1
|
Tsamoulis D, Kosmas CE, Rallidis LS. Is inverse association between lipoprotein(a) and diabetes mellitus another paradox in cardiometabolic medicine? Expert Rev Endocrinol Metab 2024; 19:63-70. [PMID: 38078437 DOI: 10.1080/17446651.2023.2293108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The impact of Type II Diabetes mellitus (T2DM) on cardiovascular disease (CVD) is well-established, while lipoprotein(a) [Lp(a)] has recently emerged as a recognized CVD risk factor. The rising prevalence of T2DM resulting from modern lifestyles and the development of specific Lp(a)-lowering agents brought the association between T2DM and Lp(a) in the forefront. AREAS COVERED Despite advancements in T2DM treatment, diabetic patients remain at very-high risk of CVD. Lp(a) may, to some extent, contribute to the persistent CVD risk seen in diabetic patients, and the coexistence of T2DM and elevated Lp(a) levels appears to synergistically amplify overall CVD risk. The relationship between T2DM and Lp(a) is paradoxical. On one hand, high Lp(a) plasma concentrations elevate the risk of diabetic microvascular and macrovascular complications. On the other hand, low Lp(a) plasma concentrations have been linked to an increased risk of developing T2DM. EXPERT OPINION Comprehending the association between T2DM and Lp(a) is critical due to the pivotal roles both entities play in overall CVD risk, as well as the unique aspects of their relationship. The mechanisms underlying the inverse association between T2DM and Lp(a) remain incompletely understood, necessitating further meticulous research.
Collapse
Affiliation(s)
- Donatos Tsamoulis
- Second Department of Cardiology, National & Kapodistrian University of Athens, Athens, Greece
| | - Constantine E Kosmas
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Loukianos S Rallidis
- Second Department of Cardiology, National & Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
2
|
Qiu Y, Hao W, Guo Y, Guo Q, Zhang Y, Liu X, Wang X, Nie S. The association of lipoprotein (a) with coronary artery calcification: A systematic review and meta-analysis. Atherosclerosis 2024; 388:117405. [PMID: 38101270 DOI: 10.1016/j.atherosclerosis.2023.117405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND AIMS Coronary artery calcification (CAC) is a crucial pathophysiological characteristic of atherosclerosis. The association between lipoprotein (a) [Lp(a)] and CAC is inconsistent. We aimed to assess the relationship between Lp(a) and CAC by exploring the association between elevated Lp(a) and CAC prevalence, the relationship between Lp(a) level and CAC prevalence, and the correlation between elevated Lp(a) and CAC progression. METHODS We searched the PubMed, Web of Science, and EMBASE databases up to November 01, 2023. Studies exploring the association between serum Lp(a) and CAC (quantified using the Agatston score) were included. Association between Lp(a) level or elevated Lp(a) (higher than the cutoff values of 30 mg/dL, 50 mg/dL, or the highest quartile ranging from 33 to 38.64 mg/dL) and prevalence [CAC score >0 or >100, log (CAC score+1) >0] or progression (an increase in CAC score >0 or ≥100) of CAC were analysed. Odds ratios and 95% confidence intervals were calculated using a random-effects model. RESULTS 40,073 individuals from 17 studies were included. Elevated Lp(a) was associated with a higher prevalence of CAC (OR, 1.31; 95% CI, 1.06 to 1.61; p = 0.01). As a continuous variable, Lp(a) level was positively correlated with the prevalence of CAC (OR, 1.05; 95% CI, 1.02 to 1.08; p = 0.003). Furthermore, elevated Lp(a) was associated with greater CAC progression (OR, 1.54; 95% CI, 1.23 to 1.92; p = 0.0002). CONCLUSIONS This meta-analysis suggested that Lp(a) is associated with prevalence and progression of CAC. Further studies are required to explore whether Lp(a)-lowering therapy could prevent or inhibit CAC, ultimately reducing coronary artery disease risk.
Collapse
Affiliation(s)
- Yuyao Qiu
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen Hao
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yingying Guo
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qian Guo
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yushi Zhang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaochen Liu
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Singh SS, van der Toorn JE, Sijbrands EJG, de Rijke YB, Kavousi M, Bos D. Lipoprotein(a) is associated with a larger systemic burden of arterial calcification. Eur Heart J Cardiovasc Imaging 2023:7135506. [PMID: 37082982 PMCID: PMC10364618 DOI: 10.1093/ehjci/jead057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
AIMS Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for cardiovascular disease. However, population-based evidence on the link between Lp(a) and subclinical arteriosclerosis is lacking. We assessed associations of Lp(a) concentrations with arteriosclerosis in multiple arteries. METHODS AND RESULTS From the population-based Rotterdam study, 2354 participants (mean age: 69.5 years, 52.3% women) underwent non-contrast computed tomography to assess arterial calcification as a hallmark of arteriosclerosis. We quantified the volume of coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial (ECAC), and intracranial carotid artery calcification (ICAC). All participants underwent blood sampling, from which plasma Lp(a) concentrations were derived. The association of plasma Lp(a) levels was assessed with calcification volumes and with severe calcification (upper quartile of calcification volume) using sex-stratified multivariable linear and logistic regression models. Higher Lp(a) levels were associated with larger ln-transformed volumes of CAC [fully adjusted beta 95% confidence interval (CI) per 1 standard deviation (SD) in women: 0.09, 95% CI 0.04-0.14, men: 0.09, 95% CI 0.03-0.14], AAC (women: 0.06, 95% CI 0.01-0.11, men: 0.09, 95% CI 0.03-0.14), ECAC (women: 0.07, 95% CI 0.02-0.13, men: 0.08, 95% CI 0.03-0.14), and ICAC (women: 0.09, 95% CI 0.03-0.14, men: 0.05, 95% CI -0.02 to 0.11]. In the highest Lp(a) percentile, severe ICAC was most prevalent in women [fully adjusted odds ratio (OR) 2.41, 95% CI 1.25-4.63] and severe AAC in men (fully adjusted OR 3.29, 95% CI 1.67-6.49). CONCLUSION Higher Lp(a) was consistently associated with a larger calcification burden in all major arteries. The findings of this study indicate that Lp(a) is a systemic risk factor for arteriosclerosis and thus potentially an effective target for treatment. Lp(a)-reducing therapies may reduce the burden from arteriosclerotic events throughout the arterial system. TRANSLATIONAL PERSPECTIVE In 2354 participants from the Rotterdam study, we assessed the link between Lp(a) concentrations and arterial calcifications, as proxy for arteriosclerosis, in major arteries. We found that higher Lp(a) levels were consistently associated with larger volumes of calcification in the coronary arteries, aortic arch, extracranial carotid arteries, and intracranial carotid arteries. The findings of our study indicate that Lp(a) is a systemic risk factor for arteriosclerosis, suggesting that the systemic burden of arteriosclerosis throughout the arterial system could be reduced by targeting Lp(a).
Collapse
Affiliation(s)
- Sunny S Singh
- Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Janine E van der Toorn
- Department of Epidemiology, Erasmus MC, University Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Yolanda B de Rijke
- Department of Clinical Chemistry, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC, University Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| |
Collapse
|
4
|
Lipoprotein(a), Cardiovascular Events and Sex Differences: A Single Cardiological Unit Experience. J Clin Med 2023; 12:jcm12030764. [PMID: 36769413 PMCID: PMC9918149 DOI: 10.3390/jcm12030764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/20/2023] Open
Abstract
Lipoprotein(a)-Lp(a), which retains proatherogenic and prothrombotic properties, may be modified by hormonal and metabolic factors. However, few studies have focused on differences related to sex and cardiometabolic risk factors in the relationship between Lp(a) and cardiovascular disease, especially in terms of prognosis. This study aimed at evaluating the predictive value of Lp(a) (cut-off 30 mg/dL) for hard events (HEs: mortality and non-fatal myocardial infarction) according to sex and cardiometabolic risk factors in 2110 patients (1501 males, mean age: 68 ± 9 years) undergoing coronary angiography for known or suspected coronary artery disease. There were 211 events over a median follow-up period of 33 months. Lp(a) > 30 mg/dL did not confer a worse prognosis on the overall population. However, Kaplan-Meier subgroup analysis evidenced a worse prognosis in type 2 diabetes (T2D) females with elevated Lp(a) (log-rank test: p = 0.03) vs. T2D males and no-T2D patients, but not in other high-risk cardiovascular states (e.g., smoking, hypertension, reduced left ventricular ejection fraction or obesity). After Cox multivariate adjustment, Lp(a) remained an independent determinant for HEs in the T2D female subgroup, conferring an HR of 2.9 (95% CI 1.1-7.7, p < 0.05). Lp(a) is therefore a strong independent predictor of HR in T2D women, but not in T2D men, or in noT2D patients.
Collapse
|
5
|
Naami R, Miller DM, Al-Kindi S, Neeland IJ. Coronary artery calcium scoring as a tool for risk stratification in patients with an elevated lipoprotein(a) level. Front Cardiovasc Med 2022; 9:1084814. [PMID: 36620645 PMCID: PMC9815437 DOI: 10.3389/fcvm.2022.1084814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Robert Naami
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Drew M. Miller
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Sadeer Al-Kindi
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Cleveland, OH, United States,Center for Cardiovascular Prevention, Harrington Heart and Vascular Institute, Cleveland, OH, United States
| | - Ian J. Neeland
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States,University Hospitals Cleveland Medical Center, Cleveland, OH, United States,Center for Cardiovascular Prevention, Harrington Heart and Vascular Institute, Cleveland, OH, United States,*Correspondence: Ian J. Neeland ✉
| |
Collapse
|
6
|
Kim J, Choi SW, Lee YS, Lee JM, Chung H, Woo JS, Kim WS, Choi YY, Kim W. Correlations Between Coronary Artery Disease, Coronary Artery Calcium Score, and Lipoprotein(a) Level in Korea. Ther Clin Risk Manag 2022; 18:981-987. [PMID: 36212048 PMCID: PMC9533785 DOI: 10.2147/tcrm.s374372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
Collapse
Affiliation(s)
- Joan Kim
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Seung Woo Choi
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Young Shin Lee
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Jung Myung Lee
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Hyemoon Chung
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Jong Shin Woo
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Woo-Shik Kim
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
| | - Yun Young Choi
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Weon Kim
- Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea
- Correspondence: Weon Kim, Tel +82 2 958 8176, Email
| |
Collapse
|
7
|
Dutta P, Sengupta A, Chakraborty S. Epigenetics: a new warrior against cardiovascular calcification, a forerunner in modern lifestyle diseases. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:62093-62110. [PMID: 34601672 DOI: 10.1007/s11356-021-15718-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Arterial and aortic valve calcifications are the most prevalent pathophysiological conditions among all the reported cases of cardiovascular calcifications. It increases with several risk factors like age, hypertension, external stimuli, mechanical forces, lipid deposition, malfunction of genes and signaling pathways, enhancement of naturally occurring calcium inhibitors, and many others. Modern-day lifestyle is affected by numerous environmental factors and harmful toxins that impair our health rather than providing benefits. Applying the combinatorial approach or targeting the exact mechanism could be a new strategy for drug designing or attenuating the severity of calcification. Most of the non-communicable diseases are life-threatening; thus, altering the phenotype and not the genotype may reveal the gateway for fighting with upcoming hurdles. Overall, this review summarizes the reason behind the generation of arterial and aortic valve calcification and its related signaling pathways and also the detrimental effects of calcification. In addition, the individual process of epigenetics and how the implementation of this process becomes a novel approach for diminishing the harmful effect of calcification are discussed. Noteworthy, as epigenetics is linked with genetics and environmental factors necessitates further clinical trials for complete and in-depth understanding and application of this strategy in a more specific and prudent manner.
Collapse
Affiliation(s)
- Parna Dutta
- Department of Life Sciences, Presidency University, 86/1, College Street, Baker building, 2nd floor, Kolkata, West Bengal, 700073, India
| | - Arunima Sengupta
- Department of Life science & Bio-technology, Jadavpur University, Kolkata, 700032, India
| | - Santanu Chakraborty
- Department of Life Sciences, Presidency University, 86/1, College Street, Baker building, 2nd floor, Kolkata, West Bengal, 700073, India.
| |
Collapse
|
8
|
Obisesan OH, Kou M, Wang FM, Boakye E, Honda Y, Uddin SMI, Dzaye O, Osei AD, Orimoloye OA, Howard‐Claudio CM, Coresh J, Blumenthal RS, Hoogeveen RC, Budoff MJ, Matsushita K, Ballantyne CM, Blaha MJ. Lipoprotein(a) and Subclinical Vascular and Valvular Calcification on Cardiac Computed Tomography: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2022; 11:e024870. [PMID: 35656990 PMCID: PMC9238743 DOI: 10.1161/jaha.121.024870] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Lipoprotein(a) (Lp(a)) is a potent causal risk factor for cardiovascular events and mortality. However, its relationship with subclinical atherosclerosis, as defined by arterial calcification, remains unclear. This study uses the ARIC (Atherosclerosis Risk in Communities Study) to evaluate the relationship between Lp(a) in middle age and measures of vascular and valvular calcification in older age. Methods and Results Lp(a) was measured at ARIC visit 4 (1996-1998), and coronary artery calcium (CAC), together with extracoronary calcification (including aortic valve calcium, aortic valve ring calcium, mitral valve calcification, and thoracic aortic calcification), was measured at visit 7 (2018-2019). Lp(a) was defined as elevated if >50 mg/dL and CAC/extracoronary calcification were defined as elevated if >100. Logistic and linear regression models were used to evaluate the association between Lp(a) and CAC/extracoronary calcification, with further stratification by race. The mean age of participants at visit 4 was 59.2 (SD 4.3) years, with 62.2% women. In multivariable adjusted analyses, elevated Lp(a) was associated with higher odds of elevated aortic valve calcium (adjusted odds ratio [aOR], 1.82; 95% CI, 1.34-2.47), CAC (aOR, 1.40; 95% CI, 1.08-1.81), aortic valve ring calcium (aOR, 1.36; 95% CI, 1.07-1.73), mitral valve calcification (aOR, 1.37; 95% CI, 1.06-1.78), and thoracic aortic calcification (aOR, 1.36; 95% CI, 1.05-1.77). Similar results were obtained when Lp(a) and CAC/extracoronary calcification were examined on continuous logarithmic scales. There was no significant difference in the association between Lp(a) and each measure of calcification by race or sex. Conclusions Elevated Lp(a) at middle age is significantly associated with vascular and valvular calcification in older age, represented by elevated CAC, aortic valve calcium, aortic valve ring calcium, mitral valve calcification, thoracic aortic calcification. Our findings encourage assessing Lp(a) levels in individuals with increased cardiovascular disease risk, with subsequent comprehensive vascular and valvular assessment where elevated.
Collapse
Affiliation(s)
- Olufunmilayo H. Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Medstar Union Memorial HospitalBaltimoreMD
| | - Minghao Kou
- Tulane University School of Public Health and Tropical MedicineNew OrleansLA
| | | | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | - Yasuyuki Honda
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | | | | | - Josef Coresh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute at Harbor‐UCLA Medical CenterLos AngelesCA
| | - Kunihiro Matsushita
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| |
Collapse
|
9
|
Bellinge JW, Lee SC, Schultz CJ. Use of cardiovascular imaging in risk restratification of the diabetic patient. Curr Opin Endocrinol Diabetes Obes 2021; 28:122-133. [PMID: 33394721 DOI: 10.1097/med.0000000000000611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Diabetes mellitus is no longer considered a cardiovascular disease (CVD) risk equivalent, but the optimal methods of risk stratification are a matter of debate. The coronary calcium score (CCS) is a measure of the burden of atherosclerosis and is widely used for CVD risk stratification in the general population. We review recently published data to describe the role of the CCS in people with diabetes mellitus. RECENT FINDINGS People with diabetes mellitus have 10-year event rates for CVD and CVD mortality that are considered high, at a much lower level of CCS than the general population. Different categories of CCS are pertinent to men and women with diabetes mellitus. CCS may be particularly useful in clinical settings when CVD risk is known to be increased but difficult to quantify, for example peri-menopausal women, young persons with diabetes, type 1 diabetic individuals and others. With modern techniques, the radiation dose of a CSS has fallen to levels wherein screening and surveillance could be considered. SUMMARY The CCS is able to quantify CVD risk in people with diabetes mellitus when there is clinical uncertainty and identifies those with very high event rates. Future research should aim to identify effective risk reduction strategies in this important group.
Collapse
Affiliation(s)
- Jamie W Bellinge
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sing Ching Lee
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
10
|
Chung YH, Lee BK, Kwon HM, Min PK, Choi EY, Yoon YW, Hong BK, Rim SJ, Kim JY. Coronary calcification is associated with elevated serum lipoprotein (a) levels in asymptomatic men over the age of 45 years: A cross-sectional study of the Korean national health checkup data. Medicine (Baltimore) 2021; 100:e24962. [PMID: 33655963 PMCID: PMC7939167 DOI: 10.1097/md.0000000000024962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/08/2021] [Indexed: 01/04/2023] Open
Abstract
Lipoprotein a (Lp (a)) and coronary artery calcification (CAC) are markers of coronary artery and cardiovascular diseases. However, the association between Lp (a) and CAC in asymptomatic individuals remains unclear. In this study, we aimed to determine the influence of Lp (a) on CAC in asymptomatic individuals.We included 2019 asymptomatic Korean adults who underwent testing for a coronary artery calcium score (CACS) and Lp (a) at the Gangnam Severance Hospital Health Checkup Center in Korea from January 2017 to August 2019. Participants were divided into 2 groups: CACS = 0 and CACS > 0. Factors affecting the CACS were analyzed by sex. Because age is a major risk factor for atherosclerosis, ≥45 years in men and ≥55 years in women, we further divided participants into 4 subgroups (≥45 and <45 in men, ≥55 and <55 in women). Factors affecting the CACS in the 4 groups were analyzed.There was a positive correlation between the CACS and traditional cardiovascular risk factors. Lp (a) positively correlated with the CACS in men (P < .01) and remained significant after multivariable logistic regression (P < .01). The same result was observed in men aged ≥45 years (P < .01).Lp (a) is an independently associated factor of CAC and a marker of coronary atherosclerosis in asymptomatic men aged ≥45 years. In asymptomatic men aged ≥45 years, Lp (a) should be measured, and intensive Lp (a)-lowering treatment should be considered.
Collapse
|
11
|
Cardoso-Saldaña GC, González-Salazar MDC, Posadas-Sánchez R, Vargas-Alarcón G. Metabolic syndrome, lipoprotein(a) and subclinical atherosclerosis in Mexican population. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:307-314. [PMID: 33268905 PMCID: PMC8351643 DOI: 10.24875/acm.20000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the relationship of metabolic syndrome (MetS) and Lp(a) with subclinical atherosclerosis (CAC) in Mexican adults. Method Clinical, biochemical and tomographic data of visceral, subcutaneous, hepatic abdominal fat and CAC were evaluated in 953 women and men. Lp(a) was determined by nephelometry and MetS was diagnosed according to ATP III criteria. Multivariate logistic regression analysis was performed to determine the independent association of these variables with CAC. Results Age, weight, body mass index, systolic and diastolic blood pressure, volumes of visceral, subcutaneous and hepatic abdominal fat, lipids, glucose, insulin and HOMA-RI were significantly higher in subjects with MetS. The median Lp(a) was lower in subjects with MetS compared to subjects without MetS (3.7 [IR: 2.3-9.2 vs. 5.9 [IR: 2.5-13.1) mg/dL; p < 0.01). The number of components and the MetS were inversely associated with the elevated Lp(a) (> 30 mg / dL). The presence of MetS was associated with a CAC risk >0 (OR: 2.19, [95% CI (1.64-2.94)]; p < 0.001), independently of elevated Lp(a). The components of MetS that were independently associated with the presence of CAC > 0 UA were glycaemia > 100 mg/dL (OR 2.42, [95% CI (1.7-3.4)]; p < 0.0001) and high blood pressure (OR 2.14 [95% CI (1.5-3.1)]; p < 0.0001). Conclusions In Mexican population there is an inverse association between Lp(a) levels and MetS. The MetS and its components were associated with subclinical atherosclerosis. The high prevalence of obesity, diabetes, high blood pressure high triglycerides and low HDL-C, characteristics of Mexican population could explain the differences with other populations.
Collapse
Affiliation(s)
| | | | | | - Gilberto Vargas-Alarcón
- Departamento de Biología Molecular. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| |
Collapse
|
12
|
Sun X, Zhou S, He X, Wang Y, Cui W. Sex-Specific Association between Serum 25-Hydroxyvitamin D and Metabolic Risk Factors in T2DM Patients. Int J Endocrinol 2020; 2020:9238719. [PMID: 32565795 PMCID: PMC7292989 DOI: 10.1155/2020/9238719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between serum 25-hydroxyvitamin (25(OH)D) levels and metabolic risk factor levels in patients with type 2 diabetes mellitus (T2DM) on a sex-specific basis. METHODS Our study comprised 507 patients with T2DM (321 men, 186 women; median age, 59 years). The metabolic risk factors examined included lipoprotein(a), glycated albumin (GA-L), and random blood glucose (RBG); the levels of these parameters were determined enzymatically. Serum 25(OH)D levels were measured by commercial ELISA kits. Participants were divided into low and high 25(OH)D groups according to the median 25(OH)D concentration (13.2 ng/mL). Two-way analysis of covariance and multiple linear regression analysis were performed. RESULTS The median 25(OH)D concentration was 13.9 ng/mL in men and 12.2 ng/mL in women. 25(OH)D levels inversely correlated with levels of three metabolic risk factors in a sex-dependent manner after adjusting for several confounding factors. These were lipoprotein(a) in men (141.3 ± 137.9 and 195.3 ± 204.8 mg/L in high and low 25(OH)D groups, respectively; P < 0.05); GA-L in women (22.2 ± 8.8 vs. 23.3 ± 7.3% in high and low 25(OH)D groups, respectively; P < 0.05). In a subgroup analysis, serum 25(OH)D levels inversely correlated with lipoprotein(a) levels in men (β = -0.185, P = 0.002) and RBG levels in women (β = -0.176, P = 0.028). CONCLUSION Higher serum 25(OH)D levels indicate a more favorable lipid profile in men and a more favorable glucose profile in women.
Collapse
Affiliation(s)
- Xiaomin Sun
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Sirui Zhou
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Xin He
- Department of Geriatric Endocrinology, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, Shaanxi 710061, China
- Department of Endocrinology, Xi'an Aerospace General Hospital, 159 Jitai Road, Yanta District, Xi'an, Shaanxi 710061, China
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Wei Cui
- Department of Geriatric Endocrinology, First Affiliated Hospital, Xi'an Jiaotong University Health Science Center, 76 West Yanta Road, Xi'an, Shaanxi 710061, China
| |
Collapse
|
13
|
Abstract
Vascular calcification (VC) is strongly associated with all-cause mortality and is an independent predictor of cardiovascular events. Resulting from its complex, multifaceted nature, targeted treatments for VC have not yet been developed. Lipoproteins are well characterized in the pathogenesis of atherosclerotic plaques, leading to the development of plaque regressing therapeutics. Although their roles in plaque progression are well documented, their roles in VC, and calcification of a plaque, are not well understood. In this review, early in vitro data and clinical correlations suggest an inhibitory role for HDL (high-density lipoproteins) in VC, a stimulatory role for LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein) and a potentially causal role for Lp(a) (lipoprotein [a]). Additionally, after treatment with a statin or PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor, plaque calcification is observed to increase. With the notion that differing morphologies of plaque calcification associate with either a more stable or unstable plaque phenotype, uncovering the mechanisms of lipoprotein-artery wall interactions could produce targeted therapeutic options for VC.
Collapse
Affiliation(s)
- Emma J. Akers
- From the South Australian Health and Medical Research Institute, Adelaide, Australia (E.J.A.)
- The University of Adelaide, Australia (E.J.A.)
| | - Stephen J. Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia (S.J.N.)
| | - Belinda A. Di Bartolo
- The Kolling Institute of Medical Research, The University of Sydney, Australia (B.A.D.B.)
| |
Collapse
|
14
|
Álvarez C, Ramírez-Campillo R, Lucia A, Ramírez-Vélez R, Izquierdo M. Concurrent exercise training on hyperglycemia and comorbidities associated: Non-responders using clinical cutoff points. Scand J Med Sci Sports 2019; 29:952-967. [PMID: 30825342 DOI: 10.1111/sms.13413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 12/15/2022]
Abstract
This study examined the effects of a 20-week concurrent training (CT, ie, resistance plus endurance training) intervention on cardiovascular risk factors, such as body composition, blood pressure, and lipid profile among adult women with hyperglycemia. A secondary aim was to report prevalence of non-responders for the different study outcomes. Physically inactive overweight/obese and hyperglycemic adult women (42 ± 6 years; BMI = 30.9 ± 4.8 kg/m2 ) were randomly assigned to a 20-week CT intervention group or a control (non-exercise) group (CG) (n = 14/group). Cardiovascular risk factors for body composition (body mass, waist circumference [WC], fat mass, and lean mass), blood pressure, and lipid profile (total, LDL cholesterol and HDL cholesterol, triglycerides, and fasting glucose) were assessed before and after the 20-week intervention. Our results show that a CT intervention results in a reduction of comorbidities in terms of abdominal obesity and cardiovascular risk in adult women with hyperglycemia by decreasing WC and improving lipid profile in "mean" terms. At the individual level, after CT, some subjects changed their status from a "high" to a "low" cardiovascular risk in terms of WC, while others changed from hypertension to either high blood pressure or normotension, or from high blood pressure to normotension, and others changed from hypercholesterolemia/dyslipidemia to normocholesterolemia. Overall, there were ~30%, 50%, and 20% of individuals in the CT exercise group who showed no change/adverse response for body composition, blood pressure, and lipid profile, respectively, after the 20-week CT intervention.
Collapse
Affiliation(s)
- Cristian Álvarez
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile.,Quality of Life and Wellness Research Group, Universidad de Los Lagos, Osorno, Chile
| | - Rodrigo Ramírez-Campillo
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile.,Quality of Life and Wellness Research Group, Universidad de Los Lagos, Osorno, Chile
| | | | - Robinson Ramírez-Vélez
- Department of Health Sciences, Public University of Navarre, Navarrabiomed, Idisna, CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00315), Pamplona, Navarre, Spain
| | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarre, Navarrabiomed, Idisna, CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00315), Pamplona, Navarre, Spain
| |
Collapse
|
15
|
Huffman MD, Kandula NR, Baldridge AS, Tsai MY, Prabhakaran D, Kanaya AM. Evaluating the Potential Association Between Lipoprotein(a) and Atherosclerosis (from the Mediators of Atherosclerosis Among South Asians Living in America Cohort). Am J Cardiol 2019; 123:919-921. [PMID: 30626499 DOI: 10.1016/j.amjcard.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/30/2018] [Accepted: 12/07/2018] [Indexed: 12/31/2022]
Abstract
We sought to report the distribution of Lp(a) levels in the Mediators of Atherosclerosis among South Asians Living in America cohort of participants who were free from clinical atherosclerotic cardiovascular disease (ASCVD) at baseline and to evaluate the cross-sectional association with atherosclerosis measured by coronary artery calcification (CAC) and carotid intima media thickness. Among 886 participants (mean [SD] age: 55.4 [9.4] years, 54% male), median lipoprotein (a) level was 17 (9, 33) mg/dl. Compared with the lowest quartile (9 mg/dl), subjects in the highest Lp(a) quartile (33 to 178 mg/dl) were more likely to be women (51% vs 37%, p <0.01) and had a higher mean (SD) total cholesterol (193 [37] mg/dl vs 181 [35] mg/dl, p <0.01). CAC was present in 42% and both the presence and degree of CAC was similar across Lp(a) quartiles (p = 0.58). Median Interquartile range (IQR) common and internal carotid intima-media thickness (IMT) thicknesses were 0.84 (0.73, 0.98) mm and 1.12 (0.95, 1.34) mm, respectively, and were also similar across Lp(a) quartiles. After adjustment for cardiovascular risk factors, Lp(a) quartile had no association with prevalent CAC (p = 0.98), internal carotid IMT (p = 0.46), or common carotid IMT (p = 0.97). Among South Asian Americans, mean Lp(a) levels were higher than previous reports among Whites, Hispanic/Latino, and Chinese-Americans but lower than in Blacks. Unlike findings from other race/ethnic groups, Lp(a) levels were not associated with atherosclerosis among South Asian Americans.
Collapse
|
16
|
Steffen BT, Thanassoulis G, Duprez D, Stein JH, Karger AB, Tattersall MC, Kaufman JD, Guan W, Tsai MY. Race-Based Differences in Lipoprotein(a)-Associated Risk of Carotid Atherosclerosis. Arterioscler Thromb Vasc Biol 2019; 39:523-529. [PMID: 30727753 PMCID: PMC6393189 DOI: 10.1161/atvbaha.118.312267] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective- Lp(a) [lipoprotein(a)] is a well-described risk factor for atherosclerosis, but Lp(a)-associated risk may vary by race/ethnicity. We aimed to determine whether race/ethnicity modifies Lp(a)-related risk of carotid atherosclerotic plaque outcomes among black, white, Chinese, and Hispanic individuals. Approach and Results- Carotid plaque presence and score were assessed by ultrasonography at baseline (n=5155) and following a median 9.4 year period (n=3380) in MESA (Multi-Ethnic Study of Atherosclerosis) participants. Lp(a) concentrations were measured by immunoassay and examined as a continuous and categorical variable using clinically-based cutoffs, 30 and 50 mg/dL. Lp(a) was related to greater risk of prevalent carotid plaque at baseline in whites alone (all P<0.001): per log unit (relative risk, 1.05); Lp(a)≥30 mg/dL (relative risk, 1.16); and Lp(a)≥50 mg/dL (relative risk, 1.20). Lp(a) levels over 50 mg/dL were associated with a higher plaque score at baseline in whites (all P<0.001) and Hispanics ( P=0.04). In prospective analyses, whites with Lp(a) ≥50 mg/dL were found to have greater risk of plaque progression (relative risk, 1.12; P=0.03) and higher plaque scores (all P<0.001) over the 9.4-year follow-up. Race-based differences between whites and black participants were significant for cross-sectional associations and for carotid plaque score following the 9.4 year study period. Conclusions- Race was found to be a modifying variable in Lp(a)-related risk of carotid plaque, and Lp(a) levels may have greater influence on plaque burden in whites than in black individuals. Borderline results in Hispanics suggest that elevated Lp(a) may increase the risk of carotid plaque, but follow-up studies are needed.
Collapse
Affiliation(s)
- Brian T. Steffen
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, USA
| | | | - Daniel Duprez
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - James H. Stein
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, WI 53792
| | - Amy B. Karger
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Mathew C. Tattersall
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, WI 53792
| | - Joel D. Kaufman
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98105
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Michael Y. Tsai
- Department of Laboratory Medicine & Pathology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
17
|
Palaniappan L, Garg A, Enas E, Lewis H, Bari S, Gulati M, Flores C, Mathur A, Molina C, Narula J, Rahman S, Leng J, Gany F. South Asian Cardiovascular Disease & Cancer Risk: Genetics & Pathophysiology. J Community Health 2018; 43:1100-1114. [PMID: 29948525 PMCID: PMC6777562 DOI: 10.1007/s10900-018-0527-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
South Asians (SAs) are at heightened risk for cardiovascular disease as compared to other ethnic groups, facing premature and more severe coronary artery disease, and decreased insulin sensitivity. This disease burden can only be partially explained by conventional risk factors, suggesting the need for a specific cardiovascular risk profile for SAs. Current research, as explored through a comprehensive literature review, suggests the existence of population specific genetic risk factors such as lipoprotein(a), as well as population specific gene modulating factors. This review catalogues the available research on cardiovascular disease and genetics, anthropometry, and pathophysiology, and cancer genetics among SAs, with a geographical focus on the U.S. A tailored risk profile will hinge upon population customized classification and treatment guidelines, informed by continued research.
Collapse
Affiliation(s)
| | - Arun Garg
- Laboratory Medicine and Pathology, Fraser Health Authority, New Westminster, BC, Canada
| | - Enas Enas
- Coronary Artery Disease among Asian Indians (CADI) Research Foundation, Lisle, IL, USA
| | - Henrietta Lewis
- Rollins School of Public Health, Global Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Cristina Flores
- The Warren Alpert Medical School, The Brown Human Rights Asylum Clinic (BHRAC), Brown University, Providence, RI, USA
| | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | - Cesar Molina
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | | | - Shahid Rahman
- I-Say, Bangladeshi American Youth Association, Teach & Travel, New York, NY, USA
| | - Jennifer Leng
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Center, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|
18
|
Elevated lipoprotein(a) levels are associated with coronary artery calcium scores in asymptomatic individuals with a family history of premature atherosclerotic cardiovascular disease. J Clin Lipidol 2018; 12:597-603.e1. [DOI: 10.1016/j.jacl.2018.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/30/2018] [Accepted: 02/13/2018] [Indexed: 11/20/2022]
|
19
|
Ellis KL, Boffa MB, Sahebkar A, Koschinsky ML, Watts GF. The renaissance of lipoprotein(a): Brave new world for preventive cardiology? Prog Lipid Res 2017; 68:57-82. [DOI: 10.1016/j.plipres.2017.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 12/24/2022]
|
20
|
Function, Role, and Clinical Application of MicroRNAs in Vascular Aging. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6021394. [PMID: 28097140 PMCID: PMC5209603 DOI: 10.1155/2016/6021394] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 01/31/2023]
Abstract
Vascular aging, a specific type of organic aging, is related to age-dependent changes in the vasculature, including atherosclerotic plaques, arterial stiffness, fibrosis, and increased intimal thickening. Vascular aging could influence the threshold, process, and severity of various cardiovascular diseases, thus making it one of the most important risk factors in the high mortality of cardiovascular diseases. As endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) are the main cell biological basis of these pathology changes of the vasculature, the structure and function of ECs and VSMCs play a key role in vascular aging. MicroRNAs (miRNAs), small noncoding RNAs, have been shown to regulate the expression of multiple messenger RNAs (mRNAs) posttranscriptionally, contributing to many crucial aspects of cell biology. Recently, miRNAs with functions associated with aging or aging-related diseases have been studied. In this review, we will summarize the reported role of miRNAs in the process of vascular aging with special emphasis on EC and VSMC functions. In addition, the potential application of miRNAs to clinical practice for the diagnosis and treatment of cardiovascular diseases will also be discussed.
Collapse
|
21
|
Immunomodulatory effects of adipose tissue-derived stem cells on elastin scaffold remodeling in diabetes. Tissue Eng Regen Med 2016; 13:701-712. [PMID: 30603451 DOI: 10.1007/s13770-016-0018-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 01/11/2023] Open
Abstract
Diabetes is a major risk factor for the progression of vascular disease, contributing to elevated levels of glycoxidation, chronic inflammation and calcification. Tissue engineering emerges as a potential solution for the treatment of vascular diseases however there is a considerable gap in the understanding of how scaffolds and stem cells will perform in patients with diabetes. We hypothesized that adipose tissue-derived stem cells (ASCs) by virtue of their immunosuppressive potential would moderate the diabetes-intensified inflammatory reactions and induce positive construct remodeling. To test this hypothesis, we prepared arterial elastin scaffolds seeded with autologous ASCs and implanted them subdermally in diabetic rats and compared inflammatory markers, macrophage polarization, matrix remodeling, calcification and bone protein expression to control scaffolds implanted with and without cells in nondiabetic rats. ASC-seeded scaffolds exhibited lower levels of CD8+ T-cells and CD68+ pan-macrophages and higher numbers of M2 macrophages, smooth muscle cell-like and fibroblast-like cells. Calcification and osteogenic markers were reduced in ASCseeded scaffolds implanted in non-diabetic rats but remained unchanged in diabetes, unless the scaffolds were first pre-treated with penta-galloyl glucose (PGG), a known anti-oxidative elastin-binding polyphenol. In conclusion, autologous ASC seeding in elastin scaffolds is effective in combating diabetes-related complications. To prevent calcification, the oxidative milieu needs to be reduced by elastin-binding antioxidants such as PGG.
Collapse
|
22
|
Cho JH, Lee DY, Lee ES, Kim J, Park SE, Park CY, Lee WY, Oh KW, Park SW, Rhee EJ. Increased risk of coronary artery calcification progression in subjects with high baseline Lp(a) levels: The Kangbuk Samsung Health Study. Int J Cardiol 2016; 222:233-237. [PMID: 27497100 DOI: 10.1016/j.ijcard.2016.07.219] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Results from previous studies support the association of lipoprotein(a) [Lp(a)] levels and coronary artery disease risk. In this study, we analyzed the association between baseline Lp(a) levels and future progression of coronary artery calcification (CAC) in apparently healthy Korean adults. METHODS A total of 2611 participants (mean age: 41years, 92% mend) who underwent a routine health check-up in 2010 and 2014 were enrolled. Coronary artery calcium score (CACS) were measured by multi-detector computed tomography. Baseline Lp(a) was measured by high-sensitivity immunoturbidimetric assay. Progression of CAC was defined as a change in CACS >0 over four years. RESULTS Bivariate correlation analyses with baseline Lp(a) and other metabolic parameters revealed age, total cholesterol, HDL-C, LDL-C and CACS to have a significant positive correlation, while body weight, fasting glucose level, blood pressure and triglyceride level were negatively correlated with baseline Lp(a) level. After four years of follow-up, 635 subjects (24.3%) had CAC progression. The participants who had CAC progression were older, composed of more men, more obese, and had higher fasting glucose levels and worse baseline lipid profiles compared to those who did not have CAC progression. The mean serum Lp(a) level was significantly higher in subjects who had CAC progression compared to those who did not (32.5 vs. 28.9mg/dL, p<0.01). When the risk for CAC progression according to baseline Lp(a) was calculated, those with Lp(a) level≥50mg/dL had an odds ratio of 1.333 (95% CI 1.027-1.730) for CAC progression compared to those with Lp(a)<50mg/dL after adjusting for confounding factors. CONCLUSIONS In this study, the subjects who had higher Lp(a) were at significantly higher risk for CAC progression after four years of follow-up, suggesting the role of high Lp(a) in CAC progression.
Collapse
Affiliation(s)
- Jung Hwan Cho
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Da Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Seo Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihyun Kim
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Eun Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-Young Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won-Young Lee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ki-Won Oh
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Woo Park
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun-Jung Rhee
- Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
23
|
Sticchi E, Magi A, Kamstrup PR, Marcucci R, Prisco D, Martinelli I, Mannucci PM, Abbate R, Giusti B. Apolipoprotein(a) Kringle-IV Type 2 Copy Number Variation Is Associated with Venous Thromboembolism. PLoS One 2016; 11:e0149427. [PMID: 26900838 PMCID: PMC4762703 DOI: 10.1371/journal.pone.0149427] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/02/2016] [Indexed: 11/18/2022] Open
Abstract
In addition to the established association between high lipoprotein(a) [Lp(a)] concentrations and coronary artery disease, an association between Lp(a) and venous thromboembolism (VTE) has also been described. Lp(a) is controlled by genetic variants in LPA gene, coding for apolipoprotein(a), including the kringle-IV type 2 (KIV-2) size polymorphism. Aim of the study was to investigate the role of LPA gene KIV-2 size polymorphism and single nucleotide polymorphisms (SNPs) (rs1853021, rs1800769, rs3798220, rs10455872) in modulating VTE susceptibility. Five hundred and sixteen patients with VTE without hereditary and acquired thrombophilia and 1117 healthy control subjects, comparable for age and sex, were investigated. LPA KIV-2 polymorphism, rs3798220 and rs10455872 SNPs were genotyped by TaqMan technology. Concerning rs1853021 and rs1800769 SNPs, PCR-RFLP assay was used. LPA KIV-2 repeat number was significantly lower in patients than in controls [median (interquartile range) 11(6–17) vs 15(9–25), p<0.0001]. A significantly higher prevalence of KIV-2 repeat number ≤7 was observed in patients than in controls (33.5% vs 15.5%, p<0.0001). KIV-2 repeat number was independently associated with VTE (p = 4.36 x10-9), as evidenced by the general linear model analysis adjusted for transient risk factors. No significant difference in allele frequency for all SNPs investigated was observed. Haplotype analysis showed that LPA haplotypes rather than individual SNPs influenced disease susceptibility. Receiver operating characteristic curves analysis showed that a combined risk prediction model, including KIV-2 size polymorphism and clinical variables, had a higher performance in identifying subjects at VTE risk than a clinical-only model, also separately in men and women.
Collapse
Affiliation(s)
- Elena Sticchi
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Pia R. Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital—Herlev, Herlev, Denmark
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence—SOD Patologia Medica, Center for Autoimmune Systemic Diseases, Behçet Center and Lupus Clinic, Careggi Hospital, Florence, Italy
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center—Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Mannuccio Mannucci
- A. Bianchi Bonomi Hemophilia and Thrombosis Center—Ospedale Maggiore Policlinico, Milan, Italy
- Scientific Direction, Fondazione Ca’ Granda–Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosanna Abbate
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence—Atherothrombotic Disease Center, Careggi Hospital, Florence, Italy
- * E-mail:
| |
Collapse
|
24
|
Yeang C, Cotter B, Tsimikas S. Experimental Animal Models Evaluating the Causal Role of Lipoprotein(a) in Atherosclerosis and Aortic Stenosis. Cardiovasc Drugs Ther 2016; 30:75-85. [DOI: 10.1007/s10557-015-6634-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
25
|
Abstract
Arterial calcification is highly prevalent and correlated with cardiovascular mortality, especially in patients with ESRD or diabetes. The pathogenesis of arterial calcification is multifactorial, with both genetic and environmental factors being implicated. In recent years, several mechanisms contributing to arterial calcification have been proposed. However, these can only explain a small proportion of the variability in arterial calcification, which is a major obstacle for its prevention and management. Epigenetics has emerged as one of the most promising areas that may fill in some of the gaps in our current knowledge of the interaction between the environmental insults with gene regulation in the development of diseases. Epigenetics refers to heritable and acquired changes in gene transcription that occur independently of the DNA sequence. Well-known components of epigenetic regulation include DNA methylation, histone modifications, and microRNAs. Epigenetics research in the regulation of arterial calcification has only recently been elucidated. In this review, we will summarise recent progress in epigenetic pathways involved in arterial calcification and discuss potential therapeutic interventions based on epigenetic mechanisms.
Collapse
|
26
|
|
27
|
Koschinsky ML, Boffa MB. Lipoprotein(a): an important cardiovascular risk factor and a clinical conundrum. Endocrinol Metab Clin North Am 2014; 43:949-62. [PMID: 25432390 DOI: 10.1016/j.ecl.2014.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Elevated plasma concentrations of lipoprotein(a) (Lp[a]) are an emerging risk factor for the development of coronary heart disease (CHD). Recent genetic and epidemiologic data have provided strong evidence for a causal role of Lp(a) in CHD. Despite these developments, which have attracted increasing interest from clinicians and basic scientists, many unanswered questions persist. The true pathogenic mechanism of Lp(a) remains a mystery. Significant uncertainty exists concerning the appropriate use of Lp(a) in the clinical setting. No therapeutic intervention remains that can specifically lower plasma Lp(a) concentrations, although the list of compounds that lower Lp(a) and LDL continues to expand.
Collapse
Affiliation(s)
- Marlys L Koschinsky
- Department of Chemistry and Biochemistry, University of Windsor, 401 Sunset Avenue, Windsor, Ontario N9B 3P4, Canada.
| | - Michael B Boffa
- Department of Chemistry and Biochemistry, University of Windsor, 401 Sunset Avenue, Windsor, Ontario N9B 3P4, Canada
| |
Collapse
|
28
|
Anagnostis P, Majeed A, Johnston DG, Godsland IF. Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: is it indeed higher than men? Eur J Endocrinol 2014; 171:R245-55. [PMID: 25117464 DOI: 10.1530/eje-14-0401] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The relative risk for cardiovascular disease (CVD) events and mortality in diabetic women (in comparison with non-diabetic women) is believed to be greater than that in diabetic men. However, the absolute risk for CVD mortality and morbidity does not appear to be higher in women. In general, there is heterogeneity between studies, and whether there is any definite difference in the CVD risk between sexes at any level of glycaemia is not known. The same arguments also apply when comparing the CVD risk factors, such as lipid profiles and systemic inflammation indices, which seem to be worse in women than in men with diabetes mellitus (DM). The same questions emerge at any given glycaemic state: are women at worse risk and do they have a worse risk factor profile than men? These issues have yet to be resolved. Similar, though less extensive, data have been reported for prediabetes. Furthermore, women with DM are suboptimally treated compared with men regarding lipid and blood pressure targets. Large prospective studies representative of the general population are therefore needed to define the differences between sexes regarding CVD events and mortality at a given glucose level and after adjusting for any other confounders.
Collapse
Affiliation(s)
- Panagiotis Anagnostis
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Azeem Majeed
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Desmond G Johnston
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| | - Ian F Godsland
- Division of DiabetesEndocrinology and Metabolism, Department of Medicine, Diabetes Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College London, Room G1, Norfolk Place, St Mary's Campus, London W2 1NH, UKDepartment of Primary Care and Public HealthFaculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
29
|
Boffa MB, Koschinsky ML. Update on lipoprotein(a) as a cardiovascular risk factor and mediator. Curr Atheroscler Rep 2014; 15:360. [PMID: 23990263 DOI: 10.1007/s11883-013-0360-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Recent genetic studies have put the spotlight back onto lipoprotein(a) [Lp(a)] as a causal risk factor for coronary heart disease. However, there remain significant gaps in our knowledge with respect to how the Lp(a) particle is assembled, the route of its catabolism, and the mechanism(s) of Lp(a) pathogenicity. It has long been speculated that the effects of Lp(a) in the vasculature can be attributed to both its low-density lipoprotein moiety and the unique apolipoprotein(a) component, which is strikingly similar to the kringle-containing fibrinolytic zymogen plasminogen. However, the ability of Lp(a) to modulate either purely thrombotic or purely atherothrombotic processes in vivo remains unclear. The presence of oxidized phospholipid on Lp(a) may underlie many of the proatherosclerotic effects of Lp(a) that have been identified both in cell models and in animal models, and provides a possible avenue for identifying therapeutics aimed at mitigating the effects of Lp(a) in the vasculature. However, the beneficial effects of targeted Lp(a) therapeutics, designed to either lower Lp(a) concentrations or interfere with its effects, on cardiovascular outcomes remains to be determined.
Collapse
Affiliation(s)
- Michael B Boffa
- Department of Chemistry & Biochemistry, University of Windsor, 401 Sunset Avenue, Windsor, ON, Canada.
| | | |
Collapse
|
30
|
Liao XB, Zhang ZY, Yuan K, Liu Y, Feng X, Cui RR, Hu YR, Yuan ZS, Gu L, Li SJ, Mao DA, Lu Q, Zhou XM, de Jesus Perez VA, Yuan LQ. MiR-133a modulates osteogenic differentiation of vascular smooth muscle cells. Endocrinology 2013; 154:3344-52. [PMID: 23798596 DOI: 10.1210/en.2012-2236] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Arterial calcification is a key pathologic component of vascular diseases such as atherosclerosis, coronary artery disease, and peripheral vascular disease. A hallmark of this pathological process is the phenotypic transition of vascular smooth muscle cells (VSMCs) to osteoblast-like cells. Several studies have demonstrated that microRNAs (miRNAs) regulate osteoblast differentiation, but it is unclear whether miRNAs also regulate VSMC-mediated arterial calcification. In the present study, we sought to characterize the role of miR-133a in regulating VSMC-mediated arterial calcification. Northern blotting analysis of VSMCs treated with β-glycerophosphate demonstrated that miR-133a was significantly decreased during osteogenic differentiation. Overexpression of miR-133a inhibited VSMC transdifferentiation into osteoblast-like cells as evidenced by a decrease in alkaline phosphatase activity, osteocalcin secretion, Runx2 expression, and mineralized nodule formation. Conversely, the knockdown of miR-133a using an miR-133a inhibitor promoted osteogenic differentiation of VSMCs by increasing alkaline phosphatase activity, osteocalcin secretion, and Runx2 expression. Runx2 was identified as a direct target of miR-133a by a cotransfection experiment in VSMCs with luciferase reporter plasmids containing wild-type or mutant 3'-untranslated region sequences of Runx2. Furthermore, the pro-osteogenic effects of miR-133a inhibitor were abrogated in Runx2-knockdown cells, and the inhibition of osteogenic differentiation by pre-miR-133a was reversed by overexpression of Runx2, providing functional evidence that the effects of miR-133a in osteogenic differentiation were mediated by targeting Runx2. These results demonstrate that miR-133a is a key negative regulator of the osteogenic differentiation of VSMCs.
Collapse
MESH Headings
- 3' Untranslated Regions/drug effects
- Animals
- Biomarkers/metabolism
- Cell Transdifferentiation/drug effects
- Cells, Cultured
- Core Binding Factor Alpha 1 Subunit/antagonists & inhibitors
- Core Binding Factor Alpha 1 Subunit/biosynthesis
- Core Binding Factor Alpha 1 Subunit/genetics
- Core Binding Factor Alpha 1 Subunit/metabolism
- Female
- Gene Silencing
- Genes, Reporter/drug effects
- Glycerophosphates/metabolism
- Mice
- Mice, Inbred C57BL
- MicroRNAs/antagonists & inhibitors
- MicroRNAs/genetics
- MicroRNAs/metabolism
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Mutation
- Oligonucleotides, Antisense/adverse effects
- Osteoblasts/drug effects
- Osteoblasts/metabolism
- Osteoblasts/pathology
- Osteocalcin/metabolism
- Recombinant Proteins/antagonists & inhibitors
- Recombinant Proteins/biosynthesis
- Recombinant Proteins/metabolism
- Vascular Calcification/chemically induced
- Vascular Calcification/metabolism
- Vascular Calcification/pathology
- Vascular Calcification/prevention & control
Collapse
Affiliation(s)
- Xiao-Bo Liao
- Departments of Cardiothoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, People’s Republic of China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Serum lipoprotein(a) positively correlates with coronary artery calcification in low-risk chinese han patients: a study from a single center. PLoS One 2013; 8:e71673. [PMID: 23951216 PMCID: PMC3741126 DOI: 10.1371/journal.pone.0071673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 07/02/2013] [Indexed: 11/30/2022] Open
Abstract
Background Elevated plasma levels of lipoprotein(a) (Lp(a)) and a higher degree of coronary artery calcification (CAC) are both considered to be risk factors for atherosclerosis. However, previous studies have demonstrated that the relationship between Lp(a) levels and the degree of CAC indicates significant heterogeneity that may be due to varying ethnicities. The purpose of this study was to examine the predictive power of Lp(a) for CAC as measured by multidetector computed tomography (MDCT) in the Han ethnic group of China. Methods A total of 1082 subjects were recruited in this study. The patients were divided into four groups: patients without hypertension or diabetes were group 1, patients with hypertension were group 2, patients with diabetes were group 3 and patients with both hypertension and diabetes were group 4. CAC score (CACs), lipid profiles (Lp(a), LDL, HDL, TG, TC), HbA1C, glucose, personal health history and body morphology were measured in all participants. The predictive power of Lp(a) for calcified atherosclerotic plaque was determined by correlations and ordinal logistic regression. Results There was no significant difference in the CACs between group 2 and group 3 (z = 1.790, p = 0.736), and there were significant differences among the other groups. However, there was no significant difference in the total Lp(a) among the 4 groups (χ2 = 0.649, p = 0.885). Only In group 1, Lp(a) was a statistically significant predictor of the presence of calcified coronary plaque using ordinal logistic regression. Conclusions Levels of Lp(a) positively correlate with CACs among Chinese Han people who are without diabetes and hypertension, suggesting that Lp(a) may be an important risk factor for the presence of calcified atheromas.
Collapse
|
32
|
Ward MS, Fotheringham AK, Cooper ME, Forbes JM. Targeting advanced glycation endproducts and mitochondrial dysfunction in cardiovascular disease. Curr Opin Pharmacol 2013; 13:654-61. [DOI: 10.1016/j.coph.2013.06.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 06/25/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
|
33
|
Erbel R, Lehmann N, Churzidse S, Möhlenkamp S, Moebus S, Mahabadi AA, Schmermund A, Stang A, Dragano N, Grönemeyer D, Seibel R, Kälsch H, Bauer M, Bröcker-Preuss M, Mann K, Jöckel KH. Gender-specific association of coronary artery calcium and lipoprotein parameters: the Heinz Nixdorf Recall Study. Atherosclerosis 2013; 229:531-40. [PMID: 23701995 DOI: 10.1016/j.atherosclerosis.2013.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 03/19/2013] [Accepted: 04/07/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Coronary atherosclerosis can be detected by computed tomography. The amount of coronary artery calcification (CAC) is related to cardiovascular risk factors, the strength of the gender specific relation between lipoprotein parameters and CAC has not extensively been studied. Especially, the role of routinely determined lipoproteins in contrast to less common and computed lipid parameters (e.g. ratios) remains to be clarified. METHODS AND RESULTS The study cohort (n = 3956, 52% women, age 45-75 years) was randomly selected from three cities of a German metropolitan area. Lipoproteins-low-and high density lipoprotein (LDL-C/HDL-C), total cholesterol, apolipoprotein A-1 and B (apoA-1/apoB) as well as lipoprotein (a) (Lp(a)) were measured, while non-HDL-C was calculated. All participants received an electron-beam computed tomography (EBCT) for quantification of CAC. Adjusted for age and cardiovascular risk factors, CAC increased by a factor of 1.97 (1.51-2.57, 95% CI) and 1.94 (1.53-2.45, 95% CI) comparing the fourth to the first quartile of LDL-C for men and women, respectively. This association with LDL-C was also found after dichotomization of CAC at thresholds >0, ≥ 100 and ≥ 400. The best association of CAC was, however, found to be apoB and the second best was non HDL-C, in both men and women. For apoB, the model including all risk factors reached an explained variance for CAC of 20.2% in men and of 21.6% in women. When using LDL-C as a given parameter according to the current practice and advice, HDL-C in men and apoB in women provided an additional but small benefit. CONCLUSION ApoB showed the best association with CAC compared to all other tested lipoproteins. Neither the ratio LDL-C/HDL-C nor apoB/apoA-1, or Lp(a) revealed a closer association with CAC. While lipoproteins are related to CAC more closely in women than in men, their association with CAC is, however, not particularly strong. Our results may influence primary and secondary prevention advices in order to improve detection of subclinical atherosclerosis, for which lipoprotein parameters can only play a minor role.
Collapse
Affiliation(s)
- Raimund Erbel
- Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Wang C, Niu DM, Hu J, Guan XC, Yang W, Wang JJ, Zhang CY, Zhang CN. Elevated serum β2-glycoprotein-I-lipoprotein(a) complexes levels are associated with the presence and complications in type 2 diabetes mellitus. Diabetes Res Clin Pract 2013; 100:250-6. [PMID: 23549246 DOI: 10.1016/j.diabres.2013.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/16/2013] [Accepted: 03/01/2013] [Indexed: 01/30/2023]
Abstract
AIMS To examine the serum levels of β2-glycoprotein I-lipoprotein(a) complexes [β2-GPI-Lp(a)] in type 2 diabetes mellitus (T2DM) patients and evaluate the association of the complexes with complications in T2DM. METHODS Fifty two T2DM patients (22 with complications and 30 free of complications) and 52 age/gender-matched healthy controls were studied. Serum concentrations of β2-GPI-Lp(a) and ox-Lp(a) were measured by "sandwich" ELISAs and their associations with complications were examined using multiple linear regression. RESULTS Mean serum β2-GPI-Lp(a) (1.19 ± 0.30 U/mL vs. 0.89 ± 0.20 U/mL, p<0.001) and ox-Lp(a) concentrations (13.34 ± 11.73 mg/L vs. 5.26 ± 3.34 mg/L, p<0.001) were both significantly higher in T2DM than in controls. The area under the ROC curve (AUC) for β2-GPI-Lp(a) and ox-Lp(a) was 0.725 and 0.738, respectively. β2-GPI-Lp(a) levels were markedly higher in patients with complications than those without complication (1.39 ± 0.28 U/mL vs. 1.04 ± 0.31 U/mL, p<0.01), whereas no marked difference was found in ox-Lp(a). In multivariate regression analysis, the association between β2-GPI-Lp(a) and complications remained significant (β=0.249, p<0.05, respectively) after adjustments were made for other traits. CONCLUSIONS Elevated β2-GPI-Lp(a) may reflect chronic underlying pathophysiological processes involved in development of complications of T2DM.
Collapse
Affiliation(s)
- Cheng Wang
- Department of Clinical Laboratory, Jinling Hospital, Clinical School of Medicine, Nanjing University, Nanjing, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Jug B, Papazian J, Lee R, Budoff MJ. Association of lipoprotein subfractions and coronary artery calcium in patient at intermediate cardiovascular risk. Am J Cardiol 2013; 111:213-8. [PMID: 23141758 DOI: 10.1016/j.amjcard.2012.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/20/2012] [Accepted: 09/20/2012] [Indexed: 01/07/2023]
Abstract
More precise estimation of the atherogenic lipid parameters could improve identification of residual risk beyond what is possible using traditional lipid risk factors. The aim of the present study was to explore the association between advanced analysis of lipoprotein subfractions and the prevalence of coronary artery calcium. Consecutive participants at intermediate cardiovascular risk who were undergoing computed tomographic assessment of coronary calcium (calcium score) were included. Using a validated ultracentrifugation method (the vertical autoprofile II test), cholesterol in eluting lipoprotein subfractions [i.e., low- (LDL), very-low-, intermediate-, and high-density lipoprotein subclasses, lipoprotein (a), and predominant LDL distribution] was directly quantified. A total of 410 patients were included (29% women, mean age 57 years), of whom 297 (72.4%) had coronary artery calcium. LDL pattern B (predominance of small dense particles) emerged as an independent predictor of coronary calcium after adjustment for traditional risk factors (odds ratio 4.46, 95% confidence interval 1.19 to 16.7). However, after additional stratification for dyslipidemia, as defined by conventional lipid profiling, a statistically significant prediction was only retained for high-density lipoprotein subfraction 2 (odds ratio 3.45, 95% confidence interval 2.03 to 50.1) and "real" LDL (odds ratio 6.10, 95% confidence interval 1.26 to 23.41) in the normolipidemia group and for lipoprotein (a) (odds ratio 7.81, 95% confidence interval 1.41 to 43.5) in the dyslipidemic group. In conclusion, advanced assessment of the lipoprotein subfractions [i.e., LDL pattern B, high-density lipoprotein subfraction 2, "real" LDL, and lipoprotein (a)] using the vertical autoprofile II test provided additional information to that of conventional risk factors on the prevalence of coronary artery calcium in patients at intermediate cardiovascular risk.
Collapse
Affiliation(s)
- Borut Jug
- Division of Cardiology, Los Angeles Biomedical Research Institute at UCLA-Harbor Medical Center, Torrance, California, USA.
| | | | | | | |
Collapse
|
36
|
Greif M, Arnoldt T, von Ziegler F, Ruemmler J, Becker C, Wakili R, D'Anastasi M, Schenzle J, Leber AW, Becker A. Lipoprotein (a) is independently correlated with coronary artery calcification. Eur J Intern Med 2013; 24:75-9. [PMID: 23021791 DOI: 10.1016/j.ejim.2012.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Lipoprotein a (Lp(a)) has been recognized as a risk factor for both coronary heart diseases and for cardiovascular events. Coronary artery calcification (CAC) is a well proven marker for coronary artery disease and risk factor for cardiovascular events. Still there are conflicting data regarding the relationship of Lp(a) and CAC. We therefore wanted to evaluate the influence of Lp(a) on CAC. METHODS 1560 European patients (1123 men, age 59.3 ± 20.8 years) with typical or atypical chest pain underwent CAC scoring by a multi-slice CT-scanner, using a standard protocol. Blood samples were evaluated the same day using an automated particle enhanced immunoturbidimetric assay to determine Lp(a) serum levels. RESULTS There was a positive correlation between CAC score, age, and common cardiovascular risk factors. Lp(a) serum levels were not associated with age but a positive correlation between Lp(a) serum levels and CAC was found. In the multivariate analysis age, diabetes, statin therapy, and Lp(a) could be identified as independent risk factors for CAC. (p<0.001). BMI, smoking, hypertension and LDL-C were not independently associated with CAC. CONCLUSION Lp (a) could be identified as an independent predictor of CAC, a marker of coronary atherosclerosis. Further a positive correlation between increasing Lp (a) levels and CAC scores was found.
Collapse
Affiliation(s)
- Martin Greif
- Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Qasim AN, Rafeek H, Rasania SP, Churchill TW, Yang W, Ferrari VA, Jha S, Master SM, Mulvey CK, Terembula K, Dailing C, Budoff MJ, Kawut SM, Reilly MP. Cardiovascular risk factors and mitral annular calcification in type 2 diabetes. Atherosclerosis 2012; 226:419-24. [PMID: 23273961 DOI: 10.1016/j.atherosclerosis.2012.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 09/20/2012] [Accepted: 11/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Mitral annular calcification (MAC) is a degenerative process of the mitral annulus associated with cardiac disease and stroke. Although thought to be more prevalent in type 2 diabetes (T2DM), MAC remains poorly characterized in this population, due to confounding by renal and cardiac disease. Our goal was to study the risk factors for MAC in a sample of T2DM subjects without renal and cardiac disease. METHODS The Penn Diabetes Heart Study (PDHS) is a cross-sectional study of diabetic individuals without clinical cardiovascular or renal disease. We quantified and analyzed MAC Agatston scores in baseline cardiac CTs from 1753 individuals. Logistic and tobit regression were used to assess MAC's relationship with risk factors and coronary artery calcium (CAC). RESULTS MAC was present in 12.0% of subjects, with a median Agatston score of 72.3 [Interquartile range (22.2-256.9)]. Older age, female gender, Caucasian race, and longer diabetes duration were independently associated with both the presence and extent MAC even after controlling for CAC; however, hypertension, hyperlipidemia, tobacco use, CRP levels, and other comorbidities were not associated. CAC was strongly associated with MAC [OR of 4.0 (95% CI 2.4-6.6)] in multivariable models. CONCLUSIONS Age, female gender, Caucasian race, and diabetes duration were associated with the presence and extent of MAC in T2DM subjects, independent of CAC, which was also strongly associated with MAC. These data suggest that additional mechanisms for MAC formation in diabetics may exist which are distinct from those related to generalized atherosclerosis and deserve further investigation.
Collapse
Affiliation(s)
- Atif N Qasim
- University of California at San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Kadoglou NPE, Fotiadis G, Athanasiadou Z, Vitta I, Lampropoulos S, Vrabas IS. The effects of resistance training on ApoB/ApoA-I ratio, Lp(a) and inflammatory markers in patients with type 2 diabetes. Endocrine 2012; 42:561-9. [PMID: 22407494 DOI: 10.1007/s12020-012-9650-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/28/2012] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate the effects of resistance training (RT) on novel cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM). We enrolled 52 overweight/obese, type 2 diabetic patients, with inadequate glycemic control (HbA1c > 6.5 %), but without overt diabetic vascular complications. Participants were randomly assigned into two equivalent groups (n = 26): (1) Resistance exercise group: subjects underwent a supervised RT program (3-times/week, 60 min/session, 2-3 sets of 8 machine-weight exercises, 60-80 % of one-repetition maximum). (2) Control group (CG): at study entrance, they received a structured exercise counseling to increase daily physical activity. Clinical parameters, cardiorespiratory capacity, glycemic and lipid profile, apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), Lipoprotein(a) [Lp(a)], insulin resistance (HOMA-IR), high-sensitivity CRP (hsCRP), fibrinogen were measured before and after 3 months. RT significantly reduced glycemic indexes, insulin resistance and systolic blood pressure, compared to CG (p < 0.05). Moreover, exercise-treated patients conferred a remarkable downregulation in ApoB levels (from 135.92 ± 30.97 mg/dL to 85.9 ± 26.46 mg/dL, p < 0.001) as compared to CG (from 126.33 ± 36.59 mg/dL to 116.23 ± 27.52 mg/dL, p = 0.872) (p < 0.001). Similarly, ApoB/ApoA-I ratio was considerably decreased in REG rather than CG (-0.32 ± 0.09 vs 0.02 ± 0.01, p < 0.001). Notably, ApoA-I, Lp(a), hsCRP, fibrinogen, the rest of lipid parameters, body weight and exercise capacity remained unaltered in both groups (p > 0.05). Among variables, HOMA-IR reduction was found to be an independent predictor of changes in ApoB/ApoA-I ratio (R (2) = 0.406, p = 0.041) in REG. Long-term RT ameliorated glycemic control, insulin sensitivity and ApoB/ApoA-I ratio in individuals with T2DM. Although we did not observe significant benefits in the rest of cardiovascular risk factors, our results indicate a merely beneficial impact of RT.
Collapse
Affiliation(s)
- Nikolaos P E Kadoglou
- Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Ag Ioannis, 62110, Serres, Greece.
| | | | | | | | | | | |
Collapse
|
39
|
Güdücü N, Işçi H, Yiğiter AB, Dünder I. C-reactive protein and lipoprotein-a as markers of coronary heart disease in polycystic ovary syndrome. J Turk Ger Gynecol Assoc 2012; 13:227-32. [PMID: 24592047 DOI: 10.5152/jtgga.2012.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 11/12/2012] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the risk factors of coronary heart disease, CRP and Lipoprotein-a in polycystic ovary syndrome patients. MATERIAL AND METHODS Prospectively collected data of polycystic ovary syndrome patients (n=62) and control group (n=40) were compared. RESULTS PCOS patients had higher HOMA-IR, CRP, DHEAS, free testosterone, FAI, LH and prolactin levels when compared to the control group. Lipoprotein-a levels did not differ between the groups. The obese PCOS group had statistically significantly higher fasting blood glucose, total cholesterol, triglyceride, free testosterone, insulin, CRP and HOMA-IR and statistically significantly lower HDL and SHBG when compared to normal weight PCOS persons. Fasting blood glucose, total cholesterol, LDL, SHBG, CRP, Lipoprotein-a, FSH, LH, TSH, DHEAS and prolactin levels did not differ between the normal weight and obese control groups. CONCLUSION CRP levels increase in polycystic ovary syndrome patients and can be used as a marker of coronary heart disease. Future studies can be directed at treatments to decrease CRP levels, including antiinflammatory treatments.
Collapse
Affiliation(s)
- Nilgün Güdücü
- Department of Obstetrics and Gynecology, İstanbul Bilim University Avrupa Florence Nightingale Hospital, İstanbul, Turkey
| | - Herman Işçi
- Department of Obstetrics and Gynecology, İstanbul Bilim University Avrupa Florence Nightingale Hospital, İstanbul, Turkey
| | - Alin Başgül Yiğiter
- Department of Obstetrics and Gynecology, İstanbul Bilim University Avrupa Florence Nightingale Hospital, İstanbul, Turkey
| | - Ilkkan Dünder
- Department of Obstetrics and Gynecology, İstanbul Bilim University Avrupa Florence Nightingale Hospital, İstanbul, Turkey
| |
Collapse
|
40
|
|
41
|
Chandni R, Ramamoorthy KP. Lipoprotein(a) in type 2 diabetic subjects and its relationship to diabetic microvascular complications. World J Diabetes 2012; 3:105-9. [PMID: 22645639 PMCID: PMC3360222 DOI: 10.4239/wjd.v3.i5.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/15/2012] [Accepted: 05/11/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To estimate the level of serum lipoprotein (a) [Lp (a)] in type 2 diabetes mellitus patients and to determine the relationship between Lp(a) in type 2 diabetes mellitus patients and micro-vascular complications.
METHODS: A cross sectional study was performed that enrolled 144 subjects with type 2 diabetes mellitus above the age of 25 years attending outpatient clinic of Government Medical College, Kozhikode. Lp(a) levels were measured quantitatively in venous samples using Turbidimetric Immunoassay in all subjects. Each patient was evaluated for micro vascular complications, namely diabetic retinopathy, nephropathy and neuropathy. The relationship between Lp(a) levels and the micro vascular complications was assessed by univariate analysis.
RESULTS: Mean age of cases was 53.93 ± 10.74 years with a male to female ratio of 1.3:1. Mean duration of diabetes was 9.53 ± 7.3 years. Abnormal Lp(a) levels (≥ 30 mg/dL) were observed in 38 (26.4%) diabetic subjects. Seventy-eight (54.16%) cases had diabetic nephropathy and significantly higher Lp(a) levels were found among these cases [Median 28.2 mg/dL (Interquartile range; IQR 24.4-33.5) vs 19.3 mg/dL (IQR 14.7-23.5); P < 0.05]. Retinopathy was present among 66 (45.13%) cases and peripheral neuropathy was detected among 54 (37.5%) cases. However, Lp(a) levels were not significantly different among those with or without retinopathy and neuropathy. Positive correlation was found between higher Lp(a) levels and duration of diabetes (r = 0.165, P < 0.05) but not with HbA1c values (r = – 0.083).
CONCLUSION: Abnormal Lp(a) levels were found among 26.4% of diabetic subjects. Patients with diabetic nephropathy had higher Lp(a) levels. No association was found between Lp(a) levels and diabetic retinopathy or neuropathy. Longer duration of diabetes correlated with higher Lp(a) levels.
Collapse
Affiliation(s)
- Radhakrishnan Chandni
- Radhakrishnan Chandni, Kollengode Parameswaran Ramamoorthy, Department of Medicine, Government Medical College, Kozhikode, PIN 673008, Kerala, India
| | | |
Collapse
|
42
|
Atar AI, Yilmaz OC, Akin K, Selcoki Y, Er O, Eryonucu B. Association between gamma-glutamyltransferase and coronary artery calcification. Int J Cardiol 2012; 167:1264-7. [PMID: 22498419 DOI: 10.1016/j.ijcard.2012.03.157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 02/22/2012] [Accepted: 03/18/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The exact mechanisms behind the association between atherosclerosis and gamma-glutamyltransferase (GGT) are unclear. Coronary artery calcification (CAC) detected by computerized tomography is an important marker of atherosclerosis and its severity correlates with coronary plaque burden. The aim of this study was to investigate if serum GGT levels are associated with CAC in patients without known coronary heart disease (CHD) who had low-intermediate risk for CHD. METHODS Two hundred and seventy two patients who had low-intermediate risk for coronary artery disease were included in the study. Serum GGT levels were measured spectrophotometrically. CACS (Agatston method) were performed using a 64-slice computerized tomography scanner. The patients were grouped according to their GGT values in four quartiles. RESULTS Patients in higher GGT quartiles had elevated CAC score (P<0.001). Patients in higher GGT quartiles were predominantly males (P<0.001) and were more likely to be smoking (P=0.004), and have elevated uric acid (P<0.001), fasting blood glucose (P<0.001), CRP levels (P=0.003) and 10-year total cardiovascular risk (P=0.007) and low HDL levels (P<0.001). Positive correlations were found between log GGT and CAC (r=0.233, P<0.001). In the multivariate analysis GGT, age, smoking and serum uric acid levels appeared as independent factors predictive of presence of CAC. CONCLUSIONS We demonstrated a significant correlation between serum GGT levels and CAC and CHD risk factors. Serum GGT level was an independent marker of CAC.
Collapse
Affiliation(s)
- Asli I Atar
- Department of Cardiology, Fatih University, School of Medicine, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
43
|
Demer L, Tintut Y. The roles of lipid oxidation products and receptor activator of nuclear factor-κB signaling in atherosclerotic calcification. Circ Res 2011; 108:1482-93. [PMID: 21659652 DOI: 10.1161/circresaha.110.234245] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This review focuses on the roles of oxylipids and receptor activator of nuclear factor-κB ligand signaling in calcific cardiovascular disease. Both intimal and valvular calcifications are closely associated with atherosclerosis, leading investigators to study the role of atherogenic oxidatively modified lipids (oxylipids). Results have identified the molecular signaling through which oxylipids induce osteogenic differentiation and calcification in vascular cells. A surprising concomitant finding was that, in bona fide osteoblasts from skeletal bone, oxylipids have the opposite effect, ie, inhibiting osteoblastic maturation. This is the basis for the lipid hypothesis of osteoporosis. Oxylipids also induce resorptive osteoclastic cells within the bone environment, raising the question of whether resorptive osteoclasts can be harnessed in the vascular context for cell-based therapy to remove artery wall mineral deposits. The challenge is that vascular cells produce antiosteoclastogenic factors, including the soluble decoy receptor for receptor activator of nuclear factor-κB ligand, possibly accounting for the paucity of resorptive cells and the dominance of mineral in atherosclerotic plaque. These factors may have therapeutic use in osteoclastogenic removal of mineral deposits from arteries.
Collapse
Affiliation(s)
- Linda Demer
- Department of Medicine, University of California, Los Angeles, CA, USA.
| | | |
Collapse
|
44
|
Abstract
Arterial calcifications as found with various imaging techniques, like plain X-ray, computed tomography or ultrasound are associated with increased cardiovascular risk. The prevalence of arterial calcification increases with age and is stimulated by several common cardiovascular risk factors. In this review, the clinical importance of arterial calcification and the currently known proteins involved are discussed. Arterial calcification is the result of a complex interplay between stimulating (bone morphogenetic protein type 2 [BMP-2], RANKL) and inhibitory (matrix Gla protein, BMP-7, osteoprotegerin, fetuin-A, osteopontin) proteins. Vascular calcification is especially prevalent and related to adverse outcome in patients with renal insufficiency and diabetes mellitus. We address the special circumstances and mechanisms in these patient groups. Treatment and prevention of arterial calcification is possible by the use of specific drugs. However, it remains to be proven that reduction of vascular calcification in itself leads to a reduced cardiovascular risk.
Collapse
Affiliation(s)
- Roger J M W Rennenberg
- Department of Internal Medicine, Maastricht University Medical Centre (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
| | | | | | | |
Collapse
|