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Yu X, Yu Y, Wei C, Wang L, Jiang J, Zhang R, Dai Q, Kang Y, Chen X. Association between small dense low-density lipoprotein cholesterol and neuroimaging markers of cerebral small vessel disease in middle-aged and elderly Chinese populations. BMC Neurol 2021; 21:436. [PMID: 34753453 PMCID: PMC8576978 DOI: 10.1186/s12883-021-02472-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral small vascular disease (CSVD) is one of the leading causes of death in the aged population and is closely related to abnormalities in low-density lipoprotein cholesterol (LDL-C). Our study aims to clarify the relationship between small and dense low-density lipoprotein cholesterol (sdLDL-C) (a subcomponent of LDL-C) and neuroimaging markers of CSVD. METHODS In total, 1211 Chinese adults aged ≥45 years with cranial magnetic resonance imaging (MRI) were recruited in this retrospective study from January 2018 to May 2021. Serum lipids and other baseline characteristics were investigated in relation to the occurrence of CSVD. A logistic regression model was performed to analyze the relationships between LDL subtypes and CSVD risk, and the Pearson correlation coefficient was used to analyze the correlation between clinical characteristics and CSVD risk. ROC curves and AUCs were created and depicted to predict the best cutoff value of LDL-C subtypes for CSVD risk. Based on these data, we performed comprehensive analyses to investigate the risk factors for CSVD. RESULTS Ultimately, 623 eligible patients were included in the present study. Of the 623 eligible patients, 487 were included in the CSVD group, and 136 were included in the group without CSVD (control group). We adjusted for confounders in the multivariate logistic regression model, and LDL-C3 was still higher in the CSVD patients than in the group of those without CSVD (OR (95% CI), 1.22(1.08-1.38), P < 0.05). Pearson correlation showed that there was a positive correlation between the levels of LDL-C3, LDL-C4, LDL-C5, glucose, age, hypertension, previous ischemic stroke and CSVD risk (r > 0.15, P < 0.01). Moreover, the best cutoff value of LDL-C3 to predict CSVD was 9.5 mg/dL with 68.4% sensitivity and 72.8% specificity, and the best cutoff value of LDL-C4 to predict CSVD was 5.5 mg/dL with 50.5% sensitivity and 90.4% specificity. CONCLUSION The results indicate that LDL-C3 is an independent risk factor for CSVD. A new prediction model based on LDL-C3 and LDL-C4 can help clinicians identify high-risk CSVD, even in people with normal LDL-C levels. The levels of sdLDL-C should be considered in the assessment and management of CSVD.
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Affiliation(s)
- Xiaorong Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yanhua Yu
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Cunsheng Wei
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Lin Wang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Junying Jiang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Rui Zhang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Qi Dai
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Yue Kang
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China
| | - Xuemei Chen
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, 211100, Jiangsu, China.
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Duan R, Xue W, Wang K, Yin N, Hao H, Chu H, Wang L, Meng P, Diao L. Estimation of the LDL subclasses in ischemic stroke as a risk factor in a Chinese population. BMC Neurol 2020; 20:414. [PMID: 33183255 PMCID: PMC7664065 DOI: 10.1186/s12883-020-01989-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/30/2020] [Indexed: 01/09/2023] Open
Abstract
Background Acute ischemic stroke (AIS) is one of the leading causes of mortality and long-term disability worldwide. Our study aims to clarify the role of low-density lipoproteins (LDL) subclasses in the occurrence of AIS and develop a risk xprediction model based on these characteristics to identify high-risk people. Methods Five hundred and sixty-six patients with AIS and 197 non-AIS controls were included in this study. Serum lipids and other baseline characteristics including fasting blood glucose (GLU), serum creatinine (Scr), and blood pressure were investigated in relation to occurrence of AIS. The LDL subfractions were classified and measured with the Lipoprint System by a polyacrylamide gel electrophoresis technique. Results Levels of LDL-3, LDL-4 and LDL-5 subclasses were significantly higher in the AIS group compared to the non-AIS group and lower level of LDL-1 was prevalent in the AIS patients. Consistently, Spearman correlation coefficient demonstrated that sd-demonevels, especially LDL-3 and LDL-4 levels, were significantly positively correlated with AIS. Furthermore, there is a significant positive correlation between small dense LDL (sd-LDL, that is LDL-3 to 7) levels and serum lipids including total cholesterol (TC), Low density lipoprotein cholesterol (LDL-C), and Triglyceride (TG). Increased LDL-3 and LDL-4 as well as decreased LDL-1 and LDL-2 were correlated to the occurrence of AIS, even in the people with normal LDL-C levels. A new prediction model including 12 variables can accurately predict the AIS risk in Chinese patients (AUC = 0.82 ± 0.04). Conclusions Levels of LDL subclasses should be considered in addition to serum LDL-C in assessment and management of AIS. A new prediction model based on clinical variables including LDL subtractions can help clinicians identify high of AIS, even in the people with norm.
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Affiliation(s)
- Ruisheng Duan
- Department of Neurology, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China.
| | - Wenjun Xue
- Department of Neurology, the First People's Hospital of Pingdingshan, Henan, 467000, Pingdingshan, China
| | - Kunpeng Wang
- Department of Neurosurgery, the Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China
| | - Nan Yin
- Department of Neurology, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China
| | - Hongyu Hao
- Department of Neurology, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China
| | - Hongshan Chu
- Department of Neurology, Hebei General Hospital, Shijiazhuang, 050000, Hebei, China
| | - Lijun Wang
- Department of Medicine, Shanghai Zhangjiang institute of Medical innovation, Biotecan Pharmaceuticals co., ltd., Shanghai, 201204, China
| | - Peng Meng
- Department of Medicine, Shanghai Zhangjiang institute of Medical innovation, Biotecan Pharmaceuticals co., ltd., Shanghai, 201204, China.
| | - Le Diao
- Department of Medicine, Shanghai Zhangjiang institute of Medical innovation, Biotecan Pharmaceuticals co., ltd., Shanghai, 201204, China.
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Patti AM, Giglio RV, Pafili K, Rizzo M, Papanas N. Pharmacotherapy for gestational diabetes. Expert Opin Pharmacother 2018; 19:1407-1414. [PMID: 30136869 DOI: 10.1080/14656566.2018.1509955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) represents impaired carbohydrate metabolism during pregnancy and is characterized by progressive insulin resistance and compensatory hyperinsulinaemia. If inadequately treated, it may lead to fetal macrosomia and other adverse outcomes. AREAS COVERED In this review, the authors summarize the current evidence from studies on the use of insulin and other agents for the treatment of women with GDM. EXPERT OPINION Lifestyle management is of paramount importance for the treatment of GDM. In pharmacotherapy, insulin remains the long-established mainstay of treatment. NPH (Neutral Protamine Hagedorn) and soluble human insulin have long been established for use, but favorable experience has now also accumulated with the newer insulins (aspart, lispro, detemir). Alternatively, metformin and glyburide have been used in GDM, but they have never gained wide acceptance. Nutritional supplements based on micronutrients and bioactives (probiotics and myoinositol) have shown promising results as well. Further experience with incretin agents (DPP-4 inhibitors and GLP-1 receptor agonists) is awaited.
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Affiliation(s)
- Angelo Maria Patti
- a Department of Internal Medicine and Medical Specialties , University of Palermo , Palermo , Italy
| | - Rosaria Vincenza Giglio
- a Department of Internal Medicine and Medical Specialties , University of Palermo , Palermo , Italy
| | - Kalliopi Pafili
- b Diabetes Centre, Second Department of Internal Medicine , Democritus University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Manfredi Rizzo
- a Department of Internal Medicine and Medical Specialties , University of Palermo , Palermo , Italy
| | - Nikolaos Papanas
- b Diabetes Centre, Second Department of Internal Medicine , Democritus University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
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Silva ITD, Almeida-Pititto BD, Ferreira SRG. Reassessing lipid metabolism and its potentialities in the prediction of cardiovascular risk. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:171-80. [PMID: 25993681 DOI: 10.1590/2359-3997000000031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/13/2014] [Indexed: 11/22/2022]
Abstract
There are numerous particles, enzymes, and mechanisms in the lipid metabolism that are involved in the genesis of cardiovascular disease (CVD). Given its prevalence in populations and its impact on mortality, it is relevant to review the lipid metabolism as it may potentially provide subsidies to better prediction. This article reviews the importance of traditional cardiovascular risk factors and comments on the potential of novel lipid biomarkers involved in the physiopathology of CVD. The Framingham cohorts proved the role of traditional risk factors (physical inactivity, smoking, blood pressure, total cholesterol, LDL-C, HDL-C, plasma glucose) in the prediction of cardiovascular events. However, a significant number of individuals that suffer from a cardiovascular event has few or none of these factors. Such finding indicates the need for new biomarkers able to identify plaques that are more susceptible to rupture. Some of bloodstream biomarkers related to lipid metabolism are modified LDL particles, apolipoprotein AI (apo AI), apolipoprotein B, lipoprotein (a) [Lp (a)], cholesteryl ester transfer protein (CETP), subtypes of LDL and HDL particles, and lipoprotein-associated phospholipase A2 (Lp-PLA2). These factors participate in the atherosclerotic process, and are abnormal in individuals at high risk, or in those who suffered from a cardiovascular event. Lp (a) determination is already employed in clinical practice and should be included as a reference parameter for CVD monitoring. Furthermore, there are expectations for wider use of apo B, non-HDL cholesterol and total cholesterol / HDL-C determination to improve cardiovascular risk assessment.
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Affiliation(s)
- Isis Tande da Silva
- Department of Epidemiology, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Sandra Roberta G Ferreira
- Department of Epidemiology, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil
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Golshahi J, Validi E, Akbari M. The association between fasting serum insulin, apo-lipoproteins level, and severity of coronary artery involvement in non-diabetic patients. Adv Biomed Res 2014; 3:192. [PMID: 25298960 PMCID: PMC4189209 DOI: 10.4103/2277-9175.140624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 02/09/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In the previous studies, fasting insulin and apo-lipoproteins are considered as one of the risk-factor of coronary artery disease (CAD) but did not have the same results. In this study, we attempted to define the association of high fasting insulin and apo-lipoproteins of serum in non-diabetic patients who were afflicted with coronary arteries disease with severity of coronary arteries involvement. MATERIALS AND METHODS This study was conducted between September 2011 and February 2012 on three groups, each one consisting of 100 members while using angiographic scores of Gensini with three equal groups with low, medium, and high stenosis of coronary arteries. The evaluation of non-diabetic patients afflicted with CADs, included the fasting glucose level less than 126 mg/dl or non-consumption of blood glucose reduction drugs or negativity history of diabetes. RESULTS In this study, there were 300 non-diabetic patients afflicted with CAD in three groups of low, medium, and high extremity. Due to attained results, the patients afflicted with high CAD had a higher level of insulin (18.3 ± 0.8) in relation with low and medium groups (P < 0.001). As it was observed, the level of serum apo-lipoproteins of A1 (APO-A1) in low group of CAD (175 ± 36.4) is meaningfully higher than its quantity in high-CAD group (158 ± 42.4, P < 0.001). Furthermore, the quantity of serum apo-lipoproteins of B (APO-B) in mild CAD group (139 ± 30.4) is meaningfully less than severe CAD group (155.21 ± 29.7, P < 0.001). CONCLUSION Our findings show that insulin, APO-A1, APO-B, and total cholesterol measurement is a good case for defining the severity of coronary artery involvement, while high-density lipoprotein, low-density lipoprotein, and triglyceride are not important risk-factors.
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Affiliation(s)
- Jafar Golshahi
- Department of Cardiovascular Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ebrahim Validi
- Department of Cardiovascular Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Department of Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Ji MS, Jeong MH, Ahn Y, Kim YJ, Chae SC, Hong TJ, Seong IW, Chae JK, Kim CJ, Cho MC, Rha SW, Bae JH, Seung KB, Park SJ. One-Year Clinical Outcomes among Patients with Metabolic Syndrome and Acute Myocardial Infarction. Korean Circ J 2013; 43:519-26. [PMID: 24044010 PMCID: PMC3772296 DOI: 10.4070/kcj.2013.43.8.519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/24/2013] [Accepted: 08/01/2013] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Metabolic syndrome (MetS) is an important risk factor for cardiovascular disease. However, the clinical outcome of acute myocardial infarction (AMI) with MetS has not been well examined. The purpose of this study was to evaluate the clinical outcomes of AMI patients with MetS. Subjects and Methods We evaluated a total of 6352 AMI patients who had successful percutaneous coronary interventions and could be identified for MetS between 2005 and 2008 at 51 hospitals participating in the Korea Acute Myocardial Infarction Registry. They were divided into 2 groups according to the presence of MetS: the MetS group (n=2493, 39.2%) versus the Non-MetS group (n=3859, 60.8%). In addition, 4049 AMI patients with high levels of low density lipoprotein-cholesterol (LDL-C) (≥100 mg/dL) among them, were divided into the MetS group (n=1561, 38.6%) versus the Non-MetS group (n=2488, 61.4%). Results In the overall population, there was no significant difference in 12-month the major adverse cardiac events (MACE) rate between the 2 groups. However, the MetS group showed a significantly higher 12-month MACE rate in the high LDL-C population. Multivariate analysis showed that MetS was an independent prognostic factor for 12-month MACE {hazard ratio (HR) 1.607, 95% confidence interval (CI) 1.027 to 2.513, adjusted p=0.038} and for 12-month target vessel revascularization (HR 1.564, 95% CI 1.092 to 2.240, adjusted p=0.015) in the high LDL-C population. Conclusion MetS patients with AMI in the overall population showed no significant difference in 12-month clinical outcomes. However, in patients with higher LDL-C ≥100 mg/dL, they showed significantly worse clinical outcome than Non-MetS patients. Therefore, it is important to ascertain the presence of MetS in AMI patients, and more aggressive therapy should be strongly considered for AMI patient with MetS.
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Affiliation(s)
- Mi Seon Ji
- Chonnam National University Hospital, Gwangju, Korea
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