Optimal management of hyperlipidemia in primary prevention of cardiovascular disease

Lindenane sesquiterpenoid dimers from Chloranthus japonicus improve LDL uptake by regulating PCSK9 and LDLR

UPLC-TOF-MS/MDF directed phytochemical research of Chloranthus japonicus led to the isolation of 46 lindenane sesquiterpenoid dimers, which included 13 new analogs. Their structures with absolute configurations were elucidated by analysis of spectroscopic data. Fourteen compounds with ester chains significantly decreased PCSK9 protein level in medium of HepG2 cells, especially for compounds 14 and 29 (5 µM) with inhibition rates of 69.0% and 72.8%, respectively. Compound 14 in HepG2 cells was evaluated via DiI-LDL uptake assays and found to increase LDL uptake by upregulating LDLR mRNA and protein level. Meanwhile, 14 decreased the secretion of PCSK9 protein in medium and downregulated intracellular PCSK9 protein and mRNA level. The discovery of these natural small molecule compounds provides a novel structure basis for design PCSK9 regulators, making them a promising lead for development of new lipid-lowering agents.

Prevalence and Safety of Prescribing PPIs with Clopidogrel in Palestine

BACKGROUND

Proton pump inhibitors (PPIs) are commonly prescribed medications that are thought to increase the risk of cardiovascular events because they reduce the effectiveness of clopidogrel via shared hepatic pathways.

OBJECTIVE

This study examined the prevalence of concomitant prescribing of clopidogrel/PPI among patients diagnosed with acute coronary syndrome and the adverse cardiovascular event associated with this interaction.

METHODS

A retrospective cohort study was conducted by retrieving patient data from the Nat Health Insurance claims processor database in Palestine. Adults diagnosed with Acute Coronary Syndrome (ACS) from 2019 through 2021 who were prescribed clopidogrel or clopidogrel in combination with a PPI were included in the study. Endpoints were adverse cardiac events, including readmission for revascularization during the first year of treatment.

RESULTS

The study included 443 patients; the prevalence of prescribing concomitant clopidogrel with a PPI was 74.7%, whereas 49.2% were prescribed interacting PPI (omeprazole, esomeprazole, and lansoprazole). 59 (13.3%) of participants experienced a cardiovascular event within 1 year of starting therapy, including 27 (12.4%) patients who had a cardiovascular event while taking an interacting PPI. No significant association was found between PPI administration and increased CV event risk in patients receiving concomitant clopidogrel and PPIs therapy (p = 0.579).

CONCLUSION

In this study, we observed a high prevalence of prescribing a PPI in combination with clopidogrel, regardless of the FDA recommendations. No significant increase in cardiovascular events was observed in patients receiving concomitant clopidogrel and PPI therapy.

Bile Acid Sequestrants for Hypercholesterolemia Treatment Using Sustainable Biopolymers: Recent Advances and Future Perspectives

Bile acids, the endogenous steroid nucleus containing signaling molecules, are responsible for the regulation of multiple metabolic processes, including lipoprotein and glucose metabolism to maintain homeostasis. Within our body, they are directly produced from their immediate precursors, cholesterol C (low-density lipoprotein C, LDL-C), through the enzymatic catabolic process mediated by 7-α-hydroxylase (CYP7A1). Bile acid sequestrants (BASs) or amphiphilic resins that are nonabsorbable to the human body (being complex high molecular weight polymers/electrolytes) are one of the classes of drugs used to treat hypercholesterolemia (a high plasma cholesterol level) or dyslipidemia (lipid abnormalities in the body); thus, they have been used clinically for more than 50 years with strong safety profiles as demonstrated by the Lipid Research Council-Cardiovascular Primary Prevention Trial (LRC-CPPT). They reduce plasma LDL-C and can slightly increase high-density lipoprotein C (HDL-C) levels, whereas many of the recent clinical studies have demonstrated that they can reduce glucose levels in patients with type 2 diabetes mellitus (T2DM). However, due to higher daily dosage requirements, lower efficacy in LDL-C reduction, and concomitant drug malabsorption, research to develop an "ideal" BAS from sustainable or natural sources with better LDL-C lowering efficacy and glucose regulations and lower side effects is being pursued. This Review discusses some recent developments and their corresponding efficacies as bile removal or LDL-C reduction of natural biopolymer (polysaccharide)-based compounds.

Camellia oil Enhances Plasma Antioxidant Metabolism and Improves Plasma Lipid Metabolism in High-fat Diet-fed Rats

Living on a high-fat, high-calorie, and high-protein diet for a long period may compromise human immunity due to the long-term accumulation of free radicals and plasma lipids. The antioxidant and lipid-lowering compounds (ie polyphenols and vitamin E) in Camellia oil help to decrease the risk of numerous ailments, including cardiovascular disease (CVD), and obesity.

The aims of this study were to study the hypolipidemic and antioxidant effects of Camellia oil in high-fat-fed rats and to promote the high-value use of camellia resources. The high-fat-fed rats were administrated with 2.5, 7.5, and 15 mL/kg BW Camellia oil (Camellia oil group), and 10 mg/kg BW atorvastatin (atorvastatin group), respectively, and compared with a model group (only fed with high fat) and a control group (fed with basal diet). Several parameters were measured, including (1) body weight (BW), liver-to-BW ratio; (2) plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C); and (3) alanine aminotransferase (ALT), alanine aminotransferase (AST), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activity, model driven architecture (MDA) content, lipid metabolism-related genes, and antioxidant-related genes in liver tissue.

Compared with the model group, the high-fat-fed rats in the Camellia oil and atorvastatin group had significantly lower BW and liver-to-BW ratio ( P < .01), plasma TC, TG, and LDL-C levels and ALT and AST activities, but higher HDL-C levels. The relative expressions of ACAT1, DGAT2, FAS, and SREBP genes were significantly reduced in the Camellia oil and atorvastatin groups, while the relative expressions of LCAT, UCP2, MCD, and CPT-1 genes were significantly increased. The rats in the Camellia oil group showed significantly higher SOD and GSH-Px activities, significantly lower MDA content, and significantly higher relative expression of antioxidant genes (eg SOD1, GPx1, CAT, and Gclm). Thus, atorvastatin and Camellia oil exhibited significant hypolipidemic and antioxidant effects, which were better at a dose of 7.5 mL/kg (BW) of Camellia oil. Therefore, Camellia oil becomes a potential new natural resource for future research and development of antioxidant and hypolipidemic drugs, nutraceuticals, and additives.

Synthesis of Novel Benzimidazole-2-carboxamide Derivatives and in Vivo Antihyperlipidemic Activity Evaluation

Hyperlipidemia is known as an elevation of plasma lipid components. It contributes significantly to atherosclerosis which is one of the most important causative factors in cardiovascular diseases. Agents that cause a dramatic decrease in serum lipid levels are of great value in the treatment of cardiovascular diseases. For this purpose, a new series of benzimidazole propyl carboxamide benzophenone derivatives have been synthesized (7, 8, and 9). These compounds were tested in vivo to evaluate their potential hypolipidemic activity using Triton WR-1339 induced hyperlipidemic rats. All the synthesized compounds have proved to be highly biologically active, with compound 9 being the most active derivative.

Pharmacological Screening of Trachyspermum ammi for Antihyperlipidemic Activity in Triton X-100 Induced Hyperlipidemia Rat Model

BACKGROUND

Mortality rate is increasing due to cardiovascular problems throughout the world. These cardiac problems are directly associated with dyslipidemia.

AIM

The aim of this study was to evaluate the antihyperlipidemic effect of aqueous extract and methanol extract of Trachyspermum ammi at 1 g/kg, 3 g/kg, and 5 g/kg dose levels in rats.

MATERIALS AND METHODS

For this purpose, 45 male albino rats were used and randomly divided into nine equal groups (n = 5). The lipid levels were increased after 24 h of single intraperitoneal injection of Triton X-100 (100 mg/kg) in rats. Aqueous and methanol extracts equivalent to 1 g/kg, 3 g/kg, and 5 g/kg were administered orally to the rats for 21 days. Atorvastatin (10 mg/kg) was used as standard drug. Blood samples were collected at 0, 2nd, 9th, 16th, and 23rd day by a direct cardiac puncture in Vacuette® heparin tubes. Serum was separated and then analyzed for lipid profile, liver function test (LFT), and renal function test (RFT) using standard diagnostic kits.

RESULTS

Results showed that extracts at 3 g/kg and 5 g/kg decreased the levels of total cholesterol, triglyceride, and low-density lipoprotein and increased high-density lipoprotein concentration in serum. T. ammi also decreased LFT and RFT parameters at the end of the study.

CONCLUSION

T. ammi possessed antioxidant and antihyperlipidemic activities along with hepato- and nephro-protective effects.

SUMMARY

Aqueous and methanol extracts of T. ammi were administered orally at 1-, 3-, and 5 g/kg doses to hyperlipidemic rats (Triton X-100 induced hyperlipidemia) and atorvastatin (10 mg/kg, orally) was used as standard drug. Methanol extract at 5 g/kg showed antihyperlipidemic effect that is identical to that of standard drug.Abbreviations Used: LDL: Low-density lipoprotein; TC: Total cholesterol; VLDL: Very low-density lipoprotein; HDL: High-density lipoprotein; T. ammi: Trachyspermum ammi; WHO: World Health Organization; CAD: Coronary artery disease; BHT: Butylated hydroxytoluene; BUN: Blood urea nitrogen; AST: Aspartate transaminase; ALT: Alanine transaminase; IP: Intraperitoneal.

Polyphenols from Wine Lees as a Novel Functional Bioactive Compound in the Protection Against Oxidative Stress and Hyperlipidaemia

The study examines the potential of wine industry by-product, the lees, as a rich mixture of natural polyphenols, and its physiological potential to reduce postprandial metabolic and oxidative stress caused by a cholesterol-rich diet in in vivo model. Chemical analysis of wine lees showed that their total solid content was 94.2%. Wine lees contained total phenols, total nonflavonoids and total flavonoids expressed in mg of gallic acid equivalents per 100 g of dry mass: 2316.6±37.9, 1332.5±51.1 and 984.1±28.2, respectively. The content of total anthocyanins expressed in mg of cyanidin-3-glucoside equivalents per 100 g of dry mass was 383.1±21.6. Antioxidant capacity of wine lees determined by the DPPH and FRAP methods and expressed in mM of Trolox equivalents per 100 g was 259.8±1.8 and 45.7±1.05, respectively. The experiment lasted 60 days using C57BL/6 mice divided in four groups: group 1 was fed normal diet and used as control, group 2 was fed normal diet with added wine lees, group 3 was fed high-cholesterol diet (HCD), i.e. normal diet with the addition of sunflower oil, and group 4 was fed HCD with wine lees. HCD increased serum total cholesterol (TC) by 2.3-fold, triacylglycerol (TAG) by 1.5-fold, low-density lipoprotein (LDL) by 3.5-fold and liver malondialdehyde (MDA) by 50%, and reduced liver superoxide dismutase (SOD) by 50%, catalase (CAT) by 30% and glutathione (GSH) by 17.5% compared to control. Conversely, treatment with HCD and wine lees reduced TC and LDL up to 1.4 times more than with HCD only, with depletion of lipid peroxidation (MDA) and restoration of SOD and CAT activities in liver, approximating values of the control. HDL levels were unaffected in any group. Serum transaminase activity showed no hepatotoxic properties in the treatment with lees alone. In the proposed model, wine lees as a rich polyphenol source could be a basis for functional food products without alcohol.

Estimation of plasma apolipoprotein B concentration using routinely measured lipid biochemical tests in apparently healthy Asian adults

Background

Increased low-density lipoprotein cholesterol (LDL) concentration is associated with increased risk of coronary heart disease (CHD) but a substantial risk of cardiovascular disease often remains after LDL concentrations have been treated to target. Apolipoprotein B (apo B) is the major apolipoprotein contained within atherogenic lipoproteins such as LDL, and apo B is a more reliable indicator of cardiovascular risk than LDL concentration.

Aim and methods

Our aim was to develop a formula for calculating apo B using lipid biochemistry measurements that are commonly available in clinical practice. We examined the clinical and laboratory data from 73,047 Koreans who underwent a medical health check that included apolipoprotein B concentration. The study sample was randomly divided into a training set for prediction model building and a validation set of equal size. Multivariable linear regression analysis was used to develop a prediction model equation for estimating apo B and to validate the developed model.

Results

The best results for estimating apo B were derived from an equation utilising LDL and triglyceride (TG) concentrations [ApoB = −33.12 + 0.675*LDL + 11.95*ln(tg)]. This equation predicted the apo B result with a concordance correlation coefficient (CCC and 95%CIs) = 0.936 (0.935,0.937)).

Conclusion

Our equation for predicting apo B concentrations from routine analytical lipid biochemistry provides a simple method for obtaining precise information about an important cardiovascular risk marker.

Synthesis, characterization and in vitro hydrolysis of a gemfibrozil-nicotinic acid codrug for improvement of lipid profile

Combination therapy of fibrates and nicotinic acid has been reported to be synergistic. Herein, we describe a covalent codrug of gemfibrozil (GEM) and nicotinic acid (NA) that was synthesized and characterized by (1)H NMR, (13)C NMR, FT-IR, MS analysis and elemental analysis. A validated HPLC method was developed that allows for the accurate quantitative determination of the codrug and its hydrolytic products that are formed during the in vitro chemical and enzymatic hydrolysis. The physico-chemical properties of codrug were improved compared to its parent drugs in term of water solubility and partition coefficient. The kinetics of hydrolysis of the codrug was studied using accelerated hydrolysis experiments at high temperatures in aqueous phosphate buffer solution in pH 1.2, 6.8 and 7.4. Using the Arrhenius equation, the extrapolated half-life at 37°C were 289 days at pH 1.2 for the codrug and 130 and 20,315 days at pH 6.8 for the codrug and gemfibrozil 2-hydroxyethyl ester (GHEE), respectively. The shortest half-lives were at pH 7.4; 42 days for the codrug and 5837 days for GHEE, respectively. The hydrolysis of the latter was studied, alone, at 80°C and pH 1.2 and compared to its hydrolysis when it is produced from the codrug using similar conditions. The k(obs) was found in both cases to be 1.60×10(-3)h(-1). The half-lives in plasma were 35.24 min and 26.75 h for the codrug and GHEE, respectively. With regard to liver homogenate, the hydrolysis half-lives were 1.96 min and 48.13 min for the codrug and GHEE, respectively. It can be expected that in vivo, the codrug will liberate NA immediately in plasma then GEM will be liberated from its 2-hydroxyethyl ester in the liver.

Primary prevention in high-risk dyslipidemic patients without an established cardiovascular disease: Undertreatment and rationale for lipid-lowering therapy

BACKGROUND

Recent updated guidelines expand the usage of lipid-lowering therapy for primary prevention in high-risk individuals without an established cardiovascular disease (CVD). In contrast to secondary prevention, the extent of the target population and the utilization of lipid-lowering drugs are insufficiently clear. We examine the implementation of statin therapy as primary prevention in high-risk patients without a known CVD and discuss the rationale for the management of dyslipidemia in this population.

METHODS

Records of 371 consecutive patients without an established CVD who were hospitalized in an internal medicine department between January and June 2005 were evaluated for CVD-equivalent high-risk factors (diabetes mellitus, stroke of carotid origin, peripheral vascular disease, abdominal aortic aneurysm, or Framingham 10-year risk score >/=20%). Demographic and clinical data, in addition to lipid profile and usage of statin drugs prior to and during hospitalization, were analyzed.

RESULTS

Of the 371 non-cardiovascular patients, 88 (24%) were defined as high-risk individuals eligible for statin therapy as primary prevention of CVD. Their mean age was 71+/-11 years and their mean LDL-C level was 132+/-30 mg/dL. Seventeen patients (19%) were treated with statin drugs prior to admission and only two more patients (19/88, 22%) received statins in addition during hospitalization. Patients treated with statins had non-significantly higher LDL-C levels.

CONCLUSIONS

There is considerable undertreatment of high-risk patients without an established CVD with lipid-lowering drugs. There is also sub-optimal implementation of guidelines in clinical practice, despite well-established evidence of the benefits of statins in the primary prevention of CVD for high-risk individuals with average cholesterol levels, diabetes mellitus, and in elderly patients, as represented by our study population.