Smoking cessation reduces the lectin-like low-density lipoprotein receptor index, an independent cardiovascular risk marker of vascular inflammation

Cigarette Smoke-Induced Respiratory Response: Insights into Cellular Processes and Biomarkers

Cigarette smoke (CS) poses a significant risk factor for respiratory, vascular, and organ diseases owing to its high content of harmful chemicals and reactive oxygen species (ROS). These substances are known to induce oxidative stress, inflammation, apoptosis, and senescence due to their exposure to environmental pollutants and the presence of oxidative enzymes. The lung is particularly susceptible to oxidative stress. Persistent oxidative stress caused by chronic exposure to CS can lead to respiratory diseases such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis (PF), and lung cancer. Avoiding exposure to environmental pollutants, like cigarette smoke and air pollution, can help mitigate oxidative stress. A comprehensive understanding of oxidative stress and its impact on the lungs requires future research. This includes identifying strategies for preventing and treating lung diseases as well as investigating the underlying mechanisms behind oxidative stress. Thus, this review aims to investigate the cellular processes induced by CS, specifically inflammation, apoptosis, senescence, and their associated biomarkers. Furthermore, this review will delve into the alveolar response provoked by CS, emphasizing the roles of potential therapeutic target markers and strategies in inflammation and oxidative stress.

Cardiovascular risk factors among Jordanian patients with rheumatoid arthritis: A cohort study

AIM

To determine the frequency of risk factors for cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) in Jordan.

METHOD

During this study, 158 patients with RA were enlisted from the outpatient rheumatology clinic at King Hussein Hospital of the Jordanian Medical Services, from 1 June 2021, to 31 December 2021. Demographic data and disease duration were recorded. After 14 h of fasting, venous blood samples were drawn to determine the levels of cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein. History of smoking, diabetes mellitus, and hypertension was recorded. Body mass index and Framingham's 10-year risk score (FRS) were calculated for each patient. Disease duration was noted.

RESULTS

The mean age of the male population was 49.29 years and that of the female population was 46.06 years. Most of the study population were female (78.5%) and 27.2% of the study population had one modifiable risk factor. The most frequent risk factors observed in the study were obesity (38%) and dyslipidemia (38%). Diabetes mellitus was the least frequent risk factor, with a frequency of 14.6%. The FRS differed significantly between the sexes, with the risk score of men being 9.80, whereas that of women was 5.34 (p < .00). Regression analysis revealed that age increased the odds ratio of diabetes mellitus, hypertension, obesity, and a high-to-moderate FRS by 0.7%, 10.9%, 0.33%, and 10.3%, respectively.

CONCLUSION

Rheumatoid arthritis patients have increased chances of developing cardiovascular risk factors leading to cardiovascular events.

Autoimmune Rheumatic Diseases: An Update on the Role of Atherogenic Electronegative LDL and Potential Therapeutic Strategies

Atherosclerosis has been linked with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Autoimmune rheumatic diseases (AIRDs) are associated with accelerated atherosclerosis and ASCVD. However, the mechanisms underlying the high ASCVD burden in patients with AIRDs cannot be explained only by conventional risk factors despite disease-specific factors and chronic inflammation. Nevertheless, the normal levels of plasma low-density lipoprotein (LDL) cholesterol observed in most patients with AIRDs do not exclude the possibility of increased LDL atherogenicity. By using anion-exchange chromatography, human LDL can be divided into five increasingly electronegative subfractions, L1 to L5, or into electropositive and electronegative counterparts, LDL (+) and LDL (-). Electronegative L5 and LDL (-) have similar chemical compositions and can induce adverse inflammatory reactions in vascular cells. Notably, the percentage of L5 or LDL (-) in total LDL is increased in normolipidemic patients with AIRDs. Electronegative L5 and LDL (-) are not recognized by the normal LDL receptor but instead signal through the lectin-like oxidized LDL receptor 1 (LOX-1) to activate inflammasomes involving interleukin 1β (IL-1β). Here, we describe the detailed mechanisms of AIRD-related ASCVD mediated by L5 or LDL (-) and discuss the potential targeting of LOX-1 or IL-1β signaling as new therapeutic modalities for these diseases.

Improvement in Cardiometabolic Risk Factors During Smoking Cessation Treatment in Patients with Type 2 Diabetes: A Retrospective Cohort Study

PURPOSE

Smoking cessation reduces morbidity and mortality of cardiovascular diseases. The purpose of this study was to evaluate the effect during smoking cessation treatment on glycemic control and cardiometabolic risk factors, including blood pressure and lipid levels, in patients with type 2 diabetes.

PATIENTS AND METHODS

This retrospective cohort study included patients with type 2 diabetes who participated in a smoking cessation program, which comprised health education and medication prescription at an outpatient clinic in combination with a 3-month follow-up by phone. Data on patient background characteristics, cardiometabolic factors, smoking status, body weight, and body mass index before and after the program were collected for analysis.

RESULTS

The analysis included 241 participants with an average age of 58.6 ± 10.6 years. The rate of successful cessation at three months was 34.0%. Compared with the baseline levels, there were significant decreases in the levels of fasting plasma glucose (10.0 ± 46.8 mg/dL, P = 0.001), HbA1c (0.3 ± 1.4%, P = 0.004), systolic blood pressure (4.6 ± 17.5 mmHg, P < 0.001), diastolic blood pressure (2.9 ± 11.3 mmHg, P < 0.001), and total cholesterol (7.9 ± 42.8 mg/dL, P = 0.020) after participation in the smoking cessation program while there was no significant difference in body weight (0.1 ± 1.2 kg, P = 0.444). After adjustment for covariates, the decreases in HbA1c and total cholesterol levels were significantly better in younger participants and higher baseline nicotine dependence scores were associated with decreases in the levels of blood pressure, fasting plasma glucose, and triglycerides. However, the decrease in smoking amount was not associated with the changes in cardiometabolic factors.

CONCLUSION

Participation in a smoking cessation program was associated with improvements in glycemic control and cardiometabolic risk factors in patients with type 2 diabetes. The observed improvements were associated with participation in the program but not with the decrease in smoking amount.

Effect of 12-Week Daily Intake of the High-Lycopene Tomato (Solanum Lycopersicum), A Variety Named "PR-7", on Lipid Metabolism: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study

Tomato (Solanum lycopersicum) is a rich source of lycopene, a carotenoid that confers various positive biological effects such as improved lipid metabolism. Here, we conducted a randomized, double-blind, placebo-controlled, parallel-group comparative study to investigate the effects of regular and continuous intake of a new high-lycopene tomato, a variety named PR-7, for 12 weeks, based on 74 healthy Japanese subjects with low-density lipoprotein cholesterol (LDL-C) levels ≥120 to <160 mg/dL. The subjects were randomly assigned to either the high-lycopene tomato or placebo (lycopene-free tomato) group. Each subject in the high-lycopene group ingested 50 g of semidried PR-7 (lycopene, 22.0–27.8 mg/day) each day for 12 weeks, while subjects in the placebo group ingested placebo semidried tomato. Medical interviews were conducted, vital signs were monitored, body composition was determined, and blood and saliva samples were taken at weeks 0 (baseline), 4, 8, and 12. The primary outcome assessed was LDL-C. The intake of high-lycopene tomato increased lycopene levels in this group compared to levels in the placebo group (p < 0.001). In addition, high-lycopene tomato intake improved LDL-C (p = 0.027). The intake of high-lycopene tomato, PR-7, reduced LDL-C and was confirmed to be safe.

LOX-1 and atherosclerotic-related diseases

Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), a scavenger receptor of oxidized low-density lipoprotein (ox-LDL) found in various cells, plays a crucial role in the formation and progression of atherosclerotic plaques. Animal studies have suggested that LOX-1 mediates the balance between internalization and degeneration of endothelial cells, thereby contributing to various steps in the atherosclerotic process, from initiation to plaque rupture. Under pathological conditions, the extracellular domain of membrane bound LOX-1 can be largely proteolytically cleaved into a soluble form (sLOX-1), which is proportional and linked to the LOX-1 expression level. Circulating levels of sLOX-1 are regarded as a risk biomarker for plaque rupture and acute coronary syndrome (ACS). Recently, studies have shown that sLOX-1 is also elevated in patients with acute stroke and can be a predictive biomarker for acute stroke. With the discovery of the vital role of LOX-1 in atherosclerosis, there is growing focus on the influence of LOX-1 in atherosclerotic-related diseases, including coronary arterial disease(CAD), stroke, and other cardiovascular events. Genetic polymorphisms of LOX-1 have been investigated and have been found to modulate the risk of these diseases. Most polymorphisms have been found to be risk factors, except for the splicing isoform LOXIN. This review concludes with a discussion of the potential future applications of LOX-1 for atherosclerotic-related diseases.

Prognostic Significance of Plasma CLEC-2 (C-Type Lectin-Like Receptor 2) in Patients With Acute Ischemic Stroke

Background and Purpose- CLEC-2 (C-type lectin-like receptor 2) is a C-type lectin receptor highly expressed on platelets with the prominent involvement in platelet activation, which was increased in coronary heart disease. Given the role of platelet activation in ischemic stroke and the connections between coronary heart disease and ischemic stroke, CLEC-2 might be a candidate marker of ischemic stroke. Here, we aimed to examine the prognostic significance of CLEC-2 in patients with acute ischemic stroke (AIS). Methods- Three hundred fifty-two patients with AIS within 7 days and 112 healthy controls were prospectively studied. Plasma CLEC-2 (pCLEC-2) and some conventional risk factors of stroke were examined. Stroke progression was defined as any new neurological symptoms/signs or any neurological worsening within 7 days after stroke onset, and poor prognosis was defined as modified Rankin Scale scores >2 at 90 days. The association between pCLEC-2 and stroke progression/prognosis was evaluated using regression models. Results- Patients with AIS had a significantly higher level of pCLEC-2 than that of healthy controls (P<0.05). Patients with AIS with progressive stroke or poor prognosis had a much higher level of pCLEC-2 compared with those with stable stroke or good prognosis (all P<0.05). Increasing pCLEC-2 was significantly associated with an increased risk of stroke progression (odds ratio, 1.97; 95% CI, 1.11-3.50; P=0.021) and poor prognosis (odds ratio, 1.70; 95% CI, 1.17-2.48; P=0.006). Patients with the highest pCLEC-2 level were 7- to 8-fold more likely to have stroke progression compared with the lowest quartile (odds ratio, 7.69; 95% CI, 1.43-41.41). Patients with the highest pCLEC-2 level were also more likely to have poor prognosis at 90 days (odds ratio, 5.58; 95% CI, 1.76-17.68). The optimal cutoff points of pCLEC-2 for predicting stroke progression and poor prognosis were 235.48 and 207.08 pg/mL, respectively. Conclusions- Increased pCLEC-2 was associated with stroke progression and poor prognosis at 90 days significantly, which indicates the prognostic role of pCLEC-2 in AIS. However, it needs to be confirmed in large-scale studies.

Targeting LOX-1 in atherosclerosis and vasculopathy: current knowledge and future perspectives

LOX-1 (lectin-like oxidized low-density lipoprotein receptor-1; also known as OLR1) is the dominant receptor that recognizes and internalizes oxidized low-density lipoproteins (ox-LDLs) in endothelial cells. Several genetic variants of LOX-1 are associated with the risk and severity of coronary artery disease. The LOX-1-ox-LDL interaction induces endothelial dysfunction, leukocyte adhesion, macrophage-derived foam cell formation, smooth muscle cell proliferation and migration, and platelet activation. LOX-1 activation eventually leads to the rupture of atherosclerotic plaques and acute cardiovascular events. In addition, LOX-1 can be cleaved to generate soluble LOX-1 (sLOX-1), which is a useful diagnostic and prognostic marker for atherosclerosis-related diseases in human patients. Of therapeutic relevance, several natural products and clinically used drugs have emerged as LOX-1 inhibitors that have antiatherosclerotic actions. We hereby provide an updated overview of role of LOX-1 in atherosclerosis and associated vascular diseases, with an aim to highlighting the potential of LOX-1 as a novel theranostic tool for cardiovascular disease prevention and treatment.