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Chen Y, Chen S, Han Y, Xu Q, Zhao X. Elevated ApoB/apoA-1 is Associated with in-Hospital Mortality in Elderly Patients with Acute Myocardial Infarction. Diabetes Metab Syndr Obes 2023; 16:3501-3512. [PMID: 37942174 PMCID: PMC10629450 DOI: 10.2147/dmso.s433876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
Background Apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) has been shown to be strongly associated with the risk of future cardiovascular disease, but the association between apoB/apoA-1 and the risk of in-hospital death in elderly patients with acute myocardial infarction(AMI) is inconclusive. Aim To investigate the association between apoB/apoA-1 and the risk of in-hospital death in elderly patients with AMI. Methods From December 2015 to December 2021, a total of 1495 elderly AMI patients (aged ≥ 60 years) with complete clinical history data were enrolled in the Second Hospital of Dalian Medical University. Outcome was defined as all-cause mortality during hospitalization. Multivariate logistic regression and restricted spline cubic (RCS) models were used to evaluate the association between apoB/apoA-1 and in-hospital mortality risk, respectively. Receiver operating characteristic(ROC) curves were used to evaluate the predictive value of apoB/apoA-1 for in-hospital mortality events. Discordance analysis was performed when apoB/apoA-1 and LDL-C/HDL-C were not in concordance. Results (1) A total of 128 patients (8.6%) died during hospitalization. Patients in the death group had higher apoB/apoA-1 than those in the non-death group, but lower apoA-1 levels than those in the non-death group, and the difference was statistically significant (P < 0.05); (2) Multivariate logistic regression analysis showed that apoB/apoA-1 was associated with the risk of in-hospital death in elderly AMI patients [Model 3 OR = 3.524 (1.622-7.659), P = 0.001]; (3) ROC curve analysis showed that apoB/apoA-1 (AUC = 0.572, P = 0.011) had some predictive value for the risk of in-hospital death in elderly AMI patients; (4) RCS models showed a linear dose-response relationship between apoB/apoA-1 and in-hospital death after adjusting for confounders (P for non-linearity = 0.762). Conclusion ApoB/apoA-1 is associated with the risk of in-hospital death in elderly patients with AMI, and is superior to other blood lipid parameters and blood lipid ratio.
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Affiliation(s)
- Yan Chen
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Shengyue Chen
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Yuanyuan Han
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Qing Xu
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
| | - Xin Zhao
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, People’s Republic of China
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2
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Radkhah N, Shabbidar S, Zarezadeh M, Safaeiyan A, Barzegar A. Effects of vitamin D supplementation on apolipoprotein A1 and B100 levels in adults: Systematic review and meta-analysis of controlled clinical trials. J Cardiovasc Thorac Res 2021; 13:190-197. [PMID: 34630965 PMCID: PMC8493225 DOI: 10.34172/jcvtr.2021.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/10/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death around the world. According to the studies, apolipoproteins A1 and B100 play crucial role in CVD development and progression. Also, findings have indicated the positive role of vitamin D on these factors. Thus, we conducted the present meta-analysis of randomized controlled trials (RCTs) to demonstrate the impact of vitamin D supplementation on apolipoproteins A1 and B100 levels in adults. PubMed and Scopus databases and Google Scholar were searched up to 21 December 2020. Relevant articles were screened, extracted, and assessed for quality based on the Cochrane collaboration's risk of bias tool. Data analysis conducted by random-effect model and expressed by standardized mean difference (SMD). The heterogeneity between studies was assessed by I-squared (I2) test. Subgroups and sensitivity Analyses were also conducted. Seven RCTs were identified investigating the impact of vitamin D on Apo A1 levels and six on Apo B100 levels. The findings showed the insignificant effect of vitamin D supplementation on Apo A1 (SMD=0.26 mg/dL; 95% confidence interval (CI), -0.10, 0.61; P = 0.155) and Apo B100 (standardized mean difference (SMD)=-0.06 mg/dL; 95% CI, -0.24, 0.12; P = 0.530) in adults. There was a significant between-study heterogeneity in Apo A1 (I2=89.3%, P < 0.001) and Apo B100 (I2 = 57.1%, P = 0.030). However, significant increase in Apo A1 in daily dosage of vitamin D (SMD=0.56 mg/dL; 95% CI, 0.02, 1.11; P = 0.044) and ≤12 weeks of supplementation duration (SMD=0.71 mg/dL; 95% CI, 0.08, 1.34; P = 0.028) was observed. No significant effects of vitamin D on Apo A1 and Apo B100 levels after subgroup analysis by mean age, gender, study population, dosage and duration of study. Overall, daily vitamin D supplementation and ≤12 weeks of supplementation might have beneficial effects in increasing Apo A1 levels, however, future high-quality trials considering these a primary outcome are required.
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Affiliation(s)
- Nima Radkhah
- Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Shabbidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Zarezadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.,Nutrition Research Center, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolrasoul Safaeiyan
- Department of Vital Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Barzegar
- Department of Community Nutrition, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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3
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Paul S, Gangwar A, Bhargava K, Ahmad Y. D4F prophylaxis enables redox and energy homeostasis while preventing inflammation during hypoxia exposure. Biomed Pharmacother 2021; 133:111083. [PMID: 33378979 DOI: 10.1016/j.biopha.2020.111083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 02/02/2023] Open
Abstract
Apo-A1 is correlated with conditions like hyperlipidemia, cardiovascular diseases, high altitude pulmonary edema and etc. where hypoxia constitutes an important facet.Hypoxia causes oxidative stress, vaso-destructive and inflammatory outcomes.Apo-A1 is reported to have vasoprotective, anti-oxidative, anti-apoptotic, and anti-inflammatory effects. However, effects of Apo-A1 augmentation during hypoxia exposure are unknown.In this study, we investigated the effects of exogenously supplementing Apo-A1-mimetic peptide on SD rats during hypoxia exposure. For easing the processes of delivery, absorption and bio-availability, Apo-A1 mimetic peptide D4F was used. The rats were given 10 mg/kg BW dose (i.p.) of D4F for 7 days and then exposed to hypoxia. D4F was observed to attenuate both oxidative stress and inflammation during hypoxic exposure. D4F improved energy homeostasis during hypoxic exposure. D4F did not affect HIF-1a levels during hypoxia but increased MnSOD levels while decreasing CRP and Apo-B levels. D4F showed promise as a prophylactic against hypoxia exposure.
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Affiliation(s)
- Subhojit Paul
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Anamika Gangwar
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Kalpana Bhargava
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India
| | - Yasmin Ahmad
- Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi, 110054, India.
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4
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Perry BI, Upthegrove R, Crawford O, Jang S, Lau E, McGill I, Carver E, Jones PB, Khandaker GM. Cardiometabolic risk prediction algorithms for young people with psychosis: a systematic review and exploratory analysis. Acta Psychiatr Scand 2020; 142:215-232. [PMID: 32654119 DOI: 10.1111/acps.13212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Cardiometabolic risk prediction algorithms are common in clinical practice. Young people with psychosis are at high risk for developing cardiometabolic disorders. We aimed to examine whether existing cardiometabolic risk prediction algorithms are suitable for young people with psychosis. METHODS We conducted a systematic review and narrative synthesis of studies reporting the development and validation of cardiometabolic risk prediction algorithms for general or psychiatric populations. Furthermore, we used data from 505 participants with or at risk of psychosis at age 18 years in the ALSPAC birth cohort, to explore the performance of three algorithms (QDiabetes, QRISK3 and PRIMROSE) highlighted as potentially suitable. We repeated analyses after artificially increasing participant age to the mean age of the original algorithm studies to examine the impact of age on predictive performance. RESULTS We screened 7820 results, including 110 studies. All algorithms were developed in relatively older participants, and most were at high risk of bias. Three studies (QDiabetes, QRISK3 and PRIMROSE) featured psychiatric predictors. Age was more strongly weighted than other risk factors in each algorithm. In our exploratory analysis, calibration plots for all three algorithms implied a consistent systematic underprediction of cardiometabolic risk in the younger sample. After increasing participant age, calibration plots were markedly improved. CONCLUSION Existing cardiometabolic risk prediction algorithms cannot be recommended for young people with or at risk of psychosis. Existing algorithms may underpredict risk in young people, even in the face of other high-risk features. Recalibration of existing algorithms or a new tailored algorithm for the population is required.
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Affiliation(s)
- B I Perry
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - R Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - O Crawford
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - S Jang
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - E Lau
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - I McGill
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - E Carver
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - P B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - G M Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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5
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Lee J, Hwang YC, Lee WJ, Won JC, Song KH, Park CY, Ahn KJ, Park JY. Comparison of the Efficacy and Safety of Rosuvastatin/Ezetimibe Combination Therapy and Rosuvastatin Monotherapy on Lipoprotein in Patients With Type 2 Diabetes: Multicenter Randomized Controlled Study. Diabetes Ther 2020; 11:859-871. [PMID: 32065359 PMCID: PMC7136381 DOI: 10.1007/s13300-020-00778-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Ezetimibe/statin combination therapy has been reported to provide additional cardioprotective effects compared to statin monotherapy. The apolipoprotein B/A1 (apoB/A1) ratio is an effective predictor of cardiovascular diseases. The aim of this study was to compare the efficacy and safety of rosuvastatin/ezetimibe combination therapy versus rosuvastatin monotherapy using the apoB/A1 ratio in patients with diabetes and hypercholesterolemia. METHODS In this randomized, multicenter, open-label, parallel-group study, patients were randomly assigned to receive the combination therapy of rosuvastatin 5 mg/ezetimibe 10 mg once daily (n = 68) or monotherapy with rosuvastatin 10 mg once daily (n = 68), for 8 weeks. RESULTS After the 8-week treatment, percentage change (least-square means ± standard error) in the apoB/A1 ratio in the rosuvastatin/ezetimibe group was significantly decreased compared to the rosuvastatin group (- 46.14 ± 1.58% vs. - 41.30 ± 1.58%, respectively; P = 0.03). In addition, the proportion of patients achieving > 50% reduction in low-density lipoprotein-cholesterol (LDL-C) and in the comprehensive lipid target (LDL-C < 70 mg/dL, non-HDL-cholesterol [non-HDL-C] < 100 mg/dL, and apoB < 80 mg/dL) was significantly different between the two groups (76.5 and 73.5% in the rosuvastatin/ezetimibe group and 47.1 and 45.6% in the rosuvastatin group, respectively; P < 0.001). The reduction in total cholesterol, non-HDL-C, LDL-C, and apoB were greater in the rosuvastatin/ezetimibe group than in the rosuvastatin group. Both treatments were well tolerated, and no between-group differences in drug-related adverse events were observed. CONCLUSION The apoB/A1 ratio was significantly reduced in patients receiving combination therapy with ezetimibe and rosuvastatin compared to those receiving rosuvastatin monotherapy. Both treatments were well tolerated in patients with type 2 diabetes and hypercholesterolemia. TRIAL REGISTRATION NCT03446261.
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Affiliation(s)
- Jiwoo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - You-Cheol Hwang
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278 Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
| | - Jong Chul Won
- Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342, Dongil-ro, Nowon-gu, Seoul, 01757 Korea
| | - Kee-Ho Song
- Division of Endocrinology and Metabolism, Konkuk University Medical Center, Konkuk University School of Medicine, 120, Neungdong-ro, Gwangjin-gu, Seoul, 05029 Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181 Korea
| | - Kyu Jeung Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892, Dongnam-ro, Gangdong-gu, Seoul, 05278 Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 Korea
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6
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Massy ZA, Caskey FJ, Finne P, Harambat J, Jager KJ, Nagler E, Stengel B, Sever MS, Vanholder R, Blankestijn PJ, Bruchfeld A, Capasso G, Fliser D, Fouque D, Goumenos D, Soler MJ, Rychlík I, Spasovski G, Stevens K, Wanner C, Zoccali C. Nephrology and Public Policy Committee propositions to stimulate research collaboration in adults and children in Europe. Nephrol Dial Transplant 2020; 34:1469-1480. [PMID: 31197325 PMCID: PMC6736134 DOI: 10.1093/ndt/gfz089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 12/18/2022] Open
Abstract
The strengths and the limitations of research activities currently present in Europe are explored in order to outline how to proceed in the near future. Epidemiological and clinical research and public policy in Europe are generally considered to be comprehensive and successful, and the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) is playing a key role in the field of nephrology research. The Nephrology and Public Policy Committee (NPPC) aims to improve the current situation and translation into public policy by planning eight research topics to be supported in the coming 5 years by ERA-EDTA.
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Affiliation(s)
- Ziad A Massy
- Division of Nephrology, Ambroise Paré Hospital, APHP, Paris-Ile-de-France-West University (UVSQ), Boulogne-Billancourt, Paris, France.,INSERM U1018 Team5, Paris-Saclay University, Villejuif, France
| | - Fergus J Caskey
- Consultant Senior Lecturer, Population Health Sciences University of Bristol, UK
| | - Patrik Finne
- Finnish Registry for Kidney Diseases, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jerome Harambat
- Pediatric Nephrology Unit, Pellegrin-Enfants Hospital, Bordeaux University Hospital, and University of Bordeaux, INSERM, Team LEHA, Bordeaux, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Evi Nagler
- European Renal Best Practice, London, UK
| | | | - Mehmet Sukru Sever
- Department of Nephrology/Internal Medicine, Istanbul School of Medicine, Istanbul University, Millet Caddesi, Istanbul, Turkey
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Corneel Heymanslaan, Ghent, Belgium
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center, Utrecht, The Netherlands
| | - Annette Bruchfeld
- Department of Renal Medicine, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Giovambattista Capasso
- Department of Medical Translational Sciences, University of "Luigi Vanvitelli" Naples and Biogem, Ariano Irpino, Italy
| | - Danilo Fliser
- Department of Internal Medicine IV-Nephrology and Hypertension, Saarland University Medical Centre, Homburg, Germany
| | - Denis Fouque
- Department of Nephrology, Dialysis, Nutrition, Université de Lyon, CARMEN, Centre Hospitalier Lyon Sud, Pierre Bénite Cedex, France
| | | | - Maria Jose Soler
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain.,Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ivan Rychlík
- 1st Department of Internal Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, University of Skopje, Skopje, Former Yugoslav, Republic of Macedonia
| | - Kathryn Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital, Wuerzburg, Germany
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Michielsen CCJR, Hangelbroek RW, Feskens EJM, Afman LA. Disentangling the Effects of Monounsaturated Fatty Acids from Other Components of a Mediterranean Diet on Serum Metabolite Profiles: A Randomized Fully Controlled Dietary Intervention in Healthy Subjects at Risk of the Metabolic Syndrome. Mol Nutr Food Res 2019; 63:e1801095. [PMID: 30725537 PMCID: PMC6646913 DOI: 10.1002/mnfr.201801095] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/22/2018] [Indexed: 01/07/2023]
Abstract
SCOPE The Mediterranean (MED) diet has been associated with a decreased risk of cardiovascular diseases. It is unclear whether this health effect can be mainly contributed to high intakes of monounsaturated fatty acids (MUFA), characteristic for the MED diet, or whether other components of a MED diet also play an important role. METHODS AND RESULTS A randomized fully controlled parallel trial is performed to examine the effects of the consumption of a saturated fatty acid rich diet, a MUFA-rich diet, or a MED diet for 8 weeks on metabolite profiles, in 47 subjects at risk of the metabolic syndrome. A total of 162 serum metabolites are assessed before and after the intervention by using a targeted NMR platform. Fifty-two metabolites are changed during the intervention (false discovery rate [FDR] p < 0.05). Both the MUFA and MED diet decrease exactly the same fractions of LDL, including particle number, lipid, phospholipid, and free cholesterol fraction (FDR p < 0.05). The MED diet additionally decreases the larger subclasses of very-low-density lipoprotein (VLDL), related VLDL fractions, VLDL-triglycerides, and serum-triglycerides (FDR p < 0.05). CONCLUSION The findings clearly demonstrate that the MUFA component is responsible for reducing LDL subclasses and fractions, and therefore causes an antiatherogenic lipid profile. Interestingly, consumption of the other components in the MED diet show additional health effects.
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Affiliation(s)
| | - Roland W.J. Hangelbroek
- Division of Human Nutrition and HealthWageningen UniversityWageningenP.O. Box 17, 6700AAThe Netherlands
| | - Edith J. M. Feskens
- Division of Human Nutrition and HealthWageningen UniversityWageningenP.O. Box 17, 6700AAThe Netherlands
| | - Lydia A. Afman
- Division of Human Nutrition and HealthWageningen UniversityWageningenP.O. Box 17, 6700AAThe Netherlands
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Ismaili H, Ismaili L, Rexhepi M. Values and Correlations between C-Reactive Protein and Apolipoprotein B after Treatment with Methotrexate at Patients with Rheumatoid Arthritis. Open Access Maced J Med Sci 2019; 7:1293-1298. [PMID: 31110572 PMCID: PMC6514347 DOI: 10.3889/oamjms.2019.278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD). Lipid changes related to inflammation have been described in RA. Methotrexate (MTX) treatment is effective in controlling inflammation and decreasing the CRP (C-reactive protein) values. AIM: To examine the disease activity, CRP and Apo B values in the detection of new patients with active and untreated RA, and impact of MTX therapy on their levels after 6 months and one year of treatment, and the correlation between their values in this period. METHODS: 80 patients with active and newly discovered RA patients who meet the American Rheumatology Association (ARA) 1987 revised criteria were treated with disease-modifying anti-inflammatory drugs (DMARDs) according to the protocol for treatment. RESULTS: After a year of therapy RA patients achieved significant decrease in the DAS28 (disease activity score) (p < 0.01 and p < 0.001), and CRP values (p < 0.001). Levels of Apo B values at the 12 months were nonsignificantly higher compared to the results obtained at the beginning of the study (p < 0.001). After 6 and 12 months there was a weak nonsignificant negative correlation about the values of CRP and Apo B at baseline and after 12 months (r = –0.15 and r = -0.12 p > 0.05). CONCLUSION: Use of MTX therapy at RA patients had a reduced effect on disease activity and inflammation, but the nonsignificance effect on the values of Apo B lipoproteins.
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Affiliation(s)
- Hysni Ismaili
- University of Tetovo, Faculty of Medical Sciences, Tetovo, Republic of Macedonia
| | | | - Meral Rexhepi
- University of Tetovo, Faculty of Medical Sciences, Tetovo, Republic of Macedonia
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9
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Upadya H, Prabhu S, Prasad A, Subramanian D, Gupta S, Goel A. A randomized, double blind, placebo controlled, multicenter clinical trial to assess the efficacy and safety of Emblica officinalis extract in patients with dyslipidemia. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:27. [PMID: 30670010 PMCID: PMC6341673 DOI: 10.1186/s12906-019-2430-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dyslipidemia is one of the most frequently implicated risk factors for development of atherosclerosis. This study evaluated the efficacy of amla (Emblica officinalis) extract (composed of polyphenols, triterpenoids, oils etc. as found in the fresh wild amla fruit) in patients with dyslipidemia. METHODS A total of 98 dyslipidemic patients were enrolled and divided into amla and placebo groups. Amla extract (500 mg) or a matching placebo capsule was administered twice daily for 12 weeks to the respective group of patients. The patients were followed up for 12 weeks and efficacy of study medication was assessed by analyzing lipid profile. Other parameters evaluated were apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1), Coenzyme Q10 (CoQ10), high-sensitive C-reactive protein (hsCRP), fasting blood sugar (FBS), homocysteine and thyroid stimulating hormone (TSH). RESULTS In 12 weeks, the major lipids such as total cholesterol (TC) (p = 0.0003), triglyceride (TG) (p = 0.0003), low density lipoprotein cholesterol (LDL-C) (p = 0.0064) and very low density lipoprotein cholesterol (VLDL-C) (p = 0.0001) were significantly lower in amla group as compared to placebo group. Additionally, a 39% reduction in atherogenic index of the plasma (AIP) (p = 0.0177) was also noted in amla group. The ratio of Apo B to Apo A1 was reduced more (p = 0.0866) in the amla group as compared to the placebo. There was no significant change in CoQ10 level of amla (p = 0.2942) or placebo groups (p = 0.6744). Although there was a general trend of FBS reduction, the numbers of participants who may be classified as pre-diabetes and diabetes groups (FBS > 100 mg/dl) in the amla group were only 8. These results show that the amla extract used in the study is potentially a hypoglycaemic as well. However, this needs reconfirmation in a larger study. CONCLUSIONS The Amla extract has shown significant potential in reducing TC and TG levels as well as lipid ratios, AIP and apoB/apo A-I in dyslipidemic persons and thus has scope to treat general as well as diabetic dyslipidemia. A single agent to reduce cholesterol as well as TG is rare. Cholesterol reduction is achieved without concomitant reduction of Co Q10, in contrast to what is observed with statins. TRIAL REGISTRATION Registered with Clinical Trials Registry- India at www.ctri.nic.in (Registration number: CTRI/2015/04/005682 ) on 8 April 2015 (retrospectively registered).
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10
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Apolipoprotein B/apolipoprotein A1 ratio and mortality among incident peritoneal dialysis patients. Lipids Health Dis 2018; 17:117. [PMID: 29776362 PMCID: PMC5960196 DOI: 10.1186/s12944-018-0771-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND To investigate the association between the ratio of apolipoprotein B (apo B) / apolipoprotein A1 (apo A1) with all-cause mortality and cardiovascular events in peritoneal dialysis (PD) patients. METHODS Eight hundred and sixty incident PD patients were enrolled from November 1, 2005, to February 28, 2017, and followed until May 31, 2017. Outcomes were all-cause mortality and cardiovascular events. Associations between the apo B/apo A1 ratio with all-cause mortality and cardiovascular events were evaluated using multivariable-adjusted Cox models. RESULTS Of the 860 patients, the mean age was 49.9 ± 14.5 years, 57.6% were men, and 19.3% were diabetic patients. The median apo B/apo A1 ratio was 0.65 (range: 0.22-2.24). During a median follow-up period of 27 months (interquartile range, 13 - 41 months), 202 deaths, and 145 cardiovascular events were recorded. After adjustment for age, sex, body mass index, diabetes, cardiovascular disease, systolic blood pressure, total Kt/V, estimated glomerular filtration rate, hemoglobin level, neutrophil to lymphocyte ratio and albumin, triglyceride, and cholesterol, as well as the use of lipid-lowering agents, the highest apo B/apo A1 ratio tertile was significantly associated with a hazard ratio for all-cause mortality of 1.60 (95% CI: 1.02 to 2.49, P = 0.040) and for cardiovascular events of 2.04 (95% CI: 1.21 to 3.44, P = 0.008). CONCLUSION An increased apo B/apo A1 ratio was independently associated with all-cause mortality and cardiovascular events in PD patients.
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11
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Decreased serum apolipoprotein A1 levels are associated with poor survival and systemic inflammatory response in colorectal cancer. Sci Rep 2017; 7:5374. [PMID: 28710487 PMCID: PMC5511233 DOI: 10.1038/s41598-017-05415-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/30/2017] [Indexed: 12/12/2022] Open
Abstract
Recent studies have reported of an association between high serum apolipoprotein A1 (APOA1) levels and favorable prognosis in several malignancies, while the significance of apolipoprotein B (APOB) in cancer is less well-known. In this study, we analyzed the correlation between serum APOA1 and APOB levels, and APOB/APOA1 ratio, and their associations with clinicopathologic parameters, the levels of twenty systemic inflammatory markers, and survival in 144 colorectal cancer (CRC) patients. We demonstrated that low serum APOA1 levels associated with advanced T-class and TNM-stage but low serum APOB levels did not significantly correlate with tumor characteristics. Serum APOA1 levels showed strong negative correlation with the markers of systemic inflammation including serum CRP and interleukin (IL)-8 levels and blood neutrophil count, whereas high serum APOB levels associated with high serum CCL2 levels. High APOA1 and APOB levels and low APOB/APOA1 ratio associated with improved cancer specific and overall survival. APOA1 had independent prognostic value in Cox regression analysis. In conclusion, low serum APOA1 levels are associated with advanced stage and systemic inflammation, while serum APOB does not significantly correlate with tumor stage. Serum APOA1 represents a promising additional prognostic parameter in CRC.
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12
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Nystad T, Utsi E, Selmer R, Brox J, Melhus M, Lund E. Distribution of apoB/apoA-1 ratio and blood lipids in Sami, Kven and Norwegian populations: the SAMINOR study. Int J Circumpolar Health 2016. [DOI: 10.3402/ijch.v67i1.18238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Perera R, McFadden E, McLellan J, Lung T, Clarke P, Pérez T, Fanshawe T, Dalton A, Farmer A, Glasziou P, Takahashi O, Stevens J, Irwig L, Hirst J, Stevens S, Leslie A, Ohde S, Deshpande G, Urayama K, Shine B, Stevens R. Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling. Health Technol Assess 2016; 19:1-401, vii-viii. [PMID: 26680162 DOI: 10.3310/hta191000] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Various lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation. OBJECTIVE To determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD. DATA SOURCES We searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke's Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature. METHODS In two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year. RESULTS A total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high (I(2) = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention. LIMITATION Heterogeneity in meta-analyses. CONCLUSIONS While acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003727. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Rafael Perera
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily McFadden
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie McLellan
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom Lung
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Philip Clarke
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Teresa Pérez
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Fanshawe
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Dalton
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew Farmer
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Osamu Takahashi
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | | | - Les Irwig
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Jennifer Hirst
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Stevens
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Asuka Leslie
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Sachiko Ohde
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Gautam Deshpande
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Kevin Urayama
- St Luke's International University Center for Clinical Epidemiology, Tokyo, Japan
| | - Brian Shine
- Oxford University Hospitals Trust, Oxford, UK
| | - Richard Stevens
- National Institute for Health Research School for Primary Care Research, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Sato Y, Fujimoto S, Toida T, Nakagawa H, Yamashita Y, Iwakiri T, Fukuda A, Iwatsubo S. Apoprotein B/Apoprotein A-1 Ratio and Mortality among Prevalent Dialysis Patients. Clin J Am Soc Nephrol 2016; 11:840-846. [PMID: 26912548 PMCID: PMC4858486 DOI: 10.2215/cjn.09830915] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In dialysis patients, the associations between apoprotein profile and all-cause or cardiovascular disease (CVD)-related mortality are not well known. We, therefore, investigated whether apoprotein levels are associated with these events. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We undertook a prospective observational cohort study of prevalent hemodialysis patients aged ≥18 years (n=1081), who were followed for 4 years (2011-2014). Outcomes were all-cause and CVD-related mortality. Predictors used were baseline apoprotein levels, particularly the apoprotein B (apo B)/ apoprotein A-1 (apo A-1) ratio. A Cox regression analysis was used to calculate the hazard ratios (HRs) for mortality. Apo A-1, apo B, and apo B/ apo A-1 ratio were analyzed with adjustments in three models: model 1, basic adjustment for age and sex; model 2, basic adjustments plus dialysis conditions (dialysis vintage, mean predialysis systolic blood pressure, dry weight, and mean intradialytic weight gain); and model 3, model 2 plus metabolic and inflammatory conditions (basal kidney disease, serum albumin, C-reactive protein level, and statin use). RESULTS Of the 1081 patients included in the study, 203 deaths were recorded, 92 of which were related to CVD. The apo B/ apo A-1 ratio was significantly associated with all-cause and CVD-related mortality when analyzed by 1-SD increments or quartile IV versus I in all models. In model 3, HRs and 95% confidence intervals (95% CIs) for 1-SD increments of apo B/ apo A-1 ratio for all-cause mortality or CVD-related mortality were: HR, 1.16 (95% CI, 1.00 to 1.35), or HR, 1.38 (95% CI, 1.11 to 1.71), respectively, and for quartile IV versus I: HR, 1.65 (95% CI, 1.05 to 2.57), or HR, 2.56 (95% CI, 1.21 to 5.40), respectively. Apo A-1 was significantly associated with both mortalities in models 1 and 2. However, apo B was only significantly associated with CVD-related mortality in model 3. CONCLUSIONS Apoprotein measurement, especially the apo B/ apo A-1 ratio, was significantly associated with all-cause and CVD-related mortality in prevalent dialysis patients.
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Affiliation(s)
- Yuji Sato
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan; and
| | | | - Tatsunori Toida
- Departments of Hemovascular Medicine and Artificial Organs, and
| | - Hideto Nakagawa
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan; and
| | - Yasuhiro Yamashita
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takashi Iwakiri
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akihiro Fukuda
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan; and
| | - Shuji Iwatsubo
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Schmidt C, Bergström G, Sniderman A. The value of apoA-I in predicting heart disease and myocardial infarction. ACTA ACUST UNITED AC 2015. [DOI: 10.2217/clp.15.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Koehly LM, Morris BA, Skapinsky K, Goergen A, Ludden A. Evaluation of the Families SHARE workbook: an educational tool outlining disease risk and healthy guidelines to reduce risk of heart disease, diabetes, breast cancer and colorectal cancer. BMC Public Health 2015; 15:1120. [PMID: 26566980 PMCID: PMC4643512 DOI: 10.1186/s12889-015-2483-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/10/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Common diseases such as heart disease, diabetes, and cancer are etiologically complex with multiple risk factors (e.g., environment, genetic, lifestyle). These risk factors tend to cluster in families, making families an important social context for intervention and lifestyle-focused disease prevention. The Families Sharing Health Assessment and Risk Evaluation (SHARE) workbook was designed as an educational tool outlining family health history based risk of heart disease, type 2 diabetes, breast cancer, and colorectal cancer. The current paper describes the steps taken to develop and evaluate the workbook employing a user-centered design approach. METHODS The workbook was developed in four steps, culminating in an evaluation focusing on understanding and usability of the tool. The evaluation was based on two Phases of data collected from a sample of mothers of young children in the Washington, D.C., area. A baseline assessment and follow-up approximately two weeks after receipt of the workbook were conducted, as well as focus groups with participants. The design of the workbook was refined in response to participant feedback from the first evaluation Phase and subsequently re-evaluated with a new sample. RESULTS After incorporating user-based feedback and revising the workbook, Phase 2 evaluation results indicated that understanding of the workbook components improved for all sections (from 6.26 to 6.81 on a 7-point scale). In addition, 100% of users were able to use the algorithm to assess their disease risk and over 60% used the algorithm to assess family members' disease risk. At follow-up, confidence to increase fruit, vegetable and fiber intake improved significantly, as well. CONCLUSIONS The Families SHARE workbook was developed and evaluated resulting in a family health history tool that is both understandable and usable by key stakeholders. This educational tool will be used in intervention studies assessing the effectiveness of family genomics health educators who use the Families SHARE workbook to disseminate family risk information and encourage risk reducing behaviors. TRIAL REGISTRATION ClinicalTrials.gov, NCT01498276 . Registered 21 December 2011.
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Affiliation(s)
- Laura M Koehly
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Bronwyn A Morris
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Kaley Skapinsky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Andrea Goergen
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
| | - Amanda Ludden
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 31, Rm B1B54, Bethesda, MD, 20892-2073, USA.
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Sood S, Gallagher IJ, Lunnon K, Rullman E, Keohane A, Crossland H, Phillips BE, Cederholm T, Jensen T, van Loon LJC, Lannfelt L, Kraus WE, Atherton PJ, Howard R, Gustafsson T, Hodges A, Timmons JA. A novel multi-tissue RNA diagnostic of healthy ageing relates to cognitive health status. Genome Biol 2015; 16:185. [PMID: 26343147 PMCID: PMC4561473 DOI: 10.1186/s13059-015-0750-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diagnostics of the human ageing process may help predict future healthcare needs or guide preventative measures for tackling diseases of older age. We take a transcriptomics approach to build the first reproducible multi-tissue RNA expression signature by gene-chip profiling tissue from sedentary normal subjects who reached 65 years of age in good health. RESULTS One hundred and fifty probe-sets form an accurate classifier of young versus older muscle tissue and this healthy ageing RNA classifier performed consistently in independent cohorts of human muscle, skin and brain tissue (n = 594, AUC = 0.83-0.96) and thus represents a biomarker for biological age. Using the Uppsala Longitudinal Study of Adult Men birth-cohort (n = 108) we demonstrate that the RNA classifier is insensitive to confounding lifestyle biomarkers, while greater gene score at age 70 years is independently associated with better renal function at age 82 years and longevity. The gene score is 'up-regulated' in healthy human hippocampus with age, and when applied to blood RNA profiles from two large independent age-matched dementia case-control data sets (n = 717) the healthy controls have significantly greater gene scores than those with cognitive impairment. Alone, or when combined with our previously described prototype Alzheimer disease (AD) RNA 'disease signature', the healthy ageing RNA classifier is diagnostic for AD. CONCLUSIONS We identify a novel and statistically robust multi-tissue RNA signature of human healthy ageing that can act as a diagnostic of future health, using only a peripheral blood sample. This RNA signature has great potential to assist research aimed at finding treatments for and/or management of AD and other ageing-related conditions.
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Affiliation(s)
- Sanjana Sood
- XRGenomics Ltd, London, UK
- Division of Genetics & Molecular Medicine, King's College London, 8th Floor, Tower Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Iain J Gallagher
- XRGenomics Ltd, London, UK
- School of Health, Stirling University, Stirling, Scotland, UK
| | - Katie Lunnon
- Department of Old Age Psychiatry, King's College London, London, UK
- Present address: University of Exeter Medical School, Exeter, UK
| | - Eric Rullman
- Division of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Aoife Keohane
- Department of Old Age Psychiatry, King's College London, London, UK
| | - Hannah Crossland
- Division of Genetics & Molecular Medicine, King's College London, 8th Floor, Tower Wing, Guy's Hospital, London, SE1 9RT, UK
- School of Medicine, Derby Royal Hospital, Derbyshire, UK
| | | | - Tommy Cederholm
- Department of Public Health, Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | | | | | - Lars Lannfelt
- Department of Public Health and Caring Sciences/Molecular Geriatrics, Uppsala University, Uppsala, Sweden
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Robert Howard
- Department of Old Age Psychiatry, King's College London, London, UK
| | - Thomas Gustafsson
- Division of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Angela Hodges
- Department of Old Age Psychiatry, King's College London, London, UK
| | - James A Timmons
- XRGenomics Ltd, London, UK.
- Division of Genetics & Molecular Medicine, King's College London, 8th Floor, Tower Wing, Guy's Hospital, London, SE1 9RT, UK.
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Wessler BS, Lai Yh L, Kramer W, Cangelosi M, Raman G, Lutz JS, Kent DM. Clinical Prediction Models for Cardiovascular Disease: Tufts Predictive Analytics and Comparative Effectiveness Clinical Prediction Model Database. Circ Cardiovasc Qual Outcomes 2015; 8:368-75. [PMID: 26152680 PMCID: PMC4512876 DOI: 10.1161/circoutcomes.115.001693] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/04/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Clinical prediction models (CPMs) estimate the probability of clinical outcomes and hold the potential to improve decision making and individualize care. For patients with cardiovascular disease, there are numerous CPMs available although the extent of this literature is not well described. METHODS AND RESULTS We conducted a systematic review for articles containing CPMs for cardiovascular disease published between January 1990 and May 2012. Cardiovascular disease includes coronary heart disease, heart failure, arrhythmias, stroke, venous thromboembolism, and peripheral vascular disease. We created a novel database and characterized CPMs based on the stage of development, population under study, performance, covariates, and predicted outcomes. There are 796 models included in this database. The number of CPMs published each year is increasing steadily over time. Seven hundred seventeen (90%) are de novo CPMs, 21 (3%) are CPM recalibrations, and 58 (7%) are CPM adaptations. This database contains CPMs for 31 index conditions, including 215 CPMs for patients with coronary artery disease, 168 CPMs for population samples, and 79 models for patients with heart failure. There are 77 distinct index/outcome pairings. Of the de novo models in this database, 450 (63%) report a c-statistic and 259 (36%) report some information on calibration. CONCLUSIONS There is an abundance of CPMs available for a wide assortment of cardiovascular disease conditions, with substantial redundancy in the literature. The comparative performance of these models, the consistency of effects and risk estimates across models and the actual and potential clinical impact of this body of literature is poorly understood.
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Affiliation(s)
- Benjamin S Wessler
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA (B.S.W., L.L.Y., J.S.L., D.M.K.); Business Intelligence and Analytics, Iora Health, Cambridge, MA (W.K.); Health Economics and Reimbursement, Boston Scientific, Marlborough, MA (M.C.); and Center for Clinical Evidence Synthesis, ICRHPS, Medical Center/Tufts University School of Medicine, Boston, MA (G.R.)
| | - Lana Lai Yh
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA (B.S.W., L.L.Y., J.S.L., D.M.K.); Business Intelligence and Analytics, Iora Health, Cambridge, MA (W.K.); Health Economics and Reimbursement, Boston Scientific, Marlborough, MA (M.C.); and Center for Clinical Evidence Synthesis, ICRHPS, Medical Center/Tufts University School of Medicine, Boston, MA (G.R.)
| | - Whitney Kramer
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA (B.S.W., L.L.Y., J.S.L., D.M.K.); Business Intelligence and Analytics, Iora Health, Cambridge, MA (W.K.); Health Economics and Reimbursement, Boston Scientific, Marlborough, MA (M.C.); and Center for Clinical Evidence Synthesis, ICRHPS, Medical Center/Tufts University School of Medicine, Boston, MA (G.R.)
| | - Michael Cangelosi
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA (B.S.W., L.L.Y., J.S.L., D.M.K.); Business Intelligence and Analytics, Iora Health, Cambridge, MA (W.K.); Health Economics and Reimbursement, Boston Scientific, Marlborough, MA (M.C.); and Center for Clinical Evidence Synthesis, ICRHPS, Medical Center/Tufts University School of Medicine, Boston, MA (G.R.)
| | - Gowri Raman
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA (B.S.W., L.L.Y., J.S.L., D.M.K.); Business Intelligence and Analytics, Iora Health, Cambridge, MA (W.K.); Health Economics and Reimbursement, Boston Scientific, Marlborough, MA (M.C.); and Center for Clinical Evidence Synthesis, ICRHPS, Medical Center/Tufts University School of Medicine, Boston, MA (G.R.)
| | - Jennifer S Lutz
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA (B.S.W., L.L.Y., J.S.L., D.M.K.); Business Intelligence and Analytics, Iora Health, Cambridge, MA (W.K.); Health Economics and Reimbursement, Boston Scientific, Marlborough, MA (M.C.); and Center for Clinical Evidence Synthesis, ICRHPS, Medical Center/Tufts University School of Medicine, Boston, MA (G.R.)
| | - David M Kent
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (B.S.W.); Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA (B.S.W., L.L.Y., J.S.L., D.M.K.); Business Intelligence and Analytics, Iora Health, Cambridge, MA (W.K.); Health Economics and Reimbursement, Boston Scientific, Marlborough, MA (M.C.); and Center for Clinical Evidence Synthesis, ICRHPS, Medical Center/Tufts University School of Medicine, Boston, MA (G.R.).
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Diaf M, Khaled BM, Sellam F. Impact of corpulence parameters and haemoglobin A1c on metabolic control in type 2 diabetic patients: comparison of apolipoprotein B/A-I ratio with fasting and postprandial conventional lipid ratios. Libyan J Med 2015; 10:27400. [PMID: 25959906 PMCID: PMC4426286 DOI: 10.3402/ljm.v10.27400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The incidence of diabetes co-morbidities could probably be better assessed by studying its associations with major corpulence parameters and glycaemic control indicators. We assessed the utility of body mass index (BMI), waist circumference (WC), and glycosylated haemoglobin (HbA1c) levels in metabolic control for type 2 diabetic patients. METHODS Fasting and postprandial blood samples were collected from 238 type 2 diabetic patients aged 57.4±11.9 years. The sera were analysed for glucose, HbA1c, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and apolipoproteins (apoA-I and apoB). Ratios of lipids and apolipoproteins were calculated and their associations with BMI, WC, and HbA1c levels were analysed. RESULTS Our investigation showed increases in most fasting and postprandial lipid parameters according to BMI and WC. In men, postprandial HDL-c and TG levels were significantly higher (p<0.05) in overweight and obese patients, respectively, as well as in patients with abdominal obesity. Contrariwise, postprandial TC levels were significantly higher (p<0.01) in overweight and abdominal obese women. However, elevations of apoA-I and apoB levels were according to BMI and WC in both genders. There was a strong influence of BMI, WC, and HbA1c levels on the apoB/apoA-I ratio compared to traditional fasting and postprandial lipid ratios in both men and women. The apoB/apoA-I ratio was more correlated with postprandial TC/HDL and LDL-c/HDL-c ratios in men and with postprandial TG/HDL-c in women. CONCLUSION The apoB/apoA-I ratio is helpful in assessing metabolic risk caused by overall obesity, abdominal obesity and impaired glycaemia in type 2 diabetic patients.
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Affiliation(s)
- Mustapha Diaf
- Department of Biology, Faculty of Natural and Life Sciences, Djillali Liabes University, Sidi-Bel-Abbes, Algeria;
| | - Boumediene M Khaled
- Department of Biology, Faculty of Natural and Life Sciences, Djillali Liabes University, Sidi-Bel-Abbes, Algeria
| | - Fériel Sellam
- Department of Biology, Faculty of Natural and Life Sciences, Djillali Liabes University, Sidi-Bel-Abbes, Algeria
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The apolipoprotein B/apolipoprotein A-I ratio as a potential marker of plasma atherogenicity. DISEASE MARKERS 2015; 2015:591454. [PMID: 25852220 PMCID: PMC4380097 DOI: 10.1155/2015/591454] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/18/2015] [Accepted: 02/25/2015] [Indexed: 11/24/2022]
Abstract
Background. The apolipoprotein (apo) B/apoA-I ratio represents the balance between apoB-rich atherogenic particles and apoA-I-rich antiatherogenic particles, and this ratio is considered to be a marker of cardiovascular risk. Although many studies have demonstrated the importance of the apoB/apoA-I ratio in predicting the presence or absence of cardiovascular disease, less is known about apoB/apoA-I ratio as a marker of plasma atherogenicity. Methods. A total of 157 normolipidemic men aged 20–59 years were included in the study. The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apoA-I, apoB, and apoE were determined after a 12 h fasting period. Results. The median of the apoB/apoA-I ratio in the studied normolipidemic subjects was 0.52, with values ranging from 0.19 to 2.60. The percentage of subjects with the apoB/apoA-I ratio exceeding 0.9 (the accepted risk value of cardiovascular disease) was 19.1%. The subjects with apoB/apoA-I>0.9 were characterized by higher TG levels and atherogenic index of plasma (AIP) and lower values of ratio of low-density lipoprotein cholesterol (LDL-C) to apoB (LDL-C/apoB) and apoE levels compared with men with apoB/apoA-I<0.9. Conclusion. Despite normolipidemia, the subjects with the unfavorable apoB/apoA-I ratio had more atherogenic lipid profile.
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Leng C, Li Q, Wu F, Chen L, Su P. Detection of the single-chain precursor in the production and purification process of recombinant human insulin. Monoclon Antib Immunodiagn Immunother 2014; 32:255-61. [PMID: 23909418 DOI: 10.1089/mab.2013.0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
High quality recombinant insulin requires being free of single-chain precursor (proinsulin), a task that depends on the selectivity and sensitivity of the monitoring process for detecting proinsulin. In this study we developed an enzyme-linked immunosorbent assay (ELISA) system that was specifically tailored to detect recombinant proinsulin. The proinsulin consists of six components: an initiating methionine, 48 amino acids from human growth hormones (HGH, used as the protection peptide), first connecting Arg-residue, B-chain of insulin, and second connecting Arg-peptide and A-chain of insulin. This form of proinsulin is more stable and can be efficiently expressed by E. coli than insulin. Herein, we evaluated the specificity, precision, recovery, sensitivity, and detection range of the proinsulin ELISA kit. The results showed that the ELISA kit is a very useful tool for monitoring the proinsulin yield in early stages of insulin production as well as the residual proinsulin in the final product, insulin.
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Affiliation(s)
- Chunsheng Leng
- College of Life Science, Liaoning Normal University, Dalian, China.
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22
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Makaridze Z, Giorgadze E, Asatiani K. Association of the apolipoprotein b/apolipoprotein a-I ratio, metabolic syndrome components, total cholesterol, and low-density lipoprotein cholesterol with insulin resistance in the population of georgia. Int J Endocrinol 2014; 2014:925650. [PMID: 24949011 PMCID: PMC4053263 DOI: 10.1155/2014/925650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 11/23/2022] Open
Abstract
The study was designed to assess the association between insulin resistance (IR) and apolipoprotein B/apolipoprotein A-I ratio (ApoB/ApoA-I ratio), metabolic syndrome (MetS) components, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) in the nondiabetic population of Georgia. The subjects were 1522 Georgians of Caucasian origin (mean age = 45 years, 653 women) without diabetes who had visited the clinics for a related health checkup between 2012 and 2013. IR was calculated using the computer homeostasis model assessment (HOMA2-IR) and was defined as the upper quartile. MetS was diagnosed using the updated ATP-III definition of the metabolic syndrome. Logistic and multiple regression models were used to estimate the association between IR and other components. IR was positively correlated with age, ApoB, ApoB/ApoA-I ratio, MetS components (excluding high-density lipoprotein cholesterol-HDL-C), LDL-C, fasting insulin, and TC and negatively correlated with HDL-C and ApoA-I in both sexes (all P < 0.001). In the logistic regression models, gender, age, ApoB/ApoA-I ratio, diastolic pressure, HDL-C, LDL-C, fasting glucose, and triglycerides were the covariates significantly associated with IR (OR: 8.64, 1.03, 17.95, 1.06, 0.13, 1.17, 3.75, and 2.29, resp.; all P < 0.05). Multiple regression models demonstrated that these components (except for HDL-C) made an independent contribution to the prediction of HOMA2 (all P < 0.05).
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Affiliation(s)
- Zaza Makaridze
- “Medicore” Ltd. Tbilisi State Medical University Affiliated Clinic, 0186 Tbilisi, Georgia
- *Zaza Makaridze:
| | - Elene Giorgadze
- National Institute of Endocrinology, Tbilisi State University Affiliated Clinic, 0159 Tbilisi, Georgia
| | - Ketevan Asatiani
- National Institute of Endocrinology, Tbilisi State University Affiliated Clinic, 0159 Tbilisi, Georgia
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Schmidt C, Bergström G. Apolipoprotein B/apolipoprotein A-I ratio and apolipoprotein B: long-term predictors of myocardial infarction in initially healthy middle-aged men--a 13-year follow-up. Angiology 2013; 65:901-5. [PMID: 24277914 DOI: 10.1177/0003319713511849] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We investigated whether serum concentrations of apolipoprotein (apo) B and apoA-I and the apoB/apoA-I ratio provided predictive information on myocardial infarction (MI) and ischemic stroke during 13 years of follow-up in a group of initially clinically healthy 58-year-old men, free from previous cardiovascular disease, diabetes, other established disease, or treatment with cardiovascular drugs. Multivariate logistic regression analysis showed that the apoB/apoA-I ratio and apoB were significant and independent determinants of MI (exponentiation of the B coefficient [Exp(β)] 3.1, 95% confidence interval [CI] 1.6-6.3, P=.001, Exp(β) 2.8, 95% CI 1.1-7.7, P=.045, respectively). The area under the receiver-operating characteristics curve as a relative measure of test efficiency was highest and significant for both apoB/apoA-I ratio and apoB (area under the curve=0.75, P<.001). In conclusion, the apoB/apoA-I ratio and apoB are independent risk factors for MI and has the highest efficiencies for predicting MI in initially healthy middle-aged men.
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Affiliation(s)
- Caroline Schmidt
- Department of Molecular and Clinical Medicine, The Wallenberg Laboratory for Cardiovascular Research, Institution for Medicine, Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, The Wallenberg Laboratory for Cardiovascular Research, Institution for Medicine, Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden
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Leng C, Li Q, Wu F, Chen L, Su P. Monoclonal and polyclonal antibodies against the precursor of recombinant human insulin. Acta Biochim Biophys Sin (Shanghai) 2013; 45:704-5. [PMID: 23615536 DOI: 10.1093/abbs/gmt041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chunsheng Leng
- College of Life Science, Liaoning Normal University, Dalian 116029, China.
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Choe YG, Jin W, Cho YK, Chung WG, Kim HJ, Jeon WK, Kim BI. Apolipoprotein B/AI ratio is independently associated with non-alcoholic fatty liver disease in nondiabetic subjects. J Gastroenterol Hepatol 2013; 28:678-83. [PMID: 23215811 DOI: 10.1111/jgh.12077] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The apolipoprotein B/AI (ApoB/AI) ratio is a strong new risk factor for cardiovascular (CV) disease. Although recent reports have shown the effects of non-alcoholic fatty liver disease (NAFLD) on CV disease, NAFLD is under-recognized as a predictable risk factor for CV disease. This study was performed to assess the independent association between ApoB/AI ratio and NAFLD. METHODS This cross-sectional study was performed in 9162 subjects who participated in a health checkup program in South Korea in 2009. The presence of NAFLD was defined by ultrasonographic examination. Logistic regression analysis was applied to estimate the association between ApoB/AI ratio and NAFLD. The odds ratio (OR) and P were estimated according to the categorized level of the ApoB/AI ratio. RESULTS The overall prevalence of NAFLD was 27.9% (n = 2554, 41.7% of the men, 10.8% of the women). Men had a 5.91-fold (95% CI 5.28-6.62) greater risk for NAFLD than women. After adjusting for confounding factors, the ApoB/AI ratio was more closely associated with the prevalence of NAFLD than with any other lipid profiles (OR 8.537 in men, 16.6 in women). NAFLD risk increased as the quartiles of the ApoB/AI ratio increased from the first to the fourth quartile (OR 1.359, 2.173 and 3.124, P for trend < 0.001). CONCLUSION The ApoB/AI ratio was associated with the prevalence of NAFLD in nondiabetic subjects and was independent of obesity and other metabolic components. This result suggests that NAFLD may provide additional information for atherosclerosis progression and CV risks.
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Affiliation(s)
- Young Gil Choe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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The ApoB/ApoA1 ratio is associated with metabolic syndrome and its components in a Chinese population. Inflammation 2011; 33:353-8. [PMID: 20213498 DOI: 10.1007/s10753-010-9193-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this study, we assessed whether the apolipoprotein B/apolipoprotein A1 ratio (ApoB/ApoA1) is related to metabolic syndrome (MS) and its components in an urban Chinese population. A total of 709 community residents were enrolled. Metabolic syndrome was defined according to the International Diabetes Federation definition in 2005. The high ApoB/ApoA1 group was defined as the gender-specific upper quartile of the ApoB/ApoA1 ratio. Insulin resistance (IR) was defined as the upper quartile of Homa-IR. The ApoB/ApoA1 ratio was significantly higher in subjects with MS, compared to those without (p < 0.05). After adjusting for age and gender, subjects with MS (odds ratio [OR] = 3.5) or IR (OR = 2.3) were more likely to be in the high ApoB/ApoA1 group. The ApoB/ApoA1 ratio increased significantly as the number of MS components increased (p < 0.05). Taken together, these data demonstrate that the ApoB/ApoA1 ratio is strongly associated with MS and its components in an urban Chinese population.
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Kim SJ, Song P, Park JH, Lee YT, Kim WS, Park YG, Bang OY, Chung CS, Lee KH, Kim GM. Biomarkers of asymptomatic carotid stenosis in patients undergoing coronary artery bypass grafting. Stroke 2011; 42:734-9. [PMID: 21233473 DOI: 10.1161/strokeaha.110.595546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Carotid artery stenosis is an important etiologic factor of stroke related to coronary artery bypass surgery. We evaluated clinical and laboratory factors to identify biomarkers for pre-existing carotid artery stenosis in patients undergoing coronary artery bypass surgery. METHODS Between June 2006 and September 2008, 811 patients aged ≥50 years underwent preoperative carotid artery duplex scanning as part of a preoperative assessment for nonemergency cardiac procedures. Of these, 54 patients with previous stroke or transient ischemic attack were excluded. The association between various biomarkers and carotid artery stenosis was analyzed by multiple logistic regression analysis. The receiver operating characteristic curves were generated and analyzed to compare diagnostic performance and optimum diagnostic cutoff levels of biomarkers. RESULTS A total of 757 patients was included in the study. The prevalence of asymptomatic carotid stenosis of ≥50% and ≥70% was 26.4% and 8.6%, respectively. In multivariate analysis, plasma levels of apolipoprotein B (apoB):apoA-I, lipoprotein(a), and homocysteine were independently associated with carotid stenosis of ≥50%: the OR (95% CI) for apoB/apoA-I, lipoprotein(a), and homocysteine in the highest versus lowest quartile was 2.07 (1.18 to 3.66), 2.17 (1.16 to 4.05), and 2.13 (1.20 to 3.79), respectively. Receiver operating characteristic curve analysis indicated area under the curve values of 0.708 (apoB:apoA-I), 0.678 (lipoprotein[a]), and 0.689 (homocysteine). The sensitivity, specificity, positive and negative predictive values (%) for diagnosis of carotid stenosis ≥50% were 80.0, 50.4, 38.0, and 86.9 for apoB:apoA-I; 47.0, 78.9, 46.1, and 79.5 for lipoprotein(a); and 69.3, 62.1, 41.2, and 84.1 for homocysteine, respectively. CONCLUSIONS Our findings indicated that plasma levels of apoB/apoA-I, lipoprotein(a), and homocysteine can predict asymptomatic carotid stenosis in patients undergoing coronary artery bypass surgery.
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Affiliation(s)
- Suk Jae Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea
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Nassar BA, Nanji AA, Ransom TP, Rockwood K, Kirkland SA, MacPherson K, Connelly PW, Johnstone DE, O'Neill BJ, Bata IR, Andreou P, Title LM. Role of the fractalkine receptor CX3CR1 polymorphisms V249I and T280M as risk factors for early‐onset coronary artery disease in patients with no classic risk factors. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 68:286-91. [DOI: 10.1080/00365510701697390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sierra-Johnson J, Romero-Corral A, Somers VK, Lopez-Jimenez F. The Apolipoprotein B/Apolipoprotein AI Ratio in the Metabolic Syndrome—Should We Start Using It? ACTA ACUST UNITED AC 2008; 3:53-4. [DOI: 10.1111/j.1559-4572.2008.07610.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Proteomic identification of altered apolipoprotein patterns in pulmonary hypertension and vasculopathy of sickle cell disease. Blood 2008; 113:1122-8. [PMID: 19023114 DOI: 10.1182/blood-2008-03-142604] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is emerging as a major complication and independent risk factor for death among adults with sickle cell disease (SCD). Using surface-enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF MS), we searched for biomarkers of PAH in plasma specimens from 27 homozygous sickle cell anemia (HbSS) patients with PAH and 28 without PAH. In PAH patients, analysis consistently showed lower abundance of a 28.1-kDa peak (P < .001), identified by high-resolution mass spectrometry as the oxidant-scavenging protein apolipoprotein A-I (apoA-I), which correlated with clinical assays of apoA-I (r = .58, P < .001) and high-density lipoprotein (HDL) levels (r = .50, P = .001). Consistent with endothelial dysfunction that may mediate this effect in PAH, HbSS patients with lower apoA-I levels also displayed impaired vasodilatory responses to acetylcholine (mean +/- SEM, 189% +/- 34% [n = 13] vs 339% +/- 51% [n = 13], P < .001). As a group, patients with SCD demonstrated significantly lower apoA-I levels than African-American control subjects. The PAH cohort was further characterized by high levels of apolipoproteins A-II and B and serum amyloid A, and low levels of haptoglobin dimers and plasminogen. These results imply a relationship of apolipoproteins to the development of PAH vasculopathy in SCD, potentially involving an unexpected mechanistic parallel to atherosclerosis, another proliferative vasculopathy.
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Abstract
Morphological and immunocytochemical studies have elucidated the complex processes involved in atherogenesis. The notion of plaque instability has emerged from this work and underscored the importance of inflammation in determining clinical complications associated with atherosclerosis, such as acute coronary syndrome. Cells of the immune system have been detected within atherosclerotic lesions and auto-antibodies directed against modified LDL and heat-shock proteins have been identified in the blood of individuals with atherosclerosis. The use of risk 'engines', e.g. the Framingham coronary risk score, has facilitated the identification of individuals at high risk, but the constituent classical risk factors used in these algorithms do not adequately differentiate individuals at moderate risk. As age is a major component of the equations used in these algorithms they are not particularly useful in young adults, and their applicability to non-Caucasian populations has been questioned. Biomarkers of early disease and plaque instability have therefore both been sought. Although some of these markers have been shown individually to be associated with a significant hazard ratio, no substantial improvement in discrimination has been demonstrated when they are incorporated into a risk 'engine'. The latter has generally been assessed by receiver operator characteristic curve analysis, although this approach has been criticised. Other modalities, including imaging and functional assessments of vascular function, are now being developed for clinical use.
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Sierra-Johnson J, Fisher RM, Romero-Corral A, Somers VK, Lopez-Jimenez F, Ohrvik J, Walldius G, Hellenius ML, Hamsten A. Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: findings from a multi-ethnic US population. Eur Heart J 2008; 30:710-7. [PMID: 18676970 DOI: 10.1093/eurheartj/ehn347] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS Prospective studies indicate that apolipoprotein measurements predict coronary heart disease (CHD) risk; however, evidence is conflicting, especially in the US. Our aim was to assess whether measurements of apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) can improve the ability to predict CHD death beyond what is possible based on traditional cardiovascular (CV) risk factors and clinical routine lipid measurements. METHODS AND RESULTS We analysed prospectively associations of apolipoprotein measurements, traditional CV risk factors, and clinical routine lipid measurements with CHD mortality in a multi-ethnic representative subset of 7594 US adults (mean age 45 years; 3881 men and 3713 women, median follow-up 124 person-months) from the Third National Health and Nutrition Examination Survey mortality study. Multiple Cox-proportional hazards regression was applied. There were 673 CV deaths of which 432 were from CHD. Concentrations of apoB [hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.09-3.61], apoA-I (HR 0.48, 95% CI 0.27-0.85) and total cholesterol (TC) (HR 1.17, 95% CI 1.02-1.34) were significantly related to CHD death, whereas high density lipoprotein cholesterol (HDL-C) (HR 0.68, 95% CI 0.45-1.05) was borderline significant. Both the apoB/apoA-I ratio (HR 2.14, 95% CI 1.11-4.10) and the TC/HDL-C ratio (HR 1.10, 95% CI 1.04-1.16) were related to CHD death. Only apoB (HR 2.01, 95% CI 1.05-3.86) and the apoB/apoA-I ratio (HR 2.09, 95% CI 1.04-4.19) remained significantly associated with CHD death after adjusting for CV risk factors. CONCLUSION In the US population, apolipoprotein measurements significantly predict CHD death, independently of conventional lipids and other CV risk factors (smoking, dyslipidaemia, hypertension, obesity, diabetes and C-reactive protein). Furthermore, the predictive ability of apoB alone to detect CHD death was better than any of the routine clinical lipid measurements. Inclusion of apolipoprotein measurements in future clinical guidelines should not be discarded.
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Affiliation(s)
- Justo Sierra-Johnson
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital Solna, Building L8:03, S-17176 Stockholm, Sweden
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Abstract
LDL has been widely recognized as the major atherogenic lipoprotein and designated as the primary target for prevention of coronary heart disease (CHD); however, there is growing evidence that other triglyceride-rich lipoproteins, such as very low-density lipoprotein (VLDL) and intermediate density lipoprotein (IDL) carry atherogenic potential as well. This led to the designation of non-HDL cholesterol (HDL-C) (LDL + IDL + VLDL) as a secondary target of treatment for hyperlipidaemia. As each one of LDL, IDL and VLDL particles carries only one apolipoprotein B-100 (ApoB-100) molecule, the total ApoB value represents the total number of potentially atherogenic lipoproteins, whereas non-HDL-C provides the cholesterol content of these same lipoproteins. Recent data from epidemiological, observational and interventional studies suggest that non-HDL-C, apolipoproteins ApoA1 and ApoB may improve CHD risk assessment by identifying more high-risk individuals than the usual lipid profile alone. However, the targets for the optimal treatment of dyslipidaemia remain a subject of considerable debate. Further studies are needed to determine whether ApoB and ApoA1 are superior to conventional lipid parameters as predictors of cardiovascular disease or therapeutic targets of hyperlipidaemias. In this review, we summarize the current opinions on the use of ApoA1 and ApoB values as estimates of cardiovascular risk or as treatment goals in patients undergoing treatment for hyperlipidaemia.
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Affiliation(s)
- M Andrikoula
- Department of Endocrinology, University Hospital of Ioannina, Ioannina, Greece.
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Eggers KM, Lind L, Ahlstrom H, Bjerner T, Ebeling Barbier C, Larsson A, Venge P, Lindahl B. Prevalence and pathophysiological mechanisms of elevated cardiac troponin I levels in a population-based sample of elderly subjects. Eur Heart J 2008; 29:2252-8. [DOI: 10.1093/eurheartj/ehn327] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Auro K, Kristiansson K, Zethelius B, Berne C, Lannfelt L, Taskinen MR, Jauhiainen M, Perola M, Peltonen L, Syvänen AC. USF1 gene variants contribute to metabolic traits in men in a longitudinal 32-year follow-up study. Diabetologia 2008; 51:464-72. [PMID: 18097648 DOI: 10.1007/s00125-007-0892-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS Genetic variants of upstream transcription factor 1 (USF1) have previously been associated with dyslipidaemias in family studies. Our aim was to further address the role of USF1 in metabolic syndrome and cardiovascular traits at the population level in a large Swedish male cohort (n=2,322) with multiple measurements for risk factors during 32 years of follow-up. METHODS Participants, born in 1920-1924, were examined at 50, 60, 70 and 77 years of age. The follow-up period for cardiovascular events was 1970-2002. We genotyped three haplotype tagging polymorphisms capturing the major allelic variants of USF1. RESULTS SNP rs2774279 was associated with the metabolic syndrome. The minor allele of rs2774279 was less common among individuals with metabolic syndrome than among healthy controls [p=0.0029 when metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III; p=0.0073 when defined according to the International Diabetes Federation (IDF)]. The minor allele of rs2774279 was also associated with lower BMI, lower fasting glucose values and higher HDL-cholesterol concentrations in longitudinal analyses. With SNP rs2073658, a borderline association with metabolic syndrome was observed (p=0.036, IDF), the minor allele being the risk-increasing allele. The minor allele of rs2073658 also associated with higher total and LDL-cholesterol, apolipoprotein B-100 and lipoprotein(a) concentrations in longitudinal analyses. Importantly, these trends with respect to the allelic variants prevailed throughout the follow-up time of three decades. CONCLUSIONS/INTERPRETATION Our results suggest that USF1 variants associate with the metabolic syndrome at population level and influence the cardiovascular risk factors throughout adulthood in a consistent, longitudinal manner.
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Affiliation(s)
- K Auro
- Department of Molecular Medicine, National Public Health Institute, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland
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Eichler K, Puhan MA, Steurer J, Bachmann LM. Prediction of first coronary events with the Framingham score: a systematic review. Am Heart J 2007; 153:722-31, 731.e1-8. [PMID: 17452145 DOI: 10.1016/j.ahj.2007.02.027] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Uncertainty exists about the performance of the Framingham risk score when applied in different populations. OBJECTIVE We assessed calibration of the Framingham risk score (ie, relationship between predicted and observed coronary event rates) in US and non-US populations free of cardiovascular disease. METHODS We reviewed studies that evaluated the performance of the Framingham risk score to predict first coronary events in a validation cohort, as identified by Medline, EMBASE, BIOSIS, and Cochrane library searches (through August 2005). Two reviewers independently assessed 1496 studies for eligibility, extracted data, and performed quality assessment using predefined forms. RESULTS We included 25 validation cohorts of different population groups (n = 128,000) in our main analysis. Calibration varied over a wide range from under- to overprediction of absolute risk by factors of 0.57 to 2.7. Risk prediction for 7 cohorts (n = 18658) from the United States, Australia, and New Zealand was well calibrated (corresponding figures: 0.87-1.08; for the 5 biggest cohorts). The estimated population risks for first coronary events were strongly associated (goodness of fit: R2 = 0.84) and in good agreement with observed risks (coefficient for predicted risk: beta = 0.84; 95% CI 0.41-1.26). In 18 European cohorts (n = 109499), the corresponding figures indicated close association (R2 = 0.72) but substantial overprediction (beta = 0.58, 95% CI 0.39-0.77). The risk score was well calibrated on the intercept for both population clusters. CONCLUSION The Framingham score is well calibrated to predict first coronary events in populations from the United States, Australia, and New Zealand. Overestimation of absolute risk in European cohorts requires recalibration procedures.
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Affiliation(s)
- Klaus Eichler
- Horten Centre for Patient Oriented Research, University Hospital of Zurich, Postfach Nord, Zurich, Switzerland.
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Triantafyllou A, Chaviaras N, Sergentanis TN, Protopapa E, Tsaknis J. Chios mastic gum modulates serum biochemical parameters in a human population. JOURNAL OF ETHNOPHARMACOLOGY 2007; 111:43-9. [PMID: 17150319 DOI: 10.1016/j.jep.2006.10.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 10/23/2006] [Accepted: 10/26/2006] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Current research suggests that Chios mastic (Pistacia lentiscus var. chia) possesses beneficial (antimicrobial, antioxidant, hepatoprotective) properties. This study aims to assess its effects on cardiologic and hepatic biochemical indices of human subjects. MATERIALS AND METHODS Subjects (n=133, aged over 50) were randomly assigned to two groups, the first (high-dose group) ingesting daily 5g of mastic powder and the second receiving daily a Chios mastic solution (low-dose group). Serum biochemical parameters were determined on a monthly basis for an 18-month (high-dose group) and a 12-month (low-dose group) follow-up period. Generalized least squares random-effects linear regression was performed. RESULTS The group ingesting Chios mastic powder (high-dose group) exhibited a decrease in serum total cholesterol, LDL, total cholesterol/HDL ratio, lipoprotein (a), apolipoprotein A-1, apolipoprotein B (apoB/apoA-1 ratio did not change), SGOT, SGPT and gamma-GT levels; in the second (low-dose) group, glucose levels decreased in males. DISCUSSION Chios mastic powder could have a hepatoprotective/cardioprotective role in vivo in humans.
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Affiliation(s)
- Angeliki Triantafyllou
- Department of Biochemistry, Medical School, National University of Athens, 75, Mikras Assias Str, Athens, Greece
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Möller CS, Zethelius B, Sundström J, Lind L. Impact of follow-up time and re-measurement of the electrocardiogram and conventional cardiovascular risk factors on their predictive value for myocardial infarction. J Intern Med 2006; 260:22-30. [PMID: 16789975 DOI: 10.1111/j.1365-2796.2006.01642.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore if the predictive power of mid-life electrocardiogram (ECG) abnormalities and conventional cardiovascular risk factors for future myocardial infarction, change over a 30-year follow-up period and if repeated examination improves their predictive power. DESIGN AND SETTING Longitudinal population-based study. PARTICIPANTS A total of 2322 men aged 50 years, with a total follow-up period of 30 years and 1221 subjects were re-examined at age of 70 years. MAIN OUTCOME MEASURE Risk for fatal and nonfatal myocardial infarction (n = 470) analysed at age 50 and 70 years, and separately for 1-10, 11-20 and 21-30 years after first examination. Investigations included a 12-lead ECG, blood pressure, body mass index, smoking habits, and glucose and lipid variables. RESULTS Whilst high blood pressure and dyslipidaemia variables, such as apolipoprotein B/apolipoprotein A1 ratio, measured at age 50 showed an almost unchanged predictive power during the three decades of follow up, ECG abnormalities, insulin and BMI were only significant predictors during the two first decades of follow up. Despite increased prevalences of ECG abnormalities and obesity with age, they predicted for future myocardial infarction in midlife only whilst fasting insulin and smoking regained their predictive power when re-measured at age 70. CONCLUSION Whilst hypertension and dyslipidaemia were consistent as risk factors, length of follow-up period and age at baseline investigations affected the predictive power of ECG abnormalities, fasting insulin, BMI and smoking. In the elderly, ECG abnormalities did not contribute to the prediction of myocardial infarction but smoking and fasting insulin may be important in the pathophysiology leading to MI especially in this age group.
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Affiliation(s)
- Christina Ström Möller
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
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Lind L, Fors N, Hall J, Marttala K, Stenborg A. A comparison of three different methods to determine arterial compliance in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. J Hypertens 2006; 24:1075-82. [PMID: 16685207 DOI: 10.1097/01.hjh.0000226197.67052.89] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several different techniques to evaluate arterial compliance have been described but have not been simultaneously tested in a large-scale, population-based setting. This study aimed to evaluate the feasibility and relation to cardiac risk of three of these techniques in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study. METHODS AND RESULTS In the population-based PIVUS study (1016 participants aged 70), assessment of arterial distensibility by ultrasound in the carotid artery, by pulse wave analysis (augmentation index) and the stroke volume to pulse pressure ratio by echocardiography were successfully employed in 86, 92, 91 and 77% of the sample, respectively. All three indices of arterial compliance were inter-related (r = 0.19-0.34, P < 0.0001 for all). Although all three indices were significantly related to the Framingham risk score (r = 0.12-0.32, P = 0.0005-0.0001), only carotid artery distensibility and the stroke volume to pulse pressure ratio were independently associated with the Framingham score in multiple regression analysis (P < 0.0001 for both). CONCLUSIONS All three indices to evaluate arterial compliance were feasible to obtain in a general elderly population and were inter-related. Although all of the techniques were correlated to Framingham risk score, only carotid artery distensibility and the stroke volume to pulse pressure ratio were independently related to coronary risk, suggesting complementary use of these two indices of arterial compliance in the future.
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Affiliation(s)
- Lars Lind
- Department of Medicine, Uppsala University Hospital, Sweden.
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Thompson A, Danesh J. Associations between apolipoprotein B, apolipoprotein AI, the apolipoprotein B/AI ratio and coronary heart disease: a literature-based meta-analysis of prospective studies. J Intern Med 2006; 259:481-92. [PMID: 16629854 DOI: 10.1111/j.1365-2796.2006.01644.x] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To assess associations of circulating levels of apolipoprotein (apo) AI, apoB and the apoB/AI ratio (apoB/A) with risk of incident coronary heart disease (CHD). DESIGN Literature-based meta-analysis of prospective studies. DATA SOURCES Prospective studies in essentially general populations that reported on associations between apoAI, apoB or apoB/A and first incident CHD outcomes. Studies were identified by computer-based searches and by manual searches of the relevant literature. RESULTS Data from 23 relevant studies were identified. For apoAI, with 6333 CHD cases in 21 studies, comparison of individuals in the bottom third with those in the top third of baseline values yielded a combined relative risk of 1.62 (95% confidence interval: 1.43-1.83), i.e. an inverse association. For apoB, a combined analysis of 6320 CHD cases from 19 studies gave a relative risk of 1.99 (1.65-2.39) for a comparison of individuals in the top third versus those in the bottom third of baseline values. For apoB/A, with 3730 CHD cases from seven studies, a comparison of individuals in the top third versus the bottom third of baseline values gave a combined relative risk of 1.86 (1.55-2.22). These associations were somewhat stronger following correction for within-person variations in apolipoprotein levels. There was evidence of heterogeneity amongst the published studies, but it was only partly explained by available study-level characteristics. CONCLUSIONS The present quantitative review suggests the existence of moderately strong associations between baseline levels of each of apoAI, apoB, and apoB/A and risk of CHD. More detailed analysis, perhaps based on individual participant data from prospective studies, could help to overcome several limitations in the present review and to clarify any relevance of these apolipoproteins to disease prediction and aetiology.
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Affiliation(s)
- A Thompson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Walldius G, Jungner I. The apoB/apoA-I ratio: a strong, new risk factor for cardiovascular disease and a target for lipid-lowering therapy--a review of the evidence. J Intern Med 2006; 259:493-519. [PMID: 16629855 DOI: 10.1111/j.1365-2796.2006.01643.x] [Citation(s) in RCA: 363] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
During the last several years interest has focused on the importance of the lipid-transporting apolipoproteins--apoB transports all potentially atherogenic very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL) and LDL particles, and apoA-I transports and acts as the major antiatherogenic protein in the HDL particles. The evidence for the apoB/apoA-I ratio being a strong, new risk factor for cardiovascular (CV) disease and a target for lipid-lowering therapy is reviewed. Results from clinical prospective studies and lipid-lowering trials in healthy subjects and in patients with different clinical manifestations of atherosclerosis are reported. Risk of nonfatal and fatal myocardial infarction and stroke, and manifestations of atherosclerosis documented by angiographic, ultrasound and other techniques has been related to conventional lipids and apolipoproteins (apo). The cholesterol balance determined as the apoB/apoA-I ratio has repeatedly been shown to be a better marker than lipids, lipoproteins and lipid ratios. The results indicate that the apoB/apoA-I ratio is a simple, accurate and new risk factor for CV disease--the lower the apoB/apoA-I ratio, the lower is the risk. Guidelines should be developed in order to recognize the important clinical risk information embedded in the apoB/apoA-I ratio.
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Affiliation(s)
- G Walldius
- King Gustaf V Research Institute, Karolinska Institute, Stockholm, Sweden.
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Lind L, Vessby B, Sundström J. The Apolipoprotein B/AI Ratio and the Metabolic Syndrome Independently Predict Risk for Myocardial Infarction in Middle-Aged Men. Arterioscler Thromb Vasc Biol 2006; 26:406-10. [PMID: 16306426 DOI: 10.1161/01.atv.0000197827.12431.d0] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Both the metabolic syndrome and an increased apolipoprotein B/AI (apoB/AI) ratio are powerful risk factors for cardiovascular events. We hypothesized that the apoB/AI ratio well-characterizes the dyslipidemia associated with insulin resistance and the metabolic syndrome and investigated those relations and if the apoB/AI ratio and the metabolic syndrome independently predicted subsequent myocardial infarction (MI). METHODS AND RESULTS A community-based sample of 1826 men aged 50 was investigated at baseline and again at age 70. ApoB/AI ratio and the metabolic syndrome (National Cholesterol Education Program definition) were evaluated, and the incidence of fatal and nonfatal MI was followed for a median of 26.8 years from the age 50 baseline. ApoB/AI ratio was significantly higher in men with versus without the metabolic syndrome (P<0.0001), and increased with the number of components defining the syndrome (P<0.0001). ApoB/AI ratio was inversely related to euglycemic insulin clamp glucose disposal rate at age 70 (r=-0.34, P<0.0001). During follow-up from age 50, 462 subjects developed an MI. An apoB/AI ratio > or =0.9 (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.15 to 1.91) and presence of the metabolic syndrome (HR, 1.69; 95% CI, 1.30 to 2.21) at baseline were independent predictors for MI, adjusting for low-density lipoprotein cholesterol and smoking. CONCLUSIONS The apoB/AI ratio was related to the metabolic syndrome, as well as to a direct measurement of insulin resistance. Despite this, the apoB/AI ratio and the metabolic syndrome were both independent long-term predictors of MI in a community-based sample of middle-aged men.
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Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
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Abstract
The metabolic syndrome, which is very common in the general population, is defined by the clustering of several classic cardiovascular risk factors, such as type 2 diabetes, hypertension, high triglycerides and low high-density lipoprotein cholesterol (HDL). Central obesity and insulin resistance, which are the two underlying disorders of the syndrome, are further risk factors for cardiovascular disease. Moreover, a panel of novel (non-traditional) risk factors are ancillary features of the metabolic syndrome. They include biomarkers of chronic mild inflammation (e.g. C-reactive protein, CRP), increased oxidant stress (e.g. oxidized low density lipoprotein, LDL), thrombophilia (e.g. plasminogen activator inhibitor-1, PAI-1) and endothelial dysfunction (e.g. E-selectin). Therefore, subjects with the metabolic syndrome are potentially at high risk of developing atherosclerosis and clinical cardiovascular events.In recent years several longitudinal studies have confirmed that subjects with the metabolic syndrome present with atherosclerosis and suffer from myocardial infarction and stroke at rates higher than subjects without the syndrome. The risk of cardiovascular disease (CVD) is particularly high in women with the syndrome and in subjects with pre-existing diabetes, CVD and/or high CRP. However, an increased risk is already present in subjects with a cluster of multiple mild abnormalities. The risk related to the metabolic syndrome is definitely higher when subjects affected are compared to subjects free of any metabolic abnormality.
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Affiliation(s)
- Enzo Bonora
- Department of Endocrinology and Metabolic Diseases, University of Verona Medical School, Verona, Italy.
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