Effect of lifestyle changes on atherogenic lipids and endothelial cell adhesion molecules in young adults with familial premature coronary heart disease

Cardiovascular effects of overt and subclinical hyperthyroidism: focus on differentiated thyroid cancer

Thyroid hormone stimulates cardiac inotropy and chronotropy via direct genomic and non-genomic mechanisms. Hyperthyroidism magnifies these effects, resulting in an increase in heart rate, ejection fraction and blood volume. Hyperthyroidism also affects thrombogenesis and this may be linked to a probable tendency toward thrombosis in patients with hyperthyroidism. Patients with hyperthyroidism are therefore at higher risk for atrial fibrillation, heart failure and cardiovascular mortality. Similarly, TSH suppressive therapy for differentiated thyroid cancer is associated with increased cardiovascular risk. In this review, we present the latest insights on the cardiac effects of thyroid suppression therapy for the treatment of thyroid cancer. Finally, we will show new clinical data on how to implement this knowledge into the clinical practice of preventive medicine.

The effects of tocotrienol supplementation on lipid profile: A meta-analysis of randomized controlled trials

BACKGROUND & OBJECTIVE

Tocotrienol supplementation has been emerged as a potent candidate for the treatment of dyslipidemia. In the present study, a systematic review and meta-analysis of randomized controlled trials was performed with the aim of examining the effects of tocotrienol supplementation on the lipid profile.

METHODS

Four databases (Scopus, PubMed/Medline, Web of Science and Embase) were used to accomplish the literature search up to November 2019. Clinical trials encompassing the impact of tocotrienol supplementation on lipid profile were extracted regardless of clinical condition, with studies included involving only adults patients.

RESULTS

A total of 15 articles with 20 arms were eligible and included in the meta-analysis to estimate the pooled effect size. Overall results showed a significant effect of tocotrienol supplementation on increasing high-density lipoprotein cholesterol (HDL-C) levels (weight mean difference (WMD): 0.146 mmol/L, I² = 85.9%) and a non-significant influence on total cholesterol (TC) (WMD: 0.010 mmol/L, I² = 64.5%), low-density lipoprotein cholesterol (LDL-C) (WMD: 0.095 mmol/L, I² = 87.4%), and triglycerides (TG) (WMD: -0.112 mmol/L, I² = 67.4%) levels. Increment in HDL-C levels was significant greater for the tocotrienol dosage ≥ 200 mg/d (WMD: 0.202 mmol/L) and ≤8 weeks (WMD: 0.278 mmol/L). Moreover, studies that investigated tocotrienol dose ≥200 mg had no heterogeneity, while showing a significant decrease in TG levels (WMD: -0.177 mmol/L).

CONCLUSION

The present meta-analysis demonstrated that supplementing with tocotrienols does not decrease the concentrations of LDL-C, TC and TG. However, tocotrienol supplementation was considered a candidate for increasing HDL-C levels.

Macrophages transmit potent proangiogenic effects of oxLDL in vitro and in vivo involving HIF-1α activation: a novel aspect of angiogenesis in atherosclerosis

Neovascularization has been linked to the progression and vulnerability of atherosclerotic lesions. Angiogenesis is increased in lipid-rich plaque. Hypoxia-inducible factor alpha (HIF-1α) is a key transcriptional regulator responding to hypoxia and activating genes, which promote angiogenesis, among them vascular endothelial growth factor (VEGF). Oxidized low-density lipoprotein (oxLDL) is generated in lipid-rich plaque by oxidative stress. It triggers an inflammatory response and was traditionally thought to inhibit endothelial cells. New data, however, suggest that oxLDL can activate HIF-1α in monocytes in a hypoxia-independent fashion. We hypothesized that HIF-1α activation in monocyte-macrophages could transmit proangiogenic effects of oxLDL linking hyperlipidemia, inflammation, and angiogenesis in atherosclerosis. First, we examined the effect of oxLDL on HIF-1α and VEGF expression in monocyte-macrophages and on their proangiogenic effect on endothelial cells in vitro in a monocyte-macrophage/endothelial co-culture model. OxLDL strongly induced HIF-1α and VEGF in monocyte-macrophages and significantly increased tube formation in co-cultured endothelial cells. HIF-1α inhibition reversed this effect. Second, we demonstrated a direct proangiogenic effect of oxLDL in an in vivo angiogenesis assay. Again, HIF-1α inhibition abrogated the proangiogenic effect of oxLDL. Third, in a rabbit atherosclerosis model, we studied the effect of dietary lipid lowering on arterial HIF-1α and VEGF expression. The administration of low-lipid diet significantly reduced the expression of both HIF-1α and VEGF, resulting in decreased plaque neovascularization. Our data point to oxLDL as a proangiogenic agent linking hyperlipidemia, inflammation, and angiogenesis in atherosclerosis. This effect is dependent on macrophages and, at least in part, on the induction of the HIF-1α pathway.

Effects of therapeutic lifestyle changes on peripheral artery tonometry in patients with abdominal obesity

BACKGROUND AND AIMS

Abdominal obesity (AO) is associated with endothelial function (EF) alteration and increased global cardiovascular (CV) risk. Therapeutic lifestyle changes (TLSC) reduce CV risk, but the impact on EF assessed by peripheral artery tonometry (PAT) is unknown. In this study, we aimed to prospectively assess the effects of TLSC on EF measured by PAT in increased CV risk patients with AO.

METHODS AND RESULTS

150 patients with AO and moderate CV risk were randomized to groups receiving a one-year intervention of either conventional medical care (control group, CG) or an intensive TLSC program (intervention group, IG). Vascular studies (EF by PAT, intima-media thickness (IMT)) and lifestyle (LS) assessment were performed before and after intervention. The PAT ratio improved in the IG and worsened in the CG. The global CV risk was reduced (P = 0.017) in the IG due to a significant decrease in systolic blood pressure (P < 0.001), increase in HDL cholesterol and ApolipoproteinA1 (P = 0.013). More individuals in the IG than in the CG quit smoking (P = 0.001) and increased their physical activity (P = 0.014). The improvement in at least two LS components was associated with a PAT ratio increase (2.44 IC: 95% 0.99-6.00, P = 0.051). The PAT ratio increase determined less IMT progression (-1.1 IC: 95% 0.91-1.00, P = 0.053).

CONCLUSIONS

Good adherence to a TLSC program reduces global CV risk and determines PAT ratio improvement. The PAT ratio increase is the main determinant of lower IMT progression.

Platelet reactivity and endothelial function in children of patients with early acute myocardial infarction

AIMS

To assess whether platelet reactivity is increased in offspring of patients with early acute myocardial infarction (AMI) and its possible relation with endothelial dysfunction.

METHODS AND RESULTS

We studied 23 healthy children (15±3 years, 13 males) of patients with early AMI (≤50 years old; Group 1) and 21 healthy children of healthy subjects without any history of cardiovascular disease (14±3 years, 10 males; Group 2). Platelet reactivity was assessed by flow cytometry as the increase in monocyte-platelet aggregates (MPA) and CD41 and PAC-1 platelet expression in response to exercise stress test (EST), adenosine diphosphate (ADP) stimulation (10(-7) M), or both. Endothelial function was assessed by measuring brachial artery dilation during post-ischaemic forearm hyperaemia [flow-mediated dilation (FMD)]. Both EST and ADP induced a higher percentage increase in platelet receptor expression in Group 1, compared with Group 2, with the most significant difference being shown for the response to the combined stimuli (e.g. MPA, 23.1±12 vs. 5.63±8%, P<0.001; platelet PAC-1, 57.7±47 vs. 13.2±7%, P<0.001). Compared with Group 2, Group 1 children showed lower FMD (10.7±3.1 vs. 8.0±2.9%, respectively; P=0.007). However, no significant association was found between FMD and platelet reactivity.

CONCLUSION

Our results show increased platelet reactivity in children of patients with early AMI; the finding was not significantly correlated with endothelial dysfunction, suggesting that other mechanisms are mainly involved in the enhanced platelet response to agonistic stimuli.

Multiple risk factor interventions for primary prevention of coronary heart disease

BACKGROUND

Multiple risk factor interventions using counselling and educational methods assumed to be efficacious and cost-effective in reducing coronary heart disease (CHD) mortality and morbidity and that they should be expanded. Trials examining risk factor changes have cast doubt on the effectiveness of these interventions.

OBJECTIVES

To assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence CHD..

SEARCH STRATEGY

We updated the original search BY SEARCHING CENTRAL (2006, Issue 2), MEDLINE (2000 to June 2006) and EMBASE (1998 to June 2006), and checking bibliographies.

SELECTION CRITERIA

Randomised controlled trials of more than six months duration using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups or specific risk factors (i.e. diabetes, hypertension, hyperlipidaemia, obesity).

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently. We expressed categorical variables as odds ratios (OR) with 95% confidence intervals (CI). Where studies published subsequent follow-up data on mortality and event rates, we updated these data.

MAIN RESULTS

We found 55 trials (163,471 participants) with a median duration of 12 month follow up. Fourteen trials (139,256 participants) with reported clinical event endpoints, the pooled ORs for total and CHD mortality were 1.00 (95% CI 0.96 to 1.05) and 0.99 (95% CI 0.92 to 1.07), respectively. Total mortality and combined fatal and non-fatal cardiovascular events showed benefits from intervention when confined to trials involving people with hypertension (16 trials) and diabetes (5 trials): OR 0.78 (95% CI 0.68 to 0.89) and OR 0.71 (95% CI 0.61 to 0.83), respectively. Net changes (weighted mean differences) in systolic and diastolic blood pressure (53 trials) and blood cholesterol (50 trials) were -2.71 mmHg (95% CI -3.49 to -1.93), -2.13 mmHg (95% CI -2.67 to -1.58 ) and -0.24 mmol/l (95% CI -0.32 to -0.16), respectively. The OR for reduction in smoking prevalence (20 trials) was 0.87 (95% CI 0.75 to 1.00). Marked heterogeneity (I(2) > 85%) for all risk factor analyses was not explained by co-morbidities, allocation concealment, use of antihypertensive or cholesterol-lowering drugs, or by age of trial.

AUTHORS' CONCLUSIONS

Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high-risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations.

Does stage of change modify the effectiveness of an educational intervention to improve diet among family members of hospitalized cardiovascular disease patients?

OBJECTIVE

The purpose of this study was to evaluate whether effectiveness of a special intervention to improve diet vs a control intervention differs by readiness to reduce dietary saturated fat based on the Transtheoretical Model Stages of Change among family members of hospitalized cardiovascular disease patients.

DESIGN

Stages of change (ie, precontemplation, contemplation, preparation, action, maintenance) were assessed by standardized questionnaire. Diet was measured by Block 98 Food Frequency Questionnaire at baseline and 1 year in participants in the Family Intervention Trial for Heart Health (n=501; 36% racial/ethnic minorities; 66% female). Therapeutic Lifestyle Change diet education was provided to each special intervention subject tailored to baseline stage of change.

STATISTICAL ANALYSES

Multivariable linear regression was used to examine whether the effect of the intervention was modified by stage of change.

RESULTS

Baseline saturated fat and cholesterol intakes were lower among those in maintenance stage vs others (9.9% vs 11.2% kcal; P<0.0001 and 112.2 vs 129.7 mg/1,000 kcal; P=0.0003, respectively). Overall, change in the percentage of calories from saturated fat from baseline to 1 year was -0.7 in the special intervention vs -0.4 in the control intervention (P=0.18). Among participants in contemplation, greater reductions in saturated fat (-2.1% vs +0.3% kcal; P=0.04) and cholesterol (-34.0 vs +32.6 mg/1,000 kcal; P=0.01) were seen in the special intervention vs control intervention. The special intervention was more likely than control intervention to achieve new adherence to a diet of <10% saturated fat/<300 mg cholesterol at 1 year among those not in maintenance stage (30% vs 15%; P=0.03). Control intervention participants were more likely than special intervention to revert to lower levels on the stage of change continuum from baseline to 1 year (17% vs 7%; P=0.002).

CONCLUSION

Effectiveness of an intervention to lower saturated fat varies by baseline stage of change among family members of hospitalized cardiovascular patients. This can be important to consider when designing research or clinical diet interventions.

Effects of lifestyle modification on oxidized LDL, reactive oxygen species production and endothelial cell viability in patients with coronary artery disease

OBJECTIVES

We evaluated the effects of lifestyle modification (LM) on lipid profile, oxidative stress and serum-stimulated human coronary artery endothelial cell (HCAEC) viability in coronary artery disease (CAD) patients after 6months.

DESIGN AND METHODS

Thirty patients with CAD were randomly assigned to LM intervention (n=15) and usual care control (n=15) groups. LM-intervened patients were instructed to consume low-fat, high-antioxidants and fiber diets. Moderate exercise and stress management were also advised. Group support to maintain patients' compliance was applied.

RESULTS

Serum cholesterol, triglyceride, oxidized LDL and protein carbonyl were decreased in LM group. Serum triglyceride was increased in control group. HCAEC viability was increased, while intracellular reactive oxygen species was decreased, by serum from the LM group.

CONCLUSION

LM is capable of improving lipid profile, reducing oxidative stress and increasing HCAEC survival in the patients with CAD, hence lowering a risk for the future cardiovascular event.

Association of Indian Diabetes Risk Score with arterial stiffness in Asian Indian nondiabetic subjects: the Chennai Urban Rural Epidemiology Study (CURES-84)

OBJECTIVE

In this study, we aim to determine the association of Indian Diabetes Risk Score (IDRS) with augmentation index (AI), a preclinical marker of early atherosclerotic changes.

METHODS

Subjects without known diabetes (n = 1985) were randomly selected from the Chennai Urban Rural Epidemiology Study, an ongoing population-based study on a representative population (aged >or=20 years) of Chennai, the largest city in Southern India. Augmentation index was measured using the Sphygmocor apparatus (Sphygmocor BPAS-1; PWV Medical, Sydney, Australia). Serum lipids were measured in an overnight fasting sample along with other biochemical parameters. Indian Diabetes Risk Score includes four parameters: age, abdominal obesity, family history of type 2 diabetes, and physical activity.

RESULTS

Arterial stiffness values increased with an increase in IDRS. Subjects with IDRS >or=60 had significantly higher AI (24.6 +/- 7.2; p < .001) compared to subjects with an IDRS of 30-60 (16.4 +/- 5.5; p < .001) and with IDRS <30 (13.3 +/- 4.5), and the p for trend was statistically significant (<.001). Pearson correlation analysis in the total population revealed that AI was significantly correlated with age (p < .001), systolic and diastolic blood pressure (p < .001), IDRS (p < .001), glycated hemoglobin A1c (A1C) (p < .001), serum cholesterol (p < .001), serum triglycerides (p < .001), high-density lipoprotein (HDL) cholesterol (p < .001), low-density lipoprotein cholesterol (p < .001), and non-HDL cholesterol (p < .001). In linear regression analysis, IDRS showed a significant association with AI even after adjusting for blood pressure, smoking, insulin resistance, A1C, cholesterol, and triglycerides (beta = 6.388; p < .001).

CONCLUSION

This study shows that, in addition to identifying unknown diabetes, IDRS also helps to identify those with arterial stiffness.

Behavioral intervention to promote smoking cessation and prevent weight gain: a systematic review and meta-analysis

AIMS

The prospect of weight gain discourages many cigarette smokers from quitting. Practice guidelines offer varied advice about managing weight gain after quitting smoking, but no systematic review and meta-analysis have been available. We reviewed evidence to determine whether behavioral weight control intervention compromises smoking cessation attempts, and if it offers an effective way to reduce post-cessation weight gain.

METHODS

We identified randomized controlled trials (RCTs) that compared combined smoking treatment and behavioral weight control to smoking treatment alone for adult smokers. English-language studies were identified through searches of PubMed, Ovid MEDLINE, CINAHL, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials. Of 779 articles identified and 35 potentially relevant RCTs screened, 10 met the criteria and were included in the meta-analysis.

RESULTS

Patients who received both smoking treatment and weight treatment showed increased abstinence [odds ratio (OR) = 1.29, 95% confidence interval (CI) = 1.01, 1.64] and reduced weight gain (g = -0.30, 95% CI = -0.57, -0.02) in the short term (<3 months) compared with patients who received smoking treatment alone. Differences in abstinence (OR = 1.23, 95% CI = 0.85, 1.79) and weight control (g = -0.17, 95% CI = -0.42, 0.07) were no longer significant in the long term (>6 months).

CONCLUSIONS

Findings provide no evidence that combining smoking treatment and behavioral weight control produces any harm and significant evidence of short-term benefit for both abstinence and weight control. However, the absence of long-term enhancement of either smoking cessation or weight control by the time-limited interventions studied to date provides insufficient basis to recommend societal expenditures on weight gain prevention treatment for patients who are quitting smoking.

Effect of smoking cessation on markers of inflammation and endothelial cell activation among individuals with high risk for cardiovascular disease

OBJECTIVE

To prospectively determine the effect of smoking cessation on markers of inflammation and endothelial cell activation.

MATERIAL AND METHODS

Thirty male and 22 female smokers of >7 cigarettes daily, aged 32-64 years with cardiovascular disease (CVD) or additional risk factors to smoking, participated in a program of smoking cessation with a follow-up period of 1 year. Cessation was validated by carbon monoxide measurement in expired breath, and 41 of the patients completed the study (17 quitters and 24 non-quitters). Plasma samples were drawn at baseline and after 1 year, and inflammatory markers were analyzed by enzyme immunoassays. Peripheral blood mononuclear cells (PBMCs) were isolated at baseline and 1 year in 6 quitters and 6 smokers and mRNA levels of interleukin-8 (IL-8), tumor necrosis factor x (TNFx) and intercellular adhesion molecule 1 (ICAM-1) were analyzed by real-time quantitative RT-PCR.

RESULTS

Our main findings were: (i) While the concentration of soluble (s) ICAM-1 decreased in quitters, it increased in smokers, with a significant difference in changes between the groups (p=0.04). (ii) While there was only minor change in mRNA levels of IL-8 in smokers, those who stopped smoking showed a decrease in the gene expression of IL-8 (p < 0.09; comparing difference in changes). (iii) Concentrations of the other measured parameters (E-selectin, IL-6, sCD40 ligand, TNFx, von Willebrand factor, and C-reactive protein) were unchanged during follow-up in both groups.

CONCLUSION

Smoking cessation induced a reduction in ICAM-1, suggesting a novel mechanism for the rapid reduction in the risk of CVD following smoking cessation.

Short-term effects of smoking cessation on blood antioxidant parameters and paraoxonase activity in healthy asymptomatic long-term cigarette smokers

The aim of this study was to compare short-term effects of smoking cessation on blood oxidant/antioxidant status, cholesterol levels, and paraoxonase activity. Sixteen healthy, asymptomatic long-term cigarette smokers (mean age: 35 +/- 9 yr) participated in the study in the smoking cessation program. After and before smoking cessation, subjects were examined for oxidant/antioxidant status, cholesterol level, paraoxonase activity, breath carbon monoxide levels, and blood carboxyhemoglobin values. When compared to previous values, subjects were revealed statistically significant decreases in malondialdehyde and carbon monoxide levels 4 wk after smoking cessation. The ratio of high-density lipoprotein (HDL) low-density lipoprotein (LDL) cholesterol was found to be increased. Significantly increased to paraoxonase activity was also observed in the blood samples obtained after cigarette cessation period. It was concluded that all these changes observed after smoking cessation might be of importance in the reduction of cardiovascular risk parameters in the smokers.

High, but not moderate frequency and duration of exercise training induces downregulation of the expression of inflammatory and atherogenic adhesion molecules

BACKGROUND

Lifestyle changes which include daily exercise training have been shown to slow the progression of coronary artery disease. We designed a study to examine the effects of a multifactorial intervention on atherogenic adhesion molecules on the surface of monocytes in patients with coronary artery disease.

METHODS

We randomized 39 patients with coronary artery disease to (i) an intervention program which consisted of 4 weeks of daily 6x15 min ergometer training at submaximal intensity in addition to a 1 h/week group exercise session, followed by 5 months of home-based ergometer training of 30 min/day again in addition to a 1 h/week group exercise session or (ii) conventional therapy. All patients received a statin. Monocyte-bound cellular adhesion molecules LFA-1 (CD11a), MAC-1 (CD11b), VLA-4 (CD49d) and L-selectin (CD62L) were assessed by fluorescence activated cell sorting analysis.

RESULTS

After 4 weeks the multifactorial intervention led to a significant improvement of maximal work capacity, lipid profile, body mass index, blood pressure, fasting glucose and hemoglobin A1c. This was associated with a reduced expression of MAC-1 and VLA-4. After 5 months of a home-based intervention the beneficial effects of the cardiovascular risk profile were still apparent, whereas the effects on the expression of adhesion molecules were blunted.

CONCLUSION

In patients treated with statins, 4 weeks of high frequency and long duration exercise training led to a diminished expression of atherogenic adhesion molecules MAC-1 und VLA-4. After 5 months of home-based exercise training of moderate frequency and duration, these effects were blunted. Our data suggest that our patients in cardiac rehabilitation programs might further benefit from the antiatherogenic effects of an even higher amount of exercise training.

A diabetes risk score helps identify metabolic syndrome and cardiovascular risk in Indians - the Chennai Urban Rural Epidemiology Study (CURES-38)

AIMS

The aims of the study were to compare the recently evolved Indian Diabetes Risk Score (IDRS), in subjects with different grades of glucose intolerance and to evaluate its usefulness as an indicator of cardiovascular risk in Asian Indians, a high risk group for diabetes and coronary artery disease (CAD).

METHODS

The data for the present study were obtained from the Phase 3 (n = 2350, response rate: 90.4%) of the Chennai Urban Rural Epidemiology Study, a population-based study done in Chennai, the largest city in southern India. IDRS was developed based on multiple logistic regression analysis using four simple parameters namely age, abdominal obesity, family history of type 2 diabetes and physical activity. In all subjects, family history of diabetes was obtained, and details on physical activity were assessed using a validated questionnaire. Subjects with an IDRS of <30 was categorized as low risk, 30-50 as medium risk and those with > or =60 as high risk for diabetes. Biochemical and anthropometric measurements were done using standardized procedures. Minnesota coding was used to grade 12-lead electrocardiogram.

RESULTS

The mean IDRS increased significantly with worsening glucose intolerance [normal glucose tolerance (NGT) subjects: 48 +/- 17, impaired glucose tolerance (IGT): 57 +/- 16, newly diagnosed diabetics (NDD): 61 +/- 15 and known diabetics (KD): 68 +/- 12; p for trend <0.001]. Among NGT group, the prevalence of cardiovascular risk factors increased progressively in low-, medium- to high-risk score groups; hypertension: 9.4, 22.1 and 38.2% (p for trend: < 0.001), hypertriglyceridemia: 8.8, 19.9 and 25.3% (p for trend: < 0.001), hypercholesterolemia: 7.2, 20.3 and 34.9% (p for trend: < 0.001) and metabolic syndrome: 1.8, 14.6 and 30.3% (p for trend: < 0.001), respectively. The prevalence of CAD was also significantly higher in individuals with high risk compared with those with low risk (p = 0.030) and the medium risk (p = 0.050) in the NGT group.

CONCLUSIONS

The results suggest that in Asian Indians, (i) the diabetes risk score increases with increasing glucose intolerance, and (ii) it can serve as an effective indicator of metabolic syndrome and cardiovascular risk even among subjects with NGT.

Effects of an antiatherogenic diet during pregnancy on markers of maternal and fetal endothelial activation and inflammation: the CARRDIP study

Objective

To study the effect of an antiatherogenic diet on maternal and cord blood concentrations of systemic biomarkers of endothelial cell activation, haemostasis and inflammation.

Design

Single blinded randomised controlled clinical trial.

Setting

Obstetric outpatient clinic and maternity unit of a university hospital in Norway.

Population

Nonsmoking pregnant women aged 21–38 years carrying a single fetus and with no previous pregnancy-related complications.

Methods

Subjects (n = 290) were randomised to continue their usual diet or to adopt a diet low in saturated fat and cholesterol from gestational week 17–20 to birth. Soluble forms of cellular adhesion molecules, high-sensitivity C-reactive protein (CRP) and haemostatic markers were measured at 17–20 weeks of gestation (baseline) and subsequently up to week 36. All the above, except CRP, were also measured in cord blood.

Main outcome measures

Concentrations of maternal and fetal biomarkers and maternal CRP.

Results

All biomarkers except CRP levels increased significantly during the study period in both the intervention and control groups. None of the maternal or fetal biomarkers were influenced by the intervention (P > 0.05) except for a tendency to lower concentrations of cord blood tissue plasminogen activator antigen in the intervention group compared with the control group, median (interquartile range) 5.4 ng/ml (3.1–7.7) versus 5.8 ng/ml (3.5–11.8), P = 0.05.

Conclusion

An antiatherogenic diet in pregnancy did not significantly influence maternal or fetal blood concentrations of a range of biomarkers for inflammation. Thus, the previously reported effects of a cholesterol-lowering diet on maternal lipid profile and preterm delivery (<37 complete weeks of gestation) do not seem to involve changes in the systemic inflammatory responses of pregnancy.

Do novel risk factors differ between men and women aged 18 to 39 years with a high risk of coronary heart disease?

This study aimed to clarify whether high-risk premenopausal women have less atherogenic levels of markers of endothelial dysfunction, oxidation, thrombosis and inflammation, and adipokines than high-risk men of the same age. Thus, we studied levels of these markers and their determinants in 207 men and women aged 18 to 39 years with dyslipidemia and a family history of premature coronary heart disease. Women had favorable levels of E and P selectins, tumor necrosis factor alpha, tissue plasminogen activator, plasminogen activator inhibitor 1, thrombomodulin, thiobarbituric acid reactive substances, and adiponectin compared with men, but had higher levels of high-sensitivity C-reactive protein and leptin (all P < .05) and no difference in the L-arginine/asymmetric dimethyl arginine (ADMA) ratio. This ratio was higher among nonusers of hormonal contraception than among users (P = .02). In multivariate analyses, levels of intercellular adhesion molecule 1 and E selectin were associated with cigarette smoking and dietary sucrose (both P < .05), whereas the L-arginine/ADMA ratio was paradoxically associated with smoking (P < .05). Of 17 novel risk markers, 11 were associated with body mass index after adjustment for age, sex, smoking, and percentage of dietary energy from sucrose (regression coefficients, 0.14-0.62; all P < .05). In conclusion, the findings underscore the female advantage regarding determinants of novel risk markers in young adults at risk of coronary heart disease, although some endothelial dysfunction markers (cellular adhesion molecules, L-arginine/ADMA ratio) were not more favorable in women compared with men. Lifestyle factors including body mass index, dietary sucrose, smoking, and hormones were associated with levels of the markers independent of sex with body mass index being the most prominent factor.

Circulating markers of endothelial function in cardiovascular disease

Endothelial dysfunction is a key event in cardiovascular disease. Measurement of endothelial dysfunction in vivo presents a major challenge, but has important implications since it may identify the clinical need for therapeutic intervention, specifically in primary prevention. Several biological markers have been used as indicators of endothelial dysfunction. The soluble adhesion molecules sICAM-1 and sVCAM-1 lack specificity and are increased in inflammatory processes. Both markers are increased in coronary artery disease. sICAM-1 level predicts the risk for cardiovascular disease or diabetes mellitus in healthy individuals. sE-selectin is specific for the endothelium and is increased in coronary artery disease and diabetes mellitus. sE-selectin is also associated with diabetic risk. The endothelium-specific marker, soluble thrombomodulin, is associated with severity of coronary artery disease, stroke or peripheral occlusive arterial disease and is not increased in healthy or asymptomatic subjects. Interestingly, thrombomodulin decreases during treatment of hypercholesterolemia or hyperhomocysteinemia. In contrast, von Willebrand factor is the best endothelial biomarker and predicts risk for ischemic heart disease or stroke.