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Patel N, Mittal N, Wilkinson MJ, Taub PR. Unique features of dyslipidemia in women across a lifetime and a tailored approach to management. Am J Prev Cardiol 2024; 18:100666. [PMID: 38634109 PMCID: PMC11021917 DOI: 10.1016/j.ajpc.2024.100666] [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: 09/05/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose of Review Cardiovascular disease is a leading cause of death worldwide. Dyslipidemia is a critical modifiable risk factor for the prevention of cardiovascular disease. Dyslipidemia affects a large population of women and is especially pervasive within racial/ethnic minorities. Recent Findings Dyslipidemia in pregnancy leads to worse outcomes for patients and creates increased cardiovascular risk for women at an older age. However, women remain underscreened and undertreated compared to men. Females also comprise a small portion of clinical trial participants for lipid lowering agents with increased disease prevalence compared to trial representation. However, recent lipid trials have shown different efficacies of therapies such as ezetimibe, inclisiran, and bempedoic acid with a greater relative benefit for women. Summary Pathophysiology of dyslipidemia varies between men and women and across a woman's lifetime. While increased lipid levels or lipid imbalances are more common in postmenopausal women over age 50, conditions such as PCOS and FH produce higher cardiovascular risk for young women.Best practices for management of women with dyslipidemia include early screening with lifestyle intervention and pharmacotherapy with statin and non-statin agents to achieve guideline directed LDL-C thresholds.
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Affiliation(s)
- Neeja Patel
- University of California, Los Angeles, United States
| | | | | | - Pam R. Taub
- University of California, San Diego, United States
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Myerson ML, Paparodis RD, Block RC, Karalis DG, Mintz G, Brinton EA, Wild R. Polycystic ovary syndrome: A review of diagnosis and management, with special focus on atherosclerotic cardiovascular disease prevention. J Clin Lipidol 2024:S1933-2874(24)00179-X. [PMID: 38908968 DOI: 10.1016/j.jacl.2024.04.131] [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: 08/28/2023] [Revised: 03/12/2024] [Accepted: 04/23/2024] [Indexed: 06/24/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy worldwide with a heterogeneous clinical presentation including reproductive, metabolic, and endocrine elements. However, the assessment and management of PCOS remains inconsistent, with many women undiagnosed and untreated. We now also understand that the management of PCOS should extend throughout a woman's lifespan as many elements of the syndrome persist after menopause. Management has traditionally focused on the treatment of hyperandrogenism and oligomenorrhea. Women with PCOS often have dyslipidemia, hypertension, obesity, and metabolic syndrome, which may be worsened by the hormonal abnormalities, and are therefore at higher risk for cardiovascular disease morbidity and mortality, a risk that increases after menopause. While treatment with hormonal therapy, in particular combined oral contraceptives, may improve cardiovascular risk factors, management plans should incorporate specific diagnosis and management of these factors, if present, because of the strong contribution to the risk for atherosclerotic cardiovascular disease (ASCVD). Given the complexities of the syndrome, optimal management often requires a multi-disciplinary approach including the lipid and cardiometabolic specialist to provide counseling and support for lifestyle modification along with pharmacologic therapy as indicated to address the full range of any reproductive, endocrine, and cardiometabolic abnormalities.
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Affiliation(s)
| | - Rodis D Paparodis
- Endocrinology, Diabetes and Metabolism Clinics, Private Practice, Patras, Greece and Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA (Dr. Paparodis)
| | - Robert C Block
- Department of Public Health Sciences, Cardiology Division of the Department of Medicine, and Center for Community Health and Prevention, at the University of Rochester, Rochester NY, USA (Dr. Block)
| | - Dean G Karalis
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA (Dr. Karalis)
| | - Guy Mintz
- Sandra Atlas Bass Heart Hospital, North Shore University Hospital and Zucker School of Medicine, Manhasset, NY, USA (Dr. Mintz)
| | - Eliot A Brinton
- Utah Lipid Center, Salt Lake City UT, and Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA (Dr. Brinton)
| | - Robert Wild
- Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA (Dr. Wild)
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Stanhope KK, Gunderson EP, Suglia SF, Boulet SL, Jamieson DJ, Kiefe CI, Kershaw KN. Childhood maltreatment and trajectories of cardiometabolic health across the reproductive life span among individuals with a first birth during the Coronary Artery Risk Development in Young Adults Study. Prev Med 2024; 180:107894. [PMID: 38346564 PMCID: PMC10896584 DOI: 10.1016/j.ypmed.2024.107894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Childhood adversity is associated with poor cardiometabolic health in adulthood; little is known about how this relationship evolves through childbearing years for parous individuals. The goal was to estimate differences in cardiometabolic health indicators before, during and after childbearing years by report of childhood maltreatment in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study. METHODS Including 743 individuals nulliparous at baseline (1985-1986) with one or more pregnancies >20 weeks during follow-up (1986-2022), we fit segmented linear regression models to estimate mean differences between individuals reporting or not reporting childhood maltreatment (physical or emotional) in waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, fasting glucose, and body mass index (BMI) prior to, during, and following childbearing years using generalized estimating equations, allowing for interaction between maltreatment and time within each segment, and adjusting for total parity, parental education, and race (Black or white, self-reported). RESULTS Individuals reporting maltreatment (19%; 141) had a greater waist circumference (post-childbearing: +2.9 cm, 95% CI (0.7, 5.0), higher triglycerides [post-childbearing: +8.1 mg/dL, 95% CI (0.7, 15.6)], and lower HDL cholesterol [post-childbearing: -2.1 mg/dL, 95% CI (-4.7, 0.5)] during all stages compared to those not reporting maltreatment. There were not meaningful differences in blood pressure, fasting glucose, or BMI. Individuals who reported maltreatment did not report faster changes over time. CONCLUSION Differences in some aspects of cardiometabolic health between individuals reporting versus not reporting childhood maltreatment were sustained across reproductive life stages, suggesting potentially persistent impacts of childhood adversity.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30307, United States; Department of Epidemiology, Emory Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States of America.
| | - Erica P Gunderson
- Division of Research, Kaiser Permanente Northern California, and Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S. Los Robles Ave., Pasadena, CA 91101, United States
| | - Shakira F Suglia
- Department of Epidemiology, Emory Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322, United States of America
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30307, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, 201 Dowman Dr, Atlanta, GA 30307, United States
| | - Catarina I Kiefe
- Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, The Albert Sherman Center, Worcester, MA 01655, United States
| | - Kiarri N Kershaw
- Preventive Medicine, Northwestern Feinberg School of Medicine, Suite 1400, 680 N. Lake Shore Drive, Chicago, IL 60611, United States
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Masuda R, Wist J, Lodge S, Kimhofer T, Hunter M, Hui J, Beilby JP, Burnett JR, Dwivedi G, Schlaich MP, Bong SH, Loo RL, Holmes E, Nicholson JK, Yeap BB. Plasma lipoprotein subclass variation in middle-aged and older adults: Sex-stratified distributions and associations with health status and cardiometabolic risk factors. J Clin Lipidol 2023; 17:677-687. [PMID: 37442713 DOI: 10.1016/j.jacl.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Circulating lipids and lipoproteins mediate cardiovascular risk, however routine plasma lipid biochemistry provides limited information on pro-atherogenic remnant particles. OBJECTIVE We analysed plasma lipoprotein subclasses including very low-density and intermediate-density lipoprotein (VLDL and IDL); and assessed their associations with health and cardiometabolic risk. METHODS From 1,976 community-dwelling adults aged 45-67 years, 114/1071 women (10.6%) and 153/905 men (16.9%) were categorised as very healthy. Fasting plasma lipoprotein profiles comprising 112 parameters were measured using 1H nuclear magnetic resonance (NMR) spectroscopy, and associations with health status and cardiometabolic risk factors examined. RESULTS HDL cholesterol was higher, and IDL and VLDL cholesterol and triglycerides lower, in very healthy women compared to other women, and women compared to men. IDL and VLDL cholesterol and triglyceride were lower in very healthy men compared to other men. HDL cholesterol and apolipoprotein (apo) A-I were inversely, and IDL and VLDL cholesterol, apoB-100, and apoB-100/apoA-I ratio directly associated with body mass index (BMI) in women and men. In women, LDL, IDL and VLDL cholesterol increased with age. Women with diabetes and cardiovascular disease had higher cholesterol, triglycerides, phospholipids and free cholesterol across IDL and VLDL fractions, with similar trends for men with diabetes. CONCLUSION Lipoprotein subclasses and density fractions, and their lipid and apolipoprotein constituents, are differentially distributed by sex, health status and BMI. Very healthy women and men are distinguished by favorable lipoprotein profiles, particularly lower concentrations of VLDL and IDL, providing reference intervals for comparison with general populations and adults with cardiometabolic risk factors.
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Affiliation(s)
- Reika Masuda
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Julien Wist
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Center for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Chemistry Department, Universidad del Valle, 76001, Cali, Colombia
| | - Samantha Lodge
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Center for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Torben Kimhofer
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Center for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Michael Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Jennie Hui
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, WA, 6009, Australia
| | - John P Beilby
- School of Biomedical Sciences, University of Western Australia, Perth, WA, 6009, Australia
| | - John R Burnett
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Royal Perth Hospital & Fiona Stanley Hospital Network, Perth, WA, 6000, Australia; Medical School, University of Western Australia, Perth, WA, 6009, Australia
| | - Girish Dwivedi
- Medical School, University of Western Australia, Perth, WA, 6009, Australia; Harry Perkins Institute of Medical Research, Perth, WA, 6150, Australia; Department of Cardiology, Fiona Stanley Hospital, Perth, WA, 6150, Australia
| | - Markus P Schlaich
- Medical School, University of Western Australia, Perth, WA, 6009, Australia; Dobney Hypertension Centre, Royal Perth Hospital Medical Research Foundation, University of Western Australia, Perth, WA, 6000, Australia; Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, 6000, Australia
| | - Sze-How Bong
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Center for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Ruey Leng Loo
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Center for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia
| | - Elaine Holmes
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Center for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, United Kingdom
| | - Jeremy K Nicholson
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Center for Computational and Systems Medicine, Health Futures Institute, Murdoch University, Perth, WA, 6150, Australia; Medical School, University of Western Australia, Perth, WA, 6009, Australia; Institute of Global Health Innovation, Imperial College London, London SW7 2AZ, United Kingdom.
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, WA, 6009, Australia; Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth WA, 6150, Australia.
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There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness. Am J Prev Cardiol 2022; 12:100371. [PMID: 36124049 PMCID: PMC9482082 DOI: 10.1016/j.ajpc.2022.100371] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is epidemic throughout the world and is etiologic for such acute cardiovascular events as myocardial infarction, ischemic stroke, unstable angina, and death. ASCVD also impacts risk for dementia, chronic kidney disease peripheral arterial disease and mobility, impaired sexual response, and a host of other visceral impairments that adversely impact the quality and rate of progression of aging. The relationship between low-density lipoprotein cholesterol (LDL-C) and risk for ASCVD is one of the most highly established and investigated issues in the entirety of modern medicine. Elevated LDL-C is a necessary condition for atherogenesis induction. Basic scientific investigation, prospective longitudinal cohorts, and randomized clinical trials have all validated this association. Yet despite the enormous number of clinical trials which support the need for reducing the burden of atherogenic lipoprotein in blood, the percentage of high and very high-risk patients who achieve risk stratified LDL-C target reductions is low and has remained low for the last thirty years. Atherosclerosis is a preventable disease. As clinicians, the time has come for us to take primordial and primary prevention more serously. Despite a plethora of therapeutic approaches, the large majority of patients at risk for ASCVD are poorly or inadequately treated, leaving them vulnerable to disease progression, acute cardiovascular events, and poor aging due to loss of function in multiple visceral organs. Herein we discuss the need to greatly intensify efforts to reduce risk, decrease disease burden, and provide more comprehensive and earlier risk assessment to optimally prevent ASCVD and its complications. Evidence is presented to support that treatment should aim for far lower goals in cholesterol management, should take into account many more factors than commonly employed today and should begin significantly earlier in life.
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Effects of vinegar consumption on cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sinatora RV, Chagas EFB, Mattera FOP, Mellem LJ, dos Santos ARDO, Pereira LP, Aranão ALDC, Guiguer EL, Araújo AC, Haber JFDS, Guissoni LC, Barbalho SM. Relationship of Inflammatory Markers and Metabolic Syndrome in Postmenopausal Women. Metabolites 2022; 12:73. [PMID: 35050195 PMCID: PMC8779625 DOI: 10.3390/metabo12010073] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The increased deposition of visceral fat in the postmenopause period increases the production of inflammatory cytokines and the release of tumor necrosis factor- α (TNF-α), interleukin-6 (IL-6), and decrease in IL-10. This study investigated the relationship between inflammatory biomarkers and metabolic syndrome (MS) in postmenopausal women considering different diagnostic criteria. We conducted a cross-sectional observational study based on STROBE. Data were collected regarding the diagnostic criteria for MS (International Diabetes Federation; NCEP (International Diabetes Federation (IDF), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III), and Harmonized criteria), body composition, comorbidities, time without menstruation, values of IL-6, IL-10, and TNF-α. ANOVA, Kruskal-Wallis, Levene tests, ROC, and odds ratio were performed to analyze the data. The results showed no significant difference between the methods and no interaction between the method and the presence of MS. However, for the values of WC, body fat percentage, TNF-α, and IL-10/TNF-α ratio, a significant effect of MS was observed. In subjects with MS, lower values of body fat percentage and TNF-α and higher values of the IL-10/TNF-α ratio were also observed. The higher IL-10/TNF-α ratio in the MS group is related to the greater anti-inflationary action of IL-10. The IL-10/TNF-α ratio showed significant accuracy to discriminate patients with MS according to the NCEP-ATP III criteria.
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Affiliation(s)
- Renata Vargas Sinatora
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
| | - Eduardo Federighi Baisi Chagas
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
- Interdisciplinary Center on Diabetes (CENID), University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil;
- Postgraduate Program, Faculty of Medicine of Marília (FAMEMA), Marília 17519-030, SP, Brazil
| | - Fernando Otavio Pires Mattera
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
- Interdisciplinary Center on Diabetes (CENID), University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil;
| | - Luciano Junqueira Mellem
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
- Interdisciplinary Center on Diabetes (CENID), University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil;
| | - Ana Rita de Oliveira dos Santos
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marília 17525-902, SP, Brazil;
| | - Larissa Pires Pereira
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
| | - Ana Luíza de Carvalho Aranão
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
| | - Elen Landgraf Guiguer
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marília 17525-902, SP, Brazil;
- School of Food and Technology of Marilia (FATEC), Marília 17500-000, SP, Brazil
| | - Adriano Cressoni Araújo
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marília 17525-902, SP, Brazil;
| | - Jesselina F. dos Santos Haber
- Interdisciplinary Center on Diabetes (CENID), University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil;
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marília 17525-902, SP, Brazil;
| | - Leila Campos Guissoni
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marília 17525-902, SP, Brazil;
| | - Sandra Maria Barbalho
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil; (R.V.S.); (E.F.B.C.); (F.O.P.M.); (L.J.M.); (L.P.P.); (A.L.d.C.A.); (E.L.G.); (A.C.A.); (L.C.G.)
- Interdisciplinary Center on Diabetes (CENID), University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil;
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, 1001, Marília 17525-902, SP, Brazil;
- School of Food and Technology of Marilia (FATEC), Marília 17500-000, SP, Brazil
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