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Di Gioia G, Buzzelli L, Maestrini V, Squeo MR, Lemme E, Monosilio S, Serdoz A, Fiore R, Zampaglione D, Segreti A, Pelliccia A. Long-Term Evaluation of Lipid Profile Changes in Olympic Athletes. Int J Sport Nutr Exerc Metab 2024:1-8. [PMID: 38917988 DOI: 10.1123/ijsnem.2023-0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/06/2024] [Accepted: 04/18/2024] [Indexed: 06/27/2024]
Abstract
Dyslipidemia is a major contributor to the development of atherosclerotic cardiovascular disease. Despite high level of physical activity, athletes are not immune from dyslipidemia, but longitudinal data on the variation of lipids are currently lacking. We sought to assess lipid profile changes over time in Olympic athletes practicing different sports disciplines (power, skills, endurance, and mixed). We enrolled 957 consecutive athletes evaluated from London 2012 to Beijing 2022 Olympic Games. Dyslipidemia was defined as low-density lipoprotein (LDL) ≥115 mg/dl, high-density lipoprotein (HDL) <40 mg/dl for males, or HDL <50 mg/dl for females. Hypertriglyceridemia was defined as triglycerides >150 mg/dl. At the follow-up, a variation of ±40 mg/dl for LDL, ±6 mg/dl for HDL, and ±50 mg/dl for triglycerides was considered relevant. Athletes with follow-up <10 months or taking lower lipid agents were excluded. Follow-up was completed in 717 athletes (74.9%), with a mean duration of 55.6 months. Mean age was 27.2 ± 4.8 years old, 54.6% were male (n = 392). Overall, 19.8% (n = 142) athletes were dyslipidemic at both blood tests, being older, practicing nonendurance sports, and predominantly male. In 69.3% (n = 129) of those with elevated LDL at t0, altered values were confirmed at follow-up, while the same occurred in 36.5% (n = 15) with hypo-HDL and 5.3% (n = 1) in those with elevated triglycerides. Weight and fat mass percentage modifications did not affect lipid profile variation. LDL hypercholesterolemia tends to persist over time especially among male, older, and nonendurance athletes. LDL hypercholesterolemia detection in athletes should prompt early preventive intervention to reduce the risk of future development of atherosclerotic disease.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico,"Rome, Italy
| | - Lorenzo Buzzelli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Erika Lemme
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Sara Monosilio
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Serdoz
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Roberto Fiore
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Domenico Zampaglione
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Andrea Segreti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico,"Rome, Italy
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
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Sadabadi F, Zirak RG, Ghazizadeh H, Rastgar Moghadam A, Mouhebati M, Ehyaei S, Fadihe FT, Zare-Feyzabadi R, Ferns GA, Ghayour-Mobarhan M. Physical activity level (PAL) and risk factors of cardiovascular disease in the MASHAD study cohort. Diabetes Metab Syndr 2021; 15:102316. [PMID: 34739910 DOI: 10.1016/j.dsx.2021.102316] [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: 11/11/2020] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM The relationship between physical activity levels (PAL) and the presence of cardiovascular disease (CVD) risk factors such as anthropometric and biochemical indices and heat shock proteins 27 antibody (anti-HSP-27) concentration, and serum inflammatory markers, was investigated in the MASHAD cohort study. METHODS The overall study population consisted of 9,684 subjects (3,858 men, 5,826 women) with a mean age of 47.73 ± 8.08 to 48.87 ± 9.26 years respectively. They were divided into four categories based on their PAL. Biochemical parameters were determined for all participants. Also, serum anti-HSP-27 levels were measured using an in-house enzyme-linked immune sorbent assay method. Multiple regression analysis was used to explore the association between the anti-HSP antibody titers and physical activity after adjusting for confounding factors. The level of statistical significance was set at p < 0.05. RESULTS Several CVD risk factors were associated with the level of PAL including: body mass index, waist hip ratio, systolic and diastolic blood pressure, serum HDL-C and TG (p < 0.001) and also fasting blood glucose (0.004). Also, serum anti-HSP-27 titers were significantly higher in inactive subjects (P > 0.05). CONCLUSION We found that PAL was significantly associated with several established CVD risk factors. Also, the level of anti-HSP-27 was lower in individuals with moderate and high PAL.
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Affiliation(s)
- Fatemeh Sadabadi
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Ghaffarian Zirak
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamideh Ghazizadeh
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azam Rastgar Moghadam
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Mouhebati
- Cardiovascular Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Ehyaei
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fattaneh Tavassoli Fadihe
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Zare-Feyzabadi
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Education, Brighton & Sussex Medical School, Brighton, BN1 9PH, UK
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
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Lombardo B, Izzo V, Terracciano D, Ranieri A, Mazzaccara C, Fimiani F, Cesaro A, Gentile L, Leggiero E, Pero R, Izzo B, D'Alicandro AC, Ercolini D, D'Alicandro G, Frisso G, Pastore L, Calabrò P, Scudiero O. Laboratory medicine: health evaluation in elite athletes. Clin Chem Lab Med 2020; 57:1450-1473. [PMID: 30835249 DOI: 10.1515/cclm-2018-1107] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/24/2019] [Indexed: 02/06/2023]
Abstract
The need to evaluate the health status of an athlete represents a crucial aim in preventive and protective sports science in order to identify the best diagnostic strategy to improve performance and reduce risks related to physical exercise. In the present review we aim to define the main biochemical and haematological markers that vary significantly during and after sports training to identify risk factors, at competitive and professional levels and to highlight the set up of a specific parameter's panel for elite athletes. Moreover, we also intend to consider additional biomarkers, still under investigation, which could further contribute to laboratory sports medicine and provide reliable data that can be used by athlete's competent staff in order to establish personal attitudes and prevent sports injuries.
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Affiliation(s)
- Barbara Lombardo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Viviana Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Annaluisa Ranieri
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Fabio Fimiani
- Division of Cardiology, Department of Cardio-Thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Arturo Cesaro
- Division of Cardiology, Department of Cardio-Thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | | | - Raffaela Pero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy
| | - Barbara Izzo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Danilo Ercolini
- Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy.,Division of Microbiology, Department of Agricultural Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni D'Alicandro
- Department of Neuroscience and Rehabilitation, Center of Sports Medicine and Disability, AORN, Santobono-Pausillipon, Naples, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy
| | - Lucio Pastore
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy.,Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy
| | - Paolo Calabrò
- Division of Cardiology, Department of Cardio-Thoracic and Respiratory Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy.,CEINGE Advanced Biotechnologies, Naples, Italy.,Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy
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Ma H, Lin H, Hu Y, Li X, He W, Jin X, Gao J, Zhao N, Pan B, Gao X. Relationship between non-high-density lipoprotein cholesterol and carotid atherosclerosis in normotensive and euglycemic Chinese middle-aged and elderly adults. Lipids Health Dis 2017; 16:55. [PMID: 28302123 PMCID: PMC5356399 DOI: 10.1186/s12944-017-0451-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/09/2017] [Indexed: 11/11/2022] Open
Abstract
Background We investigate whether non–high-density lipoprotein cholesterol (non-HDL-C) provides a better estimate of cardiovascular risk than other lipid profiles in normotensive and euglycemic middle-aged and elderly adults. Methods A total of 512 males and 958 females were enrolled from the Changfeng Study. A standard interview, anthropometric measurements and laboratory analyses were performed for each participant. Bilateral carotid intima-media thicknesses (CIMTs) were measured using ultrasonography, and the presence of carotid plaques was assessed. Results The mean values of non-HDL-C were 3.4 ± 0.8 mmol/l and 3.6 ± 0.9 mmol/l for male and female subjects, respectively. Compared with female subjects with non-HDL-C in the first quartile, female subjects with non-HDL-C in the fourth quartile had 1.317-fold increased risks for carotid plaques after adjusting for conventional cardiovascular disease (CVD) risk factors and increasing quartiles of all lipid levels. Non-HDL-C was positively associated with the CIMT after adjusting for CVD risk factors in female subjects (β = 0.062, P = 0.034). Conclusions These results suggest that non-HDL-C is independently associated with carotid atherosclerosis in normotensive and euglycemic females.
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Affiliation(s)
- Hui Ma
- Department of Geriatrics, Zhong Shan Hospital, Fudan University, Shanghai, 200032, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, 200032, China
| | - Yu Hu
- Department of Geriatrics, Zhong Shan Hospital, Fudan University, Shanghai, 200032, China
| | - Xiaoming Li
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, 200032, China
| | - Wanyuan He
- Department of Ultrasonography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xuejuan Jin
- Clinical Epidemiology Center, Zhong Shan Hospital, Fudan University, Shanghai, 200032, China
| | - Jian Gao
- Department of Clinical Nutrition, Zhong Shan Hospital, Fudan University, Shanghai, 200032, China
| | - Naiqing Zhao
- Department of Biostatistics, College of Public Health, Fudan University, Shanghai, 200032, China
| | - Boshen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, 20032, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, Shanghai, 200032, China.
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Gu X, Yang X, Li Y, Cao J, Li J, Liu X, Chen J, Shen C, Yu L, Huang J, Gu D. Usefulness of Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol as Predictors of Cardiovascular Disease in Chinese. Am J Cardiol 2015; 116:1063-70. [PMID: 26250998 DOI: 10.1016/j.amjcard.2015.06.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
The predictive effect of non-high-density lipoprotein cholesterol (non-HDL-C) for cardiovascular disease (CVD) in Chinese general population has not been well demonstrated. The aim of our study was to examine the relation between non-HDL-C and CVD and compare the predictive effect of non-HDL-C and low-density lipoprotein cholesterol (LDL-C) for CVD in Chinese population. The baseline examination of 27,020 participants aged 35 to 74 years from the China Cardiovascular Health Study and the China Multicenter Collaborative Study of Cardiovascular Epidemiology was conducted in 1998 to 2001. Follow-up evaluation was conducted in 2007 to 2008 with a response rate of 79.8%. Cox proportional hazards regression models were used to obtain the multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for CVD. Compared with those with non-HDL-C level of <130 mg/dl, multivariable-adjusted hazard ratios of CVD were 1.30 (95% CI 1.04 to 1.62) and 1.93 (95% CI 1.50 to 2.47) in participants with non-HDL-C levels of 160 to 189.9 and ≥190 mg/dl, respectively. An increase of 30 mg/dl in non-HDL-C level would correspond to 15%, 24%, and 12% increase in risk of CVD, coronary heart disease, and stroke, respectively. Using likelihood ratio tests, non-HDL-C appeared to be a similar predictor for CVD incidence as LDL-C (chi-square for non-HDL-C, 18.02, p <0.001; chi-square for LDL-C, 18.90, p <0.001). In conclusion, higher non-HDL-C level is associated with the increased CVD incidence and has a similar effect as LDL-C on predicting CVD risk in Chinese.
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Skoczyńska A. Postprandial decrease in LDL-cholesterol in men with metabolic syndrome. Open Med (Wars) 2015; 10:138-151. [PMID: 28352689 PMCID: PMC5153088 DOI: 10.1515/med-2015-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 03/31/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In some epidemiological studies, blood lipids are determined at non-fasting state, which may impact cardiovascular risk estimation. The aim of this study was to evaluate postprandial LDL-C changes in men with newly diagnosed metabolic syndrome (MetSy). METHODS 36 male patients were examined: 12 men with and 24 men without MetSy. The fat tolerance test was performed before and after a three-month hypolipidemic treatment. Serum lipids were measured using routine methods, lipid peroxides (LPO) colorimetrically, apolipoproteins A-I, B, and hsCRP immunoturbidimetrically. RESULTS The postprandial increase in triglycerides was associated with a decrease in LDL-C and a small decrease in apo B. In men with MetSy, the mean change in LDL-C (-19.5 ± 2.3 mg/dl) was greater than in healthy men (-5.7 ± 3.8 mg/dl). All lipid changes (ΔTG, ΔLDL-C and ΔLPO) were linearly dependent on the postprandial non-LDL-cholesterol. After three months of hypolipidemic treatment, in all men with MetSy, the apoB/apoA-I ratio remained the same as before the therapy. CONCLUSION In men diagnosed with MetSy, postprandial decreases in LDL-cholesterol may cause underestimation of cardiovascular risk. After three months of hypolipidemic treatment, there was only a partial reduction in this risk, as the apoB/apoA-I ratio remained the same.
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7
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Virani SS, Woodard LD, Ramsey DJ, Urech TH, Akeroyd JM, Shah T, Deswal A, Bozkurt B, Ballantyne CM, Petersen LA. Gender disparities in evidence-based statin therapy in patients with cardiovascular disease. Am J Cardiol 2015; 115:21-6. [PMID: 25456865 DOI: 10.1016/j.amjcard.2014.09.041] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 11/27/2022]
Abstract
Studies have shown gender disparities in cholesterol care in patients with cardiovascular disease (CVD), with women less likely than men to have low-density lipoprotein cholesterol levels <100 mg/dl. Whether this is related to a lower evidence-based statin or high-intensity statin use is not known. We used a national cohort of 972,532 patients with CVD (coronary heart disease, peripheral artery disease, and ischemic stroke) receiving care in 130 Veterans Health Administration facilities from October 1, 2010, to September 30, 2011, to identify the proportion of male and female patients with CVD receiving any statin and high-intensity statin. Women with CVD (n = 13,371) were less likely than men to receive statins (57.6% vs 64.8%, p <0.0001) or high-intensity statins (21.1% vs 23.6%, p <0.0001). Mean low-density lipoprotein cholesterol levels (99 vs 85 mg/dl) were higher in women compared with men (p <0.0001). In adjusted models, female gender was independently associated with a lower likelihood of receiving statins (odds ratio 0.68, 95% confidence interval 0.66 to 0.71) or high-intensity statins (odds ratio 0.76, 95% confidence interval 0.73 to 0.80). The median facility-level rate of statin and high-intensity statin use among female patients (57.3% [interquartile range = 8.93%] for statin, 20% [interquartile range = 7.7%] for high-intensity statin use) showed significant variation. In conclusion, women with CVD are less likely to receive evidence-based statin and high-intensity statins compared with men, although, their use remains low in both genders. There is a significant facility-level variation in evidence-based statin or high-intensity statin use in female patients with CVD. With the "statin dose-based approach" proposed by the recent cholesterol guidelines, these results highlight areas for quality improvement.
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Mann S, Beedie C, Jimenez A. Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations. Sports Med 2014; 44:211-21. [PMID: 24174305 PMCID: PMC3906547 DOI: 10.1007/s40279-013-0110-5] [Citation(s) in RCA: 370] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a direct relationship between chronically elevated cholesterol levels (dyslipidaemia) and coronary heart disease. A reduction in total cholesterol is considered the gold standard in preventative cardiovascular medicine. Exercise has been shown to have positive impacts on the pathogenesis, symptomatology and physical fitness of individuals with dyslipidaemia, and to reduce cholesterol levels. The optimal mode, frequency, intensity and duration of exercise for improvement of cholesterol levels are, however, yet to be identified. This review assesses the evidence from 13 published investigations and two review articles that have addressed the effects of aerobic exercise, resistance training and combined aerobic and resistance training on cholesterol levels and the lipid profile. The data included in this review confirm the beneficial effects of regular activity on cholesterol levels and describe the impacts of differing volumes and intensities of exercise upon different types of cholesterol. Evidence-based exercise recommendations are presented, aimed at facilitating the prescription and delivery of interventions in order to optimize cholesterol levels.
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Affiliation(s)
- Steven Mann
- UKActive Research Institute, Centre for Sports Science and Human Performance, University of Greenwich, Chatham Maritime, Kent, ME4 4TB, UK,
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9
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Virani SS, Woodard LD, Akeroyd JM, Ramsey DJ, Ballantyne CM, Petersen LA. Is high-intensity statin therapy associated with lower statin adherence compared with low- to moderate-intensity statin therapy? Implications of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guidelines. Clin Cardiol 2014; 37:653-9. [PMID: 25324147 DOI: 10.1002/clc.22343] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The recent cholesterol guideline recommends high-intensity statins in cardiovascular disease (CVD) patients. High-intensity statins are associated with more frequent side effects. Therefore, it may be of concern that these recommendations might reduce statin adherence. HYPOTHESIS High-intensity statins are associated with lower adherence compared with low- to moderate-intensity statins. METHODS In a national database of 972,532 CVD patients from the Veterans Health Administration, we identified patients receiving statins between October 1, 2010, and September 30, 2011. We assessed statin adherence by calculating proportion of days covered (PDC) and determined whether high-intensity statin therapy was independently associated with a lower PDC. RESULTS Statins were prescribed in 629,005 (64.7%). Of those, 229,437 (36.5%) received high-intensity statins. Mean PDC (0.87 vs 0.86, P < 0.0001) and patients with PDC ≥ 0.80 (76.3% vs 74.2%, P < 0.0001) were slightly higher for those receiving low- to moderate-intensity compared with high-intensity statins. In adjusted analyses, high-intensity statin use was associated with a significant but modest PDC reduction compared with low- to moderate-intensity statin use, whether PDC was assessed as a continuous (β-coefficient: -0.008, P < 0.0001) or categorical (PDC ≥ 0.80 [odds ratio: 0.94, 95% confidence interval: 0.93-0.96]) measure of statin adherence. CONCLUSIONS An approach of high-intensity statin therapy will lead to a significant practice change, as the majority of CVD patients are not on high-intensity therapy. However, this change may be associated with a very modest reduction in statin adherence compared with low- to moderate-intensity therapy that is unlikely to be of clinical significance.
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Affiliation(s)
- Salim S Virani
- Health Policy, Quality and Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Baylor College of Medicine, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houstona, Texas; Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas
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Kim M, Tanaka K. Non-high-density lipoprotein cholesterol changes in middle-aged obese men with and without metabolic syndrome during weight loss. Metab Syndr Relat Disord 2014; 12:464-71. [PMID: 25247924 DOI: 10.1089/met.2014.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-high-density lipoprotein (non-HDL-C) is the best predictor of coronary artery disease and stroke. Studies have shown that weight loss decreases non-HDL-C levels. However, whether diet-induced weight loss in individuals with and without metabolic syndrome causes a reduction in non-HDL-C levels remains unclear. We investigated the effects of weight loss on non-HDL-C levels in 34 middle-aged obese men with and without metabolic syndrome classified using National Cholesterol Education Panel Adult Treatment Panel III criteria (metabolic syndrome, n = 17; non-metabolic syndrome, n = 17). We conducted a 12-week dietary intervention using a low-carbohydrate, -fat, and -protein diet to reduce body weight. A significant decrease in body weight and body mass index in both groups was observed. However, the non-HDL-C level after weight loss was significantly decreased in the metabolic syndrome group (151.9 ± 6.8 to 131.4 ± 6.2 mg/dL, P < 0.01) but not in the non-metabolic syndrome group (152.1 ± 8.2 to 141.2 ± 8.1 mg/dL, P > 0.05). Levels of apolipoprotein AII and B, but not AI, were similarly decreased in both groups (P > 0.05). Pearson correlation analysis showed that the change in non-HDL-C levels in the metabolic syndrome group was strongly associated with levels of total cholesterol, fasting insulin, and alanine and aspartate transaminase, as well as homeostatic model assessment index, diastolic blood pressure, and maximal oxygen uptake (P < 0.05). These results demonstrated that diet-induced weight loss without physical activity decreases non-HDL-C levels, an important factor associated with changes in cardiorespiratory fitness and insulin sensitivity, in obese individuals with metabolic syndrome.
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Affiliation(s)
- Maengkyu Kim
- 1 Sports Medicine Lab, Department of Physical Education, Kyungpook National University , Daegu, South Korea
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