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Abstract
PURPOSE OF REVIEW Elevated levels of triglycerides, independent of low-density lipoprotein cholesterol (LDL-C) levels and statin therapy, are associated with heightened cardiovascular risk. RECENT FINDINGS Mixed omega-3 fatty acid formulations, which contain varying amounts of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), lower triglycerides levels but trial results with omega-3 fatty acids combinations have generally been neutral for cardiovascular outcomes. In contrast, the REDUCE-IT trial with icosapent ethyl (IPE), a highly purified ethyl ester of EPA, demonstrated reduced cardiovascular risk in individuals with established atherosclerotic cardiovascular disease or diabetes with at least one additional risk factor, despite having relatively well controlled LDL-C levels but triglycerides at least 135 mg/dl while on statin therapy. IPE offers an important new avenue for cardiovascular risk management in statin-treated individuals with elevated triglycerides. SUMMARY This review summarizes the results from outcome trials conducted with omega-3 fatty acids, differentiating between those with combinations of EPA/DHA and those with pure EPA, as well as imaging and preclinical data that help explain the different cardiovascular efficacy observed. A list of frequently asked questions with evidence-based responses is provided to assist our colleagues and their patients in the shared-decision process when considering if IPE is appropriate for cardiovascular risk reduction.
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52
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Vine D, Proctor E, Weaver O, Ghosh M, Maximova K, Proctor S. A Pilot Trial: Fish Oil and Metformin Effects on ApoB-Remnants and Triglycerides in Women With Polycystic Ovary Syndrome. J Endocr Soc 2021; 5:bvab114. [PMID: 34286169 PMCID: PMC8282216 DOI: 10.1210/jendso/bvab114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 01/14/2023] Open
Abstract
CONTEXT Women with polycystic ovary syndrome (PCOS) have increased incidence of atherogenic dyslipidemia and cardiovascular disease (CVD). Interventions targeting atherogenic dyslipidemia to reduce CVD risk are limited in women with PCOS. OBJECTIVE This pilot study was conducted to determine the effect of 12 weeks of high dose fish oil (FO), metformin, and FO as an adjunct to metformin (FO-metformin) therapy on fasting and nonfasting plasma lipids and ApoB-remnants in young women with the metabolic syndrome (MetS) and PCOS. METHODS In this open-label parallel pilot trial, women with MetS and PCOS (18-30 years of age) were randomized into 1 of 3 interventions: (1) FO; (2) metformin; and (3) FO-metformin. Plasma lipids and ApoB (48 and 100)-lipoproteins and triglycerides (TG) were measured in the fasted and postprandial state following a high-fat meal at baseline and postintervention. RESULTS FO-metformin significantly lowered fasting plasma TG by >40% compared with FO and metformin treatments. Fasting plasma apoB48 was lowered 40% in FO-metformin and 15% in the FO groups from baseline to postintervention. ApoB48 area under the curve (ApoB48AUC), ApoB48 incremental AUC (ApoB48iAUC), ApoB100AUC, and ApoB100iAUC decreased in all groups from baseline to postintervention; however, these findings did not reach statistical significance. CONCLUSION The findings of this pilot trial show that high dose FO and FO-metformin combination therapy tend to lower fasting and postprandial plasma TG and ApoB-lipoprotein remnants compared with metformin; however, the study is limited by small sample size. These results may be clinically significant in individuals with PCOS for management of atherogenic dyslipidemia.
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Affiliation(s)
- Donna Vine
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Ethan Proctor
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Olivia Weaver
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Mahua Ghosh
- Department of Endocrinology and Metabolism, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Katerina Maximova
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Spencer Proctor
- Metabolic and Cardiovascular Diseases Laboratory, University of Alberta, Edmonton, AB T6G 2R3, Canada
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53
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Ali AA, Fasen M, Ng K, Shelley P. Lipaemic blood: alcohol-induced acute hypertriglyceridaemia. BMJ Case Rep 2021; 14:14/7/e243167. [PMID: 34210703 DOI: 10.1136/bcr-2021-243167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Aleem Azal Ali
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Madeline Fasen
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Kintin Ng
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Patrisha Shelley
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
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Blaha MJ, DeFilippis AP. Multi-Ethnic Study of Atherosclerosis (MESA): JACC Focus Seminar 5/8. J Am Coll Cardiol 2021; 77:3195-3216. [PMID: 34167645 DOI: 10.1016/j.jacc.2021.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
The MESA (Multi-Ethnic Study of Atherosclerosis) is a National Heart, Lung, and Blood Institute-sponsored prospective study aimed at studying the prevalence, progression, determinants, and prognostic significance of subclinical cardiovascular disease in a sex-balanced, multiethnic, community-dwelling U.S. cohort. MESA helped usher in an era of noninvasive evaluation of subclinical atherosclerosis presence, burden, and progression for the evaluation of atherosclerotic cardiovascular disease risk, beyond what could be predicted by traditional risk factors alone. Concepts developed in MESA have informed international patient care guidelines, providing new tools to effectively guide public health policy, population screening, and clinical decision-making. MESA is grounded in an open science model that continues to be a beacon for collaborative science. In this review, we detail the original goals of MESA, and describe how the scope of MESA has evolved over time. We highlight 10 significant MESA contributions to cardiovascular medicine, and chart the path forward for MESA in the year 2021 and beyond.
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Affiliation(s)
- Michael J Blaha
- Johns Hopkins Ciccarone Center or the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center or the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA; Division of Cardiology. Vanderbilt University Medical Center, Nashville, Tennessee, USA
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55
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Salgado MM, Manchado A, Nieto CT, Díez D, Garrido NM. Synthesis and Modeling of Ezetimibe Analogues. Molecules 2021; 26:molecules26113107. [PMID: 34067439 PMCID: PMC8196997 DOI: 10.3390/molecules26113107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Ezetimibe is a well-known drug that lowers blood cholesterol levels by reducing its absorption in the small intestine when joining to Niemann-Pick C1-like protein (NPC1L1). A ligand-based study on ezetimibe analogues is reported, together with one-hit synthesis, highlighted in the study. A convenient asymmetric synthesis of (2S,3S)-N-α-(R)-methylbenzyl-3-methoxycarbonylethyl-4-methoxyphenyl β-lactam is described starting from Baylis-Hillman adducts. The route involves a domino process: allylic acetate rearrangement, stereoselective Ireland-Claisen rearrangement and asymmetric Michael addition, which provides a δ-amino acid derivative with full stereochemical control. A subsequent inversion of ester and acid functionality paves the way to the lactam core after monodebenzylation and lactam formation. It also shows interesting results when it comes to a pharmacophore study based on ezetimibe as the main ligand in lowering blood cholesterol levels, revealing which substituents on the azetidine-2-one ring are more similar to the ezetimibe skeleton and will more likely bind to NPC1L1 than ezetimibe.
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56
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Okazaki H, Gotoda T, Ogura M, Ishibashi S, Inagaki K, Daida H, Hayashi T, Hori M, Masuda D, Matsuki K, Yokoyama S, Harada-Shiba M. Current Diagnosis and Management of Primary Chylomicronemia. J Atheroscler Thromb 2021; 28:883-904. [PMID: 33980761 PMCID: PMC8532063 DOI: 10.5551/jat.rv17054] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary chylomicronemia (PCM) is a rare and intractable disease characterized by marked accumulation of chylomicrons in plasma. The levels of plasma triglycerides (TGs) typically range from 1,000 - 15,000 mg/dL or higher.
PCM is caused by defects in the lipoprotein lipase (LPL) pathway due to genetic mutations, autoantibodies, or unidentified causes. The monogenic type is typically inherited as an autosomal recessive trait with loss-of-function mutations in LPL pathway genes (
LPL
,
LMF1
,
GPIHBP1
,
APOC2
, and
APOA5
). Secondary/environmental factors (diabetes, alcohol intake, pregnancy, etc.) often exacerbate hypertriglyceridemia (HTG).
The signs, symptoms, and complications of chylomicronemia include eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, and acute pancreatitis with onset as early as in infancy. Acute pancreatitis can be fatal and recurrent episodes of abdominal pain may lead to dietary fat intolerance and failure to thrive. The main goal of treatment is to prevent acute pancreatitis by reducing plasma TG levels to at least less than 500-1,000 mg/dL. However, current TG-lowering medications are generally ineffective for PCM. The only other treatment options are modulation of secondary/environmental factors. Most patients need strict dietary fat restriction, which is often difficult to maintain and likely affects their quality of life. Timely diagnosis is critical for the best prognosis with currently available management, but PCM is often misdiagnosed and undertreated. The aim of this review is firstly to summarize the pathogenesis, signs, symptoms, diagnosis, and management of PCM, and secondly to propose simple diagnostic criteria that can be readily translated into general clinical practice to improve the diagnostic rate of PCM. In fact, these criteria are currently used to define eligibility to receive social support from the Japanese government for PCM as a rare and intractable disease. Nevertheless, further research to unravel the molecular pathogenesis and develop effective therapeutic modalities is warranted. Nationwide registry research on PCM is currently ongoing in Japan with the aim of better understanding the disease burden as well as the unmet needs of this life-threatening disease with poor therapeutic options.
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Affiliation(s)
- Hiroaki Okazaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo
| | - Takanari Gotoda
- Department of Metabolic Biochemistry, Faculty of Medicine, Kyorin University
| | - Masatsune Ogura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Jichi Medical University
| | - Kyoko Inagaki
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Nippon Medical School
| | - Hiroyuki Daida
- Faculty of Health Science, Juntendo University, Juntendo University Graduate School of Medicine
| | - Toshio Hayashi
- School of Health Sciences, Nagoya University Graduate School of Medicine
| | - Mika Hori
- Department of Endocrinology, Research Institute of Environmental Medicine, Nagoya University
| | - Daisaku Masuda
- Department of Cardiology, Health Care Center, Rinku Innovation Center for Wellness Care and Activities (RICWA), Rinku General Medical Center
| | - Kota Matsuki
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine
| | | | - Mariko Harada-Shiba
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
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Newman C, Tannock LR, Goldberg I. Response to Letter to the Editor: "Lipid Management in Patients With Endocrine Disorders: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 2021; 106:e1926-e1927. [PMID: 33484130 DOI: 10.1210/clinem/dgaa970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Connie Newman
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa R Tannock
- Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Ira Goldberg
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
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58
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Davis SR, Stuckey BGA, Magraith KS, Baber RJ. Letter to the Editor: "Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 2021; 106:e1917-e1918. [PMID: 33484146 DOI: 10.1210/clinem/dgaa968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Susan R Davis
- Women's Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, Nedlands, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Karen S Magraith
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rodney J Baber
- Menopause and Menstrual Disorders Clinic, The Royal North Shore Hospital, Sydney
- Faculty of Medicine and Health, The University of Sydney NSW, St. Leonards, Australia
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AYDEMİR E, ÇETİN SB, AYDOĞAN ÜNSAL Y, ATEŞ C, CANDER S, ÖZ GÜL Ö, ERTÜRK E, ERSOY C. A Case of very Severe Hypertriglyceridemia during Pregnancy. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.882279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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60
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Obisesan OH, Osei AD, Uddin SMI, Dzaye O, Blaha MJ. An Update on Coronary Artery Calcium Interpretation at Chest and Cardiac CT. Radiol Cardiothorac Imaging 2021; 3:e200484. [PMID: 33778659 DOI: 10.1148/ryct.2021200484] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 11/11/2022]
Abstract
Coronary artery calcium (CAC) is a marker of overall coronary atherosclerotic burden in an individual. As such, it is an important tool in cardiovascular risk stratification and preventive treatment of asymptomatic patients with unclear cardiovascular disease risk. Several guidelines have recommended the use of CAC testing in shared decision making between the clinician and patient. With recent updates in clinical management guidelines and broad recommendations for CAC, there is a need for concise updated information on CAC interpretation on traditional electrocardiographically gated scans and nongated thoracic scans. Important points to report when interpreting CAC scans include: the absolute Agatston score and the age, sex, and race-specific CAC percentile; general recommendations on time-to-rescan for individuals with a CAC score of 0; the number of vessels with CAC; the presence of CAC in the left main coronary artery; and specific highlighting of individuals with very high CAC scores of greater than 1000. When risk factor information is available, the 10-year coronary heart disease risk can also be easily assessed using the free online Multi-Ethnic Study of Atherosclerosis risk score calculator. Recent improvements in standardizing the reporting of CAC findings across gated and nongated studies, such as the CAC Data and Reporting System, show promise for improving the widespread clinical value of CAC in clinical practice. © RSNA, 2021.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Albert D Osei
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - S M Iftekhar Uddin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 733 N Broadway, Baltimore, MD 21205 (O.H.O., A.D.O., S.M.I.U., O.D., M.J.B.); American Heart Association Tobacco Regulation and Addiction Center, Dallas, Tex (O.H.O., A.D.O., S.M.I.U., M.J.B.); and Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (O.D.)
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61
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Chung ST, Matta ST, Meyers AG, Cravalho CK, Villalobos-Perez A, Dawson JM, Sharma VR, Sampson ML, Otvos JD, Magge SN. Nuclear Magnetic Resonance Derived Biomarkers for Evaluating Cardiometabolic Risk in Youth and Young Adults Across the Spectrum of Glucose Tolerance. Front Endocrinol (Lausanne) 2021; 12:665292. [PMID: 34084151 PMCID: PMC8167058 DOI: 10.3389/fendo.2021.665292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED Youth with obesity have an increased risk for cardiometabolic disease, but identifying those at highest risk remains a challenge. Four biomarkers that might serve this purpose are "by products" of clinical NMR LipoProfile® lipid testing: LPIR (Lipoprotein Insulin Resistance Index), GlycA (inflammation marker), BCAA (total branched-chain amino acids), and glycine. All are strongly related to insulin resistance and type 2 diabetes (T2DM) in adults (glycine inversely) and are independent of biological and methodological variations in insulin assays. However, their clinical utility in youth is unclear. We compared fasting levels of these biomarkers in 186 youth (42 lean normal glucose tolerant (NGT), 88 obese NGT, 23 with prediabetes (PreDM), and 33 with T2DM. All four biomarkers were associated with obesity and glycemia in youth. LPIR and GlycA were highest in youth with PreDM and T2DM, whereas glycine was lowest in youth with T2DM. While all four were correlated with HOMA-IR (Homeostatic Model Assessment for Insulin Resistance), LPIR had the strongest correlation (LPIR: r = 0.6; GlycA: r = 0.4, glycine: r = -0.4, BCAA: r = 0.2, all P < 0.01). All four markers correlated with HbA1c (LPIR, GlycA, BCAA: r ≥ 0.3 and glycine: r = -0.3, all P < 0.001). In multi-variable regression models, LPIR, GlycA, and glycine were independently associated with HOMA-IR (Adjusted R2 = 0.473, P < 0.001) and LPIR, glycine, and BCAA were independently associated with HbA1c (Adjusted R2 = 0.33, P < 0.001). An LPIR index of >44 was associated with elevated blood pressure, BMI, and dyslipidemia. Plasma NMR-derived markers were related to adverse markers of cardiometabolic risk in youth. LPIR, either alone or in combination with GlycA, should be explored as a non-insulin dependent predictive tool for development of insulin resistance and diabetes in youth. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, identifier NCT:02960659.
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Affiliation(s)
- Stephanie T. Chung
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Stephanie T. Chung,
| | - Samantha T. Matta
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Abby G. Meyers
- Department of Endocrinology and Diabetes, Children’s National Hospital, Washington, DC, United States
| | - Celeste K. Cravalho
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Alfredo Villalobos-Perez
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Joshua M. Dawson
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Vandhna R. Sharma
- Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Maureen L. Sampson
- National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - James D. Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, United States
| | - Sheela N. Magge
- Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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