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Feng C, Yang Y, Lu A, Tan D, Lu Y, Qin L, He Y. Multi‑omics‑based analysis of the regulatory mechanism of gypenosides on bile acids in hypercholesterolemic mice. Exp Ther Med 2023; 26:438. [PMID: 37614436 PMCID: PMC10443059 DOI: 10.3892/etm.2023.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/22/2023] [Indexed: 08/25/2023] Open
Abstract
Gynostemma pentaphyllum is a traditional medicine used by ethnic minorities in southwest China and gypenosides are currently recognized as essential components of the pharmacological substances of Gynostemma pentaphyllum, which are effective in regulating metabolic syndrome, especially in improving hepatic metabolic disorders. The present study randomly divided C57BL/6J male mice into the normal diet control group (ND), high-fat diet modeling group (HFD) and gypenosides group (GP). Liquid chromatography-mass spectrometry (UPLC-MS) was applied to quantify bile acids in the liver, bile and serum of mice in ND, HFD and GP groups. Liver proteins were extracted for trypsin hydrolysis and analyzed quantitatively using UPLC-MS + MS/MS (timsTOF Pro 2). Total mouse liver RNA was extracted from ND, HFD and GP groups respectively, cDNA sequencing libraries constructed and sequenced using BGISEQ-500 sequencing platform. The expression of key genes Fxr, Shp, Cyp7a1, Cyp8b1, and Abab11 was detected by RT-qPCR. The results showed that gypenosides accelerated free bile acid synthesis by promoting the expression of bile acid synthase CYP7A1 and CYP8B1 genes and proteins and accelerating the secretion of conjugated bile acids from the liver to the bile ducts. GP inhibited the bile acid transporters solute carrier organic anion transporter family member (SLCO) 1A1 and SLCO1A4, reducing the reabsorption of free bile acids and accelerating the excretion of free bile acids from the blood to the kidneys. It also promoted the metabolic enzyme CYP3A11, which accelerated the metabolism and clearance of bile acids, thus maintaining the balance of the bile acid internal environment.
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Affiliation(s)
- Chengcheng Feng
- Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Yanping Yang
- Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Anjing Lu
- Guizhou Engineering Research Center of Industrial Key-Technology for Dendrobium Nobile, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Daopeng Tan
- Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
- Guizhou Engineering Research Center of Industrial Key-Technology for Dendrobium Nobile, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Yanliu Lu
- Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
- Guizhou Engineering Research Center of Industrial Key-Technology for Dendrobium Nobile, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Lin Qin
- Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
- Guizhou Engineering Research Center of Industrial Key-Technology for Dendrobium Nobile, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Yuqi He
- Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
- Guizhou Engineering Research Center of Industrial Key-Technology for Dendrobium Nobile, Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
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Yang E, Lv Y, Wang Z, Wang D, Li Y, Sun Y, Zhang Y, Niu J, Chen Z, Liu W, Hu X. Coagulation status and determinants of possible aspirin resistance in patients with essential thrombocythemia. Front Med (Lausanne) 2022; 9:1092281. [PMID: 36606056 PMCID: PMC9808044 DOI: 10.3389/fmed.2022.1092281] [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: 11/07/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives The currently recommended aspirin regimen appears inadequate for thromboprophylaxis in essential thrombocythemia (ET). This study aimed not only to evaluate the curative effect of aspirin but also to explore the coagulation status and determinants of aspirin resistance (AR) of ET patients. Methods A total of 80 ET patients who underwent coagulation tests, thromboelastography (TEG), and next-generation sequencing (NGS) were involved in the study. Patients were divided into the aspirin sensitivity (AS) group and AR group according to the arachidonic acid inhibition rate. Their clinical features and coagulation function were analyzed. Results The incidence of AR was 53.75% (43/80) in 80 ET patients. Fbg was significantly higher in coagulation tests in AR patients compared with AS patients (P < 0.05), while the differences in other variables (D-D, PT, PTA, INR, APTT, TT, FDP, and AT-III) were not statistically significant (P > 0.05). Compared with AS patients, the K values, α angles, MA values, and CI values of TEG in AR patients were statistically smaller (P < 0.05), but there was no significant difference in R value between them (P > 0.05). Univariate and multivariate logistic regression analysis showed that age, irregular use of aspirin, smoking, dyslipidemia, and hypertension increased the risk of AR (P < 0.05). In the routine NGS, the driver gene and non-driver gene had no effect on AR in ET patients. Conclusion Compared with AS patients, AR patients have enhanced platelet aggregation function, are in a relatively hypercoagulable state, and haveelevated fibrinogen function/levels, all of which cause a worse coagulation status. ET patients with increasing age, irregular use of aspirin, smoking, dyslipidemia, and hypertension are possibly at higher risk of AR. The routine NGS may not be helpful for the prediction of AR, therefore we recommend adding relevant drug-resistance genes to NGS.
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Affiliation(s)
- Erpeng Yang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Lv
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ziqing Wang
- Xiyuan Clinical Medical College, Beijing University of Traditional Medicine, Beijing, China
| | - Dehao Wang
- Xiyuan Clinical Medical College, Beijing University of Traditional Medicine, Beijing, China
| | - Yumeng Li
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Sun
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanyu Zhang
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jicong Niu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhuo Chen
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Weiyi Liu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,*Correspondence: Weiyi Liu,
| | - Xiaomei Hu
- Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China,Xiaomei Hu,
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Singh S, Zahoor I, Sharma N, Behl T, Kanojia N, Sehgal A, Mohan S, Almoshari Y, Salawi A, Aleya L, Bungau S. Insights into the pivotal role of statins and its nanoformulations in hyperlipidemia. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:76514-76531. [PMID: 36161571 DOI: 10.1007/s11356-022-23043-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Hyperlipidemia is the primary cause of heart disorders and has been manifested as the condition with remarkable higher levels of very-low-density lipoproteins, low-density lipoproteins, intermediate-density lipoprotein, triglycerides, and cholesterol in blood circulation. Genetic causes or systemic metabolic illnesses like diabetes mellitus, increased alcohol consumption, hypothyroidism, and primary biliary cirrhosis are several reasons behind development of hyperlipidemia. Higher levels of lipids and lipoproteins in plasma are responsible for various health disorders in human body like occlusion of blood vessels, acute pancreatitis, and reduced artery lumen elasticity. Both primary and secondary prophylaxis of heart disease can be achieved through combination of pharmacologic therapy with therapeutic lifestyle adjustments. Statins which belongs to HMG-CoA reductase inhibitors are preferred for primary prevention of hyperlipidemia particularly for individuals at higher risk of development of heart disease. This review discusses the recent advancements and outcomes of nanoparticle drug carriers for statins in the therapy of hyperlipidemia.
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Affiliation(s)
- Sukhbir Singh
- Department of Pharmaceutics, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana, 133207, India
| | - Ishrat Zahoor
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Neelam Sharma
- Department of Pharmaceutics, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Mullana-Ambala, Haryana, 133207, India.
| | - Tapan Behl
- School of Health Sciences and Technology, University of Petroleum and Energy Studies, Bidholi-248007, Dehradun, Uttarakhand, India
| | - Neha Kanojia
- School of Pharmacy, Chitkara University, Himachal Pradesh, India
| | - Aayush Sehgal
- GHG Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India
| | - Syam Mohan
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
- Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, India
| | - Yosif Almoshari
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Salawi
- Department of Pharmaceutics, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Lotfi Aleya
- Chrono-Environment Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon Cedex, France
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea, Romania
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Chi MH, Chao J, Ko CY, Huang SS. An Ethnopharmaceutical Study on the Hypolipidemic Formulae in Taiwan Issued by Traditional Chinese Medicine Pharmacies. Front Pharmacol 2022; 13:900693. [PMID: 36188612 PMCID: PMC9520573 DOI: 10.3389/fphar.2022.900693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Globally, approximately one-third of ischemic heart diseases are due to hyperlipidemia, which has been shown to cause various metabolic disorders. This study was aimed to disassemble and analyze hypolipidemic formulae sold by traditional Chinese medicine (TCM) pharmacies. Using commonly used statistical parameters in ethnopharmacology, we identified the core drug combination of the hypolipidemic formulae, thereby exploring the strategy by which the Taiwanese people select hypolipidemic drugs. Most important of all, we preserved the inherited knowledge of TCM. We visited 116 TCM pharmacies in Taiwan and collected 91 TCM formulae. The formulae were mainly disassembled by macroscopical identification, and the medicinal materials with a relative frequency of citation (RFC) >0.2 were defined as commonly used medicinal materials. Subsequently, we sorted the information of medicinal materials recorded in the Pharmacopeia, searched for modern pharmacological research on commonly used medicinal materials using PubMed database, and visualized data based on the statistical results. Finally, the core hypolipidemic medicinal materials used in folk medicine were obtained. Of the 91 TCM formulae collected in this study, 80 traditional Chinese medicinal materials were used, belonging to 43 families, predominantly Lamiaceae. Roots were the most commonly used part as a medicinal material. There were 17 commonly used medicinal materials. Based on medicinal records in Pharmacopeia, most flavors and properties were warm and pungent, the majority traditional effects were “tonifying and replenishing” and “blood-regulating.” Besides, the targeted diseases searching from modern pharmacological studies were diabetes mellitus and dyslipidemia. The core medicinal materials consisted of Astragalus mongholicus Bunge and Crataegus pinnatifida Bunge, and the core formulae were Bu-Yang-Huan-Wu-Tang and Xie-Fu-Zhu-Yu-Tang. In addition, 7 groups of folk misused medicinal materials were found. Although these TCMs have been used for a long period of time, their hypolipidemic mechanisms remain unclear, and further studies are needed to validate their safety and efficacy.
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Affiliation(s)
- Min-Han Chi
- School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Jung Chao
- Master Program for Food and Drug Safety, Chinese Medicine Research Center, Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, China Medical University, Taichung, Taiwan
| | - Chien-Yu Ko
- School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Shyh-Shyun Huang
- School of Pharmacy, China Medical University, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
- *Correspondence: Shyh-Shyun Huang,
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Qu Y, Lee JJW, Zhuo Y, Liu S, Thomas RL, Owens DR, Zee BCY. Risk Assessment of CHD Using Retinal Images with Machine Learning Approaches for People with Cardiometabolic Disorders. J Clin Med 2022; 11:jcm11102687. [PMID: 35628812 PMCID: PMC9143834 DOI: 10.3390/jcm11102687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Coronary heart disease (CHD) is the leading cause of death worldwide, constituting a growing health and social burden. People with cardiometabolic disorders are more likely to develop CHD. Retinal image analysis is a novel and noninvasive method to assess microvascular function. We aim to investigate whether retinal images can be used for CHD risk estimation for people with cardiometabolic disorders. Methods: We have conducted a case–control study at Shenzhen Traditional Chinese Medicine Hospital, where 188 CHD patients and 128 controls with cardiometabolic disorders were recruited. Retinal images were captured within two weeks of admission. The retinal characteristics were estimated by the automatic retinal imaging analysis (ARIA) algorithm. Risk estimation models were established for CHD patients using machine learning approaches. We divided CHD patients into a diabetes group and a non-diabetes group for sensitivity analysis. A ten-fold cross-validation method was used to validate the results. Results: The sensitivity and specificity were 81.3% and 88.3%, respectively, with an accuracy of 85.4% for CHD risk estimation. The risk estimation model for CHD with diabetes performed better than the model for CHD without diabetes. Conclusions: The ARIA algorithm can be used as a risk assessment tool for CHD for people with cardiometabolic disorders.
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Affiliation(s)
- Yimin Qu
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Q.); (J.J.-W.L.)
| | - Jack Jock-Wai Lee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Q.); (J.J.-W.L.)
| | - Yuanyuan Zhuo
- Department of Acupuncture and Moxibustion, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518005, China;
| | - Shukai Liu
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518005, China;
| | - Rebecca L. Thomas
- Diabetes Research Group, Swansea University, Swansea SA2 8PP, UK; (R.L.T.); (D.R.O.)
| | - David R. Owens
- Diabetes Research Group, Swansea University, Swansea SA2 8PP, UK; (R.L.T.); (D.R.O.)
| | - Benny Chung-Ying Zee
- Division of Biostatistics, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Q.); (J.J.-W.L.)
- Clinical Trials and Biostatistics Lab, CUHK Shenzhen Research Institute, Shenzhen 518057, China
- Correspondence:
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Identifying Coronary Artery Lesions by Feature Analysis of Radial Pulse Wave: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2022; 2021:5047501. [PMID: 35005017 PMCID: PMC8739924 DOI: 10.1155/2021/5047501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022]
Abstract
Background Cardiovascular diseases have been always the most common cause of morbidity and mortality worldwide. Health monitoring of high-risk and suspected patients is essential. Currently, invasive coronary angiography is still the most direct and accurate method of determining the severity of coronary artery lesions, but it may not be the optimal clinical choice for suspected patients who had clinical symptoms of coronary heart disease (CHD) such as chest pain but no coronary artery lesion. Modern medical research indicates that radial pulse waves contain substantial pathophysiologic information about the cardiovascular and circulation systems; therefore, analysis of these waves could be a noninvasive technique for assessing cardiovascular disease. Objective The objective of this study was to analyze the radial pulse wave to construct models for assessing the extent of coronary artery lesions based on pulse features and investigate the latent value of noninvasive detection technology based on pulse wave in the evaluation of cardiovascular disease, so as to promote the development of wearable devices and mobile medicine. Method This study included 529 patients suspected of CHD who had undergone coronary angiography. Patients were sorted into a control group with no lesions, a 1 or 2 lesion group, and a multiple (3 or more) lesion group as determined by coronary angiography. The linear time-domain features and the nonlinear multiscale entropy features of their radial pulse wave signals were compared, and these features were used to construct models for identifying the range of coronary artery lesions using the k-nearest neighbor (KNN), decision tree (DT), and random forest (RF) machine learning algorithms. The average precision of these algorithms was then compared. Results (1) Compared with the control group, the group with 1 or 2 lesions had increases in their radial pulse wave time-domain features H2/H1, H3/H1, and W2 (P < 0.05), whereas the group with multiple lesions had decreases in MSE1, MSE2, MSE3, MSE4, and MSE5 (P < 0.05). (2) Compared with the 1 or 2 lesion group, the multiple lesion group had increases in T1/T (P < 0.05) and decreases in T and W1 (P < 0.05). (3) The RF model for identifying numbers of coronary artery lesions had a higher average precision than the models built with KNN or DT. Furthermore, average precision of the model was highest (80.98%) if both time-domain features and multiscale entropy features of radial pulse signals were used to construct the model. Conclusion Pulse wave signal can identify the range of coronary artery lesions with acceptable accuracy; this result is promising valuable for assessing the severity of coronary artery lesions. The technique could be used to development of mobile medical treatments or remote home monitoring systems for patients suspected or those at high risk of coronary atherosclerotic heart disease.
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Chen H, Gao J, Xu Q, Wan D, Zhai W, Deng L, Qie R. MiR-145-5p modulates lipid metabolism and M2 macrophage polarization by targeting PAK7 and regulating β-catenin signaling in hyperlipidemia. Can J Physiol Pharmacol 2021; 99:857-863. [PMID: 34143694 DOI: 10.1139/cjpp-2020-0539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The present study aims to explore the role of microRNA 145-5p (miR-145-5p) in hyperlipidemia. Using bioinformatics tools and a wide range of function and mechanism assays, we attempted to understand the specific function and potential mechanism of miR-145-5p in hyperlipidemia. A cholesterol-enriched diet induced an increase of serum cholesterol and triacylglycerol but a decrease of serum high-density lipoprotein. MiR-145-5p level was decreased in hyperlipidemia rat models. MiR-145-5p regulated lipid metabolism by antagonizing the alteration of high-density lipoprotein, cholesterol, and triacylglycerol in serum mediated by a cholesterol-enriched diet. In mechanism, miR-145-5p directly bound with p21 protein (RAC1)-activated kinase 7 (PAK7) and negatively regulated mRNA and protein levels of PAK7 in THP-1 cells. Furthermore, miR-145-5p level was negatively associated with PAK7 level in rat cardiac tissues. Finally, overexpression of PAK7 reversed the effects of miR-145-5p on β-catenin activation and M2 macrophages polarization in THP-1 cells. In conclusion, MiR-145-5p modulated lipid metabolism and M2 macrophage polarization by targeting PAK7 and regulating β-catenin signaling in hyperlipidemia, which may provide a potential biomarker for the treatment of hyperlipidemia-induced cardiovascular diseases.
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Affiliation(s)
- Huijun Chen
- Department of Cardiology, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang, China
| | - Jing Gao
- Department of Cardiology, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang, China
| | - Qian Xu
- Department of Cardiology, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang, China
| | - Dongmei Wan
- Department of Cardiology, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang, China
| | - Wenji Zhai
- Department of Cardiology, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang, China
| | - Limei Deng
- Department of Cardiology, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150001, Heilongjiang, China
| | - Rui Qie
- Department of Emergency, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang, China
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Effects of a Mediterranean Diet, Dairy, and Meat Products on Different Phenotypes of Dyslipidemia: A Preliminary Retrospective Analysis. Nutrients 2021; 13:nu13041161. [PMID: 33915861 PMCID: PMC8065939 DOI: 10.3390/nu13041161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Dyslipidemia is one of the major causes of atherosclerotic cardiovascular disease (ASCVD) and a Mediterranean Diet (MD) is recommended for its prevention. The objectives of this study were to evaluate adherence to an MD at baseline and follow-up, in a cohort of dyslipidemic patients, and to evaluate how different food intakes can influence lipid profile, especially how different sources of saturated fatty acids impact lipid phenotype. Methods: A retrospective analysis was conducted on 106 dyslipidemic patients. Clinical characteristics, lipid profile, and food habits data were collected at baseline and after three months of follow-up with counseling. Adherence to an MD was evaluated with a validated food-frequency questionnaire (MEDI-LITE score). Results: The cross-sectional analysis showed that higher consumption of dairy products correlated independently with higher levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) and with lower triglycerides (TG) levels. Instead, lower HDL-C and TG levels and higher TC levels were independently associated with higher consumption of meat products. Adherence to an MD significantly improved after the follow-up period, from a mean value of 10 ± 3 (median 10, IQR 8–12) to 13 ± 2 (median 14, IQR 12–15), p < 0.0001. Conclusions: Dyslipidemic patients benefit from counseling for improving their adherence to an MD. The high intake of dairy products was associated with less atherogenic hyperlipidemia, which was characterized by higher levels of TC and HDL-C as compared withs the intake of an excessive amount of meat products, which was associated with higher levels of TC and TG and lower levels of HDL-C.
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Zeng L, Luo L, Xue Q, He Q, Chen X, Meng J, Wang S, Liang S. LC–MS based plasma metabolomics study of the intervention effect of different polar parts of Hawthorn on hyperlipidemia rats. J Sep Sci 2021; 44:963-972. [DOI: 10.1002/jssc.202000911] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Lu Zeng
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
| | - Lan Luo
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
| | - Qi Xue
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
| | - Qiong He
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
| | - Xingyu Chen
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
| | - Jiang Meng
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
| | - Shumei Wang
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
| | - Shengwang Liang
- School of Traditional Chinese Medicine Guangdong Pharmaceutical University Guangzhou Guangdong P. R. China
- Key Laboratory of Digital Quality Evaluation of Chinese Materia Medica Guangzhou Guangdong P. R. China
- Engineering & Technology Research Center for Chinese Materia Medica Quality of the Universities of Guangdong Province Guangzhou Guangdong P. R. China
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Diet and Nutraceutical Supplementation in Dyslipidemic Patients: First Results of an Italian Single Center Real-World Retrospective Analysis. Nutrients 2020; 12:nu12072056. [PMID: 32664400 PMCID: PMC7400882 DOI: 10.3390/nu12072056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Dyslipidemias are a heterogeneous group of metabolic disorders mainly characterized by an increased risk of atherosclerotic cardiovascular disease (ASCVD) or other conditions, such as acute pancreatitis in hypertriglyceridemia. The aim of this study was to evaluate the effect of diet treatment and nutraceutical (NUTs) supplementation on the plasma lipid profile in outpatient dyslipidemic subjects, considering the influence of several factors (i.e., gender, age, body mass index, alcohol consumption, and smoking habits). Methods: 487 dyslipidemic patients spanning from 2015 to 2019 were treated with a Mediterranean diet or NUTs in a real-word setting and were retrospectively analyzed. General characteristics and lipid profile at baseline and after the follow-up period were evaluated. Results: Diet alone reduced total cholesterol (−19 mg/dL, −7.7%), LDL cholesterol (−18 mg/dL, −10.1%), and triglycerides (−20 mg/dL, −16.7%). Triglycerides (TG) decreased more in men, while women were associated with higher reduction of LDL cholesterol (LDL-C). Different types of NUTs further ameliorate lipid profiles when associated with diet. Nevertheless, most patients at low ASCVD risk (222 out of 262, 81.6%) did not achieve the 2019 ESC/EAS guidelines recommended LDL-C goals (i.e., LDL-C < 116 mg/dL). Conclusion: Lipid-lowering diet improves lipid profile, and NUTs can boost its efficacy, but taken together they are mainly unsatisfactory with respect to the targets imposed by 2019 EAS/ESC guidelines.
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Hong P, Gao Y, Wang Q, Qiu X, Chen Q. The effectiveness of acupoint catgut embedding in hyperlipidemia with obesity: Protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20342. [PMID: 32481412 DOI: 10.1097/md.0000000000020342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hyperlipidemia is a common disease characterized as blood lipid metabolism disorders, which is always companied with obesity. Hyperlipidemia is the leading cause of the cardiovascular disease (CVD) closely associated with mortality, and the risk can further elevate in the obese population. Additionally, it induces stroke and acute pancreatitis. Studies demonstrated that acupoint catgut embedding is an effective therapy for hyperlipidemia with obesity. Whereas, there is no systematic review and meta-analysis to support the point. Thus, we intend to conduct a systematic review and meta-analysis to testify its effectiveness in hyperlipidemia with obesity. METHODS We will include articles by searching the following database: PubMed, Embase, Web of Science, Cochrane Controlled Trials Register (CENTRAL), China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Chinese Science Journal Database (VIP), and Wanfang database. Whats more, the manual search can be executed as the complement of database searching. Endnote X8 and RevMan V.5.3 will be used to complete the process of study selection, data analysis, as well as date management. RESULT The primary outcomes contain the reduction of TC, TG, LDL-C, HDL-C, and BMI, body weight (WB), waist circumference(WC), body fat percent (F%) from baseline to the end of studies. The second outcome is the number of adverse events during the total trial. CONCLUSION We will summarize sufficient evidence to confirm the therapeutic effect and safety of acupoint catgut embedding in hyperlipidemia with obesity. INPLASY REGISTRATION NUMBER INPLASY202040036.
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Affiliation(s)
- Peipei Hong
- Hospital of Chengdu University of Tradional Chinese Medicine, Sichuan, China
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Song DX, Jiang JG. Hypolipidemic Components from Medicine Food Homology Species Used in China: Pharmacological and Health Effects. Arch Med Res 2017; 48:569-581. [DOI: 10.1016/j.arcmed.2018.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
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Li ZY, Ding LL, Li JM, Xu BL, Yang L, Bi KS, Wang ZT. ¹H-NMR and MS based metabolomics study of the intervention effect of curcumin on hyperlipidemia mice induced by high-fat diet. PLoS One 2015; 10:e0120950. [PMID: 25786031 PMCID: PMC4364983 DOI: 10.1371/journal.pone.0120950] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/30/2015] [Indexed: 12/24/2022] Open
Abstract
Curcumin, a principle bioactive component of Curcuma longa L, is well known for its anti-hyperlipidemia effect. However, no holistic metabolic information of curcumin on hyperlipidemia models has been revealed, which may provide us an insight into the underlying mechanism. In the present work, NMR and MS based metabolomics was conducted to investigate the intervention effect of curcumin on hyperlipidemia mice induced by high-fat diet (HFD) feeding for 12 weeks. The HFD induced animals were orally administered with curcumin (40, 80 mg/kg) or lovastatin (30 mg/kg, positive control) once a day during the inducing period. Serum biochemistry assay of TC, TG, LDL-c, and HDL-c was conducted and proved that treatment of curcumin or lovastatin can significantly improve the lipid profiles. Subsequently, metabolomics analysis was carried out for urine samples. Orthogonal Partial Least Squares-Discriminant analysis (OPLS-DA) was employed to investigate the anti-hyperlipidemia effect of curcumin and to detect related potential biomarkers. Totally, 35 biomarkers were identified, including 31 by NMR and nine by MS (five by both). It turned out that curcumin treatment can partially recover the metabolism disorders induced by HFD, with the following metabolic pathways involved: TCA cycle, glycolysis and gluconeogenesis, synthesis of ketone bodies and cholesterol, ketogenesis of branched chain amino acid, choline metabolism, and fatty acid metabolism. Besides, NMR and MS based metabolomics proved to be powerful tools in investigating pharmacodynamics effect of natural products and underlying mechanisms.
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Affiliation(s)
- Ze-Yun Li
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, People’s Republic of China
| | - Li-Li Ding
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jin-Mei Li
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Bao-Li Xu
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Li Yang
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Kai-Shun Bi
- Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang, People’s Republic of China
- * E-mail: (KSB); (ZTW)
| | - Zheng-Tao Wang
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- * E-mail: (KSB); (ZTW)
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Abstract
The primary cause of mortality in most developed countries is cardiovascular disease, which is the primary cause of death in the largest clinical studies of male health conditions. There are simplistic correlations between heart health and male-specific diseases. Clinicians need to motivate and provide a simplistic and realistic set of lifestyle, dietary supplement, and prescription drug recommendations to men to affect all-cause morbidity and mortality. This article provides recommendations to assist the clinician and patient to make practical changes that may be accomplished in a short period of time, and should provide tangible overall benefit for men's health.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, Ann Arbor, USA.
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Guttierres APM, Marins JCB. Os efeitos do treinamento de força sobre os fatores de risco da síndrome metabólica. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2008. [DOI: 10.1590/s1415-790x2008000100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Medidas não-farmacológicas, como a atividade física, vêm sendo recomendadas para prevenção e tratamento de doenças crônicas não transmissíveis. OBJETIVO: Realizar revisão da literatura para verificar os mecanismos por meio dos quais o treinamento de força provoca alterações metabólicas e celulares, agindo positivamente sobre os fatores de risco da síndrome metabólica. METODODOLOGIA: Foram utilizadas as bases de dados Medline, Scielo, Science Direct e Capes. A busca foi restrita aos últimos 10 anos. Os termos utilizados para pesquisa foram: obesity, dislipidemy,hypertension, diabetes mellitus, metabolic syndrome, resistance training, weight lifting, exercise. RESULTADOS: O treinamento de força atua sobre parâmetros metabólicos e celulares promovendo efeitos positivos no controle e na prevenção dos fatores de risco relacionados à síndrome metabólica, tais como diminuição do peso corporal, aumento da sensibilidade à insulina, aumento da tolerância à glicose, diminuição dos níveis pressóricos de repouso e melhoria do perfil lipídico. CONCLUSÃO: A revisão dos artigos científicos apresentados fornece dados que permitem concluir que o treinamento de força pode contribuir de forma efetiva na diminuição dos fatores de risco relacionados à síndrome metabólica.
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Moyad MA. Step-by-Step Lifestyle Changes That Can Improve Urologic Health in Men, Part I: What Do I Tell My Patients? Prim Care 2006; 33:139-63, ix. [PMID: 16516684 DOI: 10.1016/j.pop.2005.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mark A Moyad
- University of Michigan Medical Center, Department of Urology, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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Abstract
About 1,000 children develop end-stage renal disease (ESRD) each year in the United States and about 5,000 children are currently receiving dialysis. Children who develop ESRD are eligible to receive renal replacement therapy, including renal transplantation. There are inherent risks associated with transplantation, including renal insufficiency, infections, post-transplant lymphoproliferative disorder, and cardiovascular disease (CVD). Potential risk factors for CVD in pediatric renal transplant recipients include renal insufficiency, hyperlipidemia, hyperhomocysteinemia, inflammation, malnutrition, anemia, and hyperglycemia/insulin resistance. Despite evidence that many children may possess various risk factors for CVD post-renal transplantation, there are very few studies that have attempted to assess the link between these risk factors and CVD in pediatric renal transplant recipients.
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Affiliation(s)
- Douglas M Silverstein
- Louisiana State University Health Sciences Center, Department of Pediatrics, Children's Hospital, New Orleans, LA, USA.
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Moyad MA, Carroll PR. Lifestyle recommendations to prevent prostate cancer, part I: time to redirect our attention? Urol Clin North Am 2004; 31:289-300. [PMID: 15123408 DOI: 10.1016/j.ucl.2004.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides a foundation for clinicians willing to provide lifestyle change recommendations for the prevention of prostate cancer. In part II, more general and specific lifestyle recommendations will be provided. It is imperative to provide patients with realistic and practical recommendations that are not only consistent in the medical literature, but will improve overall compliance.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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Moyad MA. Introduction to risk assessment and serum risk markers for the prevention of coronary heart disease and other potential conditions that impact men's health, part I: what do I tell my patients? Urol Clin North Am 2004; 31:195-8. [PMID: 15123398 DOI: 10.1016/j.ucl.2004.03.005] [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: 12/31/2022]
Abstract
This article covers the basic cholesterol profile and a method of assessing the potential risks for CHD for most men. It is hoped that this overview will assist clinicians and patients in raising the awareness of CHD as the leading cause of mortality in men, and help to place the overall risk for mortality into a proper perspective.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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Abstract
Red yeast rice is a source of fermented pigment with possible bioactive effect. Evidence shows that fermented red yeast rice lowers cholesterol levels moderately compared to other statin drugs, but with the added advantage of underscores its potential as a new alternative to lipid level control. It is concluded from the present evidence that other types of pigmented rice possess opportunities for development as new functional foods.
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Affiliation(s)
- Mélanie Journoud
- School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, Canada
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Bays H, Stein EA. Pharmacotherapy for dyslipidaemia--current therapies and future agents. Expert Opin Pharmacother 2004; 4:1901-38. [PMID: 14596646 DOI: 10.1517/14656566.4.11.1901] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Current lipid-altering agents that lower low density lipoprotein cholesterol (LDL-C) primarily through increased hepatic LDL receptor activity include statins, bile acid sequestrants/resins and cholesterol absorption inhibitors such as ezetimibe, plant stanols/sterols, polyphenols, as well as nutraceuticals such as oat bran, psyllium and soy proteins; those currently in development include newer statins, phytostanol analogues, squalene synthase inhibitors, bile acid transport inhibitors and SREBP cleavage-activating protein (SCAP) activating ligands. Other current agents that affect lipid metabolism include nicotinic acid (niacin), acipimox, high-dose fish oils, antioxidants and policosanol, whilst those in development include microsomal triglyceride transfer protein (MTP) inhibitors, acylcoenzyme A: cholesterol acyltransferase (ACAT) inhibitors, gemcabene, lifibrol, pantothenic acid analogues, nicotinic acid-receptor agonists, anti-inflammatory agents (such as Lp-PLA(2) antagonists and AGI1067) and functional oils. Current agents that affect nuclear receptors include PPAR-alpha and -gamma agonists, while in development are newer PPAR-alpha, -gamma and -delta agonists, as well as dual PPAR-alpha/gamma and 'pan' PPAR-alpha/gamma/delta agonists. Liver X receptor (LXR), farnesoid X receptor (FXR) and sterol-regulatory element binding protein (SREBP) are also nuclear receptor targets of investigational agents. Agents in development also may affect high density lipoprotein cholesterol (HDL-C) blood levels or flux and include cholesteryl ester transfer protein (CETP) inhibitors (such as torcetrapib), CETP vaccines, various HDL 'therapies' and upregulators of ATP-binding cassette transporter (ABC) A1, lecithin cholesterol acyltransferase (LCAT) and scavenger receptor class B Type 1 (SRB1), as well as synthetic apolipoprotein (Apo)E-related peptides. Fixed-dose combination lipid-altering drugs are currently available such as extended-release niacin/lovastatin, whilst atorvastatin/amlodipine, ezetimibe/simvastatin, atorvastatin/CETP inhibitor, statin/PPAR agonist, extended-release niacin/simvastatin and pravastatin/aspirin are under development. Finally, current and future lipid-altering drugs may include anti-obesity agents which could favourably affect lipid levels.
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Affiliation(s)
- Harold Bays
- L-MARC Research Center, 3288 Illinois Avenue, Louisville, KY 40213, USA.
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Moyad MA. The use of complementary/preventive medicine to prevent prostate cancer recurrence/progression following definitive therapy: part I--lifestyle changes. Curr Opin Urol 2003; 13:137-45. [PMID: 12584474 DOI: 10.1097/00042307-200303000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The number one cause of death in the United States and in most countries around the world is cardiovascular disease. The number one or number two cause of death in prostate cancer patients is also cardiovascular disease. These observations do not serve to belittle the impact of prostate cancer, but are a reminder that the ultimate goal of healthy lifestyle recommendations is to reduce the burden of both of these major causes of death, especially after definitive prostate therapy. Patients need to be encouraged to know their cholesterol levels and other cardiovascular markers including blood pressure, as well as being aware of their prostate-specific antigen values. RECENT FINDINGS Patients should not smoke, they should reduce their intake of saturated and trans fats, increase their consumption of a diversity of fruit and vegetables, consume moderate quantities of dietary soy or flaxseed, increase their consumption of fish or fish oils and other omega-3 fatty acids, as well as maintaining a healthy weight, getting at least 30 min/day of physical activity, and lifting weights several times a week. When in doubt it is important for the clinician and patient to realize that what is healthy for the heart is generally found to be healthy for the prostate. Many of these lifestyle changes, when accomplished on a regular basis, may dramatically reduce the risk of overall early mortality. Despite the simplistic and moderate recommendations in this manuscript, research suggests that few individuals are currently following these suggestions. SUMMARY Clinicians need to constantly emphasize these basic changes in order to truly impact the overall health of any patient following definitive prostate therapy.
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Affiliation(s)
- Mark A Moyad
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
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Talpur R, Ward S, Apisarnthanarax N, Breuer-Mcham J, Duvic M. Optimizing bexarotene therapy for cutaneous T-cell lymphoma. J Am Acad Dermatol 2002; 47:672-84. [PMID: 12399758 DOI: 10.1067/mjd.2002.124607] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Bexarotene (Targretin oral capsules), the first RXR-selective retinoid "rexinoid" approved for all stages of cutaneous T-cell lymphoma (CTCL), had a response rate (RR) of 45% at the optimal dose of 300 mg/m(2) per day in 2 multicenter trials. With hypertriglyceridemia reported at 79%, bexarotene is often administered with lipid-lowering agents (LLAs). Statins (inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase) may modulate class II major histocompatibility class expression and T-cell responses. OBJECTIVE We attempted to optimize the clinical response to bexarotene by controlling dose-limiting hypertriglyceridemia and combining bexarotene with other active agents. METHODS We prospectively evaluated 70 patients with CTCL at M. D. Anderson Cancer Center who were treated with oral bexarotene as monotherapy or in combination with other active agents. RESULTS Fifty-four patients receiving bexarotene monotherapy achieved an overall RR of 48%. Thirteen had stage IA-IIA disease (RR = 53%, 1 complete response [CR]); 41 had stage IIB-IVB disease (RR = 46%, 2 CRs). Forty-two (77%) of these also required one or more LLAs: atorvastatin (n = 29, RR 43%), atorvastatin plus fenofibrate (n = 10, RR 90%), or gemfibrozil (n = 3, RR 33%). Gemfibrozil was discontinued because it increased bexarotene and triglyceride levels. Patients taking 2 LLAs had a significantly higher RR of 90% during monotherapy than those taking one or no LLAs (P <.0001). Forty of 54 patients (74%) received thyroid hormone replacement to normalize thyroxine levels. Four patients receiving monotherapy have complete CRs of >3 years' duration and received maintenance dosing. Sixteen patients with advanced disease treated with bexarotene (225-750 mg/d) in combination with other CTCL therapies achieved an overall RR of 69% (11/16) with concomitant statin therapy. Bexarotene was safely combined with psoralen ultraviolet A (PUVA) plus interferon alfa (IFN-alpha) (n = 2, RR = 50%), with extracorporeal photopheresis (ECP) (n = 8, RR = 75%, 1 CR), with ECP/IFN-alpha (n = 4, RR =50%), with ECP/IFN-alpha/PUVA (n = 1, RR = 100%), and with IFN-alpha/PUVA/topical nitrogen mustard (n = 1, RR = 100%). Two patients receiving IFN-alpha had slight leukopenia, but rhabdomyolysis associated with multiple LLAs did not occur. CONCLUSION This single-center study supports the safety and efficacy of bexarotene as both a monotherapy and a combination therapy for CTCL. Long durable CRs may be achieved with oral monotherapy. Use of statins with bexarotene may also increase RRs by permitting higher doses to be administered without interruption, by modulating the immune response, or both. When bexarotene is combined with other active CTCL therapies, higher RRs were achieved in patients with advanced disease, without unacceptable side effects.
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Affiliation(s)
- Rakhshandra Talpur
- Division of Internal Medicine, Department of Dermatology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Affiliation(s)
- C A Miller
- Care & Counseling, Miller/Wetzler Associates, Cleveland, OH, USA
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