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Salic K, Morrison MC, Verschuren L, Wielinga PY, Wu L, Kleemann R, Gjorstrup P, Kooistra T. Resolvin E1 attenuates atherosclerosis in absence of cholesterol-lowering effects and on top of atorvastatin. Atherosclerosis 2016; 250:158-65. [PMID: 27236706 DOI: 10.1016/j.atherosclerosis.2016.05.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Besides LDL-cholesterol, local vascular inflammation plays a key role in atherogenesis. Efficient therapies to treat the inflammatory component of the disease have not been established. The discovery of specialized inflammation-resolving mediators, such as resolvins may provide new opportunities for treatment. This study examines whether the ω-3 fatty acid eicosapentaenoic acid-derived resolvin E1 (RvE1), can reduce atherosclerosis, when administered alone or in combination with a cholesterol-lowering statin. METHODS ApoE*3Leiden mice were fed a hypercholesterolemic diet for 9 weeks and subsequently treated with RvE1-low (1 mg/kg/day), RvE1-high (5 mg/kg/day), atorvastatin (1.5 mg/kg/day) or the combination of atorvastatin and RvE1-low for the following 16 weeks. RESULTS RvE1-low and RvE1-high reduced atherosclerotic lesion size to the same extent (-35%; p < 0.05), attenuated the formation of severe lesions, also seen as a proportional increase in the presence of mild lesions, but did not alter plasma cholesterol levels. Cholesterol-lowering atorvastatin reduced atherosclerosis (-27%, p < 0.05), and the combination of RvE1 and atorvastatin further attenuated lesion size (-51%, p < 0.01) and increased the content of mild lesions. RvE1 did not affect plasma SAA, E-selectin, VCAM-1 or MCP-1 but did reduce plasma EPHX4 and down-regulated the local expression of pro-atherogenic genes in the aortae, (e.g. Cd74, Cd44, Ccl2, Ccr5 and Adam17) and significantly inactivated IFN-γ (p < 0.001) and TNF-α (p < 0.001) signalling pathways. CONCLUSIONS RvE1 attenuates atherogenesis both alone and on top of a statin. The local effects of RvE1 are demonstrated by the modulated aortic expression of genes involved in inflammatory and immune responses, without altering plasma cholesterol or circulating SAA.
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Affiliation(s)
- Kanita Salic
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Zernikedreef 9, 2333 CK, Leiden, The Netherlands.
| | - Martine C Morrison
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Zernikedreef 9, 2333 CK, Leiden, The Netherlands
| | - Lars Verschuren
- Department of Microbiology and Systems Biology, Netherlands Organisation for Applied Scientific Research (TNO), Utrechtseweg 48, 3704 HE, Zeist, The Netherlands
| | - Peter Y Wielinga
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Zernikedreef 9, 2333 CK, Leiden, The Netherlands
| | - Lijun Wu
- Resolvyx Pharmaceuticals, Inc., 222 Third Street, Cambridge, MA, 02142, United States
| | - Robert Kleemann
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Zernikedreef 9, 2333 CK, Leiden, The Netherlands
| | - Per Gjorstrup
- Resolvyx Pharmaceuticals, Inc., 222 Third Street, Cambridge, MA, 02142, United States.
| | - Teake Kooistra
- Department of Metabolic Health Research, Netherlands Organisation for Applied Scientific Research (TNO), Zernikedreef 9, 2333 CK, Leiden, The Netherlands
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102
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Tajuddin N, Shaikh A, Hassan A. Prescription omega-3 fatty acid products: considerations for patients with diabetes mellitus. Diabetes Metab Syndr Obes 2016; 9:109-18. [PMID: 27143943 PMCID: PMC4846047 DOI: 10.2147/dmso.s97036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and metabolic syndrome contribute to hypertriglyceridemia, which may increase residual risk of cardiovascular disease in patients with elevated triglyceride (TG) levels despite optimal low-density lipoprotein cholesterol (LDL-C) levels with statin therapy. Prescription products containing the long-chain omega-3 fatty acids (OM3FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are an effective strategy for reducing TG levels. This article provides an overview of prescription OM3FAs, including relevant clinical data in patients with T2DM and/or metabolic syndrome. Prescription OM3FAs contain either combinations of DHA and EPA (omega-3-acid ethyl esters, omega-3-carboxylic acids, omega-3-acid ethyl esters A) or EPA alone (icosapent ethyl). These products are well tolerated and can be used safely with statins. Randomized controlled trials have demonstrated that all prescription OM3FAs produce statistically significant reductions in TG levels compared with placebo; however, differential effects on LDL-C levels have been reported. Products containing DHA may increase LDL-C levels, whereas the EPA-only product did not increase LDL-C levels compared with placebo. Because increases in LDL-C levels may be unwanted in patients with T2DM and/or dyslipidemia, the EPA-only product should not be replaced with products containing DHA. Available data on the effects of OM3FAs in patients with diabetes and/or metabolic syndrome support that these products can be used safely in patients with T2DM and have beneficial effects on atherogenic parameters; in particular, the EPA-only prescription product significantly reduced TG, non-high-density lipoprotein cholesterol, Apo B, remnant lipoprotein cholesterol, and high-sensitivity CRP levels without increasing LDL-C levels compared with placebo. Ongoing studies of the effects of prescription OM3FAs on cardiovascular outcomes will help determine whether these products will emerge as effective add-on options to statin therapy for reduction of residual cardiovascular disease risk.
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Affiliation(s)
- Nadeem Tajuddin
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ali Shaikh
- Clinic of Endocrinology, Houston, TX, USA
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103
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Ferrari R, Aguiar C, Alegria E, Bonadonna RC, Cosentino F, Elisaf M, Farnier M, Ferrières J, Filardi PP, Hancu N, Kayikcioglu M, Mello e Silva A, Millan J, Reiner Ž, Tokgozoglu L, Valensi P, Viigimaa M, Vrablik M, Zambon A, Zamorano JL, Catapano AL. Current practice in identifying and treating cardiovascular risk, with a focus on residual risk associated with atherogenic dyslipidaemia. Eur Heart J Suppl 2016; 18:C2-C12. [DOI: 10.1093/eurheartj/suw009] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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104
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Athyros VG, Doumas M, Karagiannis A. Differential residual dyslipidemia/cardiovascular risk after statin treatment between Asian-Indians and western whites. Call for action. Indian Heart J 2016; 68:596-598. [PMID: 27773395 PMCID: PMC5079131 DOI: 10.1016/j.ihj.2016.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/27/2016] [Accepted: 02/24/2016] [Indexed: 02/05/2023] Open
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105
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[Consensus for pharmacologic treatment of atherogenic dyslipidemia with statin-fenofibrate combined therapy]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2016; 28:87-93. [PMID: 26811267 DOI: 10.1016/j.arteri.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Indexed: 10/22/2022]
Abstract
LDLc levels are associated with increase of cardiovascular risk, and statins are currently used for their control. Nevertheless, a despite of LDLc levels at goal, a residual risk is persistent, commonly associated with persistent lipids modifications (high triglycerides and low HDLc). So, it is necessary to evaluate triglycerides and HDL to assessment cardiovascular risk. Clinical data are consistent with efficacy and safety of combination therapy with statin and other lipid lowering drugs, for instance fenofibrate. Patients with hipertriglyceridemia and low HDLc are the group with most potential improve. In that patients with atherogenic dyslipidemia, the target for therapeutic objectives related with non-HDL-cholesterol is a priority, because non-HDL-cholesterol is considered as a more accuracy measure to assessment cardiovascular risk.
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106
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Bai JW, Boulet G, Halpern EM, Lovblom LE, Eldelekli D, Keenan HA, Brent M, Paul N, Bril V, Cherney DZI, Weisman A, Perkins BA. Cardiovascular disease guideline adherence and self-reported statin use in longstanding type 1 diabetes: results from the Canadian study of longevity in diabetes cohort. Cardiovasc Diabetol 2016; 15:14. [PMID: 26809442 PMCID: PMC4727297 DOI: 10.1186/s12933-015-0318-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/16/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Older patients with longstanding type 1 diabetes have high cardiovascular disease (CVD) risk such that statin therapy is recommended independent of prior CVD events. We aimed to determine self-reported CVD prevention guideline adherence in patients with longstanding diabetes. RESEARCH DESIGN AND METHODS 309 Canadians with over 50 years of type 1 diabetes completed a medical questionnaire for presence of lifestyle and pharmacological interventions, stratified into primary or secondary CVD prevention subgroups based on absence or presence of self-reported CVD events, respectively. Associations with statin use were analyzed using multivariable logistic regression. RESULTS The 309 participants had mean ± SD age 65.7 ± 8.5 years, median diabetes duration 54.0 [IQR 51.0, 59.0] years, and HbA1c of 7.5 ± 1.1 % (58 mmol/mol). 159 (52.7 %) participants reported diet adherence, 296 (95.8 %) smoking avoidance, 217 (70.5 %) physical activity, 218 (71.5 %) renin-angiotensin-system inhibitor use, and 220 (72.1 %) statin use. Physical activity was reported as less common in the secondary prevention subgroup, and current statin use was significantly lower in the primary prevention subgroup (65.5 % vs. 84.8 %, p = 0.0004). In multivariable logistic regression, the odds of statin use was 0.38 [95 % CI 0.15-0.95] in members of the primary compared to the secondary prevention subgroup, adjusting for age, sex, hypertension history, body mass, HbA1c, cholesterol, microvascular complications, acetylsalicylic acid use, and renin-angiotensin system inhibitor use. CONCLUSION Despite good self-reported adherence to general CVD prevention guidelines, against the principles of these guidelines we found that statin use was substantially lower in those without CVD history. Interventions are needed to improve statin use in older type 1 diabetes patients without a history of CVD.
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Affiliation(s)
- Johnny W Bai
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada.
| | - Geneviève Boulet
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada.
| | - Elise M Halpern
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada.
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada.
| | - Devrim Eldelekli
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada.
| | | | - Michael Brent
- Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Narinder Paul
- Joint Department of Medical Imaging, Division of Cardiothoracic Radiology, University Health Network, Toronto, ON, Canada.
| | - Vera Bril
- The Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Krembil Neuroscience Centre, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - David Z I Cherney
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Alanna Weisman
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada.
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, L5-210, 60 Murray Street, Mail Box 16, Toronto, ON, M5T 3L9, Canada.
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107
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Arbel Y, Klempfner R, Erez A, Goldenberg I, Benzekry S, Shlomo N, Fisman EZ, Tenenbaum A. Bezafibrate for the treatment of dyslipidemia in patients with coronary artery disease: 20-year mortality follow-up of the BIP randomized control trial. Cardiovasc Diabetol 2016; 15:11. [PMID: 26794137 PMCID: PMC4722704 DOI: 10.1186/s12933-016-0332-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 01/08/2016] [Indexed: 02/06/2023] Open
Abstract
Background Recent data support the renewed interest in hypertriglyceridemia as a possible important therapeutic target for cardiovascular risk reduction. This study was designed to address the question of all-cause mortality during extended follow-up of the BIP trial in patients stratified by baseline triglyceride levels. Methods In the BIP trial 3090 patients with proven coronary artery disease were randomized to bezafibrate 400 mg/day or placebo. All-cause mortality data after 20 years of follow-up, were obtained from the National Israeli Population Registry. Patients with hypertriglyceridemia (triglycerides ≥200 mg/dL, n = 458) were equally distributed among the study groups (15 % in both placebo and bezafibrate groups). Results During follow-up 1869 patients died (952 in placebo vs. 917 in bezafibrate group). Following multivariate adjustment allocation to bezafibrate was associated with small but significant 10 % mortality risk reduction (HR 0.90; 95 % CI 0.82–0.98, p = 0.026). Variables associated with significantly increased mortality risk were history of a past MI, NYHA class, diabetes, age, higher BMI and glucose level. In patients with hypertriglyceridemia multivariate analysis demonstrated a 25 % all-cause mortality risk reduction associated with allocation to bezafibrate (HR 0.75, CI 95 % 0.60–0.94; p = 0.012). In patients without hypertriglyceridemia bezafibrate had no significant effect on long-term mortality. Conclusions During long-term follow-up bezafibrate-allocated patients experienced a modest but significant 10 % reduction in the adjusted risk of mortality. This effect of bezafibrate was more prominent among patients with baseline hypertriglyceridemia (25 % mortality risk reduction). Electronic supplementary material The online version of this article (doi:10.1186/s12933-016-0332-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Robert Klempfner
- Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,The Israeli Association for Cardiovascular Trials, Tel Hashomer, Israel.
| | - Aharon Erez
- Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ilan Goldenberg
- Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,The Israeli Association for Cardiovascular Trials, Tel Hashomer, Israel. .,Heart Research Follow-up Program, University of Rochester, Rochester, NY, USA.
| | - Sagit Benzekry
- Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nir Shlomo
- The Israeli Association for Cardiovascular Trials, Tel Hashomer, Israel.
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108
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Brown RE, Kuk JL. Composite Risk Scores. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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109
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VRABLÍK M, ČEŠKA R. Treatment of Hypertriglyceridemia: a Review of Current Options. Physiol Res 2015; 64:S331-40. [DOI: 10.33549/physiolres.933199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Hypertriglyceridemia is an important marker of increased levels of highly atherogenic remnant-like particles. The importance of lowering plasma levels of triglycerides (TG) has been called into question many times, but currently it is considered an integral part of residual cardiovascular risk reduction strategies. Lifestyle changes (improved diet and increased physical activity) are effective TG lowering measures. Pharmacological treatment usually starts with statins, although associated TG reductions are typically modest. Fibrates are currently the drugs of choice for hyperTG, frequently in combination with statins. Niacin and omega-3 fatty acids improve control of triglyceride levels when the above measures are inadequately effective. Some novel therapies including anti-sense oligonucleotides and inhibitors of microsomal triglyceride transfer protein have shown significant TG lowering efficacy. The current approach to the management of hypertriglyceridemia is based on lifestyle changes and, usually, drug combinations (statin and fibrate and/or omega-3 fatty acids or niacin).
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Affiliation(s)
- M. VRABLÍK
- Third Department of Internal Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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110
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Comparison of 2-year mortality according to obesity in stabilized patients with type 2 diabetes mellitus after acute myocardial infarction: results from the DIAMOND prospective cohort registry. Cardiovasc Diabetol 2015; 14:141. [PMID: 26471283 PMCID: PMC4608118 DOI: 10.1186/s12933-015-0305-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/09/2015] [Indexed: 12/22/2022] Open
Abstract
Background After acute myocardial infarction (AMI), the replicated phenomenon of obesity paradox, i.e., obesity appearing to be associated with increased survival, has not been evaluated in stabilized (i.e., without clinical events within 1 month post AMI) Asian patients with diabetes mellitus (DM). Methods Among 1192 patients in the DIabetic Acute Myocardial InfarctiON Disease (DIAMOND) Korean multicenter registry between April 2010 and June 2012, 2-year cardiac and all-cause death were compared according to obesity (body mass index ≥25 kg/m2) in 1125 stabilized DM patients. Results Compared with non-obese DM patients (62 % of AMI patients), obese DM patients had: higher incidence of dyslipidemia (31 vs. 24 %, P < 0.01); lower incidence of chronic kidney disease (26 vs. 33 %) (P < 0.01); higher left ventricular ejection fraction after AMI (53 ± 11 vs. 50 ± 12 %, P < 0.001); and lower 2-year cardiac and all-cause death occurrence (0.7 vs. 3.6 % and 1.9 vs. 5.2 %, both P < 0.01) and cumulative incidence in Kaplan–Meier analysis (P < 0.005, respectively). Likewise, both univariate and multivariate Cox hazard regression analyses adjusted for the respective confounders showed that obesity was associated with decreased risk of both cardiac [HR, 0.18 (95 % CI 0.06–0.60), P = 0.005; and 0.24 (0.07–0.78), P = 0.018, respectively] and all-cause death [0.34 (0.16–0.73), P = 0.005; and 0.44 (0.20–0.95), P = 0.038]. Conclusions In a Korean population of stabilized DM patients after AMI, non-obese patients appear to have higher cardiac and all-cause mortality compared with obese patients after adjusting for confounding factors. Electronic supplementary material The online version of this article (doi:10.1186/s12933-015-0305-1) contains supplementary material, which is available to authorized users.
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111
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Kedia AW, Lynch E. Effects of switching from omega-3-acid ethyl esters to icosapent ethyl in a statin-treated patient with elevated triglycerides. Postgrad Med 2015; 127:869-73. [DOI: 10.1080/00325481.2015.1100086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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112
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Borow KM, Nelson JR, Mason RP. Biologic plausibility, cellular effects, and molecular mechanisms of eicosapentaenoic acid (EPA) in atherosclerosis. Atherosclerosis 2015; 242:357-66. [DOI: 10.1016/j.atherosclerosis.2015.07.035] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/06/2015] [Accepted: 07/20/2015] [Indexed: 01/08/2023]
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113
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Aguiar C, Alegria E, Bonadonna RC, Catapano AL, Cosentino F, Elisaf M, Farnier M, Ferrières J, Filardi PP, Hancu N, Kayikcioglu M, Mello e Silva A, Millan J, Reiner Ž, Tokgozoglu L, Valensi P, Viigimaa M, Vrablik M, Zambon A, Zamorano JL, Ferrari R. A review of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidaemia: A report from an expert consensus meeting on the role of fenofibrate–statin combination therapy. ATHEROSCLEROSIS SUPP 2015; 19:1-12. [DOI: 10.1016/s1567-5688(15)30001-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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114
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Karpov Y, Khomitskaya Y. PROMETHEUS: an observational, cross-sectional, retrospective study of hypertriglyceridemia in Russia. Cardiovasc Diabetol 2015; 14:115. [PMID: 26303403 PMCID: PMC4549018 DOI: 10.1186/s12933-015-0268-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/31/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Data regarding the prevalence of hypertriglyceridemia in the Russian population are lacking, despite triglyceride (TG)-mediated pathways being causal in cardiovascular disease. The prevalence of mixed dyslipidemia and severe hypertriglyceridemia in the Russian population (PROMETHEUS) was undertaken to address this gap. METHODS This was an observational, cross-sectional retrospective study. Data from adults with a full/partial lipoprotein record who had blood analyses done at an INVITRO laboratory in Russia between January 1, 2011 and December 31, 2013 were analyzed. The primary endpoint was the prevalence of hypertriglyceridemia (TG ≥ 1.7 mmol/L); secondary endpoints included prevalence of borderline high, high, and very high TG and severe hypertriglyceridemia, defined as a TG level of 1.7 to <2.3, 2.3 to <5.6, ≥5.6, and ≥10.0 mmol/L, respectively. Statistical analyses involved the Wilcoxon and the Chi square tests. Correlations between log-transformed TG and low- and high-density lipoprotein cholesterol (LDL-C and HDL-C) and total cholesterol (TC) were assessed. The correlation between glycated hemoglobin (HbA1c) and TG levels in a nested sample of subjects with HbA1c and TG data was also assessed using a log-linear model. RESULTS The full dataset and nested sample comprised 357,072 and 54,602 individuals, respectively. Prevalence of hypertriglyceridemia, borderline high TG, high TG, very high TG, and severe hypertriglyceridemia in the full dataset was 29.2, 16.2, 12.9, 0.11, and 0.011%, respectively; corresponding rates in the nested sample were 19.0, 17.2, 0.25, and 0.016%, respectively. TG levels were 16.4% higher in males versus females; males had a greater risk of hypertriglyceridemia (risk ratio 1.25; 95% CI 1.24, 1.26; P < 0.0001). Prevalence of hypertriglyceridemia increased with age, peaking at 40-49 years in males (42.8%) and 60-69 years in females (34.4%); a 0.61% increase in TG levels for each year of life was predicted. Hypertriglyceridemia prevalence increased over time. Correlations between TG and LDL-C, HDL-C, TC, and HbA1c (nested sample only) were observed. CONCLUSIONS Almost one-third of Russians have hypertriglyceridemia, but severe disease (TG ≥ 10.0 mmol/L) is rare. Although the risk of hypertriglyceridemia was greater in males versus females, its prevalence increased with age, regardless of sex. TG was associated with HbA1c, LDL-C, HDL-C, and TC.
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Affiliation(s)
- Yuri Karpov
- Russian Cardiology Research and Production Complex, Moscow, Russian Federation.
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115
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Sprandel MCO, Hueb WA, Segre A, Ramires JAF, Kalil-Filho R, Maranhão RC. Alterations in lipid transfers to HDL associated with the presence of coronary artery disease in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2015; 14:107. [PMID: 26268997 PMCID: PMC4535391 DOI: 10.1186/s12933-015-0270-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/01/2015] [Indexed: 12/02/2022] Open
Abstract
Background We previously showed that unesterified-cholesterol transfer to high-density lipoprotein (HDL), a crucial step in cholesterol esterification and role in reverse cholesterol transport, was diminished in non-diabetic patients with coronary artery disease (CAD). The aim was to investigate whether, in patients with type 2 diabetes mellitus (T2DM), the occurrence of CAD was also associated with alterations in lipid transfers and other parameters of plasma lipid metabolism. Methods Seventy-nine T2DM with CAD and 76 T2DM without CAD, confirmed by cineangiography, paired for sex, age (40–80 years), BMI and without statin use, were studied. In vitro transfer of four lipids to HDL was performed by incubating plasma of each patient with a donor emulsion containing radioactive lipids during 1 h at 37 °C. Lipids transferred to HDL were measured after chemical precipitation of non-HDL fractions and the emulsion. Results are expressed as % of total radioactivity of each lipid in HDL. Results In T2DM + CAD, LDL-cholesterol and apo B were higher than in T2DM. T2DM + CAD also showed diminished transfer to HDL of unesterified cholesterol (T2DM + CAD = 7.6 ± 1.2; T2DM = 8.2 ± 1.5 %, p < 0.01) and of cholesteryl-esters (4.0 ± 0.6 vs 4.3 ± 0.7, p < 0.01). Unesterified cholesterol in the non-HDL serum fraction was higher in T2DM + CAD (0.93 ± 0.20 vs 0.85 ± 0.15, p = 0.02) and CETP concentration was diminished (2.1 ± 1.0 vs 2.5 ± 1.1, p = 0.02). Lecithin-cholesterol acyltransferase activity, HDL size and lipid composition were equal. Conclusion Reduction in T2DM + CAD of cholesterol transfer to HDL may impair cholesterol esterification and reverse cholesterol transport and altogether with simultaneous increased plasma unesterified cholesterol may facilitate CAD development in T2DM.
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Affiliation(s)
- Marilia C O Sprandel
- Lipid Metabolism Laboratory, Heart Institute, Medical School Hospital, University of São Paulo, São Paulo, Brazil.
| | - Whady A Hueb
- Clinical Cardiology Division, Heart Institute, Medical School Hospital, University of São Paulo, São Paulo, Brazil.
| | - Alexandre Segre
- Clinical Cardiology Division, Heart Institute, Medical School Hospital, University of São Paulo, São Paulo, Brazil.
| | - José A F Ramires
- Clinical Cardiology Division, Heart Institute, Medical School Hospital, University of São Paulo, São Paulo, Brazil.
| | - Roberto Kalil-Filho
- Clinical Cardiology Division, Heart Institute, Medical School Hospital, University of São Paulo, São Paulo, Brazil.
| | - Raul C Maranhão
- Lipid Metabolism Laboratory, Heart Institute, Medical School Hospital, University of São Paulo, São Paulo, Brazil. .,Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.
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Ferrannini E, DeFronzo RA. Impact of glucose-lowering drugs on cardiovascular disease in type 2 diabetes. Eur Heart J 2015; 36:2288-96. [PMID: 26063450 DOI: 10.1093/eurheartj/ehv239] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/16/2015] [Indexed: 12/11/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is characterized by multiple pathophysiologic abnormalities. With time, multiple glucose-lowering medications are commonly required to reduce and maintain plasma glucose concentrations within the normal range. Type 2 diabetes mellitus individuals also are at a very high risk for microvascular complications and the incidence of heart attack and stroke is increased two- to three-fold compared with non-diabetic individuals. Therefore, when selecting medications to normalize glucose levels in T2DM patients, it is important that the agent not aggravate, and ideally even improve, cardiovascular risk factors (CVRFs) and reduce cardiovascular morbidity and mortality. In this review, we examine the effect of oral (metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP4 inhibitors, SGLT2 inhibitors, and α-glucosidase inhibitors) and injectable (glucagon-like peptide-1 receptor agonists and insulin) glucose-lowering drugs on established CVRFs and long-term studies of cardiovascular outcomes. Firm evidence that in T2DM cardiovascular disease can be reversed or prevented by improving glycaemic control is still incomplete and must await large, long-term clinical trials in patients at low risk using modern treatment strategies, i.e., drug combinations designed to maximize HbA1c reduction while minimizing hypoglycaemia and excessive weight gain.
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Affiliation(s)
- Ele Ferrannini
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Ralph A DeFronzo
- Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA
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Extreme urinary betaine losses in type 2 diabetes combined with bezafibrate treatment are associated with losses of dimethylglycine and choline but not with increased losses of other osmolytes. Cardiovasc Drugs Ther 2015; 28:459-68. [PMID: 25060556 DOI: 10.1007/s10557-014-6542-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Betaine deficiency is a probable cardiovascular risk factor and a cause of elevated homocysteine. Urinary betaine excretion is increased by fibrate treatment, and is also often elevated in diabetes. Does fibrate further increase betaine excretion in diabetes, and does it affect the plasma concentrations and excretions of related metabolites and of other osmolytes? METHODS Samples from a previous study of type 2 diabetes were selected if participants were taking bezafibrate (n = 32). These samples were compared with participants matched for age and gender and not on a fibrate (comparator group, n = 64). Betaine, related metabolites, and osmolytes were measured in plasma and urine samples from these 96 participants. RESULTS Median urinary betaine excretion in those on bezafibrate was 5-fold higher than in the comparator group (p < 0.001), itself 3.5-fold higher than the median reported for healthy populations. In the bezafibrate group, median dimethylglycine excretion was higher (9-fold, p < 0.001). Excretions of choline, and of the osmolytes myo-inositol, taurine and glycerophosphorylcholine, were not significantly different between groups. Some participants excreted more betaine than usual dietary intakes. Several betaine fractional clearances were >100 %. Betaine excretion correlated with excretions of the osmolytes myo-inositol and glycerophosphorylcholine, and also with the excretion of choline and N,N-dimethylglycine, but it was inconclusive whether these relationships were affected by bezafibrate therapy. CONCLUSIONS Increased urinary betaine excretions in type 2 diabetes are further increased by fibrate treatment, sometimes to more than their dietary intake. Concurrent betaine supplementation may be beneficial.
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Rinkūnienė E, Laucevičius A, Petrulionienė Ž, Dženkevičiūtė V, Kutkienė S, Skujaitė A, Kasiulevičius V. The prevalence of dislipidemia and its relation to other risk factors: a nationwide survey of Lithuania. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/clp.15.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Hermans MP, Bouenizabila E, Amoussou-Guenou DK, Ahn SA, Rousseau MF. Baseline diabetes as a way to predict CV outcomes in a lipid-modifying trial: a meta-analysis of 330,376 patients from 47 landmark studies. Cardiovasc Diabetol 2015; 14:60. [PMID: 25990410 PMCID: PMC4489105 DOI: 10.1186/s12933-015-0226-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is a major cardiovascular risk factor. However, its influence on the rate of occurrence of cardiovascular (CV) events during a clinical trial that included a diabetes subgroup has not yet been quantified. AIMS To establish equations relating baseline diabetes prevalence and incident CV events, based on comparator arms data of major lipid-modifying trials. METHODS Meta-analysis of primary outcomes (PO) rates of key prospective trials, for which the baseline proportion of diabetics was reported, including studies having specifically reported CV outcomes within their diabetic subgroups. RESULTS 47 studies, representing 330,376 patients (among whom 124,115 diabetics), were analyzed as regards the relationship between CV outcomes rates (including CHD) and the number of diabetics enrolled. Altogether, a total of 18,445 and 16,156 events occurred in the comparator and treatment arms, respectively. There were significant linear relationships between diabetes prevalence and both PO and CHD rates (%/year): y = 0.0299*x + 3.12 [PO] (p = 0.0128); and y = 0.0531*x + 1.54 [CHD] (p = 0.0094), baseline diabetes predicting PO rates between 3.12 %/year (no diabetic included) and 6.11 %/year (all patients diabetic); and CHD rates between 1.54 %/year (no diabetic) and 6.85 %/year (all patients diabetic). The slopes of the equations did not differ according to whether they were derived from primary or secondary prevention trials. CONCLUSIONS Absolute and relative CV risk associated with diabetes at inclusion can be readily predicted using linear equations relating diabetes prevalence to primary outcomes or CHD rates.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Evariste Bouenizabila
- Service de Maladies Métaboliques et Endocriniennes, Centre Hospitalier et Universitaire de Brazzaville, Brazzaville, Congo.
| | - Daniel K Amoussou-Guenou
- Service d'Endocrinologie et Métabolisme, CNHU HKM Cotonou, Université d'Abomey-Calavi, Abomey-Calavi, Bénin.
| | - Sylvie A Ahn
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
| | - Michel F Rousseau
- Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
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Jinnouchi H, Morita K, Tanaka T, Kajiwara A, Kawata Y, Oniki K, Saruwatari J, Nakagawa K, Otake K, Ogata Y, Yoshida A, Hokimoto S, Ogawa H. Interactive effects of a common γ-glutamyltransferase 1 variant and low high-density lipoprotein-cholesterol on diabetic macro- and micro-angiopathy. Cardiovasc Diabetol 2015; 14:49. [PMID: 25952030 PMCID: PMC4428095 DOI: 10.1186/s12933-015-0212-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/08/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND We investigated the clinical relevance of a common variant, rs4820599, in the γ-glutamyltransferase (GGT)1 gene, associated with the serum GGT level, in Japanese type 2 diabetes mellitus (T2DM) subjects. METHODS We conducted a retrospective longitudinal study (4.9 ± 2.5 years) including 352 T2DM patients (T2DM subjects) and a cross-sectional study including 796 health screening program participants (general subjects). A real-time TaqMan allelic discrimination assay was used to identify the genotypes. Risk factors for a high brachial-ankle pulse wave velocity (baPWV) (≥1750 cm/sec) or diabetic retinopathy (DR) were determined using a generalized estimating equations approach, receiver operating characteristic (ROC) analysis or Cox proportional hazards model, etc. RESULTS The frequency of the GGT1 G allele was 20.8% in the T2DM subjects, and no associations were found between the GGT1 genotype and risk of T2DM. The mean log GGT values in the T2DM and general subjects were significantly higher among G allele carriers than non-carriers. The G allele and a low HDL-C level were identified to be risk factors for a high baPWV in the T2DM subjects [odds ratio (OR) 1.80, P = 0.008; OR 1.71, P = 0.03; respectively), and a significant interactive effect between these factors was found on the risk of a high baPWV and DR. The HDL-C level at baseline was a significant predictor of a high baPWV only in G allele carriers according to the ROC analysis. This result regarding baPWV in the T2DM subjects was replicated in the general population. Meanwhile, the GGT1 genotype was not associated with the risk of DR, although it affected the principal factors involved in the risk of DR, and a low HDL-C level was also found to be a risk factor for DR only in G allele carriers. CONCLUSIONS We herein describe for the first time the significant interactive effects of the GGT1 G allele and a low HDL-C level on a high baPWV and DR. These findings may encourage future clinical trials comparing the efficacy of agents increasing the HDL-C levels among the GGT1 genotypes. However, well-designed studies in larger cohorts are needed to confirm our results.
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Affiliation(s)
- Hideaki Jinnouchi
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan. .,Jinnouchi Clinic, Diabetes Care Center, Kumamoto, Japan.
| | - Kazunori Morita
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, 862-0973, Kumamoto, Japan.
| | - Takahiro Tanaka
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, 862-0973, Kumamoto, Japan.
| | - Ayami Kajiwara
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, 862-0973, Kumamoto, Japan.
| | - Yuki Kawata
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, 862-0973, Kumamoto, Japan.
| | - Kentaro Oniki
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, 862-0973, Kumamoto, Japan.
| | - Junji Saruwatari
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, 862-0973, Kumamoto, Japan.
| | - Kazuko Nakagawa
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, 862-0973, Kumamoto, Japan. .,Center for Clinical Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Koji Otake
- Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan.
| | - Yasuhiro Ogata
- Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan.
| | - Akira Yoshida
- Jinnouchi Clinic, Diabetes Care Center, Kumamoto, Japan.
| | - Seiji Hokimoto
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan. .,Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Hisao Ogawa
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan. .,Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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García-Fontana B, Morales-Santana S, Longobardo V, Reyes-García R, Rozas-Moreno P, García-Salcedo JA, Muñoz-Torres M. Relationship between Proinflammatory and Antioxidant Proteins with the Severity of Cardiovascular Disease in Type 2 Diabetes Mellitus. Int J Mol Sci 2015; 16:9469-83. [PMID: 25923078 PMCID: PMC4463599 DOI: 10.3390/ijms16059469] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/01/2015] [Accepted: 04/08/2015] [Indexed: 02/05/2023] Open
Abstract
Type 2 diabetes mellitus patients are at significant risk of cardiovascular disease, however, the pathophysiology of these complications is complex and incompletely known in this population. The aim of this study was to compare the serum proteome of patients with type 2 diabetes mellitus presenting or not presenting cardiovascular disease with non-diabetic subjects to find essential proteins related to these cardiovascular complications. This cross-sectional study compares the serum proteome by a combination of protein depletion with 2D-DIGE (2-dimension Difference Gel Electrophoresis) methodology. The proteins differentially expressed were identified by MALDI TOF/TOF (Matrix-assisted laser desorption/ionization and Time-Of-Flight ion detector) or LC-MS/MS (Liquid Chromatography coupled to Mass-Mass Spectrometry). Type 2 diabetes mellitus patients with cardiovascular disease showed higher expression of plasma retinol binding protein and glutathione peroxidase-3 compared to those without cardiovascular disease and non-diabetic controls. These results show that proteins related to the inflammatory and redox state appear to play an important role in the pathogenesis of the cardiovascular disease in the type 2 diabetes mellitus patients.
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Affiliation(s)
- Beatriz García-Fontana
- Bone Metabolic Unit, Endocrinology Division (RETICEF), Instituto de Investigación Biosanitaria (Ibs) Granada, University Hospital San Cecilio, Granada 18012, Spain.
| | - Sonia Morales-Santana
- Bone Metabolic Unit, Endocrinology Division (RETICEF), Instituto de Investigación Biosanitaria (Ibs) Granada, University Hospital San Cecilio, Granada 18012, Spain.
- Proteomic Research Service, Instituto de Investigación Biosanitaria (Ibs) Granada, University Hospital San Cecilio, Granada 18012, Spain.
| | - Victoria Longobardo
- Proteomic Research Service, Institute of Parasitology and Biomedicine "López Neyra" (C.S.I.C.), Granada 18016, Spain.
| | - Rebeca Reyes-García
- Bone Metabolic Unit, Endocrinology Division (RETICEF), Instituto de Investigación Biosanitaria (Ibs) Granada, University Hospital San Cecilio, Granada 18012, Spain.
| | - Pedro Rozas-Moreno
- Endocrinology Division, Ciudad Real General Hospital, Ciudad Real 13005, Spain.
| | - José Antonio García-Salcedo
- Infectious Diseases Unit, Instituto de Investigación Biosanitaria (Ibs) Granada, University Hospital San Cecilio, Av. Dr. Olóriz 16, Granada 18012, Spain.
| | - Manuel Muñoz-Torres
- Bone Metabolic Unit, Endocrinology Division (RETICEF), Instituto de Investigación Biosanitaria (Ibs) Granada, University Hospital San Cecilio, Granada 18012, Spain.
- Endocrinology Unit, University Hospital San Cecilio, Av. Dr. Olóriz 16, Granada 18012, Spain.
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Swerdlow DI, Hingorani AD, Humphries SE. Genetic Risk Factors and Mendelian Randomization in Cardiovascular Disease. Curr Cardiol Rep 2015; 17:33. [DOI: 10.1007/s11886-015-0584-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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123
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Wilke T, Mueller S, Groth A, Fuchs A, Seitz L, Kienhöfer J, Maywald U, Lundershausen R, Wehling M. Treatment-dependent and treatment-independent risk factors associated with the risk of diabetes-related events: a retrospective analysis based on 229,042 patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2015; 14:14. [PMID: 25645749 PMCID: PMC4343042 DOI: 10.1186/s12933-015-0179-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of this study was to analyse which factors predict the real-world macro-/microvascular event, hospitalisation and death risk in patients with type 2 diabetes mellitus. Furthermore, we aimed to investigate whether there exists both an under- and over-treatment risk of these patients. METHODS We used a German claims/clinical data set covering the years 2010-12. Diabetes-related events were defined as (1) macro-, (2) microvascular events leading to inpatient hospitalisation, (3) other hospitalisations with type 2 diabetes mellitus as main diagnosis, (4) all-cause death and (5) a composite outcome including all event categories 1-4. Factors associated with event risk were analysed by a Kaplan-Meier curve analysis and by multivariable Cox regression models. RESULTS 229,042 patients with type 2 diabetes mellitus (mean age 70.2 years; mean CCI 6.03) were included. Among factors that increased the event risk were patients' age, male gender, the adapted Charlson Comorbidity Index, the adapted Diabetes Complication Severity Index, previous events, and number of prescribed chronic medications. For systolic blood pressure/HbA1C, a double-J/U-curve pattern was detected: HbA1C of 6-6.5% (42-48 mmol/mol) and systolic blood pressure of 130-140 mmHg (17.3-18.7kPa) were associated with the lowest event risk, values below/above that range were associated with higher risk. However, this pattern was mainly driven by the death risk and was much less clearly observed for the macrovascular/microvascular/hospitalization risk and for young/less comorbid patients. CONCLUSIONS Both blood pressure and HbA1C seem to be very important treatment targets, especially in comorbid old patients. It is of particular clinical importance that both over- and under-treatment pose a threat to patients with type 2 diabetes mellitus.
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Affiliation(s)
- Thomas Wilke
- IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany.
| | - Sabrina Mueller
- IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany.
| | - Antje Groth
- IPAM, University of Wismar, Philipp-Müller-Str. 12, 23966, Wismar, Germany.
| | | | - Lisa Seitz
- Novo Nordisk Pharma GmbH, Brucknerstraße 1, 55127, Mainz, Germany.
| | | | - Ulf Maywald
- AOK PLUS, Sternplatz 7, 01067, Dresden, Germany.
| | | | - Martin Wehling
- Clinical Pharmacology, Mannheim/Center for Gerontopharmacology, Medical Faculty Mannheim, University of Heidelberg, Maybachstr. 14, 68169, Mannheim, Germany.
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Kootte RS, Smits LP, van der Valk FM, Dasseux JL, Keyserling CH, Barbaras R, Paolini JF, Santos RD, van Dijk TH, Dallinga-van Thie GM, Nederveen AJ, Mulder WM, Hovingh GK, Kastelein JP, Groen AK, Stroes E. Effect of open-label infusion of an apoA-I-containing particle (CER-001) on RCT and artery wall thickness in patients with FHA. J Lipid Res 2015; 56:703-712. [PMID: 25561459 DOI: 10.1194/jlr.m055665] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Reverse cholesterol transport (RCT) contributes to the anti-atherogenic effects of HDL. Patients with the orphan disease, familial hypoalphalipoproteinemia (FHA), are characterized by decreased tissue cholesterol removal and an increased atherogenic burden. We performed an open-label uncontrolled proof-of-concept study to evaluate the effect of infusions with a human apoA-I-containing HDL-mimetic particle (CER-001) on RCT and the arterial vessel wall in FHA. Subjects received 20 infusions of CER-001 (8 mg/kg) during 6 months. Efficacy was assessed by measuring (apo)lipoproteins, plasma-mediated cellular cholesterol efflux, fecal sterol excretion (FSE), and carotid artery wall dimension by MRI and artery wall inflammation by (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography scans. We included seven FHA patients: HDL-cholesterol (HDL-c), 13.8 [1.8-29.1] mg/dl; apoA-I, 28.7 [7.9-59.1] mg/dl. Following nine infusions in 1 month, apoA-I and HDL-c increased directly after infusion by 27.0 and 16.1 mg/dl (P = 0.018). CER-001 induced a 44% relative increase (P = 0.018) in in vitro cellular cholesterol efflux with a trend toward increased FSE (P = 0.068). After nine infusions of CER-001, carotid mean vessel wall area decreased compared with baseline from 25.0 to 22.8 mm(2) (P = 0.043) and target-to-background ratio from 2.04 to 1.81 (P = 0.046). In FHA-subjects, CER-001 stimulates cholesterol mobilization and reduces artery wall dimension and inflammation, supporting further evaluation of CER-001 in FHA patients.
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Affiliation(s)
- Ruud S Kootte
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands
| | - Loek P Smits
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands
| | - Fleur M van der Valk
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | - Raul D Santos
- Heart Institute (Incor), University of Sao Paolo Medical School Hospital, Sao Paulo, Brazil
| | - Theo H van Dijk
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Geesje M Dallinga-van Thie
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands
| | | | - WillemJ M Mulder
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands
| | - G Kees Hovingh
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands
| | - JohnJ P Kastelein
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands
| | - Albert K Groen
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - ErikS Stroes
- Departments of Vascular Medicine and Experimental Vascular Medicine Academic Medical Center, Amsterdam, The Netherlands.
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Retrospective Case Series of Patients with Diabetes or Prediabetes Who Were Switched from Omega-3-Acid Ethyl Esters to Icosapent Ethyl. Cardiol Ther 2014; 4:83-93. [PMID: 25515964 PMCID: PMC4472650 DOI: 10.1007/s40119-014-0032-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Indexed: 12/25/2022] Open
Abstract
Introduction Patients with diabetes and prediabetes are at increased risk of dyslipidemia and cardiovascular disease. To reduce this risk, statins and additional therapies may be considered. Omega-3 fatty acids offer an option to reduce triglycerides (TG) and potentially improve other lipid parameters, although products that contain docosahexaenoic acid (DHA) may increase low-density lipoprotein cholesterol (LDL-C) while eicosapentaenoic acid (EPA) does not. Prescription formulations include omega-3-acid mixtures (combination of predominantly EPA and DHA), and icosapent ethyl (high-purity prescription form of EPA ethyl ester); prescription omega-3 products are indicated as an adjunct to diet to reduce TGs in adult patients with severe hypertriglyceridemia at a dose of 4 g/day. Methods This was a retrospective analysis of records from a private endocrinology practice of patients who received omega-3-acid ethyl esters (OM3EE) (4 g/day) and were subsequently switched to icosapent ethyl (IPE; 4 g/day) due to the potential of OM3EE to raise LDL-C and/or cause gastrointestinal upset. Patient records were analyzed for LDL-C, TG, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C measured before and after the switch to IPE. Results The records of ten patients met the criteria for this analysis and were included. All patients had taken OM3EE for ≥1 year prior to their last lipid measurement before switching to IPE, and all had been taking IPE for >3 months at the time of their subsequent lipid measurement. Nine of the ten patients were on concomitant statin therapy throughout. Reductions in LDL-C, TC, and non-HDL-C were observed in eight patients, reductions or no changes in TG were observed in eight patients, and increases or no changes in HDL-C were observed in eight patients. No gastrointestinal adverse events were observed. Conclusion In most patients with prediabetes or diabetes who switched from OM3EE to IPE, LDL-C and other lipid parameters improved. IPE was well tolerated.
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Abstract
The recently published HPS2–THRIVE study has shown that the addition of extended release niacin to statin therapy in patients with well-controlled levels of LDL cholesterol does not reduce the risk of cardiovascular events and might even increase harm. Consequently, the use of niacin to increase levels of HDL cholesterol is not recommended.
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Affiliation(s)
- Sony Tuteja
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 11-125 Smilow Centre for Translational Research, 3400 Civic Centre Blvd, Philadelphia, PA 19104, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, 11-125 Smilow Centre for Translational Research, 3400 Civic Centre Blvd, Philadelphia, PA 19104, USA
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Athyros VG, Katsiki N, Karagiannis A, Mikhailidis DP. The 2013 American College of Cardiology/American Heart Association guidelines for the treatment of dyslipidemia: mind the gaps! Curr Med Res Opin 2014; 30:1701-5. [PMID: 24827374 DOI: 10.1185/03007995.2014.924488] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract The ACC/AHA lipid guidelines need to be reconsidered before full implementation. A new cardiovascular disease (CVD) risk estimation, preferably based in interventional multiethnic studies, will be ideal. Specific LDL-C targets may also be necessary because there are data pointing out that they are useful and pragmatic. The risk/benefit ratio should be a key issue because medicine is all about this concept (Hippocrates 460 - c. 370 BC: "first do not harm"; and then in the Hippocratic Oath: "I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous").
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Affiliation(s)
- Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital , Thessaloniki , Greece
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Wang F, Ye P, Hu D, Min Y, Zhao S, Wang Y, Mu Y, Yan X, Li Z, Wei Y, Li J. Lipid-lowering therapy and lipid goal attainment in patients with metabolic syndrome in China: subgroup analysis of the Dyslipidemia International Study-China (DYSIS-China). Atherosclerosis 2014; 237:99-105. [PMID: 25238215 DOI: 10.1016/j.atherosclerosis.2014.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/23/2014] [Accepted: 08/04/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To objectively evaluate lipid-lowering therapy and low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goal attainment in metabolic syndrome (MetS) patients in China. METHODS Data regarding patient demographics, lipid-lowering agents, lipid parameters, and cardiovascular risk profiles were analyzed for 25,317 patients of the Dyslipidemia International Study-China. MetS was defined according to criteria of the NCEP-ATP III and the 2007 Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. RESULTS The prevalence of MetS was 39.9% and 37.4% according to the NCEP-ATP III and 2007 Chinese Guidelines, respectively. LDL-C goal attainment occurred less frequently among MetS patients than in those without MetS (NCEP-ATP III: 46.9% vs 68.6%; 2007 Chinese Guidelines: 52.2% vs 67.1%; p < 0.001). Similar results were obtained for non-HDL-C goal attainment (2007 Chinese Guidelines: 51.0% vs 72.0%; p < 0.001). As the risk class increased, LDL-C and non-HDL-C goal attainment decreased. In multivariate logistic regression analysis, DM, CHD, ischemic cerebrovascular disease, and higher SBP were independently associated with failure to achieve LDL-C and non-HDL-C goal attainment. The type of lipid-lowering agent was not significantly correlated with LDL-C not at goal attainment but was correlated with non-HDL-C not at goal attainment. CONCLUSION Goal attainment for both LDL-C and non-HDL-C occurs less frequently in MetS patients than in those without MetS. The residual risk due to elevated non-HDL-C levels should be considered in MetS patients. Strategies for controlling multiple risk factors in order to decrease the residual risk related to dyslipidemia in MetS patients should be recommended in future guidelines.
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Affiliation(s)
- Fan Wang
- Department of Geriatric Cardiology, Chinese PLA General Hospital, No.28, Fuxing Rd, Haidian District, Beijing 100853, China
| | - Ping Ye
- Department of Geriatric Cardiology, Chinese PLA General Hospital, No.28, Fuxing Rd, Haidian District, Beijing 100853, China.
| | - Dayi Hu
- Department of Cardiology, Peking University People's Hospital, No.11, Xi Zhi Men Nan Da Jie, Xicheng District, Beijing 100044, China
| | - Ying Min
- Department of Geriatric Cardiology, Chinese PLA General Hospital, No.28, Fuxing Rd, Haidian District, Beijing 100853, China
| | - Shuiping Zhao
- Department of Cardiology, Second Xiangya Hospital, Central South University, No.139, People Street (M.), Changsha 410011, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xi Li, Dongcheng District, Beijing 100050, China
| | - Yiming Mu
- Department of Endocrinology, Chinese PLA General Hospital, No.28, Fuxing Rd, Haidian District, Beijing 100853, China
| | - Xiaowei Yan
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1, Shuai Fu Yuan, Dongcheng District, Beijing 100730, China
| | - Zhanquan Li
- Department of Cardiology, The People's Hospital of Liaoning Province, No. 33, Wen Yi Rd., Shenhe District, Shenyang 110016, China
| | - Yidong Wei
- Department of Cardiology, Tenth People's Hospital of Tongji University, No. 301, Yanchang Rd. (M), Shanghai 200072, China
| | - Jihu Li
- MSD China Holding Co., Ltd., No. 1601, Nanjing Rd.(W), JingAn District, Shanghai 20004, China
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129
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High-density lipoproteins in the prevention of cardiovascular disease: changing the paradigm. Clin Pharmacol Ther 2014; 96:48-56. [PMID: 24713591 DOI: 10.1038/clpt.2014.79] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/03/2014] [Indexed: 01/04/2023]
Abstract
High-density-lipoprotein cholesterol (HDL-C) has been identified in population studies as an independent inverse predictor of cardiovascular events. Although the causal nature of this association has been questioned, HDL and its major protein, apolipoprotein (apo)A1, have been shown to prevent and reverse atherosclerosis in animal models. In addition, HDL and apoA1 have several putatively atheroprotective functions, such as the ability to promote efflux of cholesterol from macrophages in the artery wall, inhibit vascular inflammation, and enhance endothelial function. Therefore, HDL-C and apoA1 have been investigated as therapeutic targets for coronary heart disease. However, recent clinical trials with drugs that raise HDL-C, such as niacin and inhibitors of cholesteryl ester transfer protein, have been disappointing. Here, we review the current state of the science regarding HDL as a therapeutic target.
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130
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Hermans MP, Ahn SA, Rousseau MF. Novel unbiased equations to calculate triglyceride-rich lipoprotein cholesterol from routine non-fasting lipids. Cardiovasc Diabetol 2014; 13:56. [PMID: 24612479 PMCID: PMC3975291 DOI: 10.1186/1475-2840-13-56] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/19/2014] [Indexed: 02/03/2023] Open
Abstract
Background Non-fasting triglyceride-rich lipoproteins cholesterol (TRL-C) contributes to cardiovascular risk, in that it includes remnant cholesterol (RC). TRL-C is computed as total C - [LDL-C + HDL-C]. Such calculation applies only if LDL-C is directly measured, or obtained from a non-Friedewald’s formula, a method as yet never benchmarked against independent markers of TRL burden. Methods The Discriminant Ratio (DR) methodology was used in 120 type 2 diabetic patients in order: (i) to compute TRL-C from non-fasting lipids; (ii) to establish the performance of TRL-C and TRL-C/apoA-I (vs. TG-based markers) to grade TRLs and atherogenic dyslipidemia (AD); and (iii) to relate TRL-C with non-fasting TG. Results Depending on apoB100 availability, TRL-C (mg/dL) can be derived from non-fasting lipids in two ways: (a) total cholesterol (TC) - [(0.0106 * TC - 0.0036 * TG + 0.017 * apoB100 - 0.27) * 38.6] - HDL-C; and (b) TC - [(0.0106 * TC - 0.0036 * TG + 0.017 * [0.65 * (TC - HDL-C) + 6.3] - 0.27) * 38.6] - HDL-C. Discrimination between log[TG] and TRL-C was similar (DR 0.94 and 0.84, respectively), whereas that of log[TG]/HDL-C was better than TRL-C/apoA-I (DR 1.01 vs. 0.65; p 0.0482). All Pearson’s correlations between pairs reached unity, allowing formulation of two unbiased equivalence equations: (a) TRL-C = 97.8 * log[TG] - 181.9; and (b) TRL-C/apoA-I = 8.15 * (log[TG]/HDL-C) - 0.18. Conclusions TRL-C and log[TG] are as effective and interchangeable for assessing remnant atherogenic particles. For grading TRL-AD, it is best to use log[TG]/HDL-C, inherently superior to TRL-C/apoA-I, while measuring the same underlying variable.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
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To Market, To Market—2013. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 2014. [DOI: 10.1016/b978-0-12-800167-7.00027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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