351
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Menéndez Valladares P, Arrobas Velilla T, Bermúdez de la Vega JA, Romero Pérez MDM, Fabiani Romero F, González Rodríguez C. [Increased lipoprotein(a) in a paediatric patient associated with nephrotic syndrome]. Clin Investig Arterioscler 2016; 28:227-229. [PMID: 27623226 DOI: 10.1016/j.arteri.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
A common complication in paediatric patients with nephrotic syndrome (NS) is hyperlipidaemia. About 20% of children do not respond to treatment with corticosteroids, presenting with a cortico-resistant NS (CRNS), which can progress to kidney failure. It has been observed that paediatric patients with CRNS have an elevated low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), and triglycerides levels, as well as elevated Lipoprotein-a [Lp (a)] levels. The case is presented of a 5 year old boy, diagnosed with CRNS, presenting with dyslipidaemia with increased LDL-c, Apo-B100, and Lp(a) levels. After the poor prognosis of the renal function, immunosuppressant treatment was started with tacrolimus and atorvastatin to control dyslipidaemia. Although tacrolimus causes an elevation of total cholesterol and LDL-c, the significant alterations of the children lipid profile suggest the existence of a high cardiovascular risk. In these cases, it would be interesting to have reference values in children in our health area.
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Affiliation(s)
- Paloma Menéndez Valladares
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - Teresa Arrobas Velilla
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España; Facultad de Medicina, Universidad Autónoma de Chile, Providencia, Región Metropolitana, Chile
| | | | - María Del Mar Romero Pérez
- Endocrinología Pediátrica, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Fernando Fabiani Romero
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Concepción González Rodríguez
- Laboratorio de Nutrición y RCV, Unidad de Gestión Clínica de Bioquímica Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
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352
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Abstract
Lipoprotein(a) [Lp(a)] is a genetic, independent and likely causal risk factor for cardiovascular disease (CVD) and calcific aortic valve stenosis (CAVS). Lp(a) levels are primarily genetically determined and tend to fluctuate only mildly around a pre-determined level. In primary care settings, one Lp(a) measurement can reclassify up to 40% of patients in intermediate risk score categories. In secondary care settings, recent data from the JUPITER and AIM-HIGH trials demonstrate that elevated Lp(a) remains part of the "residual risk" despite achievement of low-density lipoprotein cholesterol levels <70 mg/dL. Recent reports suggest that statins can increase Lp(a) levels, potentially further contributing to this residual risk. Current therapies to lower Lp(a) are limited to niacin, mipomersen and proprotein convertase subtilisin kexin-type 9 inhibitors, but these drugs are limited by weak efficacy and not specifically approved for Lp(a) lowering. Emerging therapies to lower Lp(a) may shed new light into the potential clinical benefit of lowering Lp(a) in CVD and CAVS.
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Affiliation(s)
- Sotirios Tsimikas
- Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, CA.
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353
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Yang SH, Li S, Zhang Y, Xu RX, Zhu CG, Guo YL, Wu NQ, Qing P, Gao Y, Cui CJ, Dong Q, Sun J, Li JJ. Analysis of the association between plasma PCSK9 and Lp(a) in Han Chinese. J Endocrinol Invest 2016; 39:875-83. [PMID: 26894681 DOI: 10.1007/s40618-016-0433-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/20/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE It has been reported that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can significantly reduce lipoprotein(a) [Lp(a)], and the mechanism for Lp(a) reduction remains unclear. Recently an interesting clinical research with a small sample showed a positive correlation between plasma PCSK9 and Lp(a) levels in diabetes. Here we aimed to use a relatively large sample to investigate whether such an association exists in Han Chinese. METHODS A total of 783 inpatients were consecutively enrolled and composed of 172 patients with type 2 diabetes mellitus (T2DM) and 611 non-T2DM subjects. Plasma PCSK9 level was measured by ELISA, and its association with Lp(a) was assayed by Spearman's correlation and multiple regression. Clinical and biochemical parameters were determined in all subjects studied. RESULTS No significant differences in PCSK9 and Lp(a) levels were found between T2DM and non-T2DM patients. PCSK9 level was not related to Lp(a) level either in T2DM or non-T2DM group in bivariate correlation and multiple linear regression analysis. Additionally, no association between the levels of PCSK9 and Lp(a) was found in well, poorly controlled T2DM patients or in T2DM patients with or without coronary artery disease (CAD). Besides, no difference was found among the PCSK9 values across tertiles of Lp(a) level. CONCLUSION We found no association of plasma PCSK9 levels with Lp(a) level in Han Chinese with or without T2DM, suggesting that Lp(a) reduction by PCSK9 inhibitors may not be achieved simply through PCSK9 pathway at least in Chinese.
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Affiliation(s)
- S-H Yang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - S Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - Y Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - R-X Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - C-G Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - Y-L Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - N-Q Wu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - P Qing
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - Y Gao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - C-J Cui
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - Q Dong
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - J Sun
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China
| | - J-J Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, BeiLiShi Road 167, Beijing, 100037, China.
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354
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Cho JH, Lee DY, Lee ES, Kim J, Park SE, Park CY, Lee WY, Oh KW, Park SW, Rhee EJ. Increased risk of coronary artery calcification progression in subjects with high baseline Lp(a) levels: The Kangbuk Samsung Health Study. Int J Cardiol 2016; 222:233-237. [PMID: 27497100 DOI: 10.1016/j.ijcard.2016.07.219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Results from previous studies support the association of lipoprotein(a) [Lp(a)] levels and coronary artery disease risk. In this study, we analyzed the association between baseline Lp(a) levels and future progression of coronary artery calcification (CAC) in apparently healthy Korean adults. METHODS A total of 2611 participants (mean age: 41years, 92% mend) who underwent a routine health check-up in 2010 and 2014 were enrolled. Coronary artery calcium score (CACS) were measured by multi-detector computed tomography. Baseline Lp(a) was measured by high-sensitivity immunoturbidimetric assay. Progression of CAC was defined as a change in CACS >0 over four years. RESULTS Bivariate correlation analyses with baseline Lp(a) and other metabolic parameters revealed age, total cholesterol, HDL-C, LDL-C and CACS to have a significant positive correlation, while body weight, fasting glucose level, blood pressure and triglyceride level were negatively correlated with baseline Lp(a) level. After four years of follow-up, 635 subjects (24.3%) had CAC progression. The participants who had CAC progression were older, composed of more men, more obese, and had higher fasting glucose levels and worse baseline lipid profiles compared to those who did not have CAC progression. The mean serum Lp(a) level was significantly higher in subjects who had CAC progression compared to those who did not (32.5 vs. 28.9mg/dL, p<0.01). When the risk for CAC progression according to baseline Lp(a) was calculated, those with Lp(a) level≥50mg/dL had an odds ratio of 1.333 (95% CI 1.027-1.730) for CAC progression compared to those with Lp(a)<50mg/dL after adjusting for confounding factors. CONCLUSIONS In this study, the subjects who had higher Lp(a) were at significantly higher risk for CAC progression after four years of follow-up, suggesting the role of high Lp(a) in CAC progression.
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Affiliation(s)
- Jung Hwan Cho
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Da Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Seo Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihyun Kim
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Eun Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Won Oh
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Woo Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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355
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Lakshminarayan D, Elajami TK, Devabhaktuni S, Welty FK. Ischemic stroke in a young adult with extremely elevated lipoprotein(a): A case report and review of literature. J Clin Lipidol 2016; 10:1266-71. [PMID: 27678446 DOI: 10.1016/j.jacl.2016.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022]
Abstract
Lipoprotein(a) [Lp(a)] is an apolipoprotein(a) molecule bound to 1 apolipoprotein B-100. Elevated levels of Lp(a) are thought to be an independent risk factor for atherosclerosis and to promote thrombosis through incompletely understood mechanisms. We report a 34-year-old man with an ischemic stroke in the setting of an extremely high Lp(a) level-212 mg/dL. He developed severe carotid artery stenosis over a 6-year period and had thrombus formation post-carotid endarterectomy. To our knowledge, this case is unique because the Lp(a) is the highest reported level in a patient without renal disease. Moreover, this is the first reported case of the youngest individual with a stroke presumably related to development of carotid plaque over a 6-year period. The thrombotic complication after endarterectomy may have been related to the prothrombotic properties of Lp(a). Of note, the Lp(a) level did not respond to atorvastatin but did decrease 15% after aspirin 325 mg was added although his Lp(a) levels were variable, and it is not clear that this was cause and effect. This case highlights the need to better understand the relation between Lp(a) and vascular disease and the need to screen family members for elevated Lp(a). We also review treatment options to lower Lp(a) and ongoing clinical trials of newer lipid-lowering drugs that can also lower Lp(a).
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Affiliation(s)
- Dharshan Lakshminarayan
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Tarec K Elajami
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Suresh Devabhaktuni
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Francine K Welty
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
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356
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Nam JS, Jo S, Kang S, Ahn CW, Kim KR, Park JS. Association between lipoprotein(a) and nonalcoholic fatty liver disease among Korean adults. Clin Chim Acta 2016; 461:14-8. [PMID: 27394182 DOI: 10.1016/j.cca.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] and nonalcoholic fatty liver disease (NAFLD) are risk factors for cardiovascular diseases. We investigated the relationship between Lp(a) concentrations and NAFLD among Korean adults. METHODS A total of 2242 nondiabetic subjects undergoing routine health screening examination were enrolled. Anthropometric and biochemical parameters, including Lp(a) were measured. NAFLD were assessed by ultrasonography. Adjusted Odds ratios for the presence of NAFLD according to Lp(a) tertiles were estimated using logistic regression. RESULTS Subjects were grouped according to the severity of NAFLD and Lp(a) concentrations. Lp(a) concentrations were decreased across the severity of NAFLD and the prevalence of NAFLD decreased with the Lp(a) tertiles. Compared with subjects in the lowest tertile of Lp(a), those in the highest tertile had higher total cholesterol and LDL-C concentrations and lower body mass index, blood pressure, fasting glucose, triglyceride, ALT, and HOMA-IR concentrations. In the logistic regression analysis after adjusting for multiple risk factors, the relationship between Lp(a) concentrations and the presence of NAFLD remained significant. However, this association was attenuated after adjusting for insulin resistance. CONCLUSIONS Lp(a) was inversely associated with the presence of NAFLD, but it was not an independent risk factor for NAFLD among Korean adults.
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Affiliation(s)
- Ji Sun Nam
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Sehee Jo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Shinae Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Woo Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Rae Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.
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357
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Senba H, Furukawa S, Sakai T, Niiya T, Miyake T, Yamamoto S, Ueda T, Torisu M, Minami H, Miyaoka H, Onji M, Tanaka K, Matsuura B, Tanigawa T, Hiasa Y, Miyake Y. Serum lipoprotein(a) levels and diabetic nephropathy among Japanese patients with type 2 diabetes mellitus. J Diabetes Complications 2016; 30:923-7. [PMID: 26947887 DOI: 10.1016/j.jdiacomp.2016.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/01/2016] [Accepted: 02/07/2016] [Indexed: 12/18/2022]
Abstract
AIMS We aimed to evaluate the association between serum lipoprotein(a) [Lp(a)] levels and diabetic nephropathy among Japanese patients with type 2 diabetes mellitus. METHODS This study included 581 patients with type 2 diabetes mellitus. Serum Lp(a) levels were divided into four groups; the cut-off points were at the 30th, 60th, and 90th percentile values on the basis of the distribution for all subjects. Diabetic nephropathy was defined as present when the urinary albumin-creatinine ratio was ≥33.9mg/mmol creatinine and/or the estimated glomerular filtration rate was <30ml/min/1.72m(2). Adjustment was made for age, sex, body mass index, hemoglobin A1c, duration of diabetes mellitus, current drinking, current smoking, hypertension, dyslipidemia, coronary heart disease, and stroke. RESULTS Higher serum Lp(a) levels were significantly associated with a higher prevalence of diabetic nephropathy: the adjusted odds ratios (95% confidence intervals) for diabetic nephropathy in relation to serum Lp(a) levels of ≤6, 7-15, 16-38, and ≥39mg/dl were 1.00 (reference), 2.74 (1.08-7.00), 3.31 (1.28-8.54), and 4.80 (1.57-14.60), respectively (P for trend=0.004). CONCLUSIONS The results suggest that serum Lp(a) levels may be positively associated with diabetic nephropathy among Japanese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Hidenori Senba
- Department of Epidemiology and Preventive Medicine, Ehime University GraduateSchool of Medicine, Toon, Ehime, Japan
| | - Shinya Furukawa
- Department of Epidemiology and Preventive Medicine, Ehime University GraduateSchool of Medicine, Toon, Ehime, Japan; Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Toon, Ehime, Japan.
| | - Takenori Sakai
- Department of Internal Medicine, Yawatahama General City Hospital, Yawatahama, Ehime, Japan
| | - Tetsuji Niiya
- Department of Internal Medicine, Matsuyama Shimin Hospital, Matsuyama, Ehime, Japan
| | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Shin Yamamoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Teruhisa Ueda
- Department of Diabetes and Endocrinology, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Masamoto Torisu
- Department of Internal Medicine, Saiseikai Saijo Hospital, Saijo, Ehime, Japan
| | - Hisaka Minami
- Department of Internal Medicine, Ehime Niihama Hospital, Niihama, Ehime, Japan
| | - Hiroaki Miyaoka
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama, Ehime, Japan
| | - Morikazu Onji
- Department of Internal Medicine, Saiseikai Imabari Hospital, Imabari, Ehime, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University GraduateSchool of Medicine, Toon, Ehime, Japan; Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Toon, Ehime, Japan
| | - Bunzo Matsuura
- Department of Lifestyle-related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University GraduateSchool of Medicine, Toon, Ehime, Japan; Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Toon, Ehime, Japan
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358
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Kunutsor SK, Khan H, Nyyssönen K, Laukkanen JA. Lipoprotein(a) and risk of sudden cardiac death in middle-aged Finnish men: A new prospective cohort study. Int J Cardiol 2016; 220:718-25. [PMID: 27393854 DOI: 10.1016/j.ijcard.2016.06.069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is an established and independent risk factor for cardiovascular outcomes. However, the relationship of Lp(a) with risk of sudden cardiac death (SCD) is unknown. We aimed to assess the association of Lp(a) with risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of 1881 men aged 42-61years at recruitment. METHODS AND RESULTS Plasma Lp(a) concentration was assessed at baseline and repeat measurements made several years apart. After a median follow-up of 24.7years, 141 SCDs were recorded. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed and were corrected for within-person variability in Lp(a) levels. The regression dilution ratio of loge Lp(a) adjusted for age was 0.84 (95% CI: 0.81-0.88). Lipoprotein(a) levels were log-linearly associated with risk of SCD. In analyses adjusted for established risk factors, the HR (95% CI) for SCD per 1 standard deviation (3.56-fold) higher baseline loge Lp(a) was 1.24 (1.05-1.47; P=0.013). This remained consistent on further adjustment for alcohol consumption, resting heart rate, lipids, and C-reactive protein 1.23 (1.04-1.46; P=0.018). HRs remained unchanged after accounting for incident coronary events and did not vary importantly in several relevant clinical subgroups. Adding Lp(a) to a SCD risk prediction model did not significantly improve risk discrimination beyond established risk factors, but improved the continuous net reclassification 30.2% (1.1 to 59.2%, P=0.042). CONCLUSIONS Available evidence shows a continuous and independent association between Lp(a) levels and risk of SCD. Further research is needed to replicate these findings.
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Affiliation(s)
- Setor K Kunutsor
- School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, UK.
| | - Hassan Khan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Kristiina Nyyssönen
- Eastern Finland Laboratory Center, and Department of Clinical Chemistry, University of Eastern Finland, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Central Finland Central Hospital, Jyväskylä, Finland
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359
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Matney K, Berg M, Falko JM, Draper NL. The role of lipoprotein(a) in clotting reactions during lipoprotein apheresis--A case report. J Clin Lipidol 2016; 10:438-42. [PMID: 27055976 DOI: 10.1016/j.jacl.2015.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 11/26/2022]
Abstract
In individuals with familial hypercholesterolemia (FH) who are unable to reach a target low-density lipoprotein level on a drug regimen, lipoprotein apheresis (LA) may be the treatment of choice. Severe reactions involving clotting during LA are not well described in the literature. We report a case of a 63-year-old woman with FH and markedly elevated lipoprotein(a) (Lp[a]) levels who experienced such a reaction while undergoing LA with a dextran-sulfate cellulose column on the Kaneka MA-01 Liposorber system. Owing to the clotting as well as a blood pressure drop to <100 mm Hg systolic, the procedure was stopped early. Before her second procedure, she was given an increased loading dose of unfractionated heparin. She did not develop clotting during this second procedure. A growing body of literature on the role of Lp(a) in atherothrombotic complications and hemostasis supports a possible mechanism by which clotting in the instrument could occur during apheresis. Our patient's initial pretreatment Lp(a) was 3.5 times greater than the mean Lp(a) levels in patients with FH. This theory is consistent with our case in that the patient's Lp(a) levels progressively declined with each procedure, and she had no subsequent clotting.
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Affiliation(s)
- Kathryn Matney
- Department of Pathology, University of Colorado, Aurora, CO, USA.
| | - Mary Berg
- Department of Pathology, University of Colorado, Aurora, CO, USA
| | - James M Falko
- Department of Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Nicole L Draper
- Department of Pathology, University of Colorado, Aurora, CO, USA
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360
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Diffenderfer MR, Lamon-Fava S, Marcovina SM, Barrett PHR, Lel J, Dolnikowski GG, Berglund L, Schaefer EJ. Distinct metabolism of apolipoproteins (a) and B-100 within plasma lipoprotein(a). Metabolism 2016; 65:381-90. [PMID: 26975530 PMCID: PMC4795479 DOI: 10.1016/j.metabol.2015.10.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/28/2015] [Accepted: 10/31/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Lipoprotein(a) [Lp(a)] is mainly similar in composition to LDL, but differs in having apolipoprotein (apo) (a) covalently linked to apoB-100. Our purpose was to examine the individual metabolism of apo(a) and apoB-100 within plasma Lp(a). MATERIALS AND METHODS The kinetics of apo(a) and apoB-100 in plasma Lp(a) were assessed in four men with dyslipidemia [Lp(a) concentration: 8.9-124.7nmol/L]. All subjects received a primed constant infusion of [5,5,5-(2)H3] L-leucine while in the constantly fed state. Lp(a) was immunoprecipitated directly from whole plasma; apo(a) and apoB-100 were separated by gel electrophoresis; and isotopic enrichment was determined by gas chromatography/mass spectrometry. RESULTS Multicompartmental modeling analysis indicated that the median fractional catabolic rates of apo(a) and apoB-100 within Lp(a) were significantly different at 0.104 and 0.263 pools/day, respectively (P=0.04). The median Lp(a) apo(a) production rate at 0.248nmol/kg·day(-1) was significantly lower than that of Lp(a) apoB-100 at 0.514nmol/kg·day(-1) (P=0.03). CONCLUSION Our data indicate that apo(a) has a plasma residence time (11days) that is more than twice as long as that of apoB-100 (4days) within Lp(a), supporting the concept that apo(a) and apoB-100 within plasma Lp(a) are not catabolized from the bloodstream as a unit in humans in the fed state.
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Affiliation(s)
- Margaret R Diffenderfer
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Stefania Lamon-Fava
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Santica M Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, 401 Queen Anne Avenue North, Seattle, WA 98109, USA.
| | - P Hugh R Barrett
- School of Medicine and Pharmacology and Faculty of Engineering, Computing and Mathematics, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
| | - Julian Lel
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Gregory G Dolnikowski
- Mass Spectrometry Unit, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA.
| | - Lars Berglund
- Clinical and Translational Science Center, University of California, Davis, 2921 Stockton Boulevard, Suite 1400, Sacramento, CA 95817, USA.
| | - Ernst J Schaefer
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston, MA 02111, USA.
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361
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Abstract
BACKGROUND Lipoprotein(a) (Lp(a)) is a low density lipoprotein-like particle to which apolipoprotein(a) is bound. It is recognized as an atherosclerosis-inducing risk factor. Up to now a detailed description of the effect of Lipoprotein apheresis (LA) on Lp(a) levels in the long run is lacking. METHODS We studied 59 patients with elevated Lp(a) levels who were treated with LA at the Lipoprotein Apheresis Center at the University Hospital Dresden. We analyzed Lp(a) concentrations before the start of the LA treatment and during this extracorporeal therapy. RESULTS Comparing the Lp(a) levels before the start of LA therapy and pre-apheresis (measured before the LA sessions) Lp(a) levels, we observed a reduction of the Lp(a) levels of about 22.8% in all patients. Lp(a) levels were acutely (comparing post-apheresis with pre-apheresis concentrations) reduced by all 6 available LA methods (by about 70%). A linear regression analysis was performed to differentiate the long term course of pre-apheresis Lp(a) levels. In 30 patients we saw an increase of the pre-apheresis Lp(a) levels over the time, in 15 patients a constancy and in 14 patients a decrease. Patients with a decrease of pre-apheresis Lp(a) levels over the time had significantly higher initial (before the start of the extracorporeal treatment) and pre-apheresis values and they were significantly older. These patients had significantly more severe peripheral arterial disease as well as cardiac valve and carotid stenosis. The patients with the lowest initial Lp(a) levels and an increase of the pre-apheresis Lp(a) levels over the time had the highest percentage of intake of Tredaptive(®)/Niaspan(®) though after stopping the intake of these nicotinic acid preparations no clear increase of Lp(a) concentrations was observed. The applied LA systems did not seem to have a significant influence on the course of pre-apheresis Lp(a) levels. In all patients there was a high variability of Lp(a) concentrations between LA sessions which may in part be due to the inaccuracy of the method used to measure Lp(a) concentrations. CONCLUSION Pre-apheresis Lp(a) levels (before the LA sessions) are lower than those before the start of a LA treatment but they behave differently among patients during LA treatment.
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Affiliation(s)
- E Groß
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - B Hohenstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
| | - U Julius
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
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362
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Sahebkar A, Simental-Mendía LE, Stefanutti C, Pirro M. Supplementation with coenzyme Q10 reduces plasma lipoprotein(a) concentrations but not other lipid indices: A systematic review and meta-analysis. Pharmacol Res 2016; 105:198-209. [PMID: 26836888 DOI: 10.1016/j.phrs.2016.01.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 12/17/2022]
Abstract
Plasma lipoprotein(a) [Lp(a)] elevations are associated with increased cardiovascular risk. Coenzyme Q10 (CoQ10) is a member of the mitochondrial respiratory chain with a prominent role as a potent gene regulator. The Lp(a)-lowering efficacy of CoQ10 has been investigated in different clinical settings with contrasting results. A systematic literature search in Medline, SCOPUS, Web of Science and Google Scholar databases was conducted to identify controlled trials investigating the efficacy of CoQ10 supplementation on plasma Lp(a) levels. Inverse variance-weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated for net changes in Lp(a) levels using a random-effects model. Random-effects meta-regression was performed to assess the effect of putative confounders on plasma Lp(a) levels. Seven randomized controlled trials with a total of 409 subjects (206 in the CoQ10 arm and 203 in the control arm) met the eligibility criteria. Overall, CoQ10 supplementation was paralleled by a slight but significant reduction of plasma Lp(a) levels (WMD: -3.54 mg/dL, 95% CI: -5.50, -1.58; p<0.001), this effect being more robust in those trials with higher baseline Lp(a) levels (slope: -0.44; 95% CI: -0.80, -0.08; p=0.018). Reduction of plasma Lp(a) levels was consistent across different CoQ10 doses, with an inverse association between administered CoQ10 dose and Lp(a) lowering (slope: 0.04; 95% CI: 0.01, 0.07; p=0.004). Neither total cholesterol and cholesterol subfractions, nor triglyceride levels were affected by CoQ10 supplementation. In conclusion, CoQ10 supplementation, in the tested range of doses, reduces plasma Lp(a) concentrations, particularly in patients with Lp(a)≥ 30 mg/dL. Other lipid indices were not altered by CoQ10 supplementation.
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Affiliation(s)
- Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran; Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | | | - Claudia Stefanutti
- Extracorporeal Therapeutic Techniques Unit-Immunohematology and Transfusion Medicine, Department of Molecular Medicine, University of Rome Sapienza, Umberto I Hospital, 155 Viale del Policlinico, I-00161 Rome, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Hospital "Santa Maria della Misericordia", Piazzale Menghini, 1-06156 Perugia, Italy.
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363
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O'Brien KD, Hippe DS, Chen H, Neradilek MB, Probstfield JL, Peck S, Isquith DA, Canton G, Yuan C, Polissar NL, Zhao XQ, Kerwin WS. Longer duration of statin therapy is associated with decreased carotid plaque vascularity by magnetic resonance imaging. Atherosclerosis 2016; 245:74-81. [PMID: 26708287 PMCID: PMC8629315 DOI: 10.1016/j.atherosclerosis.2015.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/06/2015] [Accepted: 11/26/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Plaque neovasculature is a major route for lipoprotein and leukocyte ingress into plaques, and has been identified as a risk factor for carotid plaque disruption. Vp, a variable derived from pharmacokinetic modeling of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), correlates with plaque neovasculature density. Because lipid-lowering therapy has been associated with regression of neovasculature in animal models, we sought to determine clinical correlates of carotid plaque neovasculature (as assessed by Vp) in participants on statin therapy for established cardiovascular disease. METHODS 98 participants from an AIM-HIGH sub-study underwent DCE-MRI of their carotid arteries. Expert readers who were blinded to all clinical variables analyzed the MR images to measure carotid plaque Vp in all participants. Associations between Vp and duration of statin therapy and other clinical risk factors were analyzed. RESULTS Prior duration of statin treatment at enrollment ranged from <1 year (21%) 1-5 years (40%) and >5 years (39%). In univariate analyses, shorter duration of statin therapy (P = 0.01), the presence of metabolic syndrome (P = 0.02), and higher body mass index (P = 0.01) and lipoprotein(a) (P = 0.01) were all significantly associated with higher baseline Vp values. In multivariate analyses, significant associations remained between shorter duration of statin therapy (P = 0.004) and lipoprotein(a) (P = 0.04). CONCLUSIONS These are the first human, in vivo findings suggesting a relationship between duration of statin therapy and regression of carotid plaque neovasculature. Future longitudinal studies are warranted both to confirm this finding and to address whether changes in neovasculature may translate into change in risk for plaque disruption. CLINICALTRIALS. GOV IDENTIFIERS NCT00880178, NCT01178320 and NCT00120289.
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Affiliation(s)
- Kevin D O'Brien
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | | | - Jeffrey L Probstfield
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Suzanne Peck
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Daniel A Isquith
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - Xue-Qiao Zhao
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
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364
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Tangvarasittichai S, Pingmuanglaew P, Tangvarasittichai O. Association of Elevated Serum Lipoprotein(a), Inflammation, Oxidative Stress and Chronic Kidney Disease with Hypertension in Non-diabetes Hypertensive Patients. Indian J Clin Biochem 2016; 31:446-51. [PMID: 27605742 DOI: 10.1007/s12291-016-0553-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
Hypertension is the most common cardiovascular risk factor. Lipoprotein(a) [Lp(a)], inflammation, oxidative stress and chronic kidney disease (CKD) exacerbate the response to tissue injury and acts as markers of the vascular disease, especially in glomerulosclerosis. We compared the clinical characteristics of 138 non-diabetes hypertensive women (ndHT) patients with 417 non-diabetes normotensive subjects and tested the association of hypertension with Lp(a), inflammation, CKD and oxidative stress by using multiple logistic regression. BP, BMI, waist circumference, creatinine, Lp(a), inflammation and malondialdehyde levels were significantly higher and CKD state in the ndHT patients (p < 0.05). Multiple logistic regression showed hypertension associated with increased Lp(a), inflammation, ORs and 95 % CIs were 2.52 (1.33, 4.80), 2.75 (1.44, 5.27) after adjusting for their covariates. Elevated serum Lp(a) and inflammation levels concomitants with increased oxidative stress and CKD were the major risk factors associated with hypertension and implications for the increased risk of HT and vascular disease.
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365
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Niccoli G, Cin D, Scalone G, Panebianco M, Abbolito S, Cosentino N, Jacoangeli F, Refaat H, Gallo G, Salerno G, Volpe M, Crea F, De Biase L. Lipoprotein (a) is related to coronary atherosclerotic burden and a vulnerable plaque phenotype in angiographically obstructive coronary artery disease. Atherosclerosis 2016; 246:214-20. [PMID: 26803430 DOI: 10.1016/j.atherosclerosis.2016.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Lipoprotein Lp(a) has been shown to be an independent risk factor for coronary artery disease (CAD). However, its association with CAD burden in patients with ACS is largely unknown, as well as the association of Lp(a) with lipid rich plaques prone to rupture. AIM We aim at assessing CAD burden by coronary angiography and plaque features including thin cap fibroatheroma (TCFA) by optical coherence tomography (OCT) in consecutive patients presenting with acute coronary syndrome (ACS) and obstructive CAD along with serum Lp(a) levels. METHODS This study comprises an angiographic and an OCT cohort. A total of 500 ACS patients (370 men, average age 66 ± 11) were enrolled for the angiographic cohort and 51 ACS patients (29 males, average age 65 ± 11) were enrolled for the OCT cohort. Angiographic CAD severity was assessed by Sullivan score and by Bogaty score including stenosis score and extent index. OCT plaque features were evaluated at the site of the minimal lumen area and along the culprit segment. RESULTS In the angiographic cohort, at multivariate analysis, Lp(a) was a weak independent predictor of Sullivan score (p < 0.0001), stenosis score (p < 0.0001) and extent index (p < 0.0001). In the OCT cohort, patients with higher Lp(a) levels (≥ 30 md/dl) compared to patients with lower Lp(a) levels (<30 md/dl) exhibited a higher prevalence of lipidic plaque at the site of the culprit stenosis (67% vs. 27%; P = 0.02), a wider lipid arc (135 ± 114 vs 59 ± 111; P = 0.03) and a higher prevalence of TCFA (38% vs. 10%; P = 0.04). CONCLUSIONS Among patients with ACS, raised Lp(a) levels are associated with an increased atherosclerotic burden and it identifies a subset of patients with features of high risk coronary atherosclerosis.
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366
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Konishi H, Miyauchi K, Tsuboi S, Ogita M, Naito R, Dohi T, Kasai T, Tamura H, Okazaki S, Isoda K, Daida H. Plasma lipoprotein(a) predicts major cardiovascular events in patients with chronic kidney disease who undergo percutaneous coronary intervention. Int J Cardiol 2015; 205:50-53. [PMID: 26710333 DOI: 10.1016/j.ijcard.2015.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/05/2015] [Accepted: 12/12/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased risk for cardiovascular disease. The predictive power of traditional risk factors for cardiovascular disease is diminished in patients with CKD. The serum level of lipoprotein(a) [Lp(a)] can be a risk factor for adverse events, but the clinical implications of Lp(a) in patients with CKD who have been treated by percutaneous coronary intervention (PCI) remain uncertain. We aimed to determine the role of Lp(a) on long-term outcomes in patients with CKD after PCI. METHODS We analyzed data from 904 patients with CKD among 3508 patients who underwent a first PCI between 1997 and 2011 at our institution. We divided patients into 2 groups [high (n=454) or low (n=450)] according to median levels of Lp(a). The primary outcome was a composite of all-cause death and acute coronary syndrome (ACS). RESULTS The baseline characteristics of the groups were similar and the median follow-up period was 4.7 years. Cumulative event-free survival was significantly worse for the group with high, than low Lp(a) (P=0.01). Multivariable analysis indicated a high Lp(a) level as an independent predictor of primary outcomes (hazard ratio, 1.35; 95% CI, 1.01-1.82; P=0.04). CONCLUSIONS A high Lp(a) value is associated with a poor prognosis after PCI for patients with CKD.
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Affiliation(s)
- Hirokazu Konishi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shuta Tsuboi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Tamura
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
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Abstract
BACKGROUND Circulating lipoprotein(a) [Lp(a)] and arterial stiffness are markers associated with the atherosclerotic processes. With regard to cardiovascular outcomes, the relationship between Lp(a) and arterial stiffness has not been sufficiently summarized. The present review focuses on the existing association between Lp(a) and arterial stiffness parameters. SUMMARY This review included human clinical studies that were published between 1980 and 2015. The metrics of arterial stiffness parameters, 'pulse wave velocity' (PWV) and 'cardio-ankle vascular index' (CAVI), were used for this search, which yielded only 4 cross-sectional studies on this topic. Of these 4 studies, 3 reports were based on the use of PWV, while 1 study was based on the use of CAVI. Three studies (including the study using CAVI) reported that high Lp(a) levels were positively associated with arterial stiffness. CONCLUSION The present review indicates a positive association between Lp(a) and arterial stiffness, as assessed by PWV and CAVI. To definitively establish these findings, there is a need for further prospective outcome studies that simultaneously measure Lp(a) and the oxidative form of Lp(a) (as a pathological marker) as well as PWV and CAVI.
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Affiliation(s)
- Alexander Sorokin
- Department of Internal Medicine, Kursk State Medical University, Kursk, Russia
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Shimotsuke, Japan ; Department of Clinical Laboratory Medicine, Jichi Medical University, Shimotsuke, Japan
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368
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Abstract
Lipoprotein(a) (Lp(a)) is a highly atherogenic and heterogeneous lipoprotein that is inherited in an autosomal codominant trait. A unique aspect of this lipoprotein is that it is fully expressed by the first or second year of life in children, a pattern that is distinctly different from other lipoproteins, which typically only reach adult levels after adolescence. Despite decades of research, Lp(a) metabolism is still poorly understood but what is abundantly clear is that it is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents does not recommend measuring Lp(a) levels as part of routine screening except in youth with an ischemic or hemorrhagic stroke or youth with a parental history of ASCVD not explained by classical risk factors. One of the reasons that both the pediatric and adult guidelines fail to include this lipoprotein as part of routine lipid screening is the absence of data to show that lowering Lp(a) will reduce current or future ASCVD risk independently of low-density lipoprotein cholesterol (LDL-C) lowering. The cholesterol carried by Lp(a) is included in the low-density lipoprotein cholesterol measurement, but a separate test is used to measure the lipoprotein mass and/or cholesterol carried only by Lp(a). Because levels seem to be largely under genetic control, studies of lifestyle modification have been inconclusive although one study in obese children showed a decrease in the Lp(a) level comparable with the favorable effect on other lipids. The most compelling data regarding the importance of Lp(a) in the pediatric population are the increased risk associated with arterial ischemic stroke, a risk that is comparable with that associated with antiphospholipid antibodies or protein C deficiency. Although no specific pharmaceutical treatments are recommended to lower Lp(a) levels in youth, it is vitally important to educate youth and their parents about the excessive risk associated with this lipoprotein and the need to avoid the acquisition of other lifestyle-related risk factors such as smoking, excess weight, and physical inactivity to preserve more ideal cardiovascular health in adulthood.
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Affiliation(s)
- Catherine J McNeal
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, USA.
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369
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Sahebkar A, Serban C, Ursoniu S, Banach M. Effect of garlic on plasma lipoprotein(a) concentrations: A systematic review and meta-analysis of randomized controlled clinical trials. Nutrition 2016; 32:33-40. [PMID: 26522661 DOI: 10.1016/j.nut.2015.06.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Garlic can play an essential role in the prevention of atherosclerosis, but the research addressing the effect of garlic on the concentration of lipoprotein(a) [Lp(a)] has not been fully demonstrated. The aim of this study was to assess the effect of garlic on plasma Lp(a) concentrations through systematic review of literature and meta-analysis of available randomized controlled trials. METHODS The literature search included SCOPUS, PubMed-Medline, ISI Web of Science, and Google Scholar databases up to March 10, 2015 to identify randomized controlled trials investigating the effect of garlic on plasma Lp(a) concentrations. Two independent reviewers extracted data on study characteristics, methods, and outcomes. Overall, the effect of garlic on plasma Lp(a) levels was reported in six trials. RESULTS Meta-analysis did not suggest a significant alteration in plasma Lp(a) levels after garlic consumption (weighted mean difference [WMD] = 16.86%; 95% confidence interval, -4.59 to 38.31; P = 0.124). This result was robust in the leave-one-out sensitivity analysis. When the studies were categorized according to the duration of supplementation, there was no effect in the subgroup of trials lasting ≤12 wk (WMD = 2.01%; 95% CI, -14.67 to 18.68; P = 0.813) but a significant elevation of plasma Lp(a) concentrations was found in trials lasting >12 wk (WMD = 54.59%; 95% CI, 30.47-78.71; P < 0.001). Random-effects meta-regression suggested an inverse association between the changes in plasma concentrations of Lp(a) and duration of supplementation (slope 1.71; 95% CI, 0.46-2.97; P = 0.007). CONCLUSIONS The present meta-analysis did not suggest a significant effect of garlic supplementation on the reduction of Lp(a) levels.
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Khalifa M, Noureen A, Ertelthalner K, Bandegi AR, Delport R, Firdaus WJJ, Geethanjali FS, Luthra K, Makemaharn O, Pang RWC, Salem AH, Sasaki J, Schiefenhoevel W, Lingenhel A, Kronenberg F, Utermann G, Schmidt K. Lack of association of rs3798220 with small apo lipoprotein(a) isoforms and high lipoprotein(a) levels in East and Southeast Asians. Atherosclerosis 2015; 242:521-8. [PMID: 26302166 DOI: 10.1016/j.atherosclerosis.2015.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The variant allele of rs3798220 in the apolipoprotein(a) gene (LPA) is used to assess the risk for coronary artery disease (CAD) in Europeans, where it is associated with short alleles of the Kringle IV-2 (KIV-2) copy number variation (CNV) and high lipoprotein(a) (Lp(a)) concentrations. No association of rs3798220 with CAD was detected in a GWAS of East Asians. Our study investigated the association of rs3798220 with Lp(a) concentrations and KIV-2 CNV size in non-European populations to explain the missing association of the variant with CAD in Asians. METHODS We screened three populations from Africa and seven from Asia by TaqMan Assay for rs3798220 and determined KIV-2 CNV sizes of LPA alleles by pulsed-field gel electrophoresis (PFGE). Additionally, CAD cases from India were analysed. To investigate the phylogenetic origin of rs3798220, 40 LPA alleles from Chinese individuals were separated by PFGE and haplotyped for further SNPs. RESULTS The variant was not found in Africans. Allele frequencies in East and Southeast Asians ranged from 2.9% to 11.6%, and were very low (0.15%) in CAD cases and controls from India. The variant was neither associated with short KIV-2 CNV alleles nor elevated Lp(a) concentrations in Asians. CONCLUSION Our study shows that rs3798220 is no marker for short KIV-2 CNV alleles and high Lp(a) in East and Southeast Asians, although the haplotype background is shared with Europeans. It appears unlikely that this SNP confers atherogenic potential on its own. Furthermore, this SNP does not explain Lp(a) attributed risk for CAD in Asian Indians.
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Affiliation(s)
- Mahmoud Khalifa
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Asma Noureen
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Ertelthalner
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ahmad Reza Bandegi
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rhena Delport
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Department of Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Wance J J Firdaus
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Finney S Geethanjali
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Department of Clinical Biochemistry, Christian Medical College Vellore, Tamil Nadu, India
| | - Kalpana Luthra
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Orawan Makemaharn
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Department of Obstetrics and Gynaecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Richard W C Pang
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Division of Clinical Biochemistry, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Abdel-Halim Salem
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jun Sasaki
- Graduate School of Pharmaceutical Medicine, International University of Health and Welfare, Fukuoka, Japan
| | | | - Arno Lingenhel
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerd Utermann
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Konrad Schmidt
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria; Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon; Department for Tropical Medicine, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
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371
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Catena C, Colussi G, Nait F, Pezzutto F, Martinis F, Sechi LA. Early renal failure as a cardiovascular disease: Focus on lipoprotein(a) and prothrombotic state. World J Nephrol 2015; 4:374-378. [PMID: 26167461 PMCID: PMC4491928 DOI: 10.5527/wjn.v4.i3.374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/13/2015] [Accepted: 04/29/2015] [Indexed: 02/06/2023] Open
Abstract
Patients with renal failure are at increased risk of cardiovascular events even at the earliest stages of disease. In addition to many classic cardiovascular risk factors, many conditions that are commonly identified as emerging risk factors might contribute to occurrence of cardiovascular disease. Changes in circulating levels of many of these emerging risk factors have been demonstrated in patients with early stages of renal failure caused by different types of renal disease and have been associated with detection of cardiovascular complications. However, for most of these factors evidence of benefits of correction on cardiovascular outcome is missing. In this article, we comment on the role of lipoprotein(a) and prothrombotic factors as potential contributors to cardiovascular events in patients with early renal failure.
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372
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Chen J, Zhang Y, Liu J, Chen MH, Guo YL, Zhu CG, Xu RX, Dong Q, Li JJ. Role of lipoprotein(a) in predicting the severity of new on-set coronary artery disease in type 2 diabetics: A Gensini score evaluation. Diab Vasc Dis Res 2015; 12:258-64. [PMID: 25861813 DOI: 10.1177/1479164115579004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of the study was to investigate the usefulness of serum lipoprotein(a) level in predicting the severity of new on-set coronary artery disease in type 2 diabetics. A total of 1254 new on-set, consecutive coronary artery disease patients were classified into two groups: diabetes group (n = 380) and non-diabetes group (n = 874). The relationship between serum lipoprotein(a) levels and the severity of coronary artery disease assessed by Gensini score was analysed. Data showed that the diabetes group had higher serum triglyceride and high sensitivity C-reactive protein levels but lower high-density lipoprotein cholesterol levels (all p < 0.05). The multivariate logistic regression analysis suggested that lipoprotein(a) was an independent predictor for high Gensini score (odds ratio = 1.82, 95% confidence interval: 1.10-3.12, p = 0.029) after adjusting for traditional cardiovascular risk factors. Additionally, lipoprotein(a) levels were positively correlated with Gensini score (rho = 0.15, p = 0.014) and significantly elevated according to the tertiles of Gensini score (p = 0.008) in diabetics. However, no such results were observed in non-diabetics. Our data indicate that lipoprotein(a) is an independent predictor for the severity of new on-set coronary artery disease patients accompanied by type 2 diabetes, suggesting that these patients may benefit from lipoprotein(a) management in clinical assessment.
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Affiliation(s)
- Juan Chen
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China The Central Hospital of Wuhan, Wuhan, China
| | - Yan Zhang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liu
- The Central Hospital of Wuhan, Wuhan, China
| | | | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng-Gang Zhu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui-Xia Xu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Dong
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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373
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Krychtiuk KA, Kastl SP, Hofbauer SL, Wonnerth A, Goliasch G, Ozsvar-Kozma M, Katsaros KM, Maurer G, Huber K, Dostal E, Binder CJ, Pfaffenberger S, Oravec S, Wojta J, Speidl WS. Monocyte subset distribution in patients with stable atherosclerosis and elevated levels of lipoprotein(a). J Clin Lipidol 2015; 9:533-41. [PMID: 26228671 DOI: 10.1016/j.jacl.2015.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/27/2015] [Accepted: 04/21/2015] [Indexed: 12/15/2022]
Abstract
Background Lipoprotein(a) (Lp(a)) is a proatherogenic plasma lipoprotein currently established as an independent risk factor for the development of atherosclerotic disease and as a predictor for acute thrombotic complications. In addition, Lp(a) is the major carrier of proinflammatory oxidized phospholipids (OxPL). Today, atherosclerosis is considered to be an inflammatory disease of the vessel wall in which monocytes and monocyte-derived macrophages are crucially involved. Circulating monocytes can be divided according to their surface expression pattern of CD14 and CD16 into at least 3 subsets with distinct inflammatory and atherogenic potential. Objective The aim of this study was to examine whether elevated levels of Lp(a) and OxPL on apolipoprotein B-100–containing lipoproteins (OxPL/apoB) are associated with changes in monocyte subset distribution. Methods We included 90 patients with stable coronary artery disease. Lp(a) and OxPL/apoB were measured, and monocyte subsets were identified as classical monocytes (CMs; CD14++CD16−), intermediate monocytes (IMs; CD14++CD16+), and nonclassical monocytes (NCMs; CD14+CD16++) by flow cytometry. Results In patients with elevated levels of Lp(a) (>50 mg/dL), monocyte subset distribution was skewed toward an increase in the proportion of IM (7.0 ± 3.8% vs 5.2 ± 3.0%; P = .026), whereas CM (82.6 ± 6.5% vs 82.0 ± 6.8%; P = .73) and NCM (10.5 ± 5.3 vs 12.8 ± 6.0; P = .10) were not significantly different. This association was independent of clinical risk factors, choice of statin treatment regime, and inflammatory markers. In addition, OxPL/apoB was higher in patients with elevated Lp(a) and correlated with IM but not CM and NCM. Conclusions In conclusion, we provide a potential link between elevated levels of Lp(a) and a proatherogenic distribution of monocyte subtypes in patients with stable atherosclerotic disease. Lipoprotein(a) serves as an independent risk factor in atherosclerotic disease. Monocyte subsets exhibit distinct inflammatory and atherogenic properties. Patients with elevated levels of Lp(a) show a shift towards intermediate monocytes. This association was independent of clinical properties and inflammatory markers. Those patients also exhibited higher OxPL/apoB concentrations.
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374
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Cha J, Niedzwiecki A, Rath M. Hypoascorbemia induces atherosclerosis and vascular deposition of lipoprotein(a) in transgenic mice. Am J Cardiovasc Dis 2015; 5:53-62. [PMID: 26064792 PMCID: PMC4447075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/17/2015] [Indexed: 06/04/2023]
Abstract
Lipoprotein(a), a variant of LDL carrying the adhesive glycoprotein apo(a), is a leading risk factor for cardiovascular disease. Lipoprotein(a) (Lp(a)) is found in humans and subhuman primates but rarely in lower mammals. Better understanding of the evolutionary advantage of this molecule should elucidate its physiological role. We developed a new mouse model with two characteristics of human metabolism: the expression of Lp(a) and the lack of endogenous ascorbate (vitamin C) production. We show that dietary deficiency of ascorbate increases serum levels of Lp(a). Moreover, chronic hypoascorbemia and complete depletion of ascorbate (scurvy) leads to Lp(a) accumulation in the vascular wall and parallels atherosclerotic lesion development. The results suggest that dietary ascorbate deficiency is a risk factor for atherosclerosis independent of dietary lipids. We provide support for the concept that Lp(a) functions as a mobile repair molecule compensating for the structural impairment of the vascular wall, a morphological hallmark of hypoascorbemia and scurvy.
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Affiliation(s)
- John Cha
- Dr. Rath Research Institute Santa Clara, CA, USA
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375
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Romagnuolo R, Scipione CA, Boffa MB, Marcovina SM, Seidah NG, Koschinsky ML. Lipoprotein(a) catabolism is regulated by proprotein convertase subtilisin/kexin type 9 through the low density lipoprotein receptor. J Biol Chem 2015; 290:11649-62. [PMID: 25778403 DOI: 10.1074/jbc.m114.611988] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Indexed: 01/07/2023] Open
Abstract
Elevated levels of lipoprotein(a) (Lp(a)) have been identified as an independent risk factor for coronary heart disease. Plasma Lp(a) levels are reduced by monoclonal antibodies targeting proprotein convertase subtilisin/kexin type 9 (PCSK9). However, the mechanism of Lp(a) catabolism in vivo and the role of PCSK9 in this process are unknown. We report that Lp(a) internalization by hepatic HepG2 cells and primary human fibroblasts was effectively reduced by PCSK9. Overexpression of the low density lipoprotein (LDL) receptor (LDLR) in HepG2 cells dramatically increased the internalization of Lp(a). Internalization of Lp(a) was markedly reduced following treatment of HepG2 cells with a function-blocking monoclonal antibody against the LDLR or the use of primary human fibroblasts from an individual with familial hypercholesterolemia; in both cases, Lp(a) internalization was not affected by PCSK9. Optimal Lp(a) internalization in both hepatic and primary human fibroblasts was dependent on the LDL rather than the apolipoprotein(a) component of Lp(a). Lp(a) internalization was also dependent on clathrin-coated pits, and Lp(a) was targeted for lysosomal and not proteasomal degradation. Our data provide strong evidence that the LDLR plays a role in Lp(a) catabolism and that this process can be modulated by PCSK9. These results provide a direct mechanism underlying the therapeutic potential of PCSK9 in effectively lowering Lp(a) levels.
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Affiliation(s)
- Rocco Romagnuolo
- From the Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario N9B 3P4, Canada
| | - Corey A Scipione
- From the Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario N9B 3P4, Canada
| | - Michael B Boffa
- From the Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario N9B 3P4, Canada
| | - Santica M Marcovina
- the Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, Washington 98109, and
| | - Nabil G Seidah
- the Laboratory of Biochemical Neuroendocrinology, Institut de Recherches Cliniques de Montréal, Montréal, Québec H2W 1R7, Canada
| | - Marlys L Koschinsky
- From the Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario N9B 3P4, Canada,
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376
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Abstract
Elevated plasma concentrations of lipoprotein(a) (Lp[a]) are an emerging risk factor for the development of coronary heart disease (CHD). Recent genetic and epidemiologic data have provided strong evidence for a causal role of Lp(a) in CHD. Despite these developments, which have attracted increasing interest from clinicians and basic scientists, many unanswered questions persist. The true pathogenic mechanism of Lp(a) remains a mystery. Significant uncertainty exists concerning the appropriate use of Lp(a) in the clinical setting. No therapeutic intervention remains that can specifically lower plasma Lp(a) concentrations, although the list of compounds that lower Lp(a) and LDL continues to expand.
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Affiliation(s)
- Marlys L Koschinsky
- Department of Chemistry and Biochemistry, University of Windsor, 401 Sunset Avenue, Windsor, Ontario N9B 3P4, Canada.
| | - Michael B Boffa
- Department of Chemistry and Biochemistry, University of Windsor, 401 Sunset Avenue, Windsor, Ontario N9B 3P4, Canada
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377
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Marzano L, Colussi G, Del Torre M, Sechi LA, Catena C. Relationships of plasma lipoprotein(a) levels with insulin resistance in hypertensive patients. Metabolism 2014; 63:1439-46. [PMID: 25212579 DOI: 10.1016/j.metabol.2014.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is an emergent cardiovascular risk factor that is related to the presence and severity of cardiovascular damage in hypertensive patients. In these patients, insulin resistance is frequently detected but its relationship with plasma Lp(a) is not clear. The aim of this study was to examine the relationships between Lp(a) and variables of glucose metabolism in hypertension. METHODS In 527 consecutive, non-diabetic, middle-aged hypertensive patients we measured anthropometric indexes, 24-hour creatinine clearance, lipid profile including Lp(a) levels, fasting glucose, insulin and C-peptide, and calculated the Homeostatic Model Assessment (HOMA) index. RESULTS Lp(a) levels were significantly and progressively lower with increasing HOMA-index values. Lp(a) was inversely related to fasting glucose, insulin, and C-peptide, HOMA-index, and creatinine clearance and directly related to LDL-cholesterol. Multiple regression analysis adjusted for age, sex, body mass index, blood pressure, smoking habit, alcohol intake, renal function, lipid profile, history of cardiovascular events, and drug use showed that HOMA-index and creatinine clearance were inversely and independently associated to Lp(a) levels. CONCLUSIONS Insulin resistance and higher fasting insulin levels are associated with lower plasma Lp(a) in hypertensive patients. This association might be relevant in the assessment of cardiovascular risk in these patients.
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Affiliation(s)
- Luigi Marzano
- Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100, Udine, Italy
| | - GianLuca Colussi
- Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100, Udine, Italy
| | - Martina Del Torre
- Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100, Udine, Italy
| | - Leonardo A Sechi
- Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100, Udine, Italy
| | - Cristiana Catena
- Clinica Medica, Department of Experimental and Clinical Medical Sciences, University of Udine, 33100, Udine, Italy.
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378
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Patel P, Davies T, Madira W, Gupta P. Serum lipoprotein(a) concentrations do not change significantly in the immediate seven-day period post myocardial infarction. Ann Clin Biochem 2014; 52:502-5. [PMID: 25344455 DOI: 10.1177/0004563214559221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lipoprotein(a) is an independent predictor of cardiovascular disease and its variability after myocardial infarction was assessed in this study. METHODS Lipoprotein(a) was analysed by a size insensitive latex immunoturbidimetric end point assay in samples from days 0 to 7 in 31 patients admitted with myocardial infarction. RESULTS Median lipoprotein(a) changed by -0.9%, -0.1% and 9.6% on days 1, 2-3 and 4-7, respectively, and was not statistically significant. Median total cholesterol reduced by 8.7%, 9.1%, 14.5% and C-reactive protein increased by 68.4%, 510%, 502% over days 1, 2-3, 4-7, respectively. CONCLUSIONS Unlike total cholesterol and C-reactive protein, lipoprotein(a) does not demonstrate significant variability for up to seven days after myocardial infarction and measurements made during this period after myocardial infarction are physiologically meaningful.
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Affiliation(s)
- Prashanth Patel
- Department of Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Timothy Davies
- Department of Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Webster Madira
- Department of Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pankaj Gupta
- Department of Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
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379
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Wu Z, Sheng H, Chen Y, Tang J, Liu Y, Chen Q, Lu L, Jin W. Copy number variation of the Lipoprotein(a) (LPA) gene is associated with coronary artery disease in a southern Han Chinese population. Int J Clin Exp Med 2014; 7:3669-3677. [PMID: 25419416 PMCID: PMC4238520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/26/2014] [Indexed: 06/04/2023]
Abstract
Copy number variations (CNVs), genomic duplication or deletion events occurring at larger than 1 kb scale, contribute to the complex diseases substantially. Lipoprotein(a) [Lp(a)] is a major inherited risk factor for atherosclerosis and coronary artery disease (CAD). We investigated the association between a CNV of the Lp(a) (LPA) gene and CAD. The case-control study included 271 CAD patients and 207 controls diagnosed by coronary angiography. A taqman real-time fluorescence PCR based technique was developed according to the 2 × 2(-ΔΔCt±SD) calculation method. We detected LPA CNVs with a range of 1, 2 and 3. The 1 copy number carriers had a significantly reduced risk of CAD compared with those with 2 copy number after adjusting for the confounding factors (P < 0.001, OR = 0.38, 95% CI 0.23-0.64). Further stratified analyses suggested a significant protective effect of the 1 copy number in the elderly population (P = 0.008), females (P = 0.007) as well as in populations with non-hyperlipidemia (P = 0.003), hypertension (P = 0.001), non-smoking (P < 0.001) and high Lp(a) (≥ 0.3 g/L) levels (P = 0.001). The 1 copy number of the LPA gene may be an independent protective factor of CAD in a southern Han Chinese population, particularly in females and the elderly.
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Affiliation(s)
- Zhijun Wu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, People’s Republic of China
| | - Haihui Sheng
- National Engineering Center for Biochip at ShanghaiShanghai, People’s Republic of China
| | - Yanjia Chen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, People’s Republic of China
| | - Jing Tang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, People’s Republic of China
| | - Yan Liu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, People’s Republic of China
| | - Qiujing Chen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, People’s Republic of China
| | - Lin Lu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, People’s Republic of China
| | - Wei Jin
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of MedicineShanghai, People’s Republic of China
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380
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Hoerl G, Ledinski G, Kager G, Thalhammer M, Koestenberger M, Juergens G, Gary T, Cvirn G. Virtually same oxidizability of LDL but higher Lp(a) levels in arterial compared to venous plasma. Chem Phys Lipids 2014; 184:38-41. [PMID: 25240239 DOI: 10.1016/j.chemphyslip.2014.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/02/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
Plaque formation is confined to the arterial trunk. We assumed that due to the higher aeration of arterial compared to venous blood, higher levels of the atherogenic agent oxidized LDL might be present in arteries, contributing to plaque formation. We aimed to compare (i) the basal oxidative status of LDL in arterial and venous blood and (ii) the susceptibility of arterial and venous LDL to oxidation. The basal oxidative status of LDL was determined by measuring lipid hydroperoxide (LPO) concentrations, plasma levels of auto-antibodies against oxidized LDL, and by measuring oxidation-specific epitopes on LDL particles. The oxidizability of arterial vs. venous LDL (catalyzed by copper) was estimated by monitoring the time-course of conjugated dienes formation. Interestingly, we found the same basal oxidative status of LDL in arterial and venous plasma. LPO concentrations and levels of auto-antibodies against oxidized LDL were similar in arterial and venous plasma and amounts of oxidation-specific epitopes were similar on the respective LDL particles. Moreover, we found similar susceptibilities of arterial and venous LDL to (copper-mediated) oxidation. Lag-times until the onset of conjugated diene formation were slightly shorter in arterial compared to venous LDL in the presence of 5 μM, but not in the presence of 1 μM CuCl2. Additionally, we found significantly higher levels of the atherogenic lipoprotein(a) in arterial plasma. We conclude that not higher oxidizability of arterial LDL but higher arterial lipoprotein(a) levels might help to explain why sclerosis is confined to the arterial trunk.
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Affiliation(s)
- Gerd Hoerl
- Institute of Physiological Chemistry, Medical University of Graz, Harrachgasse 21/II, Graz A-8010, Austria
| | - Gerhard Ledinski
- Institute of Physiological Chemistry, Medical University of Graz, Harrachgasse 21/II, Graz A-8010, Austria
| | - Gerd Kager
- Institute of Physiological Chemistry, Medical University of Graz, Harrachgasse 21/II, Graz A-8010, Austria
| | | | | | - Guenther Juergens
- Institute of Physiological Chemistry, Medical University of Graz, Harrachgasse 21/II, Graz A-8010, Austria
| | - Thomas Gary
- Department of Angiology, Medical University of Graz, Graz, Austria
| | - Gerhard Cvirn
- Institute of Physiological Chemistry, Medical University of Graz, Harrachgasse 21/II, Graz A-8010, Austria.
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381
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McConnell JP, Guadagno PA, Dayspring TD, Hoefner DM, Thiselton DL, Warnick GR, Harris WS. Lipoprotein(a) mass: a massively misunderstood metric. J Clin Lipidol 2014; 8:550-3. [PMID: 25499936 DOI: 10.1016/j.jacl.2014.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
The importance of lipoprotein (a)-Lp(a)-as a cardiovascular (CV) risk marker has been underscored by recent findings that CV risk is directly related to baseline Lp(a) levels, even in well-treated patients. Although there is currently little that can be done pharmacologically to lower Lp(a) levels, knowledge of its serum concentration is important in overall risk assessment. This review focuses on 1 aspect of Lp(a) that is rarely discussed directly: how to express its levels in serum. There is considerable confusion on this point, and a fuller understanding of what the concentration units mean will help improve study-to-study comparisons and thereby advance our understanding of the pathobiology of this lipoprotein particle. As discussed here, the term Lp(a) mass refers to the entire mass of the particle: lipids, proteins, and carbohydrates combined. At present, there are no commercially available assays that are completely insensitive to the variability in particle mass, which arises not only from differences in apo(a) isoform mass but also from variations in lipid mass. Because lipoprotein "particle number" (molar concentration) has been found to be superior to component-based metrics (ie, low-density lipoprotein particle vs cholesterol concentrations) for CV disease risk prediction, the development of a mass-insensitive Lp(a) assay should be a high priority.
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382
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García-Gómez C, Bianchi M, de la Fuente D, Badimon L, Padró T, Corbella E, Pintó X. Inflammation, lipid metabolism and cardiovascular risk in rheumatoid arthritis: A qualitative relationship? World J Orthop 2014; 5:304-311. [PMID: 25035833 PMCID: PMC4095023 DOI: 10.5312/wjo.v5.i3.304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/26/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Life expectancy in patients with rheumatoid arthritis (RA) is reduced compared to the general population owing to an increase in cardiovascular diseases (CVD) not fully explained by traditional cardiovascular risk factors. In recent years, interest has been focused on the alterations in lipid metabolism in relation to chronic inflammation as one of the possible mechanisms involved in the pathogenesis of atherosclerosis of RA patients. Research regarding this issue has revealed quantitative alterations in lipoproteins during the acute-phase reaction, and has also demonstrated structural alterations in these lipoproteins which affect their functional abilities. Although many alterations in lipid metabolism have been described in this regard, these structural changes associated with inflammation are particularly important in high-density lipoproteins as they affect their cardioprotective functions. In this respect, excessive oxidation in low-density lipoprotein (LDL) and increased lipoprotein(a) with a predominance of smaller apolipoprotein(a) isoforms has also been reported. This article will discuss proinflammatory high-density lipoproteins (piHDL), oxidized LDL and lipoprotein(a). Elevated concentrations of these lipoproteins with marked pro-atherogenic properties have been observed in RA patients, which could help to explain the increased cardiovascular risk of these patients.
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383
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Ezhov MV, Safarova MS, Afanasieva OI, Kukharchuk VV, Pokrovsky SN. Lipoprotein(a) level and apolipoprotein(a) phenotype as predictors of long-term cardiovascular outcomes after coronary artery bypass grafting. Atherosclerosis 2014; 235:477-82. [PMID: 24952151 DOI: 10.1016/j.atherosclerosis.2014.05.944] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/19/2014] [Accepted: 05/23/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the relationships of lipoprotein(a) (Lp(a)) concentration and apolipoprotein(a) (apo(a)) phenotype to major adverse cardiovascular events after coronary artery bypass grafting (CABG) in long-term follow-up. METHODS This single-center study included 356 patients with stable coronary heart disease (CHD) who underwent successful CABG. At baseline, we assessed the patient's risk factor profile for atherosclerosis, Lp(a) concentration and apo(a) phenotype. The primary endpoint was the composite of cardiovascular death and non-fatal myocardial infarction (MI). The secondary endpoint also included hospitalization for recurrent or unstable angina and repeat revascularization. RESULTS Over a mean of 8.5 ± 3.5 years (range 0.9-15.0 years), the primary and secondary endpoints were registered in 46 (13%) and 107 (30%) patients, respectively. Patients with Lp(a) ≥30 mg/dL were at significantly greater risk for the primary endpoint (hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.76-5.03, p < 0.001) and secondary endpoint (HR 3.47, 95% CI 2.48-4.85, p < 0.001) than patients with Lp(a) values <30 mg/dL. The low molecular-weight apo(a) phenotype was also associated with higher risk of both primary and secondary endpoints (3.57 (1.87-6.82) and 3.05 (2.00-4.62), respectively; p < 0.001 for both), regardless of conventional risk factors and statins use. CONCLUSION In stable CHD patients Lp(a) concentration and low molecular-weight apo(a) phenotype are independently associated with three-fold increase in risk of major adverse cardiovascular events within 15 years after CABG. Lp(a) levels may provide an additional information for postoperative cardiovascular risk assessment.
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Affiliation(s)
- Marat V Ezhov
- Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia.
| | - Maya S Safarova
- Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia.
| | - Olga I Afanasieva
- Laboratory of Atherosclerosis, Institute of Experimental Cardiology, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia.
| | - Valery V Kukharchuk
- Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia.
| | - Sergei N Pokrovsky
- Laboratory of Atherosclerosis, Institute of Experimental Cardiology, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia.
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384
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Affiliation(s)
- James Ker
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa.
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385
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Calmarza P, Bajador E, Lapresta C, García Castañón S, de Castro I, Civeira F. [Effect of biliary obstruction on lipoprotein(a) concentration]. Clin Investig Arterioscler 2014; 26:218-23. [PMID: 24629889 DOI: 10.1016/j.arteri.2014.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study was appointed to determine the correlation between the concentration of lipoprotein(a) [Lp(a)], apolipoproteins and lipids with biochemical parameters of liver function in a group of patients with reversible cholestasis. We have also determined the concentration of these parameters once solved the biliary obstruction process. MATERIAL AND METHODS Eighteen adults over 17 years with extrahepatic cholestasis were included in the study on a prospective basis, and we determined in them biochemical liver function parameters and lipoprotein metabolism parameters, particularly Lp(a) before and after unblocking. RESULTS The concentration of Lp(a) prior to desobstruction was inverse and statistically significantly correlated with the concentration of gamma glutamyl transpeptidase (correlation coefficient [r] = -0.757, P = .018). The concentration of Lp(a) (median = 2.66 mg/dL, interquartile range = 5,62) showed a statistically significant increase (median = 9.72 mg/dL, interquartile range = 28.76, P < .001), once the unblocking was performed. Concentrations of total cholesterol and triglycerides had a statistically significant decrease, and HDL cholesterol and apolipoprotein A-1 showed a statistically significant increase once the unblocking was carried out. CONCLUSIONS The concentration of Lp(a) is decreased during cholestasis, although there is a significant simultaneous hypercholesterolemia. Cholestasis has a causal role in lowering Lp(a), because the unblocking of bile duct recovers Lp(a) concentration. Our study supports the concept that bile acids exert a controlling effect on the synthesis of Lp(a) and open a mechanism for the treatment of hyper Lp(a).
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Affiliation(s)
- Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Eduardo Bajador
- Servicio de Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Carlos Lapresta
- Servicio de Medicina Preventiva, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - Isabel de Castro
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Fernando Civeira
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, Zaragoza, España
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386
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Cenarro A, Puzo J, Ferrando J, Mateo-Gallego R, Bea AM, Calmarza P, Jarauta E, Civeira F. Effect of Nicotinic acid/Laropiprant in the lipoprotein(a) concentration with regard to baseline lipoprotein(a) concentration and LPA genotype. Metabolism 2014; 63:365-71. [PMID: 24333007 DOI: 10.1016/j.metabol.2013.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/30/2013] [Accepted: 10/30/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is a lipoprotein in which apolipoproteinB-100 is linked to apolipoprotein(a) [apo(a)]. Significant variation in Lp(a) concentration is specific to LPA gene, which codes for apo(a). Nicotinic acid (NA) is used for treatment of dyslipidemias, and the lowering effect of NA on Lp(a) has been previously reported. OBJECTIVE To evaluate the Lp(a) lowering effect of 1g/20mg and 2g/40mgday of Nicotinic acid/Laropiprant in subjects with different baseline Lp(a) concentrations and depending on the LPA genotype. METHODS In an open-label, 10-week study, 1g/20mgday of NA/Laropiprant for 4weeks followed by 6weeks of 2g/40mgday conducted at 3 centers in Spain, 82 subjects were enrolled. Patients were studied at baseline and at the end of both treatment periods and were enrolled in three groups: normal Lp(a) (<50mg/dL), high Lp(a) (50-120mg/dL) and very high Lp(a) (>120mg/dL). The LPA genetic polymorphism was analyzed by a real-time PCR. RESULTS There was a significant difference in LPA genotypes among Lp(a) concentration groups and an inverse and significant correlation between baseline Lp(a) concentration and LPA genotype was found (R=-0.372, p<0.001). There were a significant decrease in total cholesterol, triglycerides, LDL cholesterol, apo B and Lp(a), and a significant increase in HDL cholesterol after NA/Laropiprant treatment, without changes in BMI. However, there were no statistical differences in percentage variation of analyzed variables depending on LPA genotype. CONCLUSION LPA genotype is a major determinant of Lp(a) baseline concentration. However, the lipid lowering effect of NA is not related to LPA genotype.
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Affiliation(s)
- Ana Cenarro
- Lipid Unit and Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - José Puzo
- Lipid Unit, Hospital San Jorge, Huesca, Spain
| | - Juan Ferrando
- Lipid Unit, Hospital Royo Villanova, Zaragoza, Spain
| | - Rocío Mateo-Gallego
- Lipid Unit and Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Ana M Bea
- Lipid Unit and Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Pilar Calmarza
- Biochemistry Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Estíbaliz Jarauta
- Lipid Unit and Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Fernando Civeira
- Lipid Unit and Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain.
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387
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Bea AM, Mateo-Gallego R, Jarauta E, Villa-Pobo R, Calmarza P, Lamiquiz-Moneo I, Cenarro A, Civeira F. [ Lipoprotein(a) is associated to atherosclerosis in primary hypercholesterolemia]. Clin Investig Arterioscler 2014; 26:176-83. [PMID: 24576773 DOI: 10.1016/j.arteri.2014.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/09/2014] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Several studies have suggested that Lp(a) could be a risk factor mainly in hypercholesterolemic patients. METHODS A total of 909 individuals were selected for this study. 307 were diagnosed of familiar hypercholesterolemia with a pathogenic mutation in LDLR or APOB genes (FH+), 291 of familiar combined hyperlipidemia (FCH) and 311 of familial hypercholesterolemia without a pathogenic mutation in LDLR nor APOB genes (FH-). Main risk factor were studied, included statin treatment. Plasma lipids, Lp(a), HbA1c and C-reactive protein. Intima-media thickness (IMT) of common and bulb carotid in both sides were measured in all subjects. RESULTS Lp(a) values (median, interquartile range) were 21.9mg/dL (9.24-50.5) in FH+, 22.4mg/dL (6.56-51.6) in FCH and 32.7 (14.6-71.5) in FH- (P<.001). Regression analysis including age, gender, HDL cholesterol, LDL cholesterol corrected for Lp(a), Lp(a), C-reactive protein, packs of cigarettes/day per year, systolic blood pressure and glucose as independent variables, demonstrate that Lp(a) was associated with carotid IMT in FH- subjects. Cardiovascular disease was more frequent in subjects with Lp(a) >50mg/dL (17.9%) than in subjects with Lp(a) <15mg/dL (9.6%), and between 15-50mg/dL (10.1%), and it was concentrated mostly in FH-group (6.7, 11.3, and 23.4% for the groups of Lp(a) <15mg/dL 15-50mg/dL, and >50mg/dL, respectively). CONCLUSIONS Our results indicate that Lp(a) is associated with atherosclerosis burden especially in subjects with FH- and concentrations of Lp(a)>50mg/dL.
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Affiliation(s)
- Ana M Bea
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Rocío Mateo-Gallego
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Estíbaliz Jarauta
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Rosa Villa-Pobo
- Instituto Aragonés de Ciencias de la Salud, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Pilar Calmarza
- Servicio de Bioquímica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Itziar Lamiquiz-Moneo
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Ana Cenarro
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Fernando Civeira
- Unidad de Lípidos y Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, España.
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388
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Khan TZ, Pottle A, Pennell DJ, Barbir MS. The expanding role of lipoprotein apheresis in the treatment of raised lipoprotein(a) in ischaemic heart disease and refractory angina. Glob Cardiol Sci Pract 2014; 2014:3-12. [PMID: 25054114 PMCID: PMC4104372 DOI: 10.5339/gcsp.2014.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/10/2014] [Indexed: 02/04/2023] Open
Abstract
It is increasingly recognised that lipoprotein(a) [Lp(a)], an inherited, genetically-determined form of LDL-cholesterol, is an independent cardiovascular risk factor and predictor of adverse cardiovascular outcomes. Lp(a) is felt to increase cardiovascular risk via its pro-thrombotic effect and by enhancing intimal lipoprotein deposition. Lipoprotein apheresis is currently the most effective treatment for raised Lp(a). There is a growing body of evidence suggesting that aggressively lowering raised Lp(a) may improve cardiovascular and clinical outcomes, although much more research is required in this field. Angina which is refractory to conventional medical therapy and revascularisation, is extremely challenging to manage. Treatment options for such patients remain very limited. We describe the case of a patient with refractory angina and raised lipoprotein(a) in whom aggressive reduction of Lp(a) with lipoprotein apheresis successfully ameliorated the progression of coronary stenosis and provided effective and durable relief of angina symptoms. In our centre, we are currently conducting a prospective, randomised controlled cross-over study of patients with refractory angina and raised Lp(a), randomised to undergoing lipoprotein apheresis or ‘sham’ apheresis with assessment of myocardial perfusion, carotid atherosclerosis, endothelial vascular function, thrombogenesis, oxidised phospholipids and their antibodies, exercise capacity, angina symptoms and quality of life at the beginning and end of treatment.
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Affiliation(s)
- Tina Z Khan
- Royal Brompton and Harefield Hospital NHS Foundation Trust, Hill End Road, London, UB9 6JH, United Kingdom
| | - Alison Pottle
- Royal Brompton and Harefield Hospital NHS Foundation Trust, Hill End Road, London, UB9 6JH, United Kingdom
| | - Dudley J Pennell
- Royal Brompton and Harefield Hospital NHS Foundation Trust, Hill End Road, London, UB9 6JH, United Kingdom
| | - Mahmoud S Barbir
- Royal Brompton and Harefield Hospital NHS Foundation Trust, Hill End Road, London, UB9 6JH, United Kingdom
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389
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Rowland CM, Pullinger CR, Luke MM, Shiffman D, Green L, Movsesyan I, Devlin JJ, Malloy MJ, Kane JP, Undas A. Lipoprotein (a), LPA Ile4399Met, and fibrin clot properties. Thromb Res 2014; 133:863-7. [PMID: 24502962 DOI: 10.1016/j.thromres.2014.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/06/2014] [Accepted: 01/20/2014] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Elevated lipoprotein(a) (Lp(a)) levels were reported to be associated with dense fibrin clots. The apo(a) component of Lp(a) is encoded by LPA, and the Met allele of the LPA Ile4399Met polymorphism is associated with elevated Lp(a) levels and cardiovascular disease risk. We investigated whether Ile4399Met was associated with fibrin clot properties. MATERIALS AND METHODS We determined plasma Lp(a) levels, fibrin clot permeability and lysis time for 64 LPA 4399Met carriers and 128 noncarriers matched for age, sex, ethnicity, and enrollment site. RESULTS Elevated Lp(a) levels were associated with reduced clot permeability and prolonged lysis time (P<0.0001). Carriers of 4399Met had higher Lp(a) levels compared with noncarriers (P=0.0003). However, this association differed by ethnicity (P=0.003 for interaction between genotype and ethnicity): compared with noncarriers, 4399Met carriers had 2.89 fold higher Lp(a) levels among Caucasians while no difference was observed among non-Caucasians (primarily East Asians and Hispanics). Among all subjects, no association was observed between Ile4399Met and clot properties, but this relationship also differed by ethnicity: among non-Caucasians, 4399Met carriers had increased clot permeability and shorter lysis time; whereas among Caucasians, the trend was for decreased permeability and longer lysis time (P<0.01 for interactions between genotype and ethnicity). CONCLUSIONS We confirmed that elevated Lp(a) levels are associated with dense fibrin clots, and found that the association of LPA 4399Met carriers and clot permeability as well as lysis time differ by ethnicity.
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390
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Habib SS, A Al Regaeiy K, Al Dokhi L. Assessment of adipokines relationships with cardiovascular risk markers in relation to body indices in normoglycemic males. Pak J Med Sci 2013; 29:21-6. [PMID: 24353501 PMCID: PMC3809172 DOI: 10.12669/pjms.291.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/11/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate the phenotypic relationship between obesity indices, resistin, adiponectin and cardiovascular risk markers in normoglycemic healthy individuals. METHODOLOGY This cross-sectional study was conducted in the Department of Physiology College of Medicine, King Saud University, Riyadh. A total of 120 male subjects were selected for the study. All subjects underwent analysis of body composition, glucose, glycosylated hemoglobin (HbA1c), lipids, adiponectin, resistin, lipoprotein(a) and high sensitivity C reactive protein (hsCRP). RESULTS Body mass index (BMI) (r=0.326, p < 0.001), body fat mass (BFM) (r=0.377, p < 0.001), body fat percentage (BF%) (r=0.326, p < 0.001), waist hip ratio (WHR) (r=0.402, p < 0.001) and basal Insulin levels (r=0.217, p=0.018) were positively correlated with hsCRP. However, serum adiponectin levels (r=0.189, p=0.0391) were negatively correlated with hsCRP. Adiponectin levels were significantly lower in obese compared to non obese subjects (p=0.0551). Keeping hsCRP as dependant variable we observed that WHR, BFM, BF%, BMI and adiponectin were significant predictors in univariate analysis. In multiple regression analysis WHR and adiponectin were independent predictors of hsCRP. CONCLUSION Obese individuals have significantly higher levels of hsCRP levels and lower adiponectin levels than non obese subjects. Serum adiponectin levels and WHR are independant predictors of hsCRP levels in normoglycemic subjects.
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Affiliation(s)
- Syed Shahid Habib
- Syed Shahid Habib, FCPS, Department of Physiology, College of Medicine, King Saud University, Riyadh-11461, Kingdom of Saudi Arabia
| | - Khlalid A Al Regaeiy
- Khlalid A Al Regaeiy, PhD, Department of Physiology, College of Medicine, King Saud University, Riyadh-11461, Kingdom of Saudi Arabia
| | - Laila Al Dokhi
- Laila Al Dokhi, PhD, Department of Physiology, College of Medicine, King Saud University, Riyadh-11461, Kingdom of Saudi Arabia
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391
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Riches K, Franklin L, Maqbool A, Peckham M, Adams M, Bond J, Warburton P, Feric NT, Koschinsky ML, O'Regan DJ, Ball SG, Turner NA, Porter KE. Apo lipoprotein(a) acts as a chemorepellent to human vascular smooth muscle cells via integrin αVβ3 and RhoA/ROCK-mediated mechanisms. Int J Biochem Cell Biol 2013; 45:1776-83. [PMID: 23726972 DOI: 10.1016/j.biocel.2013.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/24/2013] [Accepted: 05/21/2013] [Indexed: 01/31/2023]
Abstract
Lipoprotein(a) (Lp(a)) is an independent risk factor for the development of cardiovascular disease. Vascular smooth muscle cell (SMC) motility and plasticity, functions that are influenced by environmental cues, are vital to adaptation and remodelling in vascular physiology and pathophysiology. Lp(a) is reportedly damaging to SMC function via unknown molecular mechanisms. Apolipoprotein(a) (apo(a)), a unique glycoprotein moiety of Lp(a), has been demonstrated as its active component. The aims of this study were to determine functional effects of recombinant apo(a) on human vascular SMC motility and explore the underlying mechanism(s). Exposure of SMC to apo(a) in migration assays induced a potent, concentration-dependent chemorepulsion that was RhoA and integrin αVβ3-dependent, but transforming growth factor β-independent. SMC manipulation through RhoA gene silencing, Rho kinase inhibition, statin pre-treatment, αVβ3 neutralising antibody and tyrosine kinase inhibition all markedly inhibited apo(a)-mediated SMC migration. Our data reveal unique and potent activities of apo(a) that may negatively influence SMC remodelling in cardiovascular disease. Circulating levels of Lp(a) are resistant to lipid-lowering strategies and hence a greater understanding of the mechanisms underlying its functional effects on SMC may provide alternative therapeutic targets.
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392
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Baradaran A. Lipoprotein(a), type 2 diabetes and nephropathy; the mystery continues. J Nephropathol 2012; 1:126-9. [PMID: 24475402 DOI: 10.5812/nephropathol.8107] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 05/18/2012] [Accepted: 05/29/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Azar Baradaran
- Department of Clinical Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
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393
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Chandni R, Ramamoorthy KP. Lipoprotein(a) in type 2 diabetic subjects and its relationship to diabetic microvascular complications. World J Diabetes 2012; 3:105-9. [PMID: 22645639 PMCID: PMC3360222 DOI: 10.4239/wjd.v3.i5.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/15/2012] [Accepted: 05/11/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To estimate the level of serum lipoprotein (a) [Lp (a)] in type 2 diabetes mellitus patients and to determine the relationship between Lp(a) in type 2 diabetes mellitus patients and micro-vascular complications.
METHODS: A cross sectional study was performed that enrolled 144 subjects with type 2 diabetes mellitus above the age of 25 years attending outpatient clinic of Government Medical College, Kozhikode. Lp(a) levels were measured quantitatively in venous samples using Turbidimetric Immunoassay in all subjects. Each patient was evaluated for micro vascular complications, namely diabetic retinopathy, nephropathy and neuropathy. The relationship between Lp(a) levels and the micro vascular complications was assessed by univariate analysis.
RESULTS: Mean age of cases was 53.93 ± 10.74 years with a male to female ratio of 1.3:1. Mean duration of diabetes was 9.53 ± 7.3 years. Abnormal Lp(a) levels (≥ 30 mg/dL) were observed in 38 (26.4%) diabetic subjects. Seventy-eight (54.16%) cases had diabetic nephropathy and significantly higher Lp(a) levels were found among these cases [Median 28.2 mg/dL (Interquartile range; IQR 24.4-33.5) vs 19.3 mg/dL (IQR 14.7-23.5); P < 0.05]. Retinopathy was present among 66 (45.13%) cases and peripheral neuropathy was detected among 54 (37.5%) cases. However, Lp(a) levels were not significantly different among those with or without retinopathy and neuropathy. Positive correlation was found between higher Lp(a) levels and duration of diabetes (r = 0.165, P < 0.05) but not with HbA1c values (r = – 0.083).
CONCLUSION: Abnormal Lp(a) levels were found among 26.4% of diabetic subjects. Patients with diabetic nephropathy had higher Lp(a) levels. No association was found between Lp(a) levels and diabetic retinopathy or neuropathy. Longer duration of diabetes correlated with higher Lp(a) levels.
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Affiliation(s)
- Radhakrishnan Chandni
- Radhakrishnan Chandni, Kollengode Parameswaran Ramamoorthy, Department of Medicine, Government Medical College, Kozhikode, PIN 673008, Kerala, India
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394
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Alberty R, Albertyová D. Lipoprotein(a) in Children of Asian Indian Descendants and Their Caucasian Neighbors: The Slovak Lipid Community Study. Indian J Clin Biochem 2012; 27:231-8. [PMID: 26405380 DOI: 10.1007/s12291-012-0196-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 02/21/2012] [Indexed: 10/28/2022]
Abstract
To elucidate a higher rate of premature cardiovascular disease (CVD) in Asian Indian descendants (Roma) in Slovakia, we investigated frequency distribution, correlates and relationship of lipoprotein(a) [Lp(a)] to family CVD risk factors in Roma children and their Caucasian neighbors. The study sample consisted of 607 healthy children aged 7-18 years (55% Roma, 48% male) as part of the biracial (Roma-Caucasian) Slovak Lipid Community Study. Overall, frequency distribution data of Lp(a) were highly skewed to low concentrations, with markedly higher Lp(a) levels in Roma than in Caucasian children (median and range, mg/dL: 14.5; 0-159.2 vs 6.2; 0-112.3, P < 0.001), regardless of age and gender. Lp(a) was positively correlated with apo B (0.159, P = 0.004) in Roma, and LDL cholesterol (0.170, P = 0.005) in Caucasian children. In addition, daily income of the family was negatively related with Lp(a) in Roma (-0.134, P = 0.036) while positively in Caucasians (0.136, P = 0.047). For both race groups, no significant association was found between Lp(a) and age, body mass index, mean arterial pressure, smoking, and physical activity. Also, no significant relationships were examined between serum Lp(a) levels >30 mg/dL in children and family CVD risk factors, except for diabetes mellitus in parents of Caucasian origin (OR 4.46; 95%CI: 1.23-16.20). In a multivariate analysis, daily income, LDL cholesterol or apo B explained ~7% of the variance of Lp(a). This study suggests a significantly higher serum Lp(a) levels in Roma than in Caucasian children and a small effect, in general, of relevant CVD risk factors on the variation of Lp(a) levels in childhood.
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Affiliation(s)
- R Alberty
- Department of Biology and Ecology, Matthias Belivs University, SK-97401 Banská Bystrica, Slovakia ; Department of Biology and Ecology, Matthias Belivs University, SK-97401 Banská Bystrica, Slovakia
| | - D Albertyová
- Department of Biology and Ecology, Matthias Belivs University, SK-97401 Banská Bystrica, Slovakia ; Department of Clinical Biochemistry, F.D. Roosevelt Faculty Hospital, Banská Bystrica, Slovakia
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Luthra K, Vasisht S, Chhabra S, Raju KR, Agarwal DP, Manchanda SC, Srivastava LM. LP(a) phenotypes and levels in angiographically proven coronary heart disease patients and controls. Indian J Clin Biochem 1998; 13:12-9. [PMID: 23105177 PMCID: PMC3453536 DOI: 10.1007/bf02873437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lipoprotein Lp(a) excess has been identified as a powerful predictor of premature atherosclerotic vascular diseases. To evaluate this in a North-Indian population, 130 CAD patients and 130 controls were analyzed. The size of the apo(a) phenotypic isoforms was inversely proportional to Lp(a) concentrations. The mean concentration of Lp(a) in the CAD patients was 42±34 mg/dl whereas in the normal subjects it was much lower, 27±27 mg/dl. 157 subjects out of the total 260 subjects showed plasma levels of >20mg/dl. The frequency of high Lp(a) levels was much higher in patients(73%) than controls (43%). These data suggest (1) that there is heterogeneity of the Lp(a) polymorphism, (2) Higher Lp(a) levels were found in patients than in the controls, (3) Patients showed 1.5 fold increase in Lp(a) levels as compared to the controls. We conclude that low molecular weight apo(a) isoforms are significantly associated with increased risk of CAD in the North-Indian population.
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Affiliation(s)
- Kalpana Luthra
- Department of Biochemistry, CN Centre, All India Institute of Medical Sciences, 110029 New Delhi
| | - Suman Vasisht
- Department of Cardiology, CN, All India Institute of Medical Sciences, 110029 New Delhi
| | - Shivani Chhabra
- Department of Biochemistry, CN Centre, All India Institute of Medical Sciences, 110029 New Delhi
| | - K. R. Raju
- Department of Biochemistry, CN Centre, All India Institute of Medical Sciences, 110029 New Delhi
| | - D. P. Agarwal
- Institute of Human Genetics University of Hamburg, Butenfield, 22529 Hamburg, Germany
| | - S. C. Manchanda
- Department of Cardiology, CN, All India Institute of Medical Sciences, 110029 New Delhi
| | - L. M. Srivastava
- Department of Biochemistry, CN Centre, All India Institute of Medical Sciences, 110029 New Delhi
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