tolerability of gemcabene, a new lipid-altering agent, in a double-blind, randomized, dose-response study of 161 patients with high-density lipoprotein (HDL) cholesterol of <35 mg/dl and serum triglyceride (TG) levels of either >/=200 (n = 94) or <200 mg/dl (n = 67). After a 6-week, placebo, dietary lead-in period, patients were administered either 150, 300, 600, or 900 mg of gemcabene or placebo once daily for 12 weeks. In the TG >/=200 mg/dl stratum, gemcabene significantly increased serum HDL cholesterol by 18% with corresponding significant increases of 6% in both apolipoprotein A-I and A-II levels at the 150-mg dose. HDL cholesterol levels also increased 12% at the 300-mg dose; however, this did not reach statistical significance. Also, in the TG >/=200 mg/dl stratum, serum TG levels were significantly reduced by 27% and 39% at the 150- and 300-mg doses of gemcabene, respectively. No significant differences were found in serum HDL cholesterol or TG levels in the TG >/=200 mg/dl groups that received 600 or 900 mg of gemcabene, or in TG <200 mg/dl groups administered any dose of gemcabene. However, at these higher 600- and 900-mg doses, gemcabene significantly reduced serum low-density lipoprotein (LDL) cholesterol levels by 15% to 25%, respectively, in both TG strata, with proportionate decreases in the levels of apolipoprotein B. Gemcabene was well tolerated with a frequency of adverse events similar to that of placebo. In conclusion, at the lower doses, gemcabene significantly increased HDL cholesterol and reduced TG serum levels in patients with low HDL cholesterol and TG >/=200 mg/dl. At the higher doses, gemcabene significantly reduced LDL cholesterol levels in all patients with low HDL cholesterol.

Effect of pravastatin on intermediate-density and low-density lipoproteins containing apolipoprotein CIII in patients with diabetes mellitus

The apolipoprotein (apo) B lipoproteins, intermediate-density lipoproteins (IDL) and low-density lipoproteins (LDL) that contain apo-CIII are associated with coronary heart disease in patients with diabetes mellitus. Apo-CIII is prominent in diabetic dyslipidemia. We studied whether these apo-B lipoprotein types containing apo-CIII in diabetics are reduced by 1 year of pravastatin treatment. We randomly selected 45 age- and gender-matched placebo/pravastatin pairs from diabetic patients in the Cholesterol and Recurrent Events trial, a randomized, double-blinded trial of pravastatin 40 mg monotherapy. Very-low-density lipoproteins (VLDL) and IDL + LDL particles were subdivided based on the presence of apo-E and apo-CIII to yield 3 particle types: E+CIII+, E-CIII+, and E-CIII-. Compared with placebo, pravastatin reduced IDL + LDL apo-B concentrations for E+CIII+, E-CIII+, and E-CIII- by 42% (p = 0.02), 17% (p = 0.7), and 29% (p = 0.002), respectively, commensurate with IDL + LDL cholesterol concentration reductions in the particle types of 29% (p = 0.002), 25% (p = 0.2), and 36% (p <0.0001), respectively. These IDL + LDL CIII+ particles are rich in triglycerides and cholesterol and are likely to be remnant particles of VLDL. Thus, pravastatin reduced potentially atherogenic remnant particles, a prominent component of diabetic dyslipidemia associated with coronary events; these results may contribute to its demonstrated effectiveness in reducing coronary heart disease in diabetics.

Plasma concentration and lipoprotein distribution of ApoC-I is dependent on ApoE genotype rather than the Hpa I ApoC-I promoter polymorphism

An Hpa I restriction site located 317 bp upstream of the transcription initiation site of the apoC-I gene has been shown to increase apoC-I gene transcription in vitro. The aim of the present study was to determine whether this genetic polymorphism was associated in vivo with increased plasma levels of apoC-I. In a cohort of French-Canadians (n=391) recruited for a family study, we found strong linkage disequilibrium between the genes for apoC-I and apoE (as reported before for European-Americans), such that the apoC-I Hpa I-negative (H1) allele was strongly associated with apoE epsilon 3, whereas the apoC-I Hpa I-positive (H2) allele was strongly associated with apoE epsilon 2 and epsilon 4. ApoC-I and apoE were measured by ELISA in total plasma and in very low-density lipoproteins (VLDL) separated by ultracentrifugation (d<1.006 g/ml), and then by difference for the non-VLDL fraction (d>1.006 g/ml), in a subset of families selected for their diverse apoE genotypes. Subjects were divided into normolipidemic (NL, n=89, TG<2.3 mmol/l, LDL-C<3.8 mmol/l) and hyperlipidemic groups (HL, n=88, TG>2.3 mmol/l and/or LDL-C>3.8 mmol/l). In NL subjects, apoC-I levels were not significantly associated with apoC-I genotype (H1/H1, H1/H2 or H2/H2). They were, however, related to apoE genotype, such that apoE3/2 subjects tended to have higher and apoE4/3 subjects tended to have lower concentrations of total plasma and non-VLDL apoC-I and apoE. Total plasma, VLDL and non-VLDL apoC-I and E levels were also higher in HL subjects with an apoE2/2 or apoE3/2 genotype. These results suggest that plasma levels of apoC-I are more strongly influenced by apoE genotype than by the Hpa I apoC-I promoter polymorphism, which probably reflects an effect of different apoE isoforms on plasma lipoprotein and plasma apoC-I metabolism, rather than a direct effect of apoE alleles on apoC-I transcription.

Fourier-transform infrared spectrometry determination of the metabolic changes during a maximal 400-meter swimming test

We describe the metabolic changes in the blood that appeared during a maximal 400-m swimming test in 7 male swimmers by Fourier-transform infrared spectrometry (FT-IR spectrometry). A 400-m test (255.9 +/- 6.8 s) was performed during which stroke frequency and time to complete each pool distance were recorded. In three other tests, the first 100 m, 200 m, and 300 m were swam at the same stroke frequency and velocity. Capillary blood samples were taken at rest and after tests to analyze change in plasma contents by FT-IR spectrometry. Best swimmers were characterized by higher glycemia increase at the onset of exercise (r = -0.91; p < 0.01). Lactate increase was also higher after 300 m (r = -0.97; p < 0.01). Higher amounts of fatty acids were also available at the end of exercise, as assessed by the relationships found between swimming velocity and concentrations of albumin (r = 0.96; p < 0.01), apolipoprotein C 3 (r = 0.93; p < 0.01), triglycerides (r = -0.81; p < 0.05), and fatty acids (r = 0.97; p < 0.01). This metabolic response allowed the best swimmers to maintain longer their initial swimming velocity. The best swimmers presented also higher amino-acid concentration increase during exercise (r = 0.91; p < 0.01). Therefore, performance competence originated probably from better regulation in carbohydrate, lipid, and amino-acid metabolism.

[The significance of the distribution of apolipoprotein C-III in serum lipoproteins]

Apolipoprotein C-III(CIII) is distributed mainly into VLDL and HDL, and into LDL and chylomicron to a lesser degree. CIII has been proposed to inhibit lipolysis of triglyceride(TG), but the significance of its distribution in several lipoproteins is not well understood. In this study using immunofixation electrophoresis, that issue was re-evaluated. The method was advantageous in excluding CIII in chylomicron. Concentration of CIII in pre-beta and beta lipoproteins(beta-CIII) was positively correlated with serum TG, and the ratio of CIII in alpha lipoprotein(alpha-CIII) to beta-CIII(alpha/beta CIII) was negatively correlated with TG, and the ratio was positively correlated with cholesterol of alpha lipoprotein(alpha-Chol) and negatively with pre-beta-Chol, so that the ratio can be considered a predictor of the metabolic rate of apoB-containing lipoproteins(LpB). There was a tendency for negative correlation between beta-CIII and alpha-CIII. alpha/beta CIII was positively correlated with HDL-ch/apoA, which had previously been defined as an inverse predictor of catabolic rate of apoA-I. These findings indicate that distribution of CIII into serum lipoproteins being dependent upon lipolysis may induce a linkage of catabolic rate of apoA-I in inverse proportion to metabolic rate of LpB.

Indices related to apo CII and CIII serum concentrations and coronary heart disease: a case-control study

BACKGROUND

Triglycerides (TG) are carried in the circulation by diverse lipoprotein particles, which vary in their lipid and protein content, metabolism, and atherogenicity. Several indices related to apolipoproteins (apo) CII and CIII blood concentration have been proposed to reflect TG metabolism more accurately than the blood level of TG. In the present study we compared the distribution of those indices in coronary heart disease (CHD) patients and controls..

METHODS

Ninety consecutively discharged patients with CHD and 209 healthy controls were included in the analysis. Demographic, clinical, and laboratory characteristics were obtained.

RESULTS

The CHD patients differed appreciably from controls in several TG-related variables. After adjusting for cardiovascular risk factors, significant associations were found between CHD and the following: TG, VLDL-C, apo CIII, apo CIII in HDL, apo CIII in VLDL + LDL, apo CII- to- TG ratio, and apo CIII ratio (CIII in HDL/CIII in VLDL + LDL). Further adjustment for HDL-C substantially attenuated the above associations, except for those regarding apo CIII in VLDL + LDL (odds ratio (OR): 1.69 per 1 SD increment, 95%CI: 1.03-2.77) and apo CIII ratio (OR: 0.40 per 1 SD increment, 95%CI: 0.15-1.00).

CONCLUSION

Our results add to the growing evidence which links apo CIII concentration in VLDL + LDL to CHD. Further confirmation in prospective studies would be required before considering this measurement as a screening tool.

Human apoC-IV: isolation, characterization, and immunochemical quantification in plasma and plasma lipoproteins

Apolipoprotein C-IV (apoC-IV), the newest member of the low-molecular-weight apoC group, has been characterized in blood plasma of rabbits, in which it is a major proline-rich apoC component (Zhang, L-H., L. Kotite, and R. J. Havel. 1996. Identification, characterization, cloning, and expression of apoC-IV, a novel sialoglycoprotein of rabbit plasma lipoproteins. J. Biol. Chem. 271: 1776-1783). Although the decoded sequence of mouse and human apoC-IV is known, apoC-IV has not been identified in blood plasma from these or other species. Rabbit apoC-IV exists in several sialoforms, and the asialoform has an acidic isoelectric point. We show that apoC-IV is a basic protein in human, monkey, and mouse plasma, present as a minor apoC component of VLDL. Human apoC-IV, isolated from apo VLDL by DEAE-cellulose chromatography and two-dimensional electrophoresis, was identified by microsequencing four tryptic peptides. The protein exhibits two major isoforms; one is N-glycosylated, and both are variably sialylated. In normolipidemic plasma, greater than 80% of the protein is in VLDL (0.7% of total apo VLDL), with most of the remainder in HDL. The concentration of apoC-IV in the plasma and lipoproteins of rho < 1.21 g/ml is closely related to plasma triglyceride concentration up to 1,770 mg/dl, varying from 0.1-1.9 mg/dl. Neither the human nor rabbit apoC-IV gene contains a typical TATA box in the 5'-flanking region, but the 5'-untranslated region of the rabbit gene contains a unique purine-rich sequence, GGGACAG(G/A), repeated nine times in tandem, with an additional two within the 5'-flanking sequence. This sequence, functioning as a GAGA box that has been implicated in the transcription of a number of genes, may explain the higher level of expression of apoC-IV in rabbits.

Very low-density lipoprotein-apoprotein CI is increased in diabetic nephropathy: comparison with apoprotein CIII

BACKGROUND

Recent studies have suggested that apoprotein (apo) CI in very low-density lipoprotein (VLDL) plays an important role in causing hypertriglyceridemia independent of apo CIII, which is associated with coronary heart disease (CHD). Because the incidence of CHD is increased in diabetic patients and is even higher when diabetic nephropathy is developed, we measured apo CI levels in VLDL from type 2 diabetic patients, with various degree of nephropathy, and compared the results with those for healthy controls or nondiabetic patients with chronic renal failure (CRF).

METHODS

This study enrolled healthy control subjects, type 2 diabetic patients with normoalbuminuria, microalbuminuria, overt proteinuria, and CRF on hemodialysis and nondiabetic hemodialysis patients. VLDL (density <1.006) was separated by ultracentrifugation. Then the apo CI, CIII, and B concentrations in VLDL were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

The apo CI, CIII, and B concentrations in VLDL were respectively 3-, 2-, and 2-fold higher, respectively, in diabetic patients with overt proteinuria than in controls. Hemodialysis patients with diabetic nephropathy had levels of apo CI, CIII, and B in VLDL that were 2.6-, 2.7- and 2-fold higher, respectively, than those in controls. Nondiabetic hemodialysis patients also had a 2.7-fold higher level of VLDL apo CIII, whereas VLDL apo CI and VLDL apo B were not significantly increased. VLDL apo CI was significantly correlated with VLDL apo B independently of VLDL apo CIII level.

CONCLUSION

An increase of VLDL apo CIII is a prominent feature of dyslipidemia in CRF patients, regardless of whether they are diabetic or nondiabetic, whereas an increase of VLDL apo CI is more specific to diabetic nephropathy and is closely associated with an increase of VLDL particle numbers, a new risk factor for CHD.

LDL containing apolipoprotein CIII is an independent risk factor for coronary events in diabetic patients

OBJECTIVE

Triglyceride-rich lipoproteins that contain apolipoprotein CIII (apoCIII) are prominent in diabetic dyslipidemia. We hypothesized that these lipoproteins increase coronary disease risk in diabetic patients beyond that caused by standard lipid risk factors.

METHODS AND RESULTS

Diabetic patients with previous myocardial infarction were followed for 5 years, and 121 who had a recurrent coronary event were matched to 121 who did not. VLDL and LDL that contained or did not contain apoCIII (CIII+ or CIII-) were prepared by immunoaffinity chromatography and ultracentrifugation. IDL was included in the LDL fraction. LDL CIII+, rich in cholesterol and triglyceride, was the strongest predictor of coronary events (relative risk [RR] 6.6, P<0.0001, for 4th versus 1st quartile). LDL CIII+ comprised 10% of total LDL. The main type of LDL, LDL CIII-, was less strongly predictive (RR 2.2, P=0.07). The increased risk associated with LDL CIII+ was unaffected by adjustment for plasma lipids, apoB, non-HDL cholesterol, or the other VLDL and LDL types. For VLDL CIII+, RR 0.5, P=0.07; for VLDL CIII-, RR 2.3, P=0.046. The presence of apolipoprotein E with CIII on VLDL and LDL did not affect risk.

CONCLUSIONS

LDL with apoCIII strongly predicts coronary events in diabetic patients independently of other lipids and may be an atherogenic remnant of triglyceride-rich VLDL metabolism.

Apolipoprotein C-III, a strong discriminant of coronary risk in men and a determinant of the metabolic syndrome in both genders

AIMS

Apolipoprotein C-III (apoC-III) has been recognized as a useful marker of triglyceride-rich lipoproteins (TRLs) metabolism and proposed as an indicator of prognosis for coronary risk in healthy subjects. We studied cross-sectionally in a population having low cholesterol levels, but a high prevalence of the metabolic syndrome, whether serum levels of total apoC-III or its sub-fractions were independent markers of prevalent coronary heart disease (CHD) or were related to variables reflecting the metabolic syndrome.

METHODS AND RESULTS

In 857 unselected participants of the representative population sample of the Turkish Adult Risk Factor Survey in 2001, apoC-III as well as other risk variables were evaluated, and CHD was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms. The sample consisted of men and women, aged 33-82 years, having a mean waist circumference of 89.4 and 92.9 cm, respectively, 42% of whom had the metabolic syndrome identified by criteria of the ATP III. ApoC-III values were measured by turbidimetric immunoassay. Mean concentrations for non-high-density lipoprotein (nonHDL) apoC-III in men and women were 6.4 and 6.2 mg/dl, respectively, and for apoC-III in HDL were 6.2 and 6.3 mg/dl, respectively. NonHDL apoC-III was similar to, and apoC-III in HDL was higher than that in Western populations. Both fractions of apoC-III were significantly correlated with lipids, lipoproteins, apoB, anthropometric measures, and blood pressures in both genders. Correlations for both were high with serum triglycerides (r(s)=around 0.70) and apoB (r(p)=around 0.37). Total apoC-III as well as both fractions were significantly correlated in women also with levels of inflammatory risk markers: strongly (r=0.40-0.45, P<0.001) with complement C3, and weakly (r(s)=around 0.20, P<0.001) with C-reactive protein. A cutoff of >7.0 mg/dl as opposed to lower levels of nonHDL apoC-III indicated the presence of hypertriglyceridemic hyperapo B with an age-adjusted odds ratio (OR) of 13.8; it indicated the presence of metabolic syndrome with 4.66-fold likelihood. Total apoC-III and nonHDL apoC-III proved to be significantly (P-trend <0.05 and 0.002) and strongly associated with prevalent CHD in men even after adjustment for age, low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C): OR gradients across upper and lower quartiles were 3.88-fold (CI: 1.3; 11.4) and 8.8-fold (CI: 2.6; 29.8), respectively.

CONCLUSIONS

In a population among whom the metabolic syndrome prevails, total- and nonHDL apoC-III are each a determinant in both genders of the metabolic syndrome and of hypertriglyceridemic hyperapo B. Each is a powerful significant marker of prevalent CHD in men independent of LDL- and HDL-C levels. In women, despite being correlated with inflammatory risk markers, the significant association of elevated levels of apoC-III with CHD did not prove to be independent of age.

Hypertriglyceridemia but not diabetes status is associated with VLDL containing apolipoprotein CIII in patients with coronary heart disease

High apoCIII concentration in apoB lipoproteins is a prominent component of atherogenic dyslipidemia, and explains the risk of coronary heart disease (CHD) associated with high triglyceride (TG). We hypothesized that diabetic people have atherogenic dyslipidemia with apoCIII in excess of that accounted for by their high TG levels. We selected 30 diabetic and 30 nondiabetic persons, 15 of each with fasting TG<160 mg/dl and 15 with TG>/=200 mg/dl. Using immunoaffinity chromatography and ultracentrifugation, we prepared large and small VLDL, IDL and LDL with or without apoCIII or apoE. The groups with TG>/=200 mg/dl, regardless of diabetes status, had higher concentrations of large and small VLDL particles with apoCIII and higher apoCIII concentrations than the groups with fasting TG<160 mg/dl. The diabetes groups did not have higher concentrations of these lipoproteins than the nondiabetes groups within the same fasting TG criteria. In conclusion, high concentrations of apoCIII-containing VLDL are associated with hypertriglyceridemia, which may play a critical role in identifying the high risk of CHD in hypertriglyceridemic patients whether diabetic or nondiabetic. Diabetes status per se does not appear to be associated with high concentrations of apoCIII-containing TG-rich lipoprotein particles, if the plasma TG levels are similar.

Concentrations of apolipoproteins E, C2, and C3 and lipid profile in preeclampsia

OBJECTIVE

Preeclampsia is associated with an abnormal lipid profile and high apolipoprotein E (Apo E) levels. Apo E may favor lipid uptake by macrophages and is thought to increase triglycerides clearance. However, high Apo E levels may interfere with lipolysis by interacting with the lipoprotein lipase (LPL) activator, apolipoprotein C2 (Apo C2). LPL activity may also be impaired by high levels of the LPL inhibitor apolipoprotein C3 (Apo C3). Therefore, lipid profile depends on the balance between the opposing effects of Apo C2 and Apo C3 and on interference due to Apo E. We investigated the involvement of these three lipoproteins in lipid disorders associated with preeclampsia.

METHODS

Blood samples were taken from 25 normotensive and 24 preeclamptic pregnant women after a 12-hr fasting period. These samples were analyzed for standard lipid profile and Apo E, C2, C3 concentrations.

RESULTS

Concentrations of triglycerides, total cholesterol, LDL, HDL, and LDL cholesterol did not differ significantly between preeclamptic women and pregnant controls. Apo C2 concentration and Apo E/Apo C2 ratio did not differ between the two groups of women but Apo C3 and Apo E concentrations were higher in preeclamptic than in pregnant controls. The ratio of triglycerides to Apo E was similar in the two groups of women. In both groups, triglycerides levels were positively correlated with Apo E (p=0.0429), Apo C2 (p=0.0045) and Apo C3 (p=0.0004) concentrations, but not with Apo E/Apo C2 ratio (p=0.760).

CONCLUSIONS

In preeclamptic women, the increase in Apo E concentration may not increase triglycerides clearance because LPL activity seems to be inhibited by high Apo C3 concentration.

Biological and genetic determinants of serum apoC-III concentration: reference limits from the Stanislas Cohort

Apolipoprotein C-III (apoC-III) is involved in triglycerides metabolism, and is therefore important for the pathogenesis of coronary heart diseases. However, to our knowledge serum apoC-III variation factors and reference limits have never been determined, so the aim of this study was to establish them and facilitate clinical usefulness. We measured serum apoC-III concentration of apparently healthy subjects of the Stanislas Cohort by an immunoturbidimetric method. Genetic polymorphisms within the APOC3, APOE, APOAIV, and LPL genes were determined by a multiplex PCR. Serum apoC-III concentration varied from 28.2 mg/l to 225.8 mg/l in the overall sample and between subjects variability was about 30%. Factors influencing apoC-III concentration were age, BMI in adult men, alcohol consumption in adults, oral contraceptive intake in women, the post-pubescent status in boys. The APOC3 1100T allele in adult men and the APOC3 -455C allele in boys were associated with increased apoC-III concentration. The APOA4 360His allele was associated with decreased apoC-III concentration in women. We also established reference limits of serum apoC-III concentration according to age and gender.

Plasma lipoproteins, apoproteins and cardiovascular disease in type 2 diabetic patients. A nine-year follow-up study

BACKGROUND AND AIM

To evaluate the role of lipoprotein abnormalities as risk factors for macroangiopathy in Type 2 diabetes.

METHODS AND RESULTS

This prospective nine-year follow-up study involved 113 Type 2 diabetic patients (50 men and 63 women, mean age 66.9 +/- 9.9 years), 37 of whom had clinical signs of coronary heart disease (CHD) and cerebrovascular disease (CVD) at baseline. During the follow-up, 32 patients died: 17 of CHD, five of CVD, and 10 of non-vascular causes. The patients who died because of vascular disease were more frequently smokers, and had baseline symptoms of vascular disease; they were also significantly different from the other patients insofar as they were older, and had higher fasting plasma glucose levels, lower fasting C-peptide levels, and lower apoprotein (apo) AII, apo CII, apo CIII and apo E levels. Univariate analysis showed that baseline symptoms of vascular disease, current smoking, age, high fasting plasma glucose levels, low fasting C-peptide levels, and low apo AII, apo CII, apo CIII and apo E levels [but not cholesterol, triglyceride, high-density lipoprotein (HDL)-cholesterol or qualitative low-density lipoprotein or HDL abnormalities] were associated with cardiovascular mortality. Multivariate analysis showed that only age, smoking, glycated hemoglobin (HbA1c) and fasting C-peptide levels were significant independent determinants of macrovascular death.

CONCLUSIONS

In Type 2 normolipidemic diabetic patients, only age, smoking, HbA1c and fasting C-peptide levels are independent vascular risk factors. The differences in apo concentrations between patients with and without vascular disease may reflect qualitative abnormalities in plasma lipoproteins related to vascular disease.

Contribution of apo CIII reduction to the greater effect of 12-week micronized fenofibrate than atorvastatin therapy on triglyceride levels and LDL size in dyslipidemic patients

BACKGROUND

Apolipoprotein (apo) CIII plays an important role in the catabolism of triglyceride-rich lipoproteins as it is a potent inhibitor of lipoprotein lipase (LPL). A low LPL activity has been simultaneously associated with hypertriglyceridemia, low HDL cholesterol and with small LDL particles.

AIM

To compare the effects of a 12-week treatment with micronized fenofibrate (200 mg) versus atorvastatin (10 mg) on apo CIII and lipoprotein-lipid levels including LDL size.

METHOD

After a 4-week washout period, dyslipidemic patients were randomized to either micronized fenofibrate (n = 64) or atorvastatin (n = 72).

RESULTS

Both fenofibrate and atorvastatin significantly decreased apo CIII levels by -0.03 +/- 0.03 versus -0.01 +/- 0.03 g/l respectively, and increased LDL size by 4.9 +/- 3.3 versus 1.8 +/- 2.9 A. Improvements in these parameters were significantly greater with fenofibrate (P < 0.0001). Significant relationships were found between changes in triglycerides and changes in apo CIII (r = 0.81 and r = 0.59, P < 0.0001) as well as between changes in LDL size and changes in apo CIII (r = -0.41 and r = -0.45, P < 0.001), in both fenofibrate and atorvastatin groups. respectively.

CONCLUSION

The substantial reduction in apo CIII induced by micronized fenofibrate plays an important role in the greater effect of micronized fenofibrate than atorvastatin on plasma triglycerides and LDL size.