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Liu R, Xu T, Gan L, Chang C, Peng Y, Yao W, Zhai A, Fang M, Shang X, Chang S, Guo J, Zhang J. Influence of remnant cholesterol levels on carotid intima thickness in type 2 diabetes patients. Sci Rep 2024; 14:20893. [PMID: 39245669 PMCID: PMC11381536 DOI: 10.1038/s41598-024-71780-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024] Open
Abstract
Investigate the impact of remnant cholesterol (RC) levels on carotid artery intima thickness (CIT) in type 2 diabetes mellitus (T2DM) patients. From September 2021 to September 2023, a prospective multicenter study involved 158 T2DM patients. They were divided into a higher RC group (n = 80) and a lower RC group (n = 78) based on median RC levels. Additionally, 92 healthy volunteers served as the control group. CIT, carotid media thickness (CMT), and carotid intima-media thickness (CIMT) were measured. General clinical data, lab results, CIMT, CIT, and CMT differences among the three groups were compared. Multiple regression analysis explored CIT factors in T2DM patients. 1. No significant sex, age, BMI, high-density lipoprotein cholesterol (HDL-C), T2DM duration, fasting blood glucose, or glycated hemoglobin differences were found among the groups (p > 0.05). 2. CIMT and CIT were significantly higher in T2DM than the control group (p < 0.05). 3. The higher RC group had thicker CIT than the lower RC group (p < 0.05), while CIMT differences were not significant (p > 0.05). Multiple linear regression analysis showed RC as an influencing CIT factor in T2DM patients (β = 0.473, p = 0.005). CIT is significantly thicker in T2DM patients with higher RC than in those with lower RC, and RC is the influence factor of CIT, which suggests that more attention should be paid to the detection of RC in T2DM patients.
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Affiliation(s)
- Rong Liu
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Tao Xu
- Department of Ultrasound, The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Wuxi, 214200, Jiangsu, China
| | - Ling Gan
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Caihong Chang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Yao Peng
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China
| | - Wenlin Yao
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Aihua Zhai
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Ming Fang
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Xinan Shang
- Department of Ultrasound, Xiangzhou District People's Hospital of Xiangyang, Xiangyang, 441199, Hubei, China
| | - Shuai Chang
- Depatment of Ultrasound, First Affiliated Hospital of University of South China, Hengyang, 421001, Hunan, China
| | - Jianfeng Guo
- Department of Ultrasound, The Affiliated Yixing Hospital of Jiangsu University, 75 Tongzhenguan Road, Wuxi, 214200, Jiangsu, China.
| | - Jiaqi Zhang
- Department of Ultrasound, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, No 15, Jiefang Avenue, Xiangyang, 441000, Hubei, China.
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Feng X, Liu Y, Yang J, Zhou Z, Yang S, Zhou Y, Guo Q. The prognostic role of remnant cholesterol in Asian menopausal women received percutaneous coronary intervention with acute coronary syndrome. Lipids Health Dis 2024; 23:276. [PMID: 39215317 PMCID: PMC11363399 DOI: 10.1186/s12944-024-02258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Remnant cholesterol (RC) exert a significant influence on atherosclerotic cardiovascular disease development. However, the prognostic implications of RC in menopausal women received percutaneous coronary intervention (PCI) who experiencing acute coronary syndrome (ACS) remain uncertain. METHODS RC was derived by subtracting the sum of high-density lipoprotein cholesterol and low-density lipoprotein cholesterol from the total cholesterol. Kaplan-Meier survival and Cox regression analysis were employed for assessing the correlation between continuous RC levels and composite and individual adverse events in Q1-Q4 quartiles. Receiver operator characteristic (ROC) curves, derived from Cox regression, were employed for analyzing the relationship between RC and both composite and individual adverse events. RESULTS 1505 consecutive menopausal women who underwent PCI and diagnosed with ACS were included. Kaplan-Meier survival analysis demonstrated a progressive reduction in composite adverse event survival rates across the four groups, observed in both the general population and among diabetic individuals, as RC values increased (Log-rank P < 0.001). The analysis of multivariate Cox regression indicated RC remained independently associated with both composite and individual adverse events. ROC analysis showed that RC enhanced the area under the curve both in total and diabetic populations for composite adverse events. CONCLUSION Among menopausal women diagnosed with ACS who underwent PCI, heightened levels of RC were found to be independently correlated with an increased occurrence of adverse events.
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Affiliation(s)
- Xunxun Feng
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
- Department of Medicine, Division of Cardiology, University of California, Los Angeles, CA, USA
| | - Yang Liu
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Jiaqi Yang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Zhiming Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Shiwei Yang
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China.
| | - Qianyun Guo
- Department of Cardiology, Beijing Anzhen Hospital, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China.
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Piťhová P, Cichrová M, Kvapil M, Hubáček JA, Dlouhá D, Piťha J. Determinants of vascular impairment in type 1 diabetes-impact of sex and connexin 37 gene polymorphism: A cross-sectional study. Cardiovasc Diabetol 2024; 23:309. [PMID: 39175027 PMCID: PMC11342627 DOI: 10.1186/s12933-024-02401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The associations of risk factors with vascular impairment in type 1 diabetes patients seem more complex than that in type 2 diabetes patients. Therefore, we analyzed the associations between traditional and novel cardiovascular risk factors and vascular parameters in individuals with T1D and modifications of these associations according to sex and genetic factors. METHODS In a cross-sectional study, we analyzed the association of risk factors in T1D individuals younger than 65 years using vascular parameters, such as ankle brachial index (ABI) and toe brachial index (TBI), duplex ultrasound, measuring the presence of plaques in carotid and femoral arteries (Belcaro score) and intima media thickness of carotid arteries (CIMT). We also used photoplethysmography, which measured the interbranch index expressed as the Oliva-Roztocil index (ORI), and analyzed renal parameters, such as urine albumin/creatinine ratio (uACR) and glomerular filtration rate (GFR). We evaluated these associations using multivariate regression analysis, including interactions with sex and the gene for connexin 37 (Cx37) polymorphism (rs1764391). RESULTS In 235 men and 227 women (mean age 43.6 ± 13.6 years; mean duration of diabetes 22.1 ± 11.3 years), pulse pressure was strongly associated with unfavorable values of most of the vascular parameters under study (ABI, TBI, Belcaro scores, uACR and ORI), whereas plasma lipids, represented by remnant cholesterol (cholesterol - LDL-HDL cholesterol), the atherogenic index of plasma (log (triglycerides/HDL cholesterol) and Lp(a), were associated primarily with renal impairment (uACR, GFR and lipoprotein (a)). Plasma non-HDL cholesterol was not associated with any vascular parameter under study. In contrast to pulse pressure, the associations of lipid factors with kidney and vascular parameters were modified by sex and the Cx37 gene. CONCLUSION In addition to known information, easily obtainable risk factor, such as pulse pressure, should be considered in individuals with T1D irrespective of sex and genetic background. The associations of plasma lipids with kidney function are complex and associated with sex and genetic factors. The decision of whether pulse pressure, remnant lipoproteins, Lp(a) and other determinants of vascular damage should become treatment targets in T1D should be based on the results of future clinical trials.
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Affiliation(s)
- Pavlína Piťhová
- Department of Geriatric Internal Medicine, 2nd Medical Faculty Motol, Prague, Czech Republic
| | - Michaela Cichrová
- Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
| | - Milan Kvapil
- Department of Geriatric Internal Medicine, 2nd Medical Faculty Motol, Prague, Czech Republic
| | - Jaroslav A Hubáček
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dana Dlouhá
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Piťha
- Centre for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Hansen MK, Mortensen MB, Olesen KKW, Thrane PG, Thomsen RW, Maeng M. Non-HDL cholesterol and residual cardiovascular risk in statin-treated patients with and without diabetes: the Western Denmark Heart Registry. Eur J Prev Cardiol 2024; 31:1238-1248. [PMID: 38513361 DOI: 10.1093/eurjpc/zwae119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 03/23/2024]
Abstract
AIMS Assessment of residual cardiovascular risk in statin-treated patients with atherosclerotic cardiovascular disease (ASCVD) is pivotal for optimizing secondary preventive therapies. This study investigates if non-high-density lipoprotein cholesterol (non-HDL-C) is associated with residual ASCVD risk in statin-treated ischaemic heart disease (IHD) patients with and without diabetes. METHODS AND RESULTS Using the Western Denmark Heart Registry, we identified statin-treated patients with IHD examined by coronary angiography (CAG) from 2011 to 2020. Non-HDL-C was assessed within 1 year after CAG. Outcomes were ASCVD (myocardial infarction, ischaemic stroke, and cardiovascular death) and all-cause death. Cox regression analyses obtained hazard ratios (HRs) adjusted for age, sex, smoking, and hypertension. A total of 42 057 patients were included: 8196 patients with diabetes and 33 861 without diabetes. During the median 4.6 years of follow-up, event rates per 1000 person-years of ASCVD were 28.8 (27.1-30.5) and 17.2 (16.5-17.8) among patients with and without diabetes. In patients with diabetes, the adjusted HRs of ASCVD as compared with non-HDL-C < 25th percentile were 1.0 (0.9-1.2), 1.3 (1.1-1.6), and 1.6 (1.2-2.1) for patients in the 25th-74th, 75th-94th, and ≥95th percentiles. In patients without diabetes, the corresponding adjusted HRs were 1.1 (0.9-1.1), 1.2 (1.1-1.4), and 1.7 (1.4-2.0). Results were consistent across sex, age, clinical presentation, and low-density lipoprotein cholesterol strata. CONCLUSION In statin-treated IHD patients with and without diabetes, non-HDL-C, especially above the 75th percentile, is associated with residual cardiovascular risk. These results have implications for secondary prevention, targeting patients who may benefit most from intensified preventive therapy.
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Affiliation(s)
- Malene Kærslund Hansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, 8200 Aarhus, Denmark
- John Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, John Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Pernille Gro Thrane
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, 8200 Aarhus, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Dai Y, Sheng Y, Zheng Z, Di W. Cumulative remnant cholesterol exposure during young adulthood and middle age and risk of cardiovascular events: A 30-year population-based cohort study. Int J Cardiol 2024; 414:132435. [PMID: 39121920 DOI: 10.1016/j.ijcard.2024.132435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/22/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Remnant cholesterol (RC) is recognized as a residual risk factor for cardiovascular diseases (CVD). Most studies on the association between RC and CVD have focused on RC level at a single time point, typically during middle or older age. Limited data have characterized long-term RC exposures among young adult. Here we aimed to investigate the association of cumulative RC exposure during young adulthood and middle age with incident CVD later in life. METHODS This cohort study enrolled 3416 CARDIA (Coronary Artery Risk Development in Young Adults) participants aged 18-30 years. Cumulative RC exposure was determined as cumulative RC and time-weighted average (TWA) RC during young adulthood and middle age. Multivariable Cox proportional hazards models were employed to examine the association between cumulative RC exposure and incident CVD. RESULTS Of the 3416 included participants, 193 (5.6%) primary CVD outcomes occurred with a median 30.4-year follow-up. In multivariable Cox proportional hazards regression models that adjusted for LDL-C level, the most recent RC level and other CVD risk factors, the hazard ratios for primary CVD ourtcomes were as follows: 2.01 (95% CI, 1.23-3.27; P for trend = 0.021) for cumulative RC, and 2.11 (95% CI, 1.28-3.47; P for trend = 0.011) for TWA RC. Similar results were observed in other secondary outcomes. CONCLUSIONS Greater exposures to cumulative RC and TWA RC during young adulthood and middle age were independently associated with an increased risk of cardiovascular events, suggesting that maintaining low RC levels early in life may reduce the lifetime CVD risk.
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Affiliation(s)
- Yongbin Dai
- Department of Cardiology, Shenzhen Third People's Hospital, Shenzhen 518000, China
| | - Yanhua Sheng
- Department of Cardiology, Shenzhen Third People's Hospital, Shenzhen 518000, China
| | - Zhenzhong Zheng
- Department of Cardiology, Shenzhen Third People's Hospital, Shenzhen 518000, China.
| | - Wencheng Di
- Department of Cardiology, Shenzhen Third People's Hospital, Shenzhen 518000, China.
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Guardiola M, Rehues P, Amigó N, Arrieta F, Botana M, Gimeno-Orna JA, Girona J, Martínez-Montoro JI, Ortega E, Pérez-Pérez A, Sánchez-Margalet V, Pedro-Botet J, Ribalta J. Increasing the complexity of lipoprotein characterization for cardiovascular risk in type 2 diabetes. Eur J Clin Invest 2024; 54:e14214. [PMID: 38613414 DOI: 10.1111/eci.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/15/2024]
Abstract
The burden of cardiovascular disease is particularly high among individuals with diabetes, even when LDL cholesterol is normal or within the therapeutic target. Despite this, cholesterol accumulates in their arteries, in part, due to persistent atherogenic dyslipidaemia characterized by elevated triglycerides, remnant cholesterol, smaller LDL particles and reduced HDL cholesterol. The causal link between dyslipidaemia and atherosclerosis in T2DM is complex, and our contention is that a deeper understanding of lipoprotein composition and functionality, the vehicle that delivers cholesterol to the artery, will provide insight for improving our understanding of the hidden cardiovascular risk of diabetes. This narrative review covers three levels of complexity in lipoprotein characterization: 1-the information provided by routine clinical biochemistry, 2-advanced nuclear magnetic resonance (NMR)-based lipoprotein profiling and 3-the identification of minor components or physical properties of lipoproteins that can help explain arterial accumulation in individuals with normal LDLc levels, which is typically the case in individuals with T2DM. This document highlights the importance of incorporating these three layers of lipoprotein-related information into population-based studies on ASCVD in T2DM. Such an attempt should inevitably run in parallel with biotechnological solutions that allow large-scale determination of these sets of methodologically diverse parameters.
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Affiliation(s)
- Montse Guardiola
- Departament de Medicina i Cirurgia, Unitat de Recerca en Lípids i Arteriosclerosi (URLA), Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Pere Rehues
- Departament de Medicina i Cirurgia, Unitat de Recerca en Lípids i Arteriosclerosi (URLA), Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Núria Amigó
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament de Ciències Mèdiques Bàsiques, Universitat Rovira i Virgili, Reus, Spain
- Biosfer Teslab, Reus, Spain
| | | | - Manuel Botana
- Departamento de Endocrinología y Nutrición, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - José A Gimeno-Orna
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Josefa Girona
- Departament de Medicina i Cirurgia, Unitat de Recerca en Lípids i Arteriosclerosi (URLA), Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - José Ignacio Martínez-Montoro
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, Málaga, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Pérez-Pérez
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Josep Ribalta
- Departament de Medicina i Cirurgia, Unitat de Recerca en Lípids i Arteriosclerosi (URLA), Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Gu X, Wang X, Wang S, Shen Y, Lu L. Nonlinear association between visceral adipose tissue area and remnant cholesterol in US adults: a cross-sectional study. Lipids Health Dis 2024; 23:228. [PMID: 39054500 PMCID: PMC11270912 DOI: 10.1186/s12944-024-02211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Excessive visceral adipose tissue (VAT) is associated with a spectrum of diseases, including diabetes, cancer, and cardiovascular diseases. Remnant cholesterol (RC), denoting cholesterol within triglyceride-rich lipoproteins and their metabolic byproducts, has been identified as a key contributor to cardiovascular diseases and related mortality. However, the association between the VAT and RC remains unclear. In this study, the objective is to provide new evidence regarding the association between VAT and RC concentrations. METHODS 4727 individuals aged 18-59 were selected from the National Health and Nutrition Examination Survey conducted between 2011 and 2018 as study participants. This study utilized several weighted linear regression models and a restricted cubic spline (RCS) to explore the association and potential nonlinearities between VAT and RC. Subgroup analyses were performed to determine the consistency of findings. RESULTS The mean VAT value was 103.82 ± 1.42 cm2, and the median RC value was 18 mg/dl. VAT demonstrated a positive association with RC in a fully adjusted model, with a β and 95% confidence interval (CI) of 0.09 (0.08, 0.11) after adjustment for potential confounders. Analysis using RCS revealed a nonlinear association between the VAT area and RC (P < 0.001 for nonlinearity). Adjusted two-piecewise regression models demonstrated β coefficients of 0.13 (95%CI: 0.11 ~ 0.16, P < 0.001) for RC in individuals with VAT < 143 cm2, and 0.02 (95%CI: -0.01 ~ 0.06, P = 0.15) for those with VAT ≥ 143 cm2. Interactions were observed among the body mass index (BMI) subgroup; the β coefficients for RC were 0.14 (95%CI: 0.12 ~ 0.16) in those with BMI < 30 kg/m2 and 0.05 (95%CI:0.04 ~ 0.07) in those with BMI ≥ 30 kg/m2, with a P-value of < 0.001 for interaction. CONCLUSIONS This study identified a nonlinear association between VAT and RC in American adults. Reducing the VAT area may be beneficial in lowering RC concentration, particularly when VAT is < 143 cm2 and those with a BMI < 30 kg/m2.
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Affiliation(s)
- Xi Gu
- Department of Endocrinology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, No.149 Chongqing South Road, Shanghai, China
| | - Xun Wang
- Department of Endocrinology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, No.149 Chongqing South Road, Shanghai, China
| | - Sujie Wang
- Department of Endocrinology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, No.149 Chongqing South Road, Shanghai, China
| | - Ying Shen
- Department of Endocrinology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, No.149 Chongqing South Road, Shanghai, China.
| | - Leiqun Lu
- Department of Endocrinology, RuiJin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, No.149 Chongqing South Road, Shanghai, China.
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Wang J, Kockx M, Bolek M, Lambert T, Sullivan D, Chow V, Kritharides L. Triglyceride-rich lipoprotein, remnant cholesterol, and apolipoproteins CII, CIII, and E in patients with schizophrenia. J Lipid Res 2024; 65:100577. [PMID: 38879166 PMCID: PMC11304881 DOI: 10.1016/j.jlr.2024.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/02/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Patients with schizophrenia show a disproportionally increased risk of cardiovascular disease. Hypertriglyceridemia is prevalent in this population; however, how this relates to levels of remnant cholesterol, triglyceride (TG)-rich lipoprotein (TRL) particle size and composition, TG turnover, and apolipoprotein (apo) and angiopoietin-like protein (ANGPTL) concentrations is unknown. Fasting levels of cholesterol (total [TC], LDL-C, HDL-C, non-HDL-C and remnant cholesterol) and TG were determined in 110 patients diagnosed with schizophrenia, and 46 healthy controls. TRL particle size, concentration and composition, and β-hydroxybutyrate (TG turnover marker) were assessed by NMR. Levels of apoCII, apoCIII, apoE, ANGPTL3, ANGPTL4, and ANGPTL8 were measured by ELISA, and apoCII, apoCIII and apoE were further evaluated in HDL and non-HDL fractions. Patients with schizophrenia had significantly elevated TG, TG:apoB ratio, non-HDL-C, remnant cholesterol, non-HDL-apoCII and non-HDL-apoCIII, and HDL-apoE (all P < 0.05), lower HDL-C and apoA-I (all P < 0.001), and comparable apoB, TC, TC:apoB ratio, LDL-C, β-hydroxybutyrate, ANGPTL3, ANGPTL4 and ANGPTL8 to healthy controls. Patients had a 12.0- and 2.5-fold increase in the concentration of large and medium TRL particles respectively, but similar cholesterol:TG ratio within each particle. Plasma TG, remnant cholesterol, and large and medium TRL particle concentrations correlated strongly with apoCII, apoCIII, and apoE in the non-HDL fraction, and with apoCIII and apoE in the HDL fraction in patients with schizophrenia. Differences in TG, HDL-C, TRL particle concentrations, apoCIII, and apoE persisted after adjustment for conventional risk factors. These results are consistent with impaired TRL lipolysis and clearance in patients with schizophrenia which may be responsive to targeting apoCIII.
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Affiliation(s)
- Jeffrey Wang
- Atherosclerosis Laboratory, ANZAC Research Institute, Concord Repatriation General Hospital and the University of Sydney, Sydney, Australia
| | - Maaike Kockx
- Atherosclerosis Laboratory, ANZAC Research Institute, Concord Repatriation General Hospital and the University of Sydney, Sydney, Australia
| | - Magdalena Bolek
- Atherosclerosis Laboratory, ANZAC Research Institute, Concord Repatriation General Hospital and the University of Sydney, Sydney, Australia
| | - Tim Lambert
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Collaborative Centre for Cardiometabolic Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - David Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Central Clinical Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Vincent Chow
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Collaborative Centre for Cardiometabolic Health, Charles Perkins Centre, University of Sydney, Sydney, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Leonard Kritharides
- Atherosclerosis Laboratory, ANZAC Research Institute, Concord Repatriation General Hospital and the University of Sydney, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia.
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9
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Luciani L, Pedrelli M, Parini P. Modification of lipoprotein metabolism and function driving atherogenesis in diabetes. Atherosclerosis 2024; 394:117545. [PMID: 38688749 DOI: 10.1016/j.atherosclerosis.2024.117545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/18/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease, characterized by raised blood glucose levels and impaired lipid metabolism resulting from insulin resistance and relative insulin deficiency. In diabetes, the peculiar plasma lipoprotein phenotype, consisting in higher levels of apolipoprotein B-containing lipoproteins, hypertriglyceridemia, low levels of HDL cholesterol, elevated number of small, dense LDL, and increased non-HDL cholesterol, results from an increased synthesis and impaired clearance of triglyceride rich lipoproteins. This condition accelerates the development of the atherosclerotic cardiovascular disease (ASCVD), the most common cause of death in T2DM patients. Here, we review the alteration of structure, functions, and distribution of circulating lipoproteins and the pathophysiological mechanisms that induce these modifications in T2DM. The review analyzes the influence of diabetes-associated metabolic imbalances throughout the entire process of the atherosclerotic plaque formation, from lipoprotein synthesis to potential plaque destabilization. Addressing the different pathophysiological mechanisms, we suggest improved approaches for assessing the risk of adverse cardiovascular events and clinical strategies to reduce cardiovascular risk in T2DM and cardiometabolic diseases.
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Affiliation(s)
- Lorenzo Luciani
- Cardio Metabolic Unit, Department of Laboratory Medicine, and Department of Medicine at Huddinge, Karolinska Institutet, Stockholm, Sweden; Interdisciplinary Center for Health Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Matteo Pedrelli
- Cardio Metabolic Unit, Department of Laboratory Medicine, and Department of Medicine at Huddinge, Karolinska Institutet, Stockholm, Sweden; Medicine Unit of Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Paolo Parini
- Cardio Metabolic Unit, Department of Laboratory Medicine, and Department of Medicine at Huddinge, Karolinska Institutet, Stockholm, Sweden; Medicine Unit of Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.
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10
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Proctor SD, Wang M, Vine DF, Raggi P. Predictive utility of remnant cholesterol in atherosclerotic cardiovascular disease. Curr Opin Cardiol 2024; 39:300-307. [PMID: 38456429 DOI: 10.1097/hco.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE OF REVIEW Remnant cholesterol (RC) is the cholesterol carried in lipoproteins derived from the catabolism of chylomicrons and very low-density lipoproteins. Evidence supporting the causal relationship of RC with atherosclerotic cardiovascular disease (ASVD) is accumulating rapidly. The number of impactful contributions to this field are increasing and provide a pathophysiological insight into the current residual cardiovascular risk beyond low-density cholesterol (LDL)-cholesterol (LDL-C). They also raise the question of whether RC should be used in prediction models and become the target of new therapeutic interventions. The intent of this review is to highlight the recent advances on the role of RC in atherogenesis and the validation of RC as a predictor of ASVD. RECENT FINDINGS Numerous prospective and retrospective cohorts helped validate a significant causal relationship of RC with various forms of ASVD, independent of LDL-C. A recent large Mendelian randomization study reinforced the existence of this relationship and showed that the risk of atherosclerotic events was driven nearly entirely by a direct effect of RC. SUMMARY Both available and accumulating evidence suggest that a lifelong reduction in RC could translate into a substantial reduction in ASVD risk. The data support a revision of current guidelines to incorporate RC as an independent risk factor for ASVD. We propose that early screening of RC should be implemented and that RC lowering should become the target of future drug developments.
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Affiliation(s)
- Spencer D Proctor
- Metabolic and Cardiovascular Diseases Laboratory, Division of Nutrition, University of Alberta
| | - Maggie Wang
- Metabolic and Cardiovascular Diseases Laboratory, Division of Nutrition, University of Alberta
| | - Donna F Vine
- Metabolic and Cardiovascular Diseases Laboratory, Division of Nutrition, University of Alberta
| | - Paolo Raggi
- Division of Cardiology and Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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11
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Lin H, Xu J, Teng C. Correlation between remnant cholesterol and hyperuricemia in patients with type 2 diabetes mellitus: a cross-sectional study. Lipids Health Dis 2024; 23:155. [PMID: 38796430 PMCID: PMC11128103 DOI: 10.1186/s12944-024-02148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/15/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Remnant cholesterol (RC) has been known as an important factor for the assessment of the metabolic syndrome (Mets) risk. However, the correlation between RC and hyperuricemia (HUA) in type 2 diabetes mellitus (T2DM) remains unclear. This study aims to explore the correlation between RC and HUA in patients with T2DM. METHODS A total of 2956 patients with T2DM admitted to the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from 2020 to 2022 were included. The correlation between RC and HUA was evaluated with Spearman's correlation, multiple logistic regression, subgroup analyses, receiver operating characteristic (ROC) curves analyses and generalized smooth curve fitting. Total cholesterol (TC) < 5.18mmol/L was defined as normal TC. RESULTS RC was correlated with uric acid in patients with T2DM (Spearman's correlation coefficient = 0.279, P < 0.001). According to the multiple logistic regression analyses, there was an independent positive correlation between RC and HUA (OR = 1.63, 95%CI = 1.40, 1.90). In addition, a non-linear correlation between RC and HUA was identified. The area under the ROC curve (AUC) of RC (0.658, 95%CI = 0.635, 0.681) was the largest compared with those of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and TC. Subgroup analyses showed a more significant positive correlation among females or normal TC groups. CONCLUSION Elevated RC is correlated with HUA in patients with T2DM significantly and positively. RC is better in its predictability for HUA than that of conventional lipid indexes.
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Affiliation(s)
- Hainiao Lin
- Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jing Xu
- Department of Endocrine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenhuai Teng
- Department of Emergency Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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12
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Cruz-Bautista I, Escamilla-Núñez C, Flores-Jurado Y, Rojas-Martínez R, Elías López D, Muñoz-Hernández L, Mehta R, Almeda-Valdes P, Del Razo-Olvera FM, Aguilar-Salinas CA, Soto-Mota A. Distribution of triglyceride-rich lipoproteins and their remnants and their contribution to cardiovascular risk in the Mexican population. J Clin Lipidol 2024:S1933-2874(24)00185-5. [PMID: 38942690 DOI: 10.1016/j.jacl.2024.05.002] [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: 04/22/2024] [Accepted: 05/12/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND AIMS In recent years, scientific interest in triglyceride-rich lipoproteins (TRL) and remnant cholesterol has increased, focusing on the evidence that these lipoproteins are a causal factor for developing atherosclerotic cardiovascular disease (ASCVD). Furthermore, a high remnant concentration (>38 mg/dL) has been associated with several non-cardiovascular risks. We aimed in this study to describe the percentile distribution of remnant cholesterol. Additionally, we evaluated the association between remnant cholesterol plasma concentration and epidemiologically relevant cardio-metabolic outcomes such as hypertension, type 2 diabetes (T2D), and ASCVD. METHODS We analyzed data from 9,591 adults from the National Survey of Health and Nutrition (ENSANUT) 2018 with fasting blood samples and complete medical history questionnaires. We built multivariate models to evaluate the association between chronic diseases and blood remnant concentration. To compare our 2018-sub-sample against a population reference, we used the NHANES (2005-2014) publicly available datasets by ethnicity. RESULTS Remnants were independently associated with cardiovascular risk, diabetes, hypertension, obesity, and metabolic syndrome. For all outcomes, the blood remnant concentration was a stronger predictor than LDL. At all deciles, the blood remnant concentration was higher in ENSANUT-2018. CONCLUSIONS A remnant blood concentration above 38 mg/dL was highly prevalent among Mexicans. Remnants were significantly associated with a higher risk of diabetes, hypertension, obesity, and cardiovascular risk. This association occurred independently of other lipid markers.
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Affiliation(s)
- I Cruz-Bautista
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota); Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Mehta, Almeda-Valdes)
| | - C Escamilla-Núñez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico (Drs Escamilla -Núñez, Rojas-Martínez)
| | - Y Flores-Jurado
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota)
| | - R Rojas-Martínez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico (Drs Escamilla -Núñez, Rojas-Martínez)
| | - D Elías López
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota)
| | - L Muñoz-Hernández
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota)
| | - R Mehta
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota); Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Mehta, Almeda-Valdes)
| | - P Almeda-Valdes
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota); Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Mehta, Almeda-Valdes)
| | - F M Del Razo-Olvera
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota)
| | - C A Aguilar-Salinas
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota); Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, México City, Mexico (Drs Aguilar-Salinas, Soto-Mota)
| | - A Soto-Mota
- Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico (Drs Cruz-Bautista, Flores Yuscely, Elías López, Muñoz-Hernández, Mehta, Almeda-Valdes, Del Razo-Olvera, Aguilar-Salinas, Soto-Mota); Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, México City, Mexico (Drs Aguilar-Salinas, Soto-Mota).
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13
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Li L, Wang C, Ye Z, Van Spall HGC, Zhang J, Lip GYH, Li G. Association Between Remnant Cholesterol and Risk of Incident Atrial Fibrillation: Population-Based Evidence From a Large-Scale Prospective Cohort Study. J Am Heart Assoc 2024; 13:e033840. [PMID: 38761084 PMCID: PMC11179806 DOI: 10.1161/jaha.123.033840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Evidence for the relationship between remnant cholesterol (RC) and incident atrial fibrillation (AF) risk remains sparse and limited. METHODS AND RESULTS Participants were enrolled between 2006 and 2010 and followed up to 2021. The multivariable Cox proportional hazards model was used to examine the relationship between RC quartiles and risk of incident AF. Subgroup analyses and sensitivity analyses were performed to explore the potential modification of the association and the robustness of the main findings. A total of 422 316 participants (mean age, 56 years; 54% women) were included for analyses. During a median follow-up of 11.9 years (first quartile-third quartile, 11.6-13.2 years), there were 24 774 AF events documented with an incidence of 4.92 events per 1000 person-years (95% CI, 4.86-4.98). Participants in higher RC quartiles had a lower risk of incident AF than those in the lowest quartile (first quartile): hazard ratio (HR)=0.96 (95% CI, 0.91-1.00) for second quartile; HR=0.92 (95% CI, 0.88-0.96) for third quartile; and HR=0.85 (95% CI, 0.81-0.89) for fourth quartile (P for trend <0.001). The association between RC quartiles and risk of incident AF was stronger in participants aged ≥65 years, in men, and in participants without history of diabetes when compared with control groups (P<0.001 for interaction). CONCLUSIONS On the basis of data from this large-scale prospective cohort study, elevated RC was associated with a lower risk of incident AF.
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Affiliation(s)
- Likang Li
- Center for Clinical Epidemiology and Methodology Guangdong Second Provincial General Hospital Guangzhou China
| | - Chuangshi Wang
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zebing Ye
- Department of Cardiology Guangdong Second Provincial General Hospital Guangzhou China
| | - Harriette G C Van Spall
- Department of Medicine McMaster University Hamilton ON Canada
- Population Health Research Institute, McMaster University Hamilton ON Canada
| | - Jingyi Zhang
- Center for Clinical Epidemiology and Methodology Guangdong Second Provincial General Hospital Guangzhou China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital Liverpool UK
- Danish Center for Health Services Research, Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology Guangdong Second Provincial General Hospital Guangzhou China
- Father Sean O'Sullivan Research Centre St. Joseph's Healthcare Hamilton Hamilton ON Canada
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14
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Pan D, Xu L, Zhang LX, Shi DZ, Guo M. Associations between remnant cholesterol levels and mortality in patients with diabetes. World J Diabetes 2024; 15:712-723. [PMID: 38680693 PMCID: PMC11045415 DOI: 10.4239/wjd.v15.i4.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Dyslipidemia is frequently present in patients with diabetes. The associations of remnant cholesterol and mortality remains unclear in patients with diabetes. AIM To explore the associations of remnant cholesterol with all-cause and cardiovascular mortality in patients with diabetes. METHODS This prospective cohort study included 4740 patients with diabetes who participated in the National Health and Nutrition Examination Survey from 1999 through 2018. Remnant cholesterol was used as the exposure variable, and all-cause and cardiovascular mortality were considered outcome events. Outcome data were obtained from the National Death Index, and all participants were followed from the interview date until death or December 31, 2019. Multivariate proportional Cox regression models were used to explore the associations between exposure and outcomes, in which remnant cholesterol was modeled as both a categorical and a continuous variable. Restricted cubic splines (RCSs) were calculated to assess the nonlinearity of associations. Subgroup (stratified by sex, age, body mass index, and duration of diabetes) and a series of sensitivity analyses were performed to evaluate the robustness of the associations. RESULTS During a median follow-up duration of 83 months, 1370 all-cause deaths and 389 cardiovascular deaths were documented. Patients with remnant cholesterol levels in the third quartile had a reduced risk of all-cause mortality [hazard ratio (HR) 95% confidence interval (CI): 0.66 (0.52-0.85)]; however, when remnant cholesterol was modeled as a continuous variable, it was associated with increased risks of all-cause [HR (95%CI): 1.12 (1.02-1.21) per SD] and cardiovascular [HR (95%CI): 1.16 (1.01-1.32), per SD] mortality. The RCS demonstrated nonlinear associations of remnant cholesterol with all-cause and cardiovascular mortality. Subgroup and sensitivity analyses did not reveal significant differences from the above results. CONCLUSION In patients with diabetes, higher remnant cholesterol was associated with increased risks of all-cause and cardiovascular mortality, and diabetes patients with slightly higher remnant cholesterol (0.68-1.04 mmol/L) had a lower risk of all-cause mortality.
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Affiliation(s)
- Deng Pan
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Graduate School, Beijing University of Chinese Medicine, Beijing 100020, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Lin Xu
- Gynecological Department of Traditional Chinese Medicine, China-Japan Friendship Hospital, Beijing 100020, China
| | - Li-Xiao Zhang
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Da-Zhuo Shi
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Ming Guo
- Department of Cardiovascular, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
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15
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Jang SY, Kang M, Song E, Jang A, Choi KM, Baik SH, Yoo HJ. Remnant cholesterol is an independent risk factor for the incidence of chronic kidney disease in newly-diagnosed type 2 diabetes: A nationwide population-based study. Diabetes Res Clin Pract 2024; 210:111639. [PMID: 38548106 DOI: 10.1016/j.diabres.2024.111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
AIMS To evaluate the impact of remnant cholesterol (remnant-C) on chronic kidney disease (CKD) incidence in newly-diagnosed type 2 diabetes. METHODS This retrospective cohort study used Korean National Health Insurance Service data on 212,836 patients with newly-diagnosed type 2 diabetes between 2009 and 2014. We conducted cox regression analysis to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for developing CKD according to remnant-C tertile. RESULTS During a median follow-up duration of 5.23 years, 6,850 CKD cases developed. In the fully adjusted model, HRs and 95 % CIs for incident CKD increased in the highest tertile of baseline remnant-C compared to the lowest (HR [95 % CI]; 1.234 [1.159-1.314]). This association was more prominent in patients with hypertension or low-income status (P for interaction < 0.05). Increased HRs in the highest tertile of remnant-C was sustained in type 2 diabetes patients within target range of conventional lipid profile such as low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL and < 70 mg/dL (1.165 [1.041-1.304] and 1.308 [1.063-1.609]), high-density lipoprotein cholesterol (HDL-C) (1.243 [1.155-1.338]) and triglyceride (1.168 [1.076-1.268]), respectively. CONCLUSIONS In newly-diagnosed type 2 diabetes patients, higher remnant-C is independently associated with CKD incidence, even when conventional lipid values are well-controlled.
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Affiliation(s)
- Soo Yeon Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Minwoong Kang
- Department of Biomedical Research Center, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Eyun Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ahreum Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Baik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye Jin Yoo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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16
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Huang H, Sun T, Liu Z. Robot-assisted versus laparoscopic pheochromocytoma resection and construction of a nomogram to predict perioperative hemodynamic instability. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107986. [PMID: 38325143 DOI: 10.1016/j.ejso.2024.107986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/25/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Despite recent improvements in perioperative outcomes after pheochromocytoma resection, hemodynamic instability (HI) remained of high concern. The emergence of robot-assisted surgery may bring different results to pheochromocytoma surgery. The purposes of this study were to investigate whether robot-assisted retroperitoneal pheochromocytoma resection promotes hemodynamic instability compared with laparoscopic retroperitoneal pheochromocytoma resection and construct a nomogram to predict perioperative hemodynamic instability. METHODS The clinical data of 221 patients who underwent pheochromocytoma resection were analyzed retrospectively. The patients were divided into two groups according to the mode of operation. Stepwise logistic regression was used to determine the independent risk factors of perioperative hemodynamic instability and to construct a visual prediction model. The final model was visualized via a nomogram. RESULTS 124 (56.1 %) out of 221 patients experienced HI. The variables that were eventually included in the model were tumor size (OR1.363(1.143-1.646), P < 0.001), abnormal blood glucose (OR3.381(1.534-7.903), P = 0.003), preoperative SBP(OR1.04(1.014-1.067),P = 0.002), robot-assisted surgery(OR0.241(0.108-0.513),P < 0.001), and catecholamines(OR4.567(2.424-8.834),P < 0.001). The receiver operating characteristic curve showed the area under curve was 0.816(95 %CI 0.761-0.871). CONCLUSION We developed a nomogram for successful prediction of perioperative hemodynamics based on five independent risk factors. Clinicians can leverage this easy-to-use nomogram to perform personalized risk predictions for HI and develop preventive interventions to improve patient safety and surgical outcomes.
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Affiliation(s)
- Hao Huang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China.
| | - Ting Sun
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China.
| | - Ziwen Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, China.
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Elías-López D, Doi T, Nordestgaard BG, Kobylecki CJ. Remnant cholesterol and low-grade inflammation jointly in atherosclerotic cardiovascular disease: implications for clinical trials. Curr Opin Clin Nutr Metab Care 2024; 27:125-135. [PMID: 38320159 DOI: 10.1097/mco.0000000000000999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE OF REVIEW Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death despite the development of effective treatments. Recently, elevated remnant cholesterol and low-grade inflammation have emerged as factors explaining part of the residual ASCVD risk. Interestingly, the coexistence of both high remnant cholesterol and low-grade inflammation can further increase the risk of ASCVD. The aim of this review is to describe the role of elevated remnant cholesterol and low-grade inflammation, separately and combined, in ASCVD. RECENT FINDINGS Results from recently published studies, including observational and genetic Mendelian randomization studies, support a causal relationship between elevated remnant cholesterol and low-grade inflammation on risk of ASCVD in both primary and secondary prevention settings. In addition, current evidence from observational studies suggests that the coexistence of elevated remnant cholesterol and low-grade inflammation further increases the risk of ASCVD. SUMMARY Recent observational studies suggest that high remnant cholesterol combined with low-grade inflammation may confer a particular high risk for ASCVD. Attention on the dual threat from high remnant cholesterol and low-grade inflammation is necessary, and further research in this field is warranted. The effect of remnant cholesterol-lowering drugs and anti-inflammatory drugs on ASCVD risk alone and combined remains to be elucidated. VIDEO ABSTRACT http://links.lww.com/COCN/A20.
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Affiliation(s)
- Daniel Elías-López
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark
- Department of Endocrinology and Metabolism and Research Center of Metabolic Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubirán, México City, México
| | - Takahito Doi
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Camilla J Kobylecki
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte
- The Copenhagen General Population Study, Copenhagen University Hospital - Herlev Gentofte, Herlev, Denmark
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Huang K, Yin S, Xiao Y, Wang J, Cui J, Wang J, Bai Y. Sexual dysfunction in patients with diabetes: association between remnant cholesterol and erectile dysfunction. Lipids Health Dis 2024; 23:55. [PMID: 38388371 PMCID: PMC10882869 DOI: 10.1186/s12944-024-02046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is closely associated with dyslipidemia; however, it is yet unknown how ED and remnant cholesterol (RC) are related. As such, this research sought to explore the correlation between RC and ED among individuals with diagnosed with diabetes. METHODS This cross-sectional study used information from 215 males from National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004. RC was calculated as follows: the values of high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were subtracted from the total cholesterol (TC) value, while ED diagnoses were based on self-reports. Weighted logistic regression analyses using both univariate and multivariate approaches were conducted to assess the correlation between RC and ED. RESULTS After comprehensive adjustment, multivariable logistic regression models revealed a strong correlation between RC and ED in subjects with diabetes (with an odds ratio (OR) of 7.49 and a 95% confidence interval (CI) of 1.98-28.37; P = 0.004). On categorizing RC into 3 grades (T1-T3), the OR corresponding to higher RC grade increased. Despite the results not reaching statistical significance upon categorization, a consistent and statistically significant trend (P for trend < 0.05) was observed. CONCLUSION This study indicated a correlation between increased RC levels and a higher prevalence of ED in diabetic males. RC may serve as a promising predictor of ED in individuals with diabetes. However, additional studies are required to confirm these findings.
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Affiliation(s)
- Ke Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yunfei Xiao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiahao Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianwei Cui
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Yunjin Bai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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