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Hyun YY, Kim KS, Hong S, Han K, Park CY. Fenofibrate and risk of end-stage renal disease: A nationwide cohort study. Diabetes Obes Metab 2024. [PMID: 39075919 DOI: 10.1111/dom.15815] [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: 04/28/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/31/2024]
Abstract
AIM Previous studies have shown that fenofibrate improves outcomes such as albuminuria and estimated glomerular filtration rate decline. We hypothesize that fenofibrate has renoprotective effects and prevents or delays the development of end-stage renal disease. The objective of this study is to investigate the risk of incident end-stage renal disease in relation to fenofibrate treatment in patients who are already taking statins. MATERIALS AND METHODS We performed a nationwide population-based cohort study using data from the Korea National Health Information Database from 2010 to 2017. Among adults using statins, 413 715 fenofibrate users were compared with 413 715 fenofibrate non-users after 1:1 age, sex and triglyceride matching. The endpoint of this study was incident end-stage renal disease. RESULTS During a median 3.96-year follow-up, the incidence per 1000 person years of end-stage renal disease was lower in fenofibrate users than in fenofibrate non-users (0.885 vs. 0.960, p < 0.0001). The hazard ratio for end-stage renal disease was lower (0.763, 95% confidence interval 0.710-0.821) in fenofibrate users. This association was significant in patients with hypertension, proteinuria and an estimated glomerular filtration rate <60 mL/min/1.732. CONCLUSIONS Fenofibrate use in patients taking statins with either hypertension, proteinuria, or decreased estimated glomerular filtration rate is associated with a low risk of incident end-stage renal disease. To confirm the renoprotective effect of fenofibrate in chronic kidney disease, a randomized controlled trial is warranted.
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Affiliation(s)
- Young Youl Hyun
- Division of Nephorology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Sangmo Hong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Xu D, Xie L, Cheng C, Xue F, Sun C. Triglyceride-rich lipoproteins and cardiovascular diseases. Front Endocrinol (Lausanne) 2024; 15:1409653. [PMID: 38883601 PMCID: PMC11176465 DOI: 10.3389/fendo.2024.1409653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
The global prevalence of cardiovascular diseases (CVD) continues to rise steadily, making it a leading cause of mortality worldwide. Atherosclerosis (AS) serves as a primary driver of these conditions, commencing silently at an early age and culminating in adverse cardiovascular events that severely impact patients' quality of life or lead to fatality. Dyslipidemia, particularly elevated levels of low-density lipoprotein cholesterol (LDL-C), plays a pivotal role in AS pathogenesis as an independent risk factor. Research indicates that abnormal LDL-C accumulation within arterial walls acts as a crucial trigger for atherosclerotic plaque formation. As the disease progresses, plaque accumulation may rupture or dislodge, resulting in thrombus formation and complete blood supply obstruction, ultimately causing myocardial infarction, cerebral infarction, and other common adverse cardiovascular events. Despite adequate pharmacologic therapy targeting LDL-C reduction, patients with cardiometabolic abnormalities remain at high risk for disease recurrence, highlighting the importance of addressing lipid risk factors beyond LDL-C. Recent attention has focused on the causal relationship between triglycerides, triglyceride-rich lipoproteins (TRLs), and their remnants in AS risk. Genetic, epidemiologic, and clinical studies suggest a causal relationship between TRLs and their remnants and the increased risk of AS, and this dyslipidemia may be an independent risk factor for adverse cardiovascular events. Particularly in patients with obesity, metabolic syndrome, diabetes, and chronic kidney disease, disordered TRLs and its remnants levels significantly increase the risk of atherosclerosis and cardiovascular disease development. Accumulation of over-synthesized TRLs in plasma, impaired function of enzymes involved in TRLs lipolysis, and impaired hepatic clearance of cholesterol-rich TRLs remnants can lead to arterial deposition of TRLs and its remnants, promoting foam cell formation and arterial wall inflammation. Therefore, understanding the pathogenesis of TRLs-induced AS and targeting it therapeutically could slow or impede AS progression, thereby reducing cardiovascular disease morbidity and mortality, particularly coronary atherosclerotic heart disease.
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Affiliation(s)
- Dandan Xu
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lin Xie
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Cheng Cheng
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Fei Xue
- State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China
| | - Chaonan Sun
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital and Institute, Shenyang, China
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3
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Su X, Yuan X, Li F, Yang G, Du L, Zhao F, Zhao R, Ou M. Expression level and clinical significance of LncRNA PVT1 in the serum of patients with LEASO. PeerJ 2023; 11:e16057. [PMID: 37744231 PMCID: PMC10516103 DOI: 10.7717/peerj.16057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Objective Our study aims to investigate the long non-coding RNA plasmacytoma variant translocation 1 (lncRNA PVT1) in lower extremity arteriosclerosis obliterans (LEASO) patient serum and its clinical significance in LEASO. Patients and Methods From July 2021 to April 2022, 133 LEASO patients diagnosed at the Qingdao Municipal Hospital were included. Among them, 44 complicated with coronary artery disease (CAD) were classified as the LEASO with CAD group. The remaining 89 were marked as the LEASO group, which was classified into single (n = 48) and double (n = 41) lower limb groups, with the former being subclassified into the left (n = 28) and right (n = 20) lower limb groups based on the affected sites. Fifty healthy individuals who came to our hospital for physical examination during the same period were randomly included and defined as the Healthy Control group. PVT1 expression was detected in serum samples from each group using a quantitative reverse transcriptase-polymerase chain reaction , and differences in expression levels were calculated. The ankle-brachial index (ABI) of patients in the LEASO group was measured using a sphygmomanometer, and its correlation with PVT1 was analyzed. Clinical data and laboratory test results (including blood routine, liver and renal function, and blood lipids) were collected for all patients upon admission. Logistic regression analyses were performed to determine the influence of PVT1 and laboratory test results on LEASO. The diagnosis and prediction of LEASO were obtained by combing PVT1 with laboratory test indicators. Results It was found that lncRNA PVT1 expression was the highest in the serum of the LEASO with CAD group, followed by the LEASO and control groups (P < 0.05). Within the LEASO group, no significant difference in PVT1 expression was seen between the left and right limbs (P > 0.05), nor between the single and double lower limb groups. Furthermore, the PVT1 expression increased with the Rutherford grades, indicating a negative correlation between PVT1 and ABI. Logistic regression analysis revealed that triglycerides (OR = 2.972, 95% CI [1.159-7.618]), cholesterol (OR = 6.655, 95% CI [1.490-29.723]), C-reactive protein (OR = 1.686, 95% CI [1.218-2.335]), and PVT1 (OR = 2.885, 95% CI [1.350-6.167]) were independent risk factors for LEASO. Finally, strong sensitivity was observed in the receiver operating characteristic curve when combining PVT1 with meaningful laboratory indicators to diagnose and predict LEASO. Conclusion lncRNA PVT1 promotes LEASO occurrence and progression and is related to atherosclerosis severity. The expression of PVT1 was negatively correlated with ABI. Logistic regression analysis suggested that blood lipid levels and inflammatory reactions might be related to LEASO occurrence. PVT1 was incorporated into laboratory indicators to predict LEASO. The subject's working curve area was large, and the prediction results were highly sensitive.
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Affiliation(s)
| | - Xiaoqing Yuan
- Guangzhou Kingmed Diagnostics Group, Guangzhou, China
| | - Fenghui Li
- Qingdao Municipal Hospital Group, Qingdao, Shandong, China
| | | | | | | | - Rui Zhao
- Qingdao University, Qingdao, China
| | - Minghui Ou
- Department of Vascular Surgery, Qingdao Municipal Hospital Group, Qingdao, China
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Han L, Qiang G, Yang L, Kou R, Li Q, Xin M, Liu R, Zhang Z. Plasma exchange therapy for familial chylomicronemia syndrome in infant: A case report. Medicine (Baltimore) 2022; 101:e29689. [PMID: 35960041 PMCID: PMC9371531 DOI: 10.1097/md.0000000000029689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Familial chylomicronemia syndrome (FCS) is a rare genetic disease. FCS usually manifests by the age of 10 years, and 25% of cases of FCS occur during infancy. Here we present a case of FCS in a male infant and summarize our experiences on the diagnosis and therapy of this case. PATIENT CONCERNS A male infant aged 1 month and 8 days had recurrent hematochezia and hyperchylomicronemia. DIAGNOSIS FCS based on symptoms and genetic test. INTERVENTIONS Plasma exchange therapy. OUTCOMES His development was normal with a good spirit and satisfactory weight gain, and no hematochezia occurred again. CONCLUSION Genetic test is important for accurate diagnosis of FCS, and we identified a new mutation of lipoprotein lipase gene c.88C>A which conformed to autosomal recessive inheritance. Plasma exchange therapy can be applied to infants with FCS with low risk and good outcomes.
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Affiliation(s)
- Lei Han
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Guangfeng Qiang
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lei Yang
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Rui Kou
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Qiubo Li
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Meiyun Xin
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ruihan Liu
- Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhengjun Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Jining, China
- * Correspondence: Zhengjun Zhang, Department of Endocrinology, Affiliated Hospital of Jining Medical University, Tianjinfu St, Jining, 272001 Shandong, China (e-mail: )
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Zhang BH, Yin F, Qiao YN, Guo SD. Triglyceride and Triglyceride-Rich Lipoproteins in Atherosclerosis. Front Mol Biosci 2022; 9:909151. [PMID: 35693558 PMCID: PMC9174947 DOI: 10.3389/fmolb.2022.909151] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/06/2022] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular disease (CVD) is still the leading cause of death globally, and atherosclerosis is the main pathological basis of CVDs. Low-density lipoprotein cholesterol (LDL-C) is a strong causal factor of atherosclerosis. However, the first-line lipid-lowering drugs, statins, only reduce approximately 30% of the CVD risk. Of note, atherosclerotic CVD (ASCVD) cannot be eliminated in a great number of patients even their LDL-C levels meet the recommended clinical goals. Previously, whether the elevated plasma level of triglyceride is causally associated with ASCVD has been controversial. Recent genetic and epidemiological studies have demonstrated that triglyceride and triglyceride-rich lipoprotein (TGRL) are the main causal risk factors of the residual ASCVD. TGRLs and their metabolites can promote atherosclerosis via modulating inflammation, oxidative stress, and formation of foam cells. In this article, we will make a short review of TG and TGRL metabolism, display evidence of association between TG and ASCVD, summarize the atherogenic factors of TGRLs and their metabolites, and discuss the current findings and advances in TG-lowering therapies. This review provides information useful for the researchers in the field of CVD as well as for pharmacologists and clinicians.
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Affiliation(s)
| | | | - Ya-Nan Qiao
- Institute of Lipid Metabolism and Atherosclerosis, Innovative Drug Research Centre, School of Pharmacy, Weifang Medical University, Weifang, China
| | - Shou-Dong Guo
- Institute of Lipid Metabolism and Atherosclerosis, Innovative Drug Research Centre, School of Pharmacy, Weifang Medical University, Weifang, China
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Zhang M, Yin T, Xia F, Xia S, Zhou W, Zhang Y, Han X, Zhao K, Feng L, Dong R, Tian D, Yu Y, Liao J. Hypertriglyceridemia may contribute to stroke and pancreatitis: A case report and review of the literature. Front Endocrinol (Lausanne) 2022; 13:960343. [PMID: 36531479 PMCID: PMC9751361 DOI: 10.3389/fendo.2022.960343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022] Open
Abstract
Hypertriglyceridemia (HTG) is one of the most common clinical dyslipidemia. Nevertheless, stroke and acute pancreatitis co-occurrence due to hypertriglyceridemia are extremely rare. We present a case of hypertriglyceridemia-associated stroke and pancreatitis in a 39-year-old woman. The patient's laboratory tests reported high triglyceride concentrations beyond the instrument's detection range, and radiological examination showed typical signs of cerebral infarction and acute pancreatitis. The patient received combined blood purification therapy, intravenous thrombolysis with urokinase, and conservative treatment of pancreatitis. We discuss the clinical features, pathogenesis, diagnosis, and treatment of hypertriglyceridemic stroke and pancreatitis combined with the relevant literature. We reviewed the mechanisms by which triglycerides contribute to atherosclerosis and acute pancreatitis. We point out the superiority of combined blood purification therapy and caution physicians about the effects of prescribed drugs on blood lipids.
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Affiliation(s)
- Mingyu Zhang
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Taoyuan Yin
- Department of Biliary-Pancreatic Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feng Xia
- Department of Hepatic Surgery Center, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Suhong Xia
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wangdong Zhou
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Zhang
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xu Han
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kai Zhao
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lina Feng
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ruonan Dong
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dean Tian
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Yu
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- *Correspondence: Yan Yu, ; Jiazhi Liao,
| | - Jiazhi Liao
- Department of Gastroenterology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- *Correspondence: Yan Yu, ; Jiazhi Liao,
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Wu G, Bockman B, Perez J. Acute Myocardial Infarction Complicated by Very Severe Hypertriglyceridemia. CASE REPORTS IN ACUTE MEDICINE 2020. [DOI: 10.1159/000511065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Hypertriglyceridemia (HTG) is the elevation of serum triglyceride levels above 150 mg/dL and is linked to complications such as pancreatitis and increased mortality risk. An uncommonly known co-presentation of HTG is acute ST-elevation myocardial infarction (STEMI), with the literature citing only one other case of acute STEMI complicated by very severe HTG. We report on a 36-year-old male with multiple comorbidities presenting with acute STEMI and elevated pancreatic enzymes suggestive of pancreatitis. A subsequent lipid profile revealed very severe HTG with a triglyceride level of 2,700 mg/dL. We discuss the pathogenesis, management, and screening guidelines of very severe HTG. Clinicians should be aware that acute STEMI complicated by HTG is rare and that earlier detection and intervention may allow for the prevention of life-threatening complications.
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8
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Gau N, Grossman BJ. Therapeutic plasma exchange for iatrogenic hypertrigylceridemia. Transfusion 2020; 60:2785-2786. [PMID: 32870503 DOI: 10.1111/trf.16016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas Gau
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Brenda J Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Ghoor S, Berlyn P, Brey N. Exchange transfusions for extreme hypertriglyceridemia in a 7-week-old infant with multi-organ failure. J Clin Lipidol 2017; 12:243-245. [PMID: 29174071 DOI: 10.1016/j.jacl.2017.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
Severe hypertriglyceridemia is the third most common cause of acute pancreatitis and is strongly associated with an increased risk of cardiovascular disease. In infants, the most common cause of severe hypertriglyceridemia is lipoprotein lipase deficiency. We describe a 7-week-old infant with severe hypertriglyceridemia, who presented with frequent gastrointestinal bleeding, respiratory distress, a decreased level of consciousness and lipemia retinalis. Triglycerides were reduced from 734 to 2 mmol/L (64,956-177 mg/dL), by exchange transfusions. The infant made a remarkable recovery with no sequelae. This case highlights atypical, protean presentations and a potential treatment when established therapies are unavailable.
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Affiliation(s)
- Samira Ghoor
- South African Medical Research Council (SAMRC), Cape Town, South Africa
| | | | - Naeem Brey
- Division of Neurology, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.
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10
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[Hyperviscosity syndrome]. Rev Med Interne 2015; 36:588-95. [PMID: 25778852 DOI: 10.1016/j.revmed.2015.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 01/08/2015] [Accepted: 02/07/2015] [Indexed: 12/12/2022]
Abstract
Hyperviscosity syndrome is a life-threatening complication. Clinical manifestations include neurological impairment, visual disturbance and bleeding. Measurement of plasma or serum viscosity by a viscometer assesses the diagnosis. Funduscopic examination is a key exam because abnormalities are well-correlated with abnormal plasma viscosity. Etiologies are various but symptomatic hyperviscosity is more common in Waldenström's macroglobulinemia and multiple myeloma. Prompt treatment is needed: treatment of the underlying disease should be considered, but generally not sufficient. Symptomatic measures aim to not exacerbate blood viscosity while urgent plasmapheresis effectively reduces the paraprotein concentration and relieves symptoms.
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11
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Li H, Qiu W, Hu B, Kang Z, Wu AM, Dai Y, Lin Y, Lu Z. Ischemic volumes and early neurologic deterioration in acute brainstem infarctions with hemoglobin A1c. Eur Neurol 2013; 70:225-32. [PMID: 24008404 DOI: 10.1159/000351356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/10/2013] [Indexed: 11/19/2022]
Abstract
AIM To investigate the association of hemoglobin A1c (HbA1c) with acute diffusion-weighted imaging lesion volumes (DIV) and early neurologic deterioration (END) in brainstem infarctions (BSIs). METHODS 152 patients with acute BSIs were included in this study. The relationship between HbA1c and DIV quartiles was examined. Data considered potentially associated with HbA1c and END after admission and patients' symptomatic changes prior to admission were collected. RESULTS There was a significant correlation between HbA1c (%) and DIV (Spearman ρ=0.201, p=0.013). The median HbA1c (%) values for successive DIV quartiles (lowest to highest quartile) were as follows: 5.90, 6.35, 6.25, and 7.50 (p=0.033). The incidence of diabetes mellitus had a significant association with DIV quartiles (p=0.042). HbA1c was significantly associated with symptomatic progression prior to admission (p=0.015). 29 patients developed END after admission. Age, HbA1c, systolic blood pressure, and fibrinogen were significantly associated with END. On logistic regression analysis, HbA1c and fibrinogen proved to be independent variables. CONCLUSIONS HbA1c may be a possible predictor for ischemic severity, early deterioration of acute BSIs, and short-term prognosis. Long-term good glycemic control is very important in BSIs. Further studies are warranted to confirm these results.
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Affiliation(s)
- Haiyan Li
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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12
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Senosiain Lalastra C, Tavío Hernández E, Moreira Vicente V, Maroto Castellanos M, García Sánchez MC, Aicart Ramos M, Téllez Vivajos L, Cuño Roldán JL. Pancreatitis aguda por hipertrigliceridemia. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 36:274-9. [DOI: 10.1016/j.gastrohep.2012.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 11/16/2012] [Indexed: 01/28/2023]
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13
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Argula RG, Strange C, Budisavljevic MN. Multiorgan system dysfunction in the chylomicronemia syndrome. J Intensive Care Med 2013; 29:175-8. [PMID: 23753228 DOI: 10.1177/0885066613475425] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe an extreme presentation of the chylomicronemia syndrome resulting in multiorgan system dysfunction. PATIENT A 40-year-old African American male with no past medical history presented with multiorgan system dysfunction manifested by acute respiratory failure and acute kidney injury. He was noted to have very-high triglyceride levels (>5000 mg/dL) at admission. INTERVENTIONS An echocardiogram showed normal cardiac function. Amylase and lipase were normal. We confirmed the chylomicronemia syndrome with a triglyceride assay. The associated hyperviscosity was treated with plasmapheresis to reduce the plasma triglyceride level. RESULTS After 3 sessions of plasmapheresis, his triglyceride levels were significantly reduced, his oxygenation improved, and his acute kidney injury resolved. He was successfully extubated on day 7 of the intensive care unit stay. His diabetes and hypertriglyceridemia were newly diagnosed and drug therapy was instituted with home discharge on day 14. CONCLUSIONS Severe chylomicronemia can cause multiorgan system dysfunction related to hyperviscosity. Early institution of plasmapheresis to reduce the triglyceride-rich lipoproteins can improve tissue perfusion and prevent further organ damage.
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Affiliation(s)
- Rahul G Argula
- Division of Pulmonary & Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
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Inokuchi R, Matsumoto A, Azihara R, Sato H, Kumada Y, Yokoyama H, Okada M, Ishida T, Nakamura K, Nakajima S, Yahagi N, Shinohara K. Hypertriglyceridemia as a possible cause of coma: a case report. J Med Case Rep 2012. [PMID: 23198781 PMCID: PMC3520695 DOI: 10.1186/1752-1947-6-412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Many studies suggest that elevated triglyceride levels are associated with increased long-term risk of stroke, including transient ischemic attacks. In addition, elevated triglyceride levels independently contribute to plasma viscosity and decreased blood flow. However, no consensus has been reached regarding the significance of hypertriglyceridemia as an independent risk factor for ischemic stroke. Case presentation We report the case of a patient admitted to our hospital for sudden onset of coma. Laboratory test results revealed he had high blood glucose (28.2mmol/L), high glycated hemoglobin (11.4 percent), considerably high serum triglyceride levels (171.5mmol/L; type V hyperlipoproteinemia), and high plasma viscosity (1.90mPa/s) with normal β-hydroxybutyric acid levels. His triglyceride levels decreased after administering intravenous fluids. Our patient’s consciousness level improved gradually over three days. All serum lipid levels decreased seven days after admission. Conclusions The findings in our patient’s case are likely explained by triglyceride-mediated hyperviscosity causing a transient ischemic attack. In the present report we suggest that when several tests do not reveal the cause of stroke-like symptoms, measurement of plasma viscosity may be informative.
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Affiliation(s)
- Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
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15
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Kwon HM, Lim JS, Park HK, Lee YS. Hypertriglyceridemia as a possible predictor of early neurological deterioration in acute lacunar stroke. J Neurol Sci 2011; 309:128-30. [PMID: 21784458 DOI: 10.1016/j.jns.2011.06.057] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 06/30/2011] [Accepted: 06/30/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Hyung-Min Kwon
- Department of Neurology, Seoul National University Boramae Hospital, South Korea
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Machida T, Sumino H, Fukushima M, Kotajima N, Amagai H, Murakami M. Blood rheology and the low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio in dyslipidaemic and normolipidaemic subjects. J Int Med Res 2011; 38:1975-84. [PMID: 21227001 DOI: 10.1177/147323001003800611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The association between blood rheology and the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) was investigated in 142 dyslipidaemic and 253 normolipidaemic subjects. Blood rheology was examined by the microchannel method and fasting serum concentrations of LDL-C, triglyceride and HDL-C were measured. Passage time of whole blood correlated positively with LDL-C concentration, triglyceride concentration and LDL-C/HDL-C ratio, and negatively with HDL-C concentration. Passage time of whole blood was significantly higher in dyslipidaemic and normolipidaemic subjects with LDL-C/HDL-C ratio > 2.0 than in those with ratio < 1.5. Thus, dyslipidaemic subjects had impaired blood rheology, elevated LDL-C and triglyceride concentrations and elevated LDL-C/HDL-C ratio, and reduced HDL-C concentrations. Dyslipidaemic and normolipidaemic subjects with a more elevated LDL-C/HDL-C ratio had greater blood rheology impairment than those with a less elevated ratio. These data suggest that an elevated LDL-C/HDL-C ratio may be helpful in predicting impaired blood rheology.
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Affiliation(s)
- T Machida
- Clinical Laboratory Centre, Gunma University Graduate School of Medicine, Gunma, Japan
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Chandran PKG. Effect of heparin-induced extracorporeal lipoprotein apheresis on renal function. J Clin Apher 2011; 26:56-7. [PMID: 21312260 DOI: 10.1002/jca.20272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 09/21/2010] [Indexed: 11/10/2022]
Abstract
During the course of heparin-induced extracorporeal lipoprotein apheresis, a patient with no prior known renal impairment or proteinuria demonstrated sustained improvement in estimated glomerular filtration rate, commensurate with reduction in serum lipids and creatine phosphokinase levels. Causes and implications of this observation, which was not a priori, are discussed.
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Affiliation(s)
- Prem K G Chandran
- Department of Internal Medicine, University of Iowa, Des Moines, Iowa 50309, USA.
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18
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Katayama Y, Horigome H, Takahashi H, Tanaka K, Yoshinaga M. Determinants of blood rheology in healthy adults and children using the microchannel array flow analyzer. Clin Appl Thromb Hemost 2009; 16:414-21. [PMID: 19633023 DOI: 10.1177/1076029609339745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The reference values of blood rheology in healthy participants, especially children, are not available. The purpose of this study was to determine the blood passage time (BPT) as an index of blood rheology, in healthy children and adults, using the microchannel array flow analyzer, and to investigate the hematological factors that define BPT. METHODS Participants were 61 healthy children (35 boys, 26 girls; age 5-6 years) and 71 healthy adults (24 men, age 35.2 +/- 14.1 years; 47 women, age 44.7 +/- 14.1 years, mean +/- standard deviation [SD]). Blood passage time and various hematological variables (blood cell count, serum lipids, and fibrinogen) were measured and compared among the 4 study groups. RESULTS Blood passage time values were significantly higher in adult men (48.8 +/- 5.8 seconds) than in boys (41.9 +/- 4.0 seconds), girls (43.7 +/- 7.8 seconds), and adult women (42.4 +/- 4.8 seconds). Stepwise regression analysis identified erythrocyte count and hemoglobin (Hb) as the significant and independent determinants of BPT (P < .05). CONCLUSION Our study demonstrates that BPT is significantly longer in healthy adult men than in adult women and children, and that erythrocyte count and Hb are significant determinants of blood rheology.
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Nara M, Sumino H, Nara M, Machida T, Amagai H, Nakajima K, Murakami M. Impaired blood rheology and elevated remnant-like lipoprotein particle cholesterol in hypercholesterolaemic subjects. J Int Med Res 2009; 37:308-17. [PMID: 19383223 DOI: 10.1177/147323000903700204] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Blood rheology, fasting serum concentrations of remnant-like lipoprotein particle cholesterol (RLP-C) and concentrations of other lipids were compared in 23 hypercholesterolaemic and 69 normocholesterolaemic subjects, and the relationship between red blood cell (RBC) deformability and RLP-C concentrations were studied in a different set of six hypercholesterolaemic and six normocholesterolaemic subjects. Passage time of whole blood and concentrations of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and RLP-C were significantly higher in hypercholesterolaemic than in normocholesterolaemic subjects. Passage time of whole blood correlated positively with TC, TG, LDL-C and RLP-C and negatively with high-density lipoprotein cholesterol. Furthermore, the passage time of 10% haematocrit-adjusted RBCs in phosphate-buffered saline, which reflects RBC deformability, correlated positively with the passage time of whole blood and RLP-C. Thus, hypercholesterolaemic subjects had impaired blood rheology and elevated RLP-C concentrations, which may be associated with the pathophysiology of atherosclerosis in hypercholesterolaemic subjects. Impaired RBC deformability may contribute to impaired blood rheology associated with elevated RLP-C in hypercholesterolaemic subjects.
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Affiliation(s)
- M Nara
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
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20
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Abstract
People are now living longer, largely because of a combination of falling rates of fertility and mortality, thus producing a greater proportion of older people in society. Thirty times more centenarians were alive in 2000 than in 1900, and the population growth in the elderly segment of society is expected to continue at an exponential rate. Vascular disease is responsible for more than a quarter of all deaths worldwide. More than 80% of individuals who die of coronary heart disease are older than 65 years. Although a myocardial infarction may be perceived as fatal, heart attacks do not always lead to death but to conditions such as congestive heart failure, ischemic cardiomyopathy, and angina, which greatly impact quality of life. These issues are only a few that must be contemplated when considering the clinical and economic effects of preventive therapies in the elderly population.
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Affiliation(s)
- Nicole Ducharme
- Division of Endocrinology, Saint Louis University Medical Center, 1402 South Grand Boulevard, Donco Building, 2nd Floor, St. Louis, MO 63104, USA.
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Kim JH, Jung WS, Choi NJ, Kim DO, Shin DH, Kim YJ. Health-promoting effects of bovine colostrum in Type 2 diabetic patients can reduce blood glucose, cholesterol, triglyceride and ketones. J Nutr Biochem 2008; 20:298-303. [PMID: 18602824 DOI: 10.1016/j.jnutbio.2008.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 03/28/2008] [Accepted: 04/01/2008] [Indexed: 11/16/2022]
Abstract
Bovine colostrum (BC) has been reported to enhance immune function, reduce fat accumulation and facilitate the movement of glucose to the muscle. However, very few attempts have been made to examine its anti-diabetic effects in diabetes patients. The aim of this study was to evaluate whether BC decreases blood glucose, as well as cholesterol, triglyceride (TG) and ketones levels, which can be elevated by obesity and stress in Type 2 diabetic patients. Sixteen patients (men=8, women=8) with Type 2 diabetes were randomized into the study. Each ingested 5 g of BC on an empty stomach every morning and night for 4 weeks. Blood glucose, ketones (beta-hydroxybutyric acid), total cholesterol and TGs were measured every week. In both the men and women, blood glucose levels at 2 and 8 h postprandial decreased continually during the experimental period. The rate of decrease in blood glucose at 8 h postprandial was not different between the men and women, but was higher in the women (14.25+/-2.66) than in the men (10.96+/-1.82%) at 2 h postprandial. Total cholesterol and TG levels decreased significantly in both the men and women after 4 weeks. Also, beta-hydroxybutyric acid level decreased with BC ingestion, but this was not significant. These results suggest that BC can decrease levels of blood glucose and ketones, as well as reduce cholesterol and TGs, all of which may cause complications in Type 2 diabetic patients.
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Affiliation(s)
- Jun Ho Kim
- Department of Food and Biotechnology, Korea University, Jochiwon, Chungnam 339-700, South Korea
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22
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Braunstein GD. Safety of testosterone treatment in postmenopausal women. Fertil Steril 2007; 88:1-17. [PMID: 17493618 DOI: 10.1016/j.fertnstert.2007.01.118] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 01/11/2007] [Accepted: 01/11/2007] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To critically examine the safety of T therapy given to postmenopausal women. DESIGN MEDLINE literature review, cross-reference of published data, and review of Food and Drug Administration transcripts. RESULT(S) Although some retrospective and observational studies provide some long-term safety data, most prospective studies have had a duration of 2 years or less. In addition, with the exception of the female-to-male transsexuals, T was administered in conjunction with estrogens or estrogens and progestins, which confound the interpretation of some of the studies. The major adverse reactions are the androgenic side effects of hirsutism and acne. There does not appear to be an increase in cardiovascular risk factors, with the exception of a lowering of high-density lipoprotein with oral T. There are little data on endometrial safety, and most of the experimental data support a neutral or beneficial effect in regards to breast cancer. There does not appear to be an increased risk of hepatotoxicity, neurobehavioral abnormalities, sleep apnea, or fetal virilization (in premenopausal women) with the physiologic treatment doses of T. CONCLUSION(S) Except for hirsutism and acne, the therapeutic administration of T in physiologic doses is safe for up to several years. However, prospectively collected long-term safety studies are needed to provide a greater degree of assurance.
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Affiliation(s)
- Glenn D Braunstein
- Department of Medicine, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90048, USA.
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23
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Bloomfield G, Dunbar K. It's all connected. Am J Med 2006; 119:654-6. [PMID: 16887408 DOI: 10.1016/j.amjmed.2006.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 06/09/2006] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
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Abstract
Obesity increases cardiovascular risk through multiple mechanisms. Abdominal (visceral) adiposity is metabolically active and is largely responsible for the atherogenic dyslipidemia, hyperinsulinemia, hypertension, chronic inflammatory state, and prothrombotic state that constitute the metabolic syndrome, and the subsequent increased risk for cardiovascular disease and acute coronary events. Cholesterol guidelines for assessing cardiovascular risk have traditionally focused on low-density lipoprotein (LDL) levels, and reduction of plasma LDL has been shown to reduce cardiovascular events and total mortality. However, the cardiovascular risks associated with the dyslipidemia of obesity--characterized by low levels of high-density lipoprotein; increased triglycerides; increased subfractions of small, dense LDL; and increased levels of apolipoprotein B-100--are also now well recognized.
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Affiliation(s)
- Wendy M Miller
- Department of Internal Medicine, Division of Nutrition and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge, Royal Oak, MI 48073, USA.
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25
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Leão LMCSM, Duarte MPC, Silva DMB, Bahia PRV, Coeli CM, de Farias MLF. Influence of methyltestosterone postmenopausal therapy on plasma lipids, inflammatory factors, glucose metabolism and visceral fat: a randomized study. Eur J Endocrinol 2006; 154:131-9. [PMID: 16382002 DOI: 10.1530/eje.1.02065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There has been a growing interest in treating postmenopausal women with androgens. However, hyperandrogenemia in females has been associated with increased risk of cardiovascular disease. OBJECTIVE We aimed to assess the effects of androgen replacement on cardiovascular risk factors. DESIGN Thirty-seven postmenopausal women aged 42-62 years that had undergone hysterectomy were prospectively enrolled in a double-blind protocol to receive, for 12 months, percutaneous estradiol (E2) (1 mg/day) combined with either methyltestosterone (MT) (1.25 mg/day) or placebo. METHODS Along with treatment, we evaluated serum E2, testosterone, sex hormone-binding globulin (SHBG), free androgen index, lipids, fibrinogen, and C-reactive protein; glucose tolerance; insulin resistance; blood pressure; body-mass index; and visceral and subcutaneous abdominal fat mass as assessed by computed tomography. RESULTS A significant reduction in SHBG (P < 0.001) and increase in free testosterone index (P < 0.05; Repeated measures analysis of variance) were seen in the MT group. Total cholesterol, triglycerides, fibrinogen, and systolic and diastolic blood pressure were significantly lowered to a similar extent by both regimens, but high-density lipoprotein cholesterol decreased only in the androgen group. MT-treated women showed a modest rise in body weight and gained visceral fat mass relative to the other group (P < 0.05), but there were no significant detrimental effects on fasting insulin levels and insulin resistance. CONCLUSION This study suggests that the combination of low-dose oral MT and percutaneous E2, for 1 year, does not result in expressive increase of cardiovascular risk factors. This regimen can be recommended for symptomatic postmenopausal women, although it seems prudent to perform baseline and follow-up lipid profile and assessment of body composition, especially in those at high risk of cardiovascular disease.
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Affiliation(s)
- Lenora M Camarate S M Leão
- Service of Endocrinology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil.
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26
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Kendall DM. The dyslipidemia of diabetes mellitus: giving triglycerides and high-density lipoprotein cholesterol a higher priority? Endocrinol Metab Clin North Am 2005; 34:27-48. [PMID: 15752920 DOI: 10.1016/j.ecl.2004.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CVD is the primary cause of morbidity and mortality in patients who have diabetes mellitus. Most such patients have at least one lipid abnormality. Managing these complex lipid disorders is a crucial component of comprehensive diabetes mellitus care and limits the risk for cardiovascular morbidity and mortality. With the high prevalence of mixed lipid disorders, management must focus on all components of the lipid profile. Lowering LDL-C levels remains the first priority, but abnormalities in HDL-C and TG levels also should be treated aggressively. Statins, fibrates, and niacin, along with newer therapies such as ezetimibe, can improve significantly components of the lipid profile. Alone or in combination, these agents can treat the dyslipidemia of diabetes mellitus effectively and safely.
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Affiliation(s)
- David M Kendall
- International Diabetes Center, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416-2699, USA.
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27
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Ademoglu E, Tamer S, Albeniz I, Gokkusu C, Tanrikulu S. Cyclosporin A-associated changes in red blood cell membrane composition, deformability, blood and plasma viscosity in rats. Acta Haematol 2004; 112:184-8. [PMID: 15564728 DOI: 10.1159/000081269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2003] [Accepted: 03/23/2004] [Indexed: 02/05/2023]
Abstract
Most of the studies concerning the effects of cyclosporin A (Cs A) on red blood cell (RBC) rheology were carried out in human transplant recipients who may still have residual insufficiency and concomitant administration of other immunosuppressive and antihypertensive drugs. The aim of this study is to evaluate the effects of Cs A on red cell rheology and membrane composition in nontransplant healthy rats. Female Wistar albino rats were divided into two groups of 10 animals each. Rats received 10 mg/kg Cs A, i.p. or saline for 4 weeks. Cs A administration significantly increased the RBC deformability, and plasma and blood viscosity (p < 0.001, p < 0.01 and p < 0.01, respectively). Cs A administration to the rats increased RBC membrane cholesterol (CHO) levels and the CHO/phospholipid (PL) ratio significantly (p < 0.01 and p < 0.05, respectively) but did not change RBC membrane proteins and membrane PL levels. These results suggest that Cs A changes the rheological functions of RBC and lipid content of RBC membrane in healthy rats and thereby it may play an important role in the regulation of microcirculation.
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Affiliation(s)
- Evin Ademoglu
- Department of Biochemistry, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
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28
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Mark M, Walter R, Contesse J, Reinhart WH. Impairment of blood rheology by cholestatic jaundice in human beings. ACTA ACUST UNITED AC 2004; 142:391-8. [PMID: 14713891 DOI: 10.1016/s0022-2143(03)00156-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bilirubin and bile acids may affect erythrocytes. We investigated blood viscosity and erythrocyte structure in patients with cholestatic jaundice ex vivo and studied the short-term effects of bilirubin and bile acids in vitro. Seventeen patients with cholestatic jaundice and controls were studied. Whole-blood viscosity (adjusted hematocrit 45%) at high (94.5 sec(-1)) and low (0.1 sec(-1)) shear rate and plasma viscosity were measured. Erythrocyte structure was assessed in wet preparations of fixed cells. In vitro whole blood was incubated with increasing concentrations of bilirubin (83% conjugated) and bile acids (cholic, lithocholic, deoxycholic, and chenodeoxycholic acid) and the abovementioned investigations were performed. In patients we observed increased whole-blood viscosity at high shear rate (5.82 +/- 0.69 vs 5.04+/- 0.27 mPa. sec, P =.0001), plasma viscosity (1.48 +/- 0.22 vs. 1.23 +/- 0.07 mPa. sec, P =.0004), and fibrinogen level (4.70 +/- 0.98 g/L vs 2.63 +/- 0.21 g/L, P < 0.001) were observed. The incubation of normal erythrocytes in patients' plasma confirmed an increase in blood viscosity at high shear rate. Erythrocytes from patients with jaundice demonstrated a slight degree of stomatocytic shape transformation (P <.0001). In vitro, bilirubin did not affect erythrocyte shape. Cholic and lithocholic acids caused a slight stomatocytic shape transformation, whereas deoxycholic acid and chenodeoxycholic acid influenced neither blood viscosity nor erythrocyte structure. Patients with cholestatic jaundice have increased whole-blood and plasma viscosity and slightly altered red blood cell shape, possibly the result of a combination of increased levels of bilirubin and bile acids plus an acute-phase reaction.
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Affiliation(s)
- Michael Mark
- Department of Internal Medicine, Kantonsspital, Chur, Switzerland
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Dronda F. Riesgo vascular en pacientes con infección crónica por el VIH-1: controversias con implicaciones terapéuticas, clínicas y pronósticas. Enferm Infecc Microbiol Clin 2004; 22:40-5. [PMID: 14757007 DOI: 10.1016/s0213-005x(04)73029-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Atherosclerosis increases cardiovascular risk and the possibility of developing acute myocardial infarction (AMI) or stroke. Patients infected with human immunodeficiency virus (HIV) often present morphological and metabolic alterations (hypercholesterolemia, hypertriglyceridemia, insulin resistance, diabetes) that can increase vascular risk. The frequent coexistence of classic risk factors (atherogenic diet, smoking, physical inactivity, cocaine abuse), the progressive increase in mean age of HIV-1 infected patients, and the polymedication they receive make it difficult to estimate the direct effect that new therapies may have on cardiovascular risk. Retrospective clinical studies with diverse designs in large cohorts offer contradictory results for cardiovascular risk in the HIV-infected population. Longer observational periods are needed and the effect of other classic risk factors needs to be controlled, in order to establish the possible detrimental effect the new therapies may have on cardiovascular risk in this population.
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Affiliation(s)
- Fernando Dronda
- Servicio de Enfermedades Infecciosas. Hospital Ramón y Cajal. Madrid. España.
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Dronda F. Riesgo vascular e infección por el virus de la inmunodeficiencia humana tipo 1. Med Clin (Barc) 2004; 122:301-3. [PMID: 15030742 DOI: 10.1016/s0025-7753(04)74215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Freyse EJ, Giessmann T, Petzke KJ, Knospe S, Engel G, Heinke P, Metges CC, Siegmund W. Effects of fatty acids on hepatic amino acid catabolism and fibrinogen synthesis in young healthy volunteers. Am J Physiol Endocrinol Metab 2003; 285:E54-62. [PMID: 12791602 DOI: 10.1152/ajpendo.00324.2002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Increased synthesis rate of fibrinogen, an independent risk factor for cardiovascular disease, was recently reported in obese insulin-resistant female adolescents with chronic elevated nonesterified fatty acids (NEFA). It is unknown whether a short-term change of NEFA concentrations controls hepatic fibrinogen synthesis. Therefore, 10 healthy male volunteers (24.5 +/- 3.3 yr, body mass index 23.5 +/- 2.9 kg/m2) were investigated in random order under basal and elevated NEFA for 8 h. Leucine metabolism, the fractional synthesis rates (FSR) of plasma fibrinogen, and endogenous urea production rates were measured during primed, continuous infusion of [1-13C]leucine and [15N2]urea, respectively. Plasma alpha-[13C]ketoisocaproic acid and [15N2]urea enrichment values were measured with GC-MS. Plasma fibrinogen was isolated with the beta-alanine method, and fibrinogen-related [13C]leucine enrichment was analyzed by GC-CIRMS. Lipofundin infusion and subcutaneous heparin tripled NEFA and triglycerides in the tests. Plasma glucose, circulating insulin, human C-peptide, and plasma glucagon were not changed by the study procedure. Fibrinogen FSR were significantly lower in tests with NEFA elevation (18.44 +/- 4.67%) than in control tests (21.48 +/- 4.32%; P < 0.05). Plasma fibrinogen concentrations measured were not significantly different (NEFA test subjects: 1.85 +/- 0.33, controls: 1.97 +/- 0.54 g/l). Parameters of leucine metabolism, such as leucine rate of appearance, leucine oxidation, and nonoxidative leucine disposal, were not influenced by NEFA elevation, and endogenous urea production remained unchanged. NEFA contributes to short-term regulation of fibrinogen FSR in healthy volunteers under unchanged hormonal status, leucine metabolism, and overall amino acid catabolism. Its contribution might be of relevance at least after fat-rich meals, counteracting by reduction of FSR the blood viscosity increase implied by hyperlipidemia.
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Empen K, Geiss HC, Lehrke M, Otto C, Schwandt P, Parhofer KG. Effect of atorvastatin on lipid parameters, LDL subtype distribution, hemorrheological parameters and adhesion molecule concentrations in patients with hypertriglyceridemia. Nutr Metab Cardiovasc Dis 2003; 13:87-92. [PMID: 12929621 DOI: 10.1016/s0939-4753(03)80023-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Hypertriglyceridemia is a risk factor for atherosclerosis that is typically associated with high concentrations of adhesion molecules, impaired hemorrheology and an unfavourable low-density lipoprotein (LDL) subtype distribution. We hypothesised that some of these risk markers might be beneficially influenced by lipid-lowering therapy with atorvastatin in hypertriglyceridemic patients. METHODS AND RESULTS Nineteen patents with primary hypertriglyceridemia were given 10 mg of atorvastatin per day for four weeks. Their cholesterol, triglyceride, LDL and high-density lipoprotein cholesterol (HDL-C) levels, LDL subtype profile, hemorrheological parameters and E-selectin, vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 concentrations were measured before and at the end of atorvastatin therapy. The levels of total and LDL cholesterol respectively decreased by 25% and 24% (both p < 0.001). Furthermore, cholesterol was reduced by 8-29% in all seven LDL subfractions (density range: 1.020-1.066 g/mL) (p < 0.05). The reduction in triglyceride concentrations was of marginal significance (9%, p = 0.1), but its degree positively correlated with the reduction of small-dense LDL (r = 0.5, p < 0.025). Plasma viscosity and blood viscosity at low shear rates were respectively reduced by 2% and 16% (both p < 0.05). The effect of the treatment on the concentrations of HDL-C, fibrinogen and adhesion molecules was not significant. CONCLUSIONS Atorvastatin (10 mg/day) not only reduced the plasma concentrations of atherogenic lipoproteins but also improved the LDL-subtype profile and reduced plasma and blood viscosity in patients with hypertriglyceridemia; however, it failed to significantly lower triglyceride concentrations.
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Affiliation(s)
- K Empen
- Medical Department II, Ludwig-Maximilians-University, Munich, Germany
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Dronda F, Moreno S, Pérez-Elías MJ, Casado JL, Antela A, Moreno A. Vascular disease in HIV-infected patients: a comparative study of two different therapeutic periods (1994-1997 versus 1998-2000). AIDS 2002; 16:1971-3. [PMID: 12351962 DOI: 10.1097/00002030-200209270-00019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Fernando Dronda
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
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Basaria S, Nguyen T, Rosenson RS, Dobs AS. Effect of methyl testosterone administration on plasma viscosity in postmenopausal women. Clin Endocrinol (Oxf) 2002; 57:209-14. [PMID: 12153599 DOI: 10.1046/j.1365-2265.2002.01584.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is the leading cause of mortality in women, with an incidence that increases after menopause, hence suggesting a cardioprotective role of oestrogen. Menopause also results in a decline in androgen levels with resulting symptoms of decreased libido and sexual dysfunction. Recently, there has been a growing interest in the treatment of postmenopausal women with androgens. However, no data are available on plasma viscosity and fibrinogen levels in postmenopausal women on combined oestrogen/androgen therapy. METHODS We conducted a randomized, double-blind, parallel-group 16-week study evaluating the effects of methyltestosterone supplementation on plasma viscosity and fibrinogen levels in postmenopausal women already on oestrogen replacement therapy (ERT) for at least 3 months. Women 21 years and older who were menopausal (natural or surgical) for at least 12 months were enrolled in the study. Participants were randomized to (1) an oestrogen-only group taking 1.25 mg esterified oestrogen (E-group) and (2) an oestrogen plus methyltestosterone (1.25 mg esterified oestrogen and 2.5 mg methyltestosterone) group (EA-group). Progesterone was not administered during the study period and women with intact uteri were given medroxyprogesterone 10 mg daily for 14 days at the completion of the study. RESULTS After 16 weeks of treatment, both groups had a significant increase in serum oestradiol levels from baseline. The levels of total oestrogen were significantly higher in the E-group compared to the EA-group (P < 0.001). There was a greater decrease in the LH and SHBG levels in the EA-group (P = 0.01). There was no difference in total testosterone; however, free testosterone levels were significantly higher in the EA-group (P = 0.01). At the end of the study, there was a significant decrease in plasma viscosity only in the EA-group (P = 0.01). Fibrinogen levels increased in both the groups, reaching significance only in the EA-group (P = 0.006). Baseline weight, body mass index (BMI) and the duration of menopausal status did not have any significant impact on the changes in plasma viscosity or fibrinogen. Women in the EA-group showed significant reductions in total cholesterol (P = 0.009), high density lipoprotein (HDL) (P < 0.001) and triglyceride (TG) levels (P = 0.001). There was no significant change in these parameters in the E-group. CONCLUSION This prospective study shows that the treatment of postmenopausal women on oestrogen with low-dose oral methyltestosterone results in a significant reduction in plasma viscosity. This lowering of plasma viscosity was achieved despite an increase in fibrinogen levels. Significant lowering of lipoproteins, especially TG levels, might have been responsible for this benefit. The combination regimen did not result in major side-effects. Based on these results, we feel confident in recommending low-dose androgens to postmenopausal women with a history of sexual dysfunction and decreased libido.
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Affiliation(s)
- Shehzad Basaria
- Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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35
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Kawano M, Kuroda Y, Terao M, Yaginuma T, Kawakami M, Kanazawa Y. Marked removal of bezafibrate-induced high-density lipoprotein-cholesterol by low-density lipoprotein apheresis. Clin Chim Acta 2002; 318:91-5. [PMID: 11880117 DOI: 10.1016/s0009-8981(01)00810-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND A case of marked reduction of the bezafibrate-induced increase of high-density lipoprotein (HDL)-cholesterol by low-density lipoprotein apheresis (LDL-apheresis) has not been previously reported. METHODS A 68-year-old Japanese man with arteriosclerosis obliterans (ASO), diabetes mellitus, and hyperlipidemia underwent LDL-apheresis, followed by the concomitant bezafibrate administration. Plasma lipids of pre- and post-LDL-apheresis were measured and apolipoprotein E (apoE) localization of the pre- and post-LDL-apheresis was detected by agarose gel electrophoresis. RESULTS Plasma concentrations of the total cholesterol, LDL-cholesterol, triglyceride, and HDL-cholesterol of pre-LDL-apheresis were 4.78 +/- 0.36, 2.74 +/- 0.24, 2.44 +/- 0.52, and 0.92 +/- 0.10 mmol/l, respectively; those of the post-LDL-apheresis were 1.94 +/- 0.31, 0.72 +/- 0.13, 0.81 +/- 0.38, and 0.86 +/- 0.11 mmol/l, respectively. LDL-apheresis reduced HDL-cholesterol by 6.4% (p=0.346). During the bezafibrate administration, plasma concentrations of the above of pre-LDL-apheresis were 5.24 +/- 0.34, 3.28 +/- 0.22, 1.26 +/- 0.25, and 1.39 +/- 0.21 mmol/l, respectively; those of the post-LDL-apheresis were 2.25 +/- 0.44, 0.80 +/- 0.12, 0.58 +/- 0.19, and 1.18 +/- 0.16 mmol/l, respectively. LDL-apheresis reduced HDL-cholesterol by 15.2% (p<0.01). Plasma apolipoprotein E detected between the prebeta- and alpha-mobility was markedly lower after the LDL-apheresis in the agarose gel electrophoresis. CONCLUSIONS The removal of the bezafibrate induced an increase of the HDL-cholesterol by LDL-apheresis.
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Affiliation(s)
- Mikihiko Kawano
- Integrated Medicine, Omiya Medical Center, Jichi Medical School, Japan.
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Rosenson RS, Shott S, Tangney CC. Hypertriglyceridemia is associated with an elevated blood viscosity Rosenson: triglycerides and blood viscosity. Atherosclerosis 2002; 161:433-9. [PMID: 11888528 DOI: 10.1016/s0021-9150(01)00656-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Elevated blood viscosity is a predictor of cardiovascular disease. The major determinants of blood viscosity are hematocrit and plasma viscosity. Plasma triglycerides elevate plasma viscosity; however, the contribution of plasma triglycerides to blood viscosity after adjustment for other major covariates has not been reported. This cross-sectional study of 257 adult subjects evaluated the associations between fasting plasma lipids, fibrinogen, total serum protein, hematocrit and blood viscosity. Blood viscosity was measured at 37 degrees C with a coaxial cylinder microviscometer at shear rates of 100 and 1 s(-1). Blood viscosity values are reported both as uncorrected measurements and measurements corrected to a hematocrit of 45% by a regression equation. Uncorrected blood viscosity at a shear rate of 100 s(-1) was significantly associated with triglycerides, fibrinogen, high density lipoprotein (HDL) cholesterol, total serum protein, and hematocrit using stepwise multivariate regression analysis. When corrected blood viscosity at 100 s(-1) was the dependent variable, there were statistically significant associations with triglycerides, HDL cholesterol, and total serum protein. Corrected blood viscosity at 1 s(-1) was significantly associated with triglycerides, fibrinogen, total serum protein, and an indicator variable for diabetes mellitus. This study supports an additional mechanism whereby triglycerides may contribute to cardiovascular risk.
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Affiliation(s)
- Robert S Rosenson
- Lipoprotein and Hemorheology Research Facility, Section of Cardiology, Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL, USA.
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37
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Corti R, Badimon JJ. Value or desirability of hemorheological-hemostatic parameter changes as endpoints in blood lipid-regulating trials. Curr Opin Lipidol 2001; 12:629-37. [PMID: 11801863 DOI: 10.1097/00041433-200112000-00006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High levels of plasma lipids have been recognized as a major risk factor in the development and progression of atherosclerosis, and to influence hemorheological factors that may predispose to thrombotic complications. Lipid-lowering interventions have been associated with a significant reduction of morbidity and mortality. Several mechanisms have been postulated for the observed clinical effect. Serum lipid-regulating therapies may reduce cardiovascular risk not only by altering the arterial wall, improving disturbed endothelial function, atherogenesis and plaque stability, but also through their antithrombogenic effects and influence on blood flow properties associated with hyperlipidemia. In this article, we will review the recent literature and discuss the value of hemorheological-hemostatic findings as surrogate endpoints for clinical trials in dyslipidemic patients.
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Affiliation(s)
- R Corti
- Cardiovascular Biology Research Laboratory, Zena and Michael A. Wiener Cardiovascular Institute, The Mount Sinai School of Medicine, New York, New York 10029, USA
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