1
|
Charach L, Charach G, Karniel E, Galin L, Bar Ziv D, Grossman L, Kaye I, Grosskopf I. Peripheral Vascular Disease and Carotid Artery Disease Are Associated with Decreased Bile Acid Excretion. Bioengineering (Basel) 2023; 10:935. [PMID: 37627820 PMCID: PMC10451290 DOI: 10.3390/bioengineering10080935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
Low bile acid excretion (BAE) is associated with a higher risk of coronary artery disease (CAD) and cerebrovascular disease (stroke). This study investigated BAE in patients with peripheral vascular disease (PVD) and carotid artery disease (CA) and those without these diseases, compared to patients with CAD, stroke, or no evidence of atherosclerosis. Patients with complaints of chest pain-suspected CAD, syncope, stroke/TIA, severe headache, intermittent claudication, or falls were enrolled. All received a 4-day standard diet with 490 mg of cholesterol and internal standard copper thiocyanate. Fecal BAE was measured using gas-liquid chromatography. One hundred and three patients, sixty-eight (66%) men and thirty-five women (34%), mean age range 60.9 ± 8.9 years, were enrolled in this prospective, 22-year follow-up study. Regression analysis showed that advanced age, total BAE, and excretion of the main fractions were the only significant independent factors that predicted prolonged survival (p < 0.001). Twenty-two years' follow-up revealed only 15% of those with BAE <262.4 mg/24 h survived, compared to >60% of participants without atherosclerosis and a mean BAE of 676 mg/24 h. BAE was lower in patients with polyvascular atherosclerosis than in those with involvement of 1-3 vascular beds. Pearson correlations were found between total BAE and various fractions of BA, as well as HDL cholesterol. BAE and short-term survival were decreased among patients with PVD compared to those with CAD or stroke. Low BAE should be considered a valuable and independent risk factor for PVD.
Collapse
Affiliation(s)
- Lior Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Gideon Charach
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Eli Karniel
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Leonid Galin
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Dorin Bar Ziv
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Lior Grossman
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Irit Kaye
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| | - Itamar Grosskopf
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba 4428164, Israel; (L.C.); (E.K.); (L.G.); (D.B.Z.); (L.G.); (I.K.); (I.G.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6139001, Israel
| |
Collapse
|
2
|
Charach G, Karniel E, Novikov I, Galin L, Vons S, Grosskopf I, Charach L. Reduced bile acid excretion is an independent risk factor for stroke and mortality: A prospective follow-up study. Atherosclerosis 2020; 293:79-85. [DOI: 10.1016/j.atherosclerosis.2019.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
|
3
|
Charach G, Argov O, Geiger K, Charach L, Rogowski O, Grosskopf I. Diminished bile acids excretion is a risk factor for coronary artery disease: 20-year follow up and long-term outcome. Therap Adv Gastroenterol 2017; 11:1756283X17743420. [PMID: 29383025 PMCID: PMC5784550 DOI: 10.1177/1756283x17743420] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patients with coronary artery disease (CAD) had significantly lower bile acid excretion (BAE) compared with non-CAD patients, leading to the hypothesis that the inability to efficiently excrete bile acids leads to coronary atherosclerosis development. We investigated the long-term role of BAE in CAD development and related mortality in 50 patients with proven CAD compared with that of 50 patients with chest pain and no CAD (controls) matched for clinical and laboratory characteristics. METHODS All subjects received a 4-day standard diet that included ~500 mg of cholesterol. Fecal bile acids from 24-h stool collections were measured by gas liquid chromatography. RESULTS CAD patients excreted lower amounts of total bile acids than controls (p < 0.001), less deoxycholic acid (p < 0.0001) and less lithocholic acid (p < 0.01). BAE was the best significant independent laboratory factor that predicted CAD (p < 0.05). Mortality and CAD development rates were significantly lower for the controls at the 20-year follow up. CONCLUSIONS These results showed that CAD patients had markedly decreased BAE levels compared with non-CAD controls. BAE <415 mg/day was associated with increased CAD long-term mortality. Impaired ability to excrete cholesterol might be considered an additional independent risk factor for CAD development.
Collapse
Affiliation(s)
- Gideon Charach
- Department of Internal Medicine ‘C’, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Sackler Medical School, 6 Weizman Street, Tel Aviv 6423906, Israel
| | - Ori Argov
- Department of Internal Medicine ‘C’, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Sackler Medical School, Israel
| | - Karyn Geiger
- Department of Internal Medicine ‘C’, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Sackler Medical School, Israel
| | - Lior Charach
- Department of Internal Medicine ‘C’, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Sackler Medical School, Israel
| | - Ori Rogowski
- Department of Internal Medicine ‘C’, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Sackler Medical School, Israel
| | - Itamar Grosskopf
- Department of Internal Medicine ‘C’, Tel Aviv Sourasky Medical Center, Affiliated to Tel Aviv University, Sackler Medical School, Israel
| |
Collapse
|
4
|
Charach G, Grosskopf I, Rabinovich A, Shochat M, Weintraub M, Rabinovich P. The association of bile acid excretion and atherosclerotic coronary artery disease. Therap Adv Gastroenterol 2011; 4:95-101. [PMID: 21694811 PMCID: PMC3105622 DOI: 10.1177/1756283x10388682] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Excess cholesterol is usually eliminated from the body by conversion to bile acids excreted in feces as bile salts. The excretion of large amounts of bile protects against atherosclerosis, while diminished excretion may lead to coronary artery disease (CAD). OBJECTIVE To investigate a relationship between CAD and bile acid excretion. METHODS Bile acid excretion was compared between 36 patients with proven CAD and 37 CAD-free individuals (controls). The groups were comparable for demographics and selected risk factors. All subjects received a 4-day standard diet that included ∼500 mg of cholesterol. Fecal bile acids from 24-hour stool collections were measured by gas liquid chromatography. RESULTS CAD patients excreted lower amounts of total bile acids (358 ± 156 mg) than controls (617 ± 293 mg; p < 0.01) and less deoxycholic acid (188.29 ± 98.12 mg versus 325.96 ± 198.57 mg; p < 0.0001) and less lithocholic acid (115.43 ± 71.89 mg versus 197.27 ± 126.87 mg; p < 0.01). Advanced age, male gender, left ventricular ejection fraction and total bile acid levels were significant independent factors that predicted CAD (p < 0.05). Mortality, CAD and cerebrovascular accident development rates were significantly lower for the controls at the 13-year follow up. CONCLUSION CAD patients have significantly decreased bile acid excretion levels than non-CAD patients. An impaired ability to excrete cholesterol may be an additional risk factor for CAD development.
Collapse
|
5
|
Junge W. Assessment of titrimetric and photometric methods for the determination of chymotrypsin catalytic activity in stool. Clin Biochem 1986; 19:323-8. [PMID: 3581464 DOI: 10.1016/s0009-9120(86)80003-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In this report a method for the spectrophotometric measurement of stool chymotrypsin (CT) is presented and compared to the more commonly used titrimetric method. Homogenisation of specimen and dissolution of CT is examined in detail. The advantages of the photometric method lie in the small size of sample required, and its easy adaptation to manual or automated analysis with a CT-specific amide substrate.
Collapse
|