Management of Dyslipidemia in Patients with Hypertension, Diabetes, and Metabolic Syndrome

Impacts of chitosan and its nanoformulations on the metabolic syndromes: a review

A significant public health issue worldwide is metabolic syndrome, a cluster of metabolic illnesses that comprises insulin resistance, obesity, dyslipidemia, hyperglycemia, and hypertension. The creation of natural treatments and preventions for metabolic syndrome is crucial. Chitosan, along with its nanoformulations, is an oligomer of chitin, the second-most prevalent polymer in nature, which is created via deacetylation. Due to its plentiful biological actions in recent years, chitosan and its nanoformulations have drawn much interest. Recently, the chitosan nanoparticle-based delivery of CRISPR-Cas9 has been applied in treating metabolic syndromes. The benefits of chitosan and its nanoformulations on insulin resistance, obesity, diabetes mellitus, dyslipidemia, hyperglycemia, and hypertension will be outlined in the present review, highlighting potential mechanisms for the avoidance and medication of the metabolic syndromes by chitosan and its nanoformulations.

Age and the Residual Risk of Cardiovascular Disease following Low Density Lipoprotein-Cholesterol Exposure

We believe that there is sufficient evidence from basic science, longitudinal cohort studies and randomised controlled trials which validates the low-density lipoprotein cholesterol (LDL-C) or lipid hypothesis. It is important that we can communicate details of the cardiovascular disease (CVD) risk reduction that the average patient could expect depending on the scale of LDL-C decrease following lipid lowering therapy. It is also essential that residual risk (ResR) of CVD be highlighted. To achieve this aim by using existing trial evidence, we developed mathematical models initially for relative risk reduction (RRR) and absolute risk (AR) reduction and then showed that despite optimising LDL-C levels, a considerable degree of ResR remains that is dependent on AR. Age is significantly associated with AR (odds ratio: 1.02, 95% confidence intervals: 1.01-1.04) as was previously demonstrated by analysing the Whickham study cohort using a logistic regression model (age remaining significant even when all the other significant risk factors such as sex, smoking, systolic blood pressure, diabetes and family history were included in the regression model). A discussion of a paper by Ference et al. provided detailed evidence of the relationship between age and AR, based on lifetime LDL-C exposure. Finally, we discussed non-traditional CVD risk factors that may contribute to ResR based on randomised controlled trials investigating drugs improving inflammation, thrombosis, metabolic and endothelial status.

Impact of Oat (Avena sativa L.) on Metabolic Syndrome and Potential Physiological Mechanisms of Action: A Current Review

Oat (Avena sativa L.), an annual herbaceous plant belonging to the Gramineae family, is widely grown in various regions including EU, Canada, America, Australia, etc. Due to the nutritional and pharmacological values, oats have been developed into various functional food including fermented beverage, noodle, cookie, etc. Meanwhile, numerous studies have demonstrated that oats may effectively improve metabolic syndrome, such as dyslipidemia, hyperglycemia, atherosclerosis, hypertension, and obesity. However, the systematic pharmacological mechanisms of oats on metabolic syndrome have not been fully revealed. Therefore, in order to fully explore the benefits of oat in food industry and clinic, this review aims to provide up-to-date information on oat and its constituents, focusing on the effects on metabolic syndrome.

The association of body mass index and its interaction with family history of dyslipidemia towards dyslipidemia in patients with type 2 diabetes: a cross-sectional study in Zhejiang Province, China

Objectives

This study aimed to investigate the association between body mass index (BMI) and dyslipidemia and to explore the interaction between BMI and family history of dyslipidemia towards dyslipidemia in patients with type 2 diabetes.

Methods

This cross-sectional study was conducted between March and November 2018 in Zhejiang Province, China. A total of 1,756 patients with type 2 diabetes were included, physical examination data, fasting blood samples and face-to-face questionnaire survey data were collected. Restricted cubic spline analysis was used to evaluate the association between BMI and the risk of dyslipidemia. Unconditional multivariable logistic regression was used to estimate the interaction between BMI and family history of dyslipidemia towards dyslipidemia.

Results

The prevalence of dyslipidemia was 53.7% in the study population. The risk of dyslipidemia elevated with increased BMI value (p for non-linearity <0.05). After adjusting for covariates, individuals with high BMI (≥24 kg/m²) and a family history of dyslipidemia had a 4.50-fold (95% CI: 2.99-6.78) increased risk of dyslipidemia compared to the normal reference group, which was higher than the risk associated with high BMI alone (OR = 1.83, 95% CI: 1.47-2.28) or family history of dyslipidemia alone (OR = 1.79 95% CI: 1.14-2.83). Significant additive interaction between high BMI and a family history of dyslipidemia was detected, with RERI, AP, and SI values of 1.88 (95% CI: 0.17-4.10), 0.42 (95% CI: 0.02-0.62), and 2.16 (95% CI: 1.07-4.37), respectively. However, stratified by status of diabetes control, this additive interaction was only find significant among patients with controlled diabetes.

Conclusion

Both high BMI and a family history of dyslipidemia were related with high risk of dyslipidemia. Moreover, there were synergistic interaction between these two factors. Patients with type 2 diabetes who had a family history of dyslipidemia were more susceptible to the negative impact of being overweight or obesity on dyslipidemia.

The Synergistic Protective Effect of γ-Oryzanol (OZ) and N-Acetylcysteine (NAC) against Experimentally Induced NAFLD in Rats Entails Hypoglycemic, Antioxidant, and PPARα Stimulatory Effects

This study estimated that the combined effect of γ-Oryzanol and N-acetylcysteine (NAC) against high-fat diet (HFD)-induced non-alcoholic fatty liver disease (NAFLD) in rats also estimated some of their mechanisms of action. Adult male rats were divided into seven groups (n = 8 each) as control, control + NAC, control + γ-Oryzanol, HFD, HFD + NAC, HFD + γ-Oryzanol, and HFD + NAC + γ-Oryzanol. NAC was administered orally at a final concentration of 200 mg/kg, whereas γ-Oryzanol was added to diets at a concentration of 0.16. All treatments were conducted for 17 weeks and daily. Both NAC and γ-Oryzanol were able to reduce final body weights, fat weights, fasting glucose, fasting insulin, serum, and serum levels of liver function enzymes as well as the inflammatory markers such as tumor necrosis factor-α (TNF-α), interleukine-6 (IL-6), and leptin in HFD-fed rats. They also improved hepatic structure and glucose tolerance, increased adiponectin levels, and reduced serum and hepatic levels of triglycerides (TGs) and cholesterol (CHOL) in these rats. These effects were concomitant with a reduction in the hepatic levels of lipid peroxides (MDA) and serum levels of LDL-C, but also with an increment in the hepatic levels of superoxide dismutase (SOD) and glutathione (GSH). Interestingly, only treatment with γ-Oryzanol stimulated the mRNA levels of proliferator-activated receptor alpha (PPARα) and carnitine palmitoyltransferase 1 (CPT1) in the liver and white adipose tissue (WAT) of rats. Of note, the combination therapy of both drugs resulted in maximum effects and restored almost normal liver structure and basal levels of all the above-mentioned metabolic parameters. In conclusion, a combination therapy of γ-Oryzanol and NAC is an effective therapy to treat NAFLD, which can act via several mechanisms on the liver and adipose tissue.

Weekly green space visit duration is positively associated with favorable health outcomes in people with hypertension: Evidence from Shenzhen, China

BACKGROUND

Studies from high income 'western' countries indicate that green space visit duration is associated with better health. However, scant comparable research has been done in developing countries with rapid urbanization and on the potential health impacts of specific green infrastructure.

OBJECTIVE

Associations between green space visit duration, green infrastructure and various health outcomes were assessed in hypertensive patients.

METHODS

A stratified multi-stage cluster random sampling method was applied to select 1116 patients with hypertension aged 35 years or older in Shenzhen, China. Face-to-face survey, physical examination and laboratory biochemical tests were applied to obtain information. Binary logistic regressions with restricted cubic splines were used to explore the degree of linearity in associations between green space visit duration and the following health outcomes: central obesity; diabetes; blood pressure; dyslipidemia; poor physical health; poor mental health. Models were adjusted for age, sex, education, marital status, occupation, and socioeconomic status. Further analysis was made for presence of the following health promoting green infrastructure: health knowledge promotion areas; walking trails; fitness areas; group exercise venues.

RESULTS

Each additional 30 min green space visitation was linearly associated with lower odds of self-reported poor mental health [OR (95%CI): 0.937 (0.891-0.985)], self-reported poor physical health [OR (95%CI): 0.918 (0.872-0.966)], and central obesity [OR (95%CI): 0.951 (0.907-0.997)]. Odds of poor mental health [OR (95%CI): 0.886 (0.788-0.997)], poor physical health [OR (95%CI): 0.882 (0.782-0.996)] and central obesity [OR (95%CI): 0.855 (0.765-0.955)] were founded to decrease with a greater number of health promoting green infrastructure.

CONCLUSION

More time spent in green space and with more types of green infrastructure were favourably associated with central obesity, and physical and mental health in people with hypertension.

Identification of a novel hypotensive peptide from porcine plasma hydrolysate by in vitro digestion and rat model

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Porcine plasma was enzymatically hydrolyzed with different times.

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The hydrolysate with high hydrolysis degree was isolated and purified by G-15 gel chromatography and HPLC.

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The ace inhibition rates of different purified compounds were determined.

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The sequence of the polypeptide with best ace inhibition (IFPPKPKDTL) was determined by Q exactive LC-MS / MS.

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The hypotensive function of synthetic peptide IFPPKPKDTL was also determined in spontaneously hypertensive rat.

We separated a novel functional peptide IFPPKPKDTL from porcine plasma hydrolysate by chromatography, HPLC, and identified by Q Exactive LC-MS/MS. Results showed that IFPPKPKDTL had a significant ability of ACE inhibition (76.6%) likely due to the presence of hydrophobic, aromatic, and acidic amino acids that can inactivate ACE by binding Zn²⁺, providing a hydrogen atom to maintain the link between ACE and the peptide. Furthermore, the ACE inhibition of synthetic IFPPKPKDTL was improved by 15.6% after in vitro digestion. Additionally, the systolic blood pressure and diastolic blood pressure of spontaneously hypertensive rats gavaged by the peptide (30 mg/kg). Thereby, ACE inhibitory peptide IFPPKPKDTL from porcine plasma was stable and has potential functional value.

Relationship Between Lipid Profiles and Hypertension: A Cross-Sectional Study of 62,957 Chinese Adult Males

Background

Patterns of dyslipidemia and incidence of hypertension have been rarely reported in Asian populations with inconsistent findings. To accumulate further evidence in Asian populations, the study aimed to investigate the relationship between lipid profiles and hypertension in Chinese adult males.

Methods

We conducted a cross-sectional study based on the data from the DATADRYAD database. The overall population was divided into hypertensive and non-hypertensive groups based on baseline blood pressure levels. For continuous variables, Mann-Whitney test was performed between two groups, while Kruskal-Wallis and Dunn tests were used among multiple groups. The chi-square test was carried out for dichotomous variables. Spearman's correlation coefficient was employed to assess the association between systolic blood pressure (SBP), diastolic blood pressure (DBP) and lipid profiles, whereas the relationship between lipid profiles and the incidence of hypertension was evaluated using multivariate logistic regression. The Bayesian network (BN) model was adopted to investigate the relationship between clinical characteristics and hypertension, and the importance of related predictor to the incidence of hypertension was obtained to make conditional probability analysis.

Results

Finally, totally 62,957 participants were included in this study. In the lipid profiles, total cholesterol (TC), low-density cholesterol (LDL-c), and non- high-density lipoprotein cholesterol (non-HDL-c) were higher in the hypertensive population (p <0.001). In the fully multivariate model, for every 1 mg/dl increase in TC, LDL-c and non-HDL, the risk of hypertension increased by 0.2% [1.002 (1.001–1.003)], 0.1% [1.001 (1.000–1.002)], and 0.1% [1.001 (1.000–1.002)]. Meanwhile, HDL-c became positively associated with the incidence of hypertension (p for trend < 0.001) after adjusting for the body mass index (BMI), and 1 mg/dl increment in HDL-c increased the risk of hypertension by 0.2% [1.002 (1.000–1.002)] after fully adjusting for multiple variables. Furthermore, the BN showed that the importance of age, BMI, fasting plasma glucose (FPG), and TC to the effect of hypertension is 43.3, 27.2, 11.8, and 5.1%, respectively.

Conclusion

Elevated TC, LDL-c, and non-HDL-c were related to incidence of hypertension in Chinese adult males, whereas triglycerides (TG) was not significantly associated. The relationship between HDL-c and hypertension incidence shifted from no association to a positive correlation after adjusting for the BMI. Moreover, the BN model displayed that age, the BMI, FPG, and TC were strongly associated with hypertension incidence.

Comparison of the Prevalence of Cardiometabolic Disorders and Comorbidities in Korea and the United States: Analysis of the National Health and Nutrition Examination Survey

BACKGROUND

Comparison of the prevalence of cardiometabolic disorders (CMDs) and comorbidities in Korea and the United States (US) can be an important indicator for forecasting future risk of cardiovascular events in Korea. This study aimed to estimate and compare the prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, obesity, and metabolic syndrome (MetS) in Korea and the US.

METHODS

A total of 15,872 individuals from the US National Health and Nutrition Examination Survey (NHANES) 2003-2014 and 26,492 from the Korea NHANES (KNHANES) 2007-2014 were included. Additionally, 164,339 (139,345 from the Health Examinees-Gem Study and 24,994 from the Cardiovascular Disease Association Study) participants enrolled in the Korea Genome and Epidemiology Study were included to investigate the differences of CMDs between urban and rural regions. To estimate the age-standardized prevalence of CMDs in individuals aged 40-69 years, direct standardization using the World Health Organization standard population was performed.

RESULTS

The prevalence of CMDs was lower in Korea than the US (hypertension 49.9% vs. 56.8%; DM 13.4% vs. 14.3%; hypercholesterolemia 16.8% vs. 17.8%; obesity 36.2% vs. 38.6%; and MetS 29.4% vs. 36.5%). According to the median survey years, dyslipidemia has become more prevalent in Korea than in the US since 2010. The prevalence of CMDs was greater in rural than that in urban areas in Korea.

CONCLUSION

The prevalence of dyslipidemia in Korea exceeded that of the US after 2010, which was associated with increasing burden of cardiovascular events. The present study suggests that further preventive strategies are needed to mitigate the prevalence of CMDs in Korea.

Modulation of Dyslipidemia Markers Apo B/Apo A and Triglycerides/HDL-Cholesterol Ratios by Low-Carbohydrate High-Fat Diet in a Rat Model of Metabolic Syndrome

Metabolic syndrome (MetS) risks cardiovascular diseases due to its associated Dyslipidemia. It is proposed that a low-carbohydrate, high-fat (LCHF) diet positively ameliorates the MetS and reverses insulin resistance. Therefore, we aimed to investigate the protecting effect of the LCHF diet on MetS-associated Dyslipidemia in an experimental animal model. Forty male Sprague-Dawley rats were divided into four groups (10/group): the control group, dexamethasone-induced MetS (DEX) (250 µg/kg/day), LCHF-fed MetS group (DEX + LCHF), and High-Carbohydrate-Low-Fat-fed MetS group (DEX + HCLF). At the end of the four-week experiment, fasting glucose, insulin, lipid profile (LDL-C, HDL-C, Triglyceride), oxidized-LDL, and small dense-LDL using the ELISA technique were estimated. HOMA-IR, Apo B/Apo A1 ratio, and TG/HDL were calculated. Moreover, histological examination of the liver by H & E and Sudan III stain was carried out. In the DEX group, rats showed a significant (p < 0.05) increase in the HOMA-IR, atherogenic parameters, such as s-LDL, OX-LDL, Apo B/Apo A1 ratio, and TG/HDL. The LCHF diet significantly improved the parameters of Dyslipidemia (p < 0.05) by decreasing the Apo B/Apo A1 and TG/HDL-C ratios. Decreased steatosis in LCHF-fed rats compared to HCLF was also revealed. In conclusion, the LCHF diet ameliorates MetS-associated Dyslipidemia, as noted from biochemical results and histological examination.

Association between Heavy Metal Exposure and Dyslipidemia among Korean Adults: From the Korean National Environmental Health Survey, 2015-2017

Cardiovascular disease (CVD) is a leading cause of death in Korea. Dyslipidemia, characterized by the presence of abnormal lipid levels, has been suggested as an early diagnostic and preventable factor for CVD. Recent studies have shown that exposure to lead (Pb), cadmium (Cd), and mercury (Hg) affects lipid metabolism. This study aimed to verify the association between heavy metal concentrations and serum lipid profiles in the general population. A representative sample of 2591 Korean adults from the Korean National Environmental Health Survey (2015−2017) was analyzed. The associations between heavy metals [Blood Pb (BPb), blood Hg (BHg), urinary Hg (UHg), urinary Cd (UCd)] and serum lipid profiles [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), non-low level of high-density lipoprotein cholesterol (Non-HDL-C)] were assessed using regression analysis. After adjusting for demographic and socioeconomic factors, the proportional changes in serum lipid levels were significantly associated with increases in BPb, BHg, and UHg levels (p for trend < 0.05). Overall, BPb, BHg, and Uhg levels positively correlated with dyslipidemia, whereas UCd levels did not show a significant association. Our results suggest that heavy metal exposure, at low levels, may contribute to an increased prevalence of dyslipidemia in Korean adults.

Lipid-Lowering Efficacy of the Capsaicin in Patients With Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Patients with metabolic syndrome (MetS) have increased cardiovascular risk. Capsaicin (CAP) has been shown to reduce lipids, but efficacy for patients with MetS is unknown.

Methods

A systematic review was performed according to PRISMA guidelines, to compare the effects of CAP against a placebo. Differences in the weight mean difference (WMD) with 95% confidence intervals (95% CI) were then pooled using a random effects model.

Results

Nine randomized controlled trials including 461 patients were identified in the overall analysis. CAP significantly decreased total cholesterol (TC) (WMD = −0.48, 95% CI: −0.63 to −0.34, I²= 0.00%) and low-density lipoprotein cholesterol (LDL-C) (WMD = −0.23, 95% CI: −0.45 to −0.02, I² = 68.27%) among patients with MetS. No significant effects of CAP were found on triglycerides (TG) or high-density lipoprotein cholesterol (HDL-C) (WMD = −0.40, 95% CI: −1.50 to 0.71, I² = 98.32%; WMD = −0.08, 95% CI: −0.21 to 0.04, I² = 86.06%). Subgroup analyses indicated that sex and intervention period were sources of heterogeneity. The results revealed that CAP decreased TG levels in women (WMD = −0.59, 95% CI: −1.07 to −0.10) and intervention period <12 weeks (WMD = −0.65; 95% CI: −1.10 to −0.20). And there was no potential publication bias according to funnel plot, Begg' test and Egger regression test.

Conclusions

CAP supplementation is a promising approach to decreasing TC and LCL-C levels in patients with MetS. However, short-term (<12 weeks) use of CAP in women may also reduce TG levels.

Systematic Review Registration

Identifier: CRD42021228032.

Effect of EPOC on Serum MicroRNA Expression in Patients with Hypertension

In order to analyze the effect of EPOC on serum microRNA expression in patients with hypertension, we have carried out an experimental evaluation and presented a dedicated method to improve its effectiveness. For this purpose, 60 patients with hypertension treated in our hospital from January to December 2020 were selected and randomly divided into the EPOC group (30 cases) and the control group (30 cases). Patients in both groups received conventional hypertension medication according to the treatment guidelines, and education and guidance were strengthened to ensure patients' drug compliance. The EPOC group received EPOC training in addition to conventional medication. After the intervention, 6MWD, LVEF, and LVEDD in the control group and the EPOC group were significantly improved compared with that before treatment (P < 0.05). The improvement of cardiac function in the EPOC group was significantly better than that in the control group (P < 0.05). Physiological function, physiological characteristics, body pain, and general health of the control group and the EPOC group were significantly improved compared with that before treatment (P < 0.05). The improvement of quality of life in the EPOC group was significantly better than that in the control group (P < 0.05). The indexes of heart rate, oxygen pulse, minute ventilation, oxygen uptake in kg, and anaerobic threshold in the EPOC group were significantly better than those in the control group before and after treatment (P < 0.05). Full-sample real-time PCR verification of the 8 miRNAs with the highest expression differentiation showed that, compared with the control group, the expression levels of miR-20a-5p, miR-93-5p, and miR-1287-5p in the serum of the EPOC group were significantly increased, while the expression levels of miR-7706, miR-28-5p, and miR-125b-5p were significantly decreased. The expression of miR-20a-5p was the highest, while the expression of miR-125b-5p was the lowest, suggesting that miR-20a-5p and miR-125b-5p might be involved in the process of HIIT to improve hypertension. After EPOC rehabilitation treatment, patients' heart function indexes, lung function indexes, and quality of life have been significantly improved. EPOC rehabilitation can improve exercise tolerance, enhance cardiopulmonary function, and improve the prognosis of patients.

Nanomedicine of Plant Origin for the Treatment of Metabolic Disorders

Metabolic disorders are major clinical challenges of health that are progressing globally. A concurrence of metabolic disorders such as obesity, insulin resistance, atherogenic dyslipidemia, and systematic hypertension leads to metabolic syndrome. Over the past years, the metabolic syndrome leads to a five- and two-fold rise in diabetes mellitus type II and cardiovascular diseases. Natural products specifically plant extracts have insulin-sensitizing, anti-inflammatory, and antioxidant properties and are also considered as an alternative option due to few adverse effects. Nanotechnology is one of the promising strategies, which improves the effectiveness of treatment and limits side effects. This review mainly focuses on plant extract-based nanosystems in the management of the metabolic syndrome. Numerous nano-drug delivery systems, i.e., liposomes, hydrogel nanocomposites, nanoemulsions, micelles, solid lipid, and core–shell nanoparticles, have been designed using plant extracts. It has been found that most of the nano-formulations successfully reduced oxidative stress, insulin resistance, chronic inflammation, and lipid profile in in vitro and in vivo studies as plant extracts interfere with the pathways of metabolic syndrome. Thus, these novel plant-based nanosystems could act as a promising candidate for clinical applications.

The effects of the interaction between BMI and dyslipidemia on hypertension in adults

Body mass index (BMI) and dyslipidemia are indicators of human health and are often associated with high blood pressure. In this study,we explored the relationship between BMI or dyslipidemia and the risk of hypertension and further verified the possible interacting influences of BMI with dyslipidemia on the risk of hypertension. The aim is to explore the possible risk factors of hypertension and to provide scientific basis for the prevention and treatment of hypertension. Eligible subjects were selected from a cross-sectional survey in Changsha City, and we collected relevant data and clinical indicators for each participant. Body mass index (BMI) was calculated as weight (kg)/height² (m²), and divided into four categories according to the Chinese standard. Dyslipidemia is defined according to Chinese guideline. Unconditional logistic regression models were used for dichotomous variables to determine the risk or protective factors of dependent variables. Multivariate Logistic model was used to study the influence of BMI and dyslipidemia on hypertension. The following indicators were used to assess the interaction effects: (1) Relative excess risk due to interaction (RERI); (2) Attributable proportion due to interaction(AP); (3) Synergy index (SI). SPSS software was used for statistical analysis. A total of 2740 eligible participants were enrolled in the cross-sectional study, of which 765 subjects (27.9%) were diagnosed with hypertension. Multivariate Logistic model showed that overweight (OR: 1.70, 95%CI: 1.39–2.09) or obese (OR: 2.60, 95%CI: 1.84–3.66) subjects had a significantly higher risk of hypertension than normal weight people, and underweight was a protective factor for hypertension(OR: 0.52, 95%CI: 0.29–0.93). People with dyslipidemia have a higher risk of hypertension than those with normal lipids (OR: 3.05, 95%CI: 2.36–3.90). In addition,there was a significant potentiating interaction effect between overweight or obesity and dyslipidemia(overweight: RERI (1.91, 95%CI: 0.17–3.66), AP (0.40, 95%CI:0.14–0.66), SI (2.03, 95%CI:1.11–3.74) and obesity: RERI (2.20, 95%CI:1.01–3.40), AP (0.38, 95%CI:0.18–0.58), SI (1.84, 95%CI:1.18–2.89), while no interaction was found between underweight and dyslipidemia. Low body weight is an independent protective factor for hypertension, but overweight, obesity and dyslipidemia are risk factors for hypertension, and dyslipidemia significantly shared interactions with overweight and obesity that influenced the risk of hypertension.

The relationship between lipid risk score and new-onset hypertension in a prospective cohort study

BACKGROUND

Dyslipidemia and hypertension are both important risk factors for atherosclerotic cardiovascular diseases. However, the relationship between dyslipidemia and incident hypertension remains to be elucidated comprehensively. The main purpose of this study was to construct the lipid risk score to explore the risk prediction effect of integrated lipid indices on new-onset hypertension.

METHODS

This prospective cohort study with 2116 non-hypertensive subjects was conducted from 2009 to 2020. New hypertension events during the follow-up period were recorded and verified. The lipid risk score was calculated by summing coded total cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol weighted with corresponding effect sizes. Cox regression analysis was used to estimate the association between the lipid risk score or lipid indices and incident hypertension in the subgroup of age (< 55 and≥ 55 years at baseline).

RESULTS

After a median of 10.75-year follow-up, 637 incident hypertension cases were identified. The restricted cubic spline showed that the lipid risk score had a positive linear correlation with hypertension (P< 0.001). Among people< 55 years, with every increase of 0.94 in lipid risk score, the risk of hypertension increased by 37% (adjusted HR [95%CI]: 1.369 [1.164-1.610]). This association was not modified by overweight or obesity.

CONCLUSIONS

The integrated lipid risk score, independent of traditional risk factors, has a significantly predictive effect on hypertension in people younger than 55 years. This finding may aid in identifying high-risk individuals for hypertension, as well as facilitating early intervention and management to reduce adverse cardiovascular events. Comprehensive lipid management should be attached importance in the prevention and control of hypertension.

Paternal body mass index before conception associated with offspring's birth weight in Chinese population: a prospective study

Whether paternal epigenetic changes resulting from nutrition might be inherited by their offspring remains unknown. This study evaluated the relationship between preconception paternal body weight and their offspring's birth weight in 1,810 Chinese mother-father-baby trios. Information on paternal and maternal preconception body weight and height was collected via a self-reported questionnaire. Birth weight was collected from medical records. Paternal preconception body weight was associated with offspring's birth weight (p trend = .02) after multivariate adjustment. Each standard deviation increment of paternal body mass index was associated with an additional 29.6 g increase of birth weight (95% confident interval: 5.7 g, 53.5 g). The association was more pronounced in male neonates, and neonates with overweight mothers, and with mothers who gained excessive gestational weight, compared to their counterparts (all p interaction < .05). Sensitivity analyses showed similar pattern to that of the main analysis. Paternal preconception body weight was associated with birth weight of their offspring.Impact statementWhat is already known on this subject? More efforts have previously been put on the maternal contribution to birth weight, however, it is uncertain whether paternal pre-conceptional body weight, an indicator for epigenetic information, might be inherited by their offspring.What do the results of this study add? In the current study that included 1,810 Chinese mother-father-baby trios, a small but significant association was observed between paternal preconception body weight and offspring's birth weight (p trend =.02).What are the implications of these findings for clinical practice and/or further research? Paternal epigenetic information of nutrition could be inherited by their offspring.

The Effect of Curcumin in Improving Lipid Profile in Patients with Cardiovascular Risk Factors: A Systematic Review of Clinical Trials

Cardiovascular disease (CVD) is a major cause of death worldwide. Lipid abnormalities are one of the major risk factors for CVD. Curcumin is a natural polyphenol with lipid-lowering properties. Therefore, we carried out a systematic review to summarize the randomized controlled trials (RCTs) investigating the effect of curcumin on lipid profile in patients at risk of CVD. A comprehensive systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar up to March 1, 2020, to identify controlled clinical trials assessing the effects of curcumin on lipid profile in patients at risk of CVD. From 1051 initially identified studies, 22 met the eligibility criteria. Curcumin supplementation significantly reduced at least one of the lipid profile indices (triglycerides, total cholesterol, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol) in 15 studies and improved more than one index in five studies. However, curcumin had no effect on any of lipid profile indices in seven studies. Overall, studies using a bioavailable formulation of curcumin had a better impact on the lipid profile. The findings of this systematic review showed that curcumin supplementation significantly reduced at least one of the lipid profile indices in more than two-thirds of the included studies. Curcumin might be used as an accessible, inexpensive, and safe agent to reduce risk of CVD. More randomized, clinical controlled trials are needed to verify these results.

Comparative efficacy of fixed-dose statin and antihypertensive agent combinations: A network meta-analysis of randomized controlled trials

BACKGROUND

The concurrent administration of statins and antihypertensive agents has been associated with improved cardiovascular outcomes, although the optimal fixed-dose combination remains unclear. This meta-analysis aims to compare the blood pressure and lipid-lowering effects of various statin and antihypertensive drug combinations.

METHODS

PubMed, Scopus, Web of Science, CENTRAL and Clinicaltrials.gov were systematically searched from inception to 20 March 2021. Randomized controlled trials evaluating the effects of statin-antihypertensive agent combinations on systolic blood pressure or serum lipids were held eligible. A random-effects frequentist model was applied to provide estimates of mean difference of percentage change.

RESULTS

Overall, 18 studies were included, comprising 4450 patients. Compared to statin monotherapy no significant difference in the percentage change of low-density lipoprotein cholesterol was achieved by adding any antihypertensive agent. Compared to amlodipine monotherapy, the addition of moderate-intensity statin resulted in a significantly greater percentage reduction of systolic blood pressure (-2.22%, 95% confidence intervals: [-3.82 to -0.62]). Combined high-intensity statin and amlodipine lead to significant increase of high-density lipoprotein cholesterol (8.34%, 95% confidence intervals: [0.73 to 15.95]), while effective triglyceride reduction was achieved by adding amlodipine and telmisartan to high-intensity statin (-14.68%, 95% confidence intervals: [-28.48 to -0.89]). No significant difference of adverse effects was observed.

CONCLUSION

The present network meta-analysis suggests that the administration of fixed-dose combinations of statins and antihypertensive agents is safe and effective in reducing blood pressure and serum lipids. The optimal dosing strategy to prevent cardiovascular events remains to be determined.

Effects of acute moderate-intensity exercise at different duration on blood pressure and endothelial function in young male patients with stage 1 hypertension

PURPOSE

The studies regarding the effects of exercise duration on blood pressure have reported inconsistent and conflicting results. Nitric oxide (NO) is a well-known vasodilator released by endothelial cells, and endothelial microparticles (EMPs) are membranous vesicles released into the circulation from activated or apoptotic endothelial cells, both of whose level can reflect the endothelial function. But few studies have been done to explore the effect of exercise duration on blood pressure and endothelial function, especially, the EMPs response to exercise in young male patients with hypertension. This study aimed to investigate the blood pressure response during moderate-intensity exercise performed in different durations and the acute effects on post-exercise hypotension and endothelial function in hypertensive patients.

METHODS

Eighteen young male hypertensive patients who did not take antihypertensive drugs were recruited in this study. They randomly performed twice exercises on a cycle ergometer at a moderate intensity of 40%-50% of their HR reserve; one was 20 min (E20 session), the other one was 40 min (E40 session); there was 1-week break between the two exercises. Blood pressure was monitored by the YUWELL blood pressure monitor at rest, every 5 min during exercise, and 3 and 6 min post-exercise. The level of NO (nitrate/nitrite reduction) and EMPs (flow cytometry) in plasma were detected before and immediately following exercise. CD31⁺/CD42b^- events were classified as EMPs and events per microliter plasma were calculated. This study was approved by the Beijing Sport University Institutional Review Board (protocol number 2019087 H).

RESULTS

Mean age of patients was 34.8 ± 3.5 yrs, and BMI was 27.6 ± 2.7 kg/m². Systolic blood pressure (SBP) in the two sessions increased significantly during exercise. The SBP in the E20 session increased by 37 mmHg (P < .01) at 5 min during exercise and remained stable afterward. In the E40 session, the SBP increased by 35 mmHg (P < .01) at 5 min during exercise and was stable at 5 through 25 min, decreased by 8 mmHg at 25 through 35 min during exercise, and then stabilized (P < .01). There was no obvious change of diastolic blood pressure (DBP) in the two sessions during exercise. In the E20 session, SBP at 6 min following exercise was no different from the rest; in the E40 session, SBP at 6 min following exercise was 14 mmHg lower than at the rest (P < .01). DBP in the E20 session was the same as rest at 3 min following exercise and decreased by 4 mmHg at 6 min following exercise compared with the rest (P < .05), while DBP in the E40 session decreased by 3 mmHg at 3 min following exercise compared with the rest (P < .05). The plasma NO levels of E20 and E40 increased significantly following exercise (P < .01 for both). There was no difference in plasma NO level between the two sessions pre- and post-exercise, but the increased magnitude of NO level in E40 was greater than that in E20 (24.47% vs. 9.24%, P < .01). The plasma EMPs level of E20 and E40 decreased significantly following exercise (P < .01 for both). There was no difference in plasma EMPs level between the two sessions pre- and post-exercise, but the decreased magnitude of EMPs level in E40 was greater than that in E20 (15.66% vs. 8.00%, P < .01).

CONCLUSION

There is no exaggerated blood pressure response to 20-min and 40-min acute moderate-intensity exercise in young hypertensive men with no antihypertensive drugs. Both 20-min and 40-min acute moderate exercise can reduce the rest blood pressure, and improve endothelial function by increasing NO and decreasing EMPs in young male patients with hypertension, and the effects of 40-min exercise on lowering SBP and improving endothelial function are better than that of 20-min.

The emerging role of gut microbiota in cardiovascular diseases

There is mounting evidence which suggests the involvement of gut microbiota dysbiosis in the pathogenesis of various cardiovascular diseases (CVD) and associated risk states such as hypertension, type 2 diabetes, obesity and dyslipidaemia, atherosclerosis, heart failure and atrial fibrillation. The current review comprehensively summarizes the various pathogenetic mechanisms of dysbiosis in these conditions and discusses the key therapeutic implications. Further deeper understanding of the pathogenetic links between CVD and gut microbiota dysbiosis can aid in the development of novel microbiota-based targets for the management of CVDs.

Intravenous Curcumin Mitigates Atherosclerosis Progression in Cholesterol-Fed Rabbits

Orally administered curcumin has been found to have a moderate therapeutic effect on dyslipidemia and atherosclerosis. The present study was conducted to determine lipid-modulating and antiatherosclerosis effects of injectable curcumin in the rabbit model of atherosclerosis induced by a high cholesterol diet (HCD). New Zealand white male rabbits were fed on a normal chow enriched with 0.5% (w/w) cholesterol for 8 weeks. Atherosclerotic rabbits were randomly divided into three groups, including a control group receiving intravenous (IV) injection of the saline buffer, two treatment groups receiving IV administration of the injectable curcumin at low (1 mg/kg/week) and high (10 mg/kg/week) over 4 weeks. Plasma lipid parameters, including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and total cholesterol (TC) were measured. Aortic arch atherosclerotic lesions were assessed using hematoxylin and eosin (H&E) staining. The low dose of curcumin significantly reduced plasma levels of TC, LDL-C, and TG by -14.19 ± 5.19%, -6.22 ± 1.77%, and - 29.84 ± 10.14%, respectively, and increased HDL-C by 14.05 ± 6.39% (p < 0.05). High dose of curcumin exerted greater lipid-modifying effects, in which plasma levels of TC, LDL-C, and TG were significantly (p < 0.05) decreased by -56.59 ± 10.22%, -44.36 ± 3.24%, and - 25.92 ± 5.57%, respectively, and HDL-C was significantly increased by 36.24 ± 12.5%. H&E staining showed that the lesion severity was lowered significantly in the high dose (p = 0.03) but not significantly (p > 0.05) in the low-dose curcumin groups, compared to control rabbits. The median (interquartile range) of plaque grades in the high dose and low dose, and control groups was found to be 2 [2-3], 3 [2-3], and 4 [3-4], respectively. The injectable curcumin could significantly improve dyslipidemia and alleviate atherosclerotic lesion in HCD-induced atherosclerotic rabbits.

Hypolipidaemic and Insulin Secretagogue Activities of (R)-(-)-Carvone

BACKGROUND

Dyslipidaemias are common in patients with diabetes mellitus. A high prevalence of type 2 diabetes in hyperlipidaemic patients also exists. The aim of this study was to find a treatment that lowers both blood glucose and lipid levels simultaneously.

METHODS

The hypolipidaemic effect of (R)-(-)-carvone was investigated in a tyloxapol-induced hyperlipidaemia mice model. Furthermore, its effect on insulin secretion and proliferation of 1.1E7 human pancreatic β-cells was studied. In addition, using molecular docking, the binding affinity of (R)-(-)-carvone against 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase was estimated.

RESULTS

(R)-(-)-carvone (100 mg/kg) decreased plasma triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C) levels and atherogenic index by 90.6%, 49.3%, 56.6% and 70.3%, respectively, but it had no effect on high-density lipoprotein cholesterol (HDL-C). Furthermore, it increased hepatic triglyceride level and catalase activity by 79.6% and 59.6%, respectively. In-vitro, 500 μM (R)-(-)-carvone increased insulin secretion by 454.4% and proliferation of 1.1E7 cells with no cytotoxic effects up to a concentration of 100 μM. Molecular docking simulation demonstrated a good binding affinity with -5.03 Kcal/mol of (R)-(-)-carvone to HMG-CoA reductase.

CONCLUSION

The hypolipidaemic effect of (R)-(-)-carvone is comparable to that of fenofibrate. (R)-(-)-carvone has the advantage over fenofibrate of not producing hypoglycaemia in animals. Furthermore, (R)-(-)-carvone increased proliferation and insulin secretion of human pancreatic β-cells.

Prevalence and Intensity of Periodontal Disease in Individuals with Metabolic Syndrome

Metabolic syndrome is one of the actual problems of modern medicine because of its high prevalence in the general population and its essential role in the development and progression of cardiovascular diseases.

In the last decade, studying the relationship between metabolic syndrome and periodontal diseases has attracted many scientists’ attention. Based on this, the study of the clinical features of periodontal diseases in the early stages of metabolic syndrome is relevant and necessary for timely and successful pathogenetic therapy.

The purpose of our study was to investigate and analyze the prevalence and intensity of periodontal disease in people with metabolic syndrome. To solve this goal, we surveyed 190 people with metabolic syndrome who were registered at the endocrinological clinic in Chernivtsi. They formed the main observation group. The comparison observation group included 90 people without metabolic disorders. The age of the patients ranged from 25 to 55 years. Periodontal disease was detected in 155 of 190 patients with metabolic syndrome (81.58 ± 2.82%). In 90 patients without endocrinological pathology, the prevalence of periodontal disease was 1.2 times lower (65.56 ± 5.04%; p <0.01). Generalized periodontitis prevailed in the structure of periodontal diseases in patients with metabolic syndrome: 26.45±3.56% cases were in the second stage of generalized periodontitis (GP), and 21.94±3.33% in the third stage of GP, р<0.01. Therefore, the metabolic syndrome, as a state with a high risk of diabetes development, creates conditions for the formation and rapid progression of inflammatory-destructive periodontal lesions.

BMI, high-sensitivity C-reactive protein and the conversion from metabolically healthy to unhealthy phenotype in Chinese adults: a cohort study

OBJECTIVE

We performed the cohort study to evaluate the association between BMI, high-sensitivity C-reactive protein (hs-CRP) and the conversion from metabolically healthy to unhealthy phenotype in Chinese adults.

DESIGN

Metabolically healthy was defined as participants without history of metabolic diseases and with normal fasting blood glucose level, glycated Hb A1c level, blood pressure, lipid profile, serum uric acid level and liver ultrasonographic findings at baseline. Participants were either classified into normal weight (18·5 ≤ BMI < 24·0 kg/m2) and overweight (BMI ≥ 24·0 kg/m2) based on baseline BMI, or low (<1 mg/l) and high (≥1 mg/l) groups based on baseline hs-CRP. The conversion from metabolically healthy to unhealthy phenotype was deemed if any of the metabolic abnormalities had been confirmed twice or more during 5 years of follow-up.

RESULTS

Included were 4855 (1942 men and 2913 women, aged 36·0 ± 8·9 years) metabolically healthy Chinese adults. We identified 1692 participants who converted to metabolically unhealthy phenotype during the follow-up. Compared with their counterparts, the adjusted hazards ratio of the conversion was 1·19 (95 % CI 1·07, 1·33) for participants with overweight, while it was 1·15 (95 % CI 1·03, 1·29) for those with high hs-CRP level (≥1 mg/l). Further adjustment of hs-CRP did not materially change the association between BMI and the conversion. However, the association between hs-CRP and the conversion was not significant after further adjustment of BMI. The sensitivity analysis generated similar results to main analysis.

CONCLUSION

BMI was associated with the risk of the conversion from metabolically healthy to unhealthy status in Chinese adults.

Effect of green tea extract on lipid profile in patients with type 2 diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Previous studies have indicated controversial results regarding the efficacy of green tea extract (GTE) in improving the lipid profile of type 2 diabetes mellitus (T2DM) patients. We aimed to conduct a systematic review and meta-analysis to pool data from randomized controlled trials (RCTs).

METHODS

A systematic search was performed in Web of Science, PubMed, and Scopus databases, without any language and time restriction until August 2019, to retrieve the RCTs which examined the effects of GTE on serum concentrations of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG) or total cholesterol (TC) in T2DM patients. Meta-analyses were carried out using a random effects model. I2 index was used to evaluate the heterogeneity.

RESULTS

Initial search yielded 780 publications. Of these, seven studies were eligible. The supplementary intake of GTE improved lipid profile by reducing serum TG concentrations in patients with T2DM. Meanwhile, subgroup analyses based on duration of interventions (≤8 and > 8 weeks) and intervention dosage (≤800 and > 800 mg/day) showed that the GTE supplementation longer than 8 weeks and in doses >800 mg/day resulted in a significant decrease in serum TG concentrations. Furthermore, intervention longer than 8 weeks with doses lower than 800 mg/day resulted in a significant reduction in serum TC concentrations.

CONCLUSION

In conclusion, present systematic review and meta-analysis revealed that the supplementary intake of GTE may improve lipid profile by reducing serum concentrations of TG in patients with T2DM. Furthermore, the results of our stratified analyses suggested that long-term GTE intervention may reduce serum concentrations of TG and TC.

Time-varying and dose-dependent effect of long-term statin use on risk of type 2 diabetes: a retrospective cohort study

BACKGROUND

We evaluated the effect of statin use on new-onset type 2 diabetes among individuals without atherosclerotic cardiovascular disease (ASCVD) using nationally representative South Korean claims data (2002-2013, N = 1,016,820).

METHODS

A total of 13,698 patients (statin users 5273, non-statin users 5273) aged 40-74 years, newly diagnosed with dyslipidemia but without any history of diabetes or ASCVD, were selected in 2005. We followed up the final sample until 2013 and evaluated the cumulative incidence of type 2 diabetes. We used extended Cox regression models to estimate the time-varying adjusted hazard ratios of statin use on new-onset type 2 diabetes. We performed further analyses based on the cumulative defined daily dose of statin received per year to evaluate the degree of risk compared to non-statin users.

RESULTS

Over the mean follow-up period of 7.1 years, 3034 patients developed type 2 diabetes; the number of statin users exceeded that of non-users, demonstrating that statin use significantly increased the risk of new-onset type 2 diabetes. The risk of new-onset type 2 diabetes differed among statin users according to cDDD per year (adjusted HR = 1.31 [95% CI 1.18-1.46] for less than 30 cDDD per year; 1.58 [1.43-1.75] for 30-120 cDDD per year; 1.83 [1.62-2.08] for 120-180 cDDD per year; and 2.83 [2.51-3.19] for more than 180 cDDD per year). The diabetogenic effect of pitavastatin was not statistically significant, but the risk was the largest for atorvastatin. Long-term exposure (≥ 5 years) to statins was associated with a statistically significant increase in the risk of new onset type 2 diabetes in all statin subtypes explored, with the highest magnitude for simvastatin (HR = 1.916, 95% CI 1.647-2.228) followed by atorvastatin (HR = 1.830, 95% CI 1.487-2.252).

CONCLUSIONS

Statin use was significantly associated with an increased risk of new-onset type 2 diabetes. We also found a dose-response relationship in terms of statin use duration and dose maintenance. Periodic screening and monitoring for incident type 2 diabetes may be warranted in long-term statin users.

Dyslipidemia associated with body constitution in Traditional Chinese Medicine

Objective: This study aimed at investigating the association between dyslipidemia and body constitution of traditional Chinese medicine (BCTCM) may be clinically meaningful for the early diagnosis and treatment of dyslipidemia.

Methods: More than 4,000 participants were invited to a screening visit between 2011 and 2014, and 3,748 participants were available for data analysis. All study subjects underwent complete clinical baseline characteristics evaluation. Differences were determined using one-way analysis and [Formula: see text] analysis. Univariate regression analyses and multiple-variable logistic regressions (MLRs) determined the association between BCTCM variables and outcomes.

Results: In the dyslipidemia group, the Qi-deficient and Yang-deficient types accounted for more participants than others, and these two types were significantly associated with the outcome ([Formula: see text]). MLRs detected significant associations between the Qi-deficient and Yang-deficient types with dyslipidemia ([Formula: see text] for the two), and their odds ratios (ORs) for dyslipidemia were 1.211 and 1.234, respectively.

Conclusion: Qi-deficient and Yang-deficient types are independently and significantly associated with dyslipidemia. Participants with Qi-deficient and Yang-deficient constitutions have a higher incidence of dyslipidemia.

Separate and combined associations of physical activity and obesity with lipid-related indices in non-diabetic and diabetic patients

BACKGROUND

This study evaluated the separate and combined associations of physical activity and obesity with blood lipids in Chinese adults with and without diabetes.

METHODS

Data of 17,535 participants aged 18 to 78 years old were collected. Physical activity was categorized as inactive (low) or active (moderate or high) according to the International Physical Activity Questionnaire. Linear and logistic regression analyses were performed to investigate the associations of physical activity and obesity with lipid-related indices.

RESULTS

Compared with physically active participants, inactive participants had higher triglyceride (TG) level, lower high-density lipoprotein cholesterol (HDL-C) level, and higher odds ratios for abnormal TG and HDL-C. Compared with non-obese participants, obese participants had higher levels of total cholesterol (TC), TG and low-density lipoprotein cholesterol (LDL-C), lower HDL-C level, and higher odds ratios for the four abnormal lipid indices. Inactive obese participants had highest levels of TC, TG and LDL-C, lowest HDL-C level, and highest odds ratios compared to the other groups. No significant associations were found between obesity and TC, LDL-C in patients with diabetes.

CONCLUSIONS

Irrespective of diabetes, physical inactivity and obesity were associated with the presences of abnormal TG and HDL-C. Moreover, there were additive effects on blood lipids when physical inactivity and obesity co-occur.

Pharmacology of dipeptidyl peptidase-4 inhibitors and its use in the management of metabolic syndrome: a comprehensive review on drug repositioning

OBJECTIVES

Despite advances in our understanding of metabolic syndrome (MetS) and the treatment of each of its components separately, currently there is no single therapy approved to manage it as a single condition. Since multi-drug treatment increases drug interactions, decreases patient compliance and increases health costs, it is important to introduce single therapies that improve all of the MetS components.

EVIDENCE ACQUISITION

We conducted a PubMed, Scopus, Google Scholar, Web of Science, US FDA, utdo.ir and clinicaltrial.gov search, gathered the most relevant preclinical and clinical studies that have been published since 2010, and discussed the beneficial effects of dipeptidyl peptidase (DPP)-4 inhibitors to prevent and treat different constituent of the MetS as a single therapy. Furthermore, the pharmacology of DPP-4 inhibitors, focusing on pharmacodynamics, pharmacokinetics, drug interactions and their side effects are also reviewed.

RESULTS

DPP-4 inhibitors or gliptins are a new class of oral anti-diabetic drugs that seem safe drugs with no severe side effects, commonly GI disturbance, infection and inflammatory bowel disease. They increase mass and function of pancreatic β-cells, and insulin sensitivity in liver, muscle and adipose tissue. It has been noted that gliptin therapy decreases dyslipidemia. DPP-4 inhibitors increase fatty oxidation, and cholesterol efflux, and decrease hepatic triglyceride synthase and de novo lipogenesis. They delay gastric emptying time and lead to satiety. Besides, gliptin therapy has anti-inflammatory and anti-atherogenic impacts, and improves endothelial function and reduces vascular stiffness.

CONCLUSION

The gathered data prove the efficacy of DPP-4 inhibitors in managing MetS in some levels beyond anti-diabetic effects. This review could be a lead for designing new DPP-4 inhibitors with greatest effects on MetS in future. Introducing drugs with polypharmacologic effects could increase the patient's compliance and decrease the health cost that there is not in multi-drug therapy. Graphical abstract ᅟ.

Assessment Through the Short Physical Performance Battery of the Functionality in Individuals With Metabolic Syndrome Exposed to Whole-Body Vibration Exercises

Physical activity is recommended in the management of individuals with metabolic syndrome (MetS), and recent studies have suggested whole-body vibration exercise (WBVe) for this population. The aim of this study was to evaluate the functionality through the Short Physical Performance Battery (SPPB) in individuals with MetS after WBVe. The SPPB evaluates the balance, the gait speed, and the lower limb strength (five-chair stand [5CS] test). Forty-four individuals with MetS were divided into WBVe (WBVeG) and control (CG) groups. The individuals of the WBVeG performed 10 sessions of WBVe in an oscillating/vibratory platform (OVP), barefoot, for 3 minutes at the peak-to-peak displacements of 2.5, 5.0, and 7.5 mm, with a resting period of 1 minute (total time: 18 minutes/session). The frequencies ranged from 5 up to 14 Hz. The individuals of the CG performed all the steps of the study, but the OVP was turned off. Before the first and after the tenth session, the individuals performed the SPPB. Significant responses were found in the WBVeG, analyzing the total score of the SPPB (P = .005), the balance test (P = .01), the gait speed (P = .006), and the 5CS test (P = .03), resulting in the improvement of the functionality of individuals with MetS.

Quantifying the effects of spirulina supplementation on plasma lipid and glucose concentrations, body weight, and blood pressure

PURPOSE

Spirulina is generally used as a nutraceutical food supplement due to its nutrient profile, lack of toxicity, and therapeutic effects. Clinical trials have investigated the influence of spirulina on metabolic-related risk factors but have yielded conflicting results in humans. Here, we summarize the evidence of the effects of spirulina on serum lipid profile, glucose management, BP, and body weight by conducting a meta-analysis.

MATERIALS AND METHODS

Relevant studies were retrieved by systematic search of MEDLINE, EMBASE, Scopus databases, and reference lists of relevant original studies from inception to July 2018. Data were extracted following a standardized protocol. Two investigators independently extracted study characteristics, outcomes measures, and appraised methodological quality. Effect sizes were performed using a random-effects model, with weighted mean differences (WMDs) and 95% CIs between the means for the spirulina intervention and control arms. Subgroup analyses were conducted to explore the possible influences of study characteristics. Publication bias and sensitivity analysis were also performed.

RESULTS

A total of 1,868 records were identified of which 12 trials with 14 arms were eligible. The amount of spirulina ranged from 1 to 19 g/d, and intervention durations ranged from 2 to 48 weeks. Overall, data synthesis showed that spirulina supplements significantly lowered total cholesterol (WMD = -36.60 mg/dL; 95% CI: -51.87 to -21.33; P=0.0001), low-density lipoprotein cholesterol (WMD = -33.16 mg/dL; 95% CI: -50.52 to -15.75; P=0.0002), triglycerides (WMD = -39.20 mg/dL; 95% CI: -52.71 to -25.69; P=0.0001), very-low-density lipoprotein cholesterol (WMD = -8.02 mg/dL; 95% CI: -8.77 to -7.26; P=0.0001), fasting blood glucose (WMD = -5.01 mg/dL; 95% CI: -9.78 to -0.24; P=0.04), and DBP (WMD = -7.17 mmHg; 95% CI: -8.57 to -5.78; P=0.001). These findings remained stable in the sensitivity analysis, and no obvious publication bias was detected.

CONCLUSION

Our findings provide substantial evidence that spirulina supplementation has favorable effect on select cardiovascular and metabolic biomarkers in humans, including lipid, glucose, and DBP management.

Correlation between Traditional Chinese Medicine Constitution and Dyslipidemia: A Systematic Review and Meta-Analysis

Objective

To study the correlation between Traditional Chinese Medicine (TCM) constitution and dyslipidemia.

Methods

CNKI, VIP, Wanfang database, CBMdisc, PubMed, and Embase were searched, and meta-analysis was performed by Review Manager 5.2 software.

Results

Altogether 11 studies were included with 12890 individuals. The results showed that balanced constitution was a protective factor of dyslipidemia (OR = 0.62, 95% CI 0.47~0.82) while phlegm-dampness constitution was a risk factor of it (OR = 2.50, 95% CI 2.22~2.80), and the effect of phlegm-dampness constitution in South China (OR = 3.31, 95% CI 1.71~6.43) was more obvious than that in East (OR = 2.40, 95% CI 2.06~2.80) and North China (OR = 2.24, 95% CI 1.81~2.78).

Conclusion

This study provides evidence for the prevention and treatment of dyslipidemia in TCM. However, most of the studies included are of moderate quality; more high quality, multicenter, large-sample studies are expected to provide higher level evidence.

Efficacy and safety of turmeric and curcumin in lowering blood lipid levels in patients with cardiovascular risk factors: a meta-analysis of randomized controlled trials

Background

Dyslipidemia is an important and common cardiovascular risk factor in the general population. The lipid-lowering effects of turmeric and curcumin are unconfirmed. We performed a meta-analysis to assess the efficacy and safety of turmeric and curcumin in lowering blood lipids in patients at risk of cardiovascular disease (CVD).

Methods

A comprehensive literature search was conducted on PubMed, Embase, Ovid, Medline and Cochrane Library databases to identify randomized controlled trials (published as of November 2016) that assessed the effect of turmeric and curcumin on blood lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Pooled standardized mean difference (SMD) with 95% confidence interval (CI) was used to assess the effect.

Results

The analysis included 7 eligible studies (649 patients). Turmeric and curcumin significantly reduced serum LDL-C (SMD = −0.340, 95% confidence interval [CI]: −0.530 to −0.150, P < 0.0001) and TG (SMD = −0.214, 95% CI: −0.369 to −0.059, P = 0.007) levels as compared to those in the control group. These may be effective in lowering serum TC levels in patients with metabolic syndrome (MetS, SMD = −0.934, 95% CI: −1.289 to −0.579, P < 0.0001), and turmeric extract could possibly have a greater effect on reducing serum TC levels (SMD = −0.584, 95% CI: −0.980 to −0.188, P = 0.004); however, the efficacy is yet to be confirmed. Serum HDL-C levels were not obviously improved. Turmeric and curcumin appeared safe, and no serious adverse events were reported in any of the included studies.

Conclusions

Turmeric and curcumin may protect patients at risk of CVD through improving serum lipid levels. Curcumin may be used as a well-tolerated dietary adjunct to conventional drugs. Further research is required to resolve uncertainties related to dosage form, dose and medication frequency of curcumin.

Electronic supplementary material

The online version of this article (10.1186/s12937-017-0293-y) contains supplementary material, which is available to authorized users.

Effect of Cinnamaldehyde on Glucose Metabolism and Vessel Function

Background

Material/Methods

Results

Conclusions

Correlation between Glycated Hemoglobin and Triglyceride Level in Type 2 Diabetes Mellitus

Context

Dyslipidemia is quite prevalent in non-insulin dependent diabetes mellitus. Maintaining tight glycemic along with lipid control plays an essential role in preventing micro- and macro-vascular complications associated with diabetes. 

Purpose

The main purpose of the study was to highlight the relationship between glycosylated hemoglobin (HbA1c) and triglyceride levels. This may in turn help in predicting the triglyceride status of type 2 diabetics and therefore identifying patients at increased risk from cardiovascular events. Hypertriglyceridemia is one of the common risk factors for coronary artery disease in type 2 diabetes mellitus (DM). Careful monitoring of the blood glucose level can be used to predict lipid status and can prevent most of the complications associated with the disease.

Method

This is a cross-sectional study using data collected from the outpatient diabetic clinic of Jinnah Postgraduate Medical Centre (JPMC) Karachi, Pakistan. Patients of age 18 years and above were recruited from the clinic. A total of consenting 509 patients of type 2 diabetes mellitus were enrolled over a period of 11 months. 

For statistical analysis, SPSS Statistics for Windows, Version 17.0 ( IBM Corp, Armonk, New York) was used and Chi-square and Pearson’s correlation coefficient was used to find the association between triglyceride and HbA1c. The HbA1c was dichotomized into four groups on the basis of cut-off. Chi-square was used for association between HbA1c with various cut-off values and high triglyceride levels. Odds-ratio and its 95% confidence interval were calculated to estimate the level of risk between high triglyceride levels and HbA1c groups. The p-value < 0.05 was considered statistically significant for all the tests applied for significance.

Result

The association of high triglyceride was evaluated in four different groups of HbA1c, with a cut-off seven, eight, nine and 10 respectively. With HbA1c cut-off value of 7%, 74% patients had high triglycerides and showed a significant association with high triglyceride levels at p < 0.001 and odds ratio was 2.038 (95% confidence interval: 1.397 – 2.972). Logistic regression models were adjusted for demographic factors (age, race, gender), lifestyle factors (smoking, body mass index, lifestyle) and health status factors (blood pressure, physician-rated health status).

Conclusion

After adjusting for relevant covariates, glycated hemoglobin was positively correlated with high triglyceride. Hence, HbA1c can be an indicator of triglyceride level and can be one of the predictors of cardiovascular risk factors in type 2 diabetes mellitus.

Hypotensive effects of genistein: From chemistry to medicine

Genistein (4', 5, 7-trihydroxyisoflavone), a naturally occurring flavonoid characteristic of Leguminoseae plants, is a phyto-oestrogen exerting oestrogenic activity as both an agonist and an antagonist substance. A large body of evidence suggests that genistein possesses many physiological and pharmacological properties that make this molecule a potential agent for the prevention and treatment of a number of chronic diseases. Growing evidence suggests that genistein could act as a vasodilating, anti-thrombotic, and anti-atherosclerotic agent, exerting these effects through different mechanisms of action. This paper aims to review data from the literature assessing the beneficial effects of genistein on hypertension, one of the most important cardiovascular disease risk factors along with hyperglycemia and hyperlidipemia. In addition, we discuss the chemistry, main sources and bioavailability of genistein. Scientific findings support genistein's potential as a promising anti-hypertensive agent in different experimental models. However, clinical trials are very limited and more research will be required before genistein intake can be recommended as part of therapies targeting raised blood pressure.

Therapies in non-alcoholic steatohepatitis (NASH)

The hallmark of non-alcoholic fatty liver disease (NAFLD) is excessive fatty accumulation in the hepatocytes, which may be an isolated event (non-alcoholic fatty liver, NAFL) or accompanied by evidence of inflammation and cell injury with or without fibrosis (non-alcoholic steatohepatitis, NASH). NASH, the more aggressive form of NAFLD, may progress to cirrhosis and hepatocellular carcinoma. Since NASH is estimated to overtake hepatitis C virus infection as the leading cause of liver transplantation in the US in the coming decade, and there are no current FDA-approved therapies for this disease, the need to find appropriate therapeutic targets is now more urgent than ever before. Diet and other lifestyle modifications have always been difficult to maintain and this approach alone has not slowed the rising tide of the disease. While the results of traditional therapies such as vitamin E and pioglitazone have been significant for steatosis and inflammation, they have had no effect on fibrosis, which is the strongest indicator of mortality in this condition. However, the understanding of the pathogenesis and progression of NASH has evolved and several promising novel therapies to target and possibly reverse fibrosis are being evaluated, making the future outlook of NASH therapy more optimistic.