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Zhang Z, Ding Z, Chen F, Hua R, Wu J, Shen Z, Shi F, Xu X. Quantitative Analysis of Multimodal MRI Markers and Clinical Risk Factors for Cerebral Small Vessel Disease Based on Deep Learning. Int J Gen Med 2024; 17:739-750. [PMID: 38463439 PMCID: PMC10923240 DOI: 10.2147/ijgm.s446531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Cerebral small vessel disease lacks specific clinical manifestations, and extraction of valuable features from multimodal images is expected to improve its diagnostic accuracy. In this study, we used deep learning techniques to segment cerebral small vessel disease imaging markers in multimodal magnetic resonance images and analyze them with clinical risk factors. Methods and results We recruited 211 lacunar stroke patients and 83 control patients. The patients' cerebral small vessel disease markers were automatically segmented using a V-shaped bottleneck network, and the number and volume were calculated after manual correction. The segmentation results of the V-shaped bottleneck network for white matter hyperintensity and recent small subcortical infarction were in high agreement with the ground truth (DSC>0.90). In small lesion segmentation, cerebral microbleed (average recall=0.778; average precision=0.758) and perivascular spaces (average recall=0.953; average precision=0.923) were superior to lacunar infarct (average recall=0.339; average precision=0.432) in recall and precision. Binary logistic regression analysis showed that age, systolic blood pressure, and total cerebral small vessel disease load score were independent risk factors for lacunar stroke (P<0.05). Ordered logistic regression analysis showed age was positively correlated with cerebral small vessel disease load score and total cholesterol was negatively correlated with cerebral small vessel disease score (P<0.05). Conclusion Lacunar stroke patients exhibited higher cerebral small vessel disease imaging markers, and age, systolic blood pressure, and total cerebral small vessel disease score were independent risk factors for lacunar stroke patients. V-shaped bottleneck network segmentation network based on multimodal deep learning can segment and quantify various cerebral small vessel disease lesions to some extent.
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Affiliation(s)
- Zhiliang Zhang
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, People’s Republic of China
| | - Zhongxiang Ding
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of China
| | - Fenyang Chen
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of China
| | - Rui Hua
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd, Shanghai, People’s Republic of China
| | - Jiaojiao Wu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd, Shanghai, People’s Republic of China
| | - Zhefan Shen
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd, Shanghai, People’s Republic of China
| | - Xiufang Xu
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, People’s Republic of China
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2
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Li J, Li Y, Zhu P, Xu J, Tang X, Qiao S, Yang W, Yang Y, Gao R, Yuan J, Zhao X. Remnant cholesterol but not LDL cholesterol is associated with 5-year bleeding following percutaneous coronary intervention. iScience 2023; 26:107666. [PMID: 37736035 PMCID: PMC10510087 DOI: 10.1016/j.isci.2023.107666] [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: 06/13/2023] [Revised: 07/24/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023] Open
Abstract
This study was aimed to investigate the association between remnant cholesterol (RC) and low-density lipoprotein cholesterol (LDL-C) concentrations and long-term bleeding. A total of 10,724 consecutive patients who underwent percutaneous coronary intervention in 2013 were prospectively enrolled. During a median follow-up of 5.1 years, 411 bleeding events and 42 intracranial hemorrhages (ICH) were recorded. The findings revealed that lower RC concentrations were independently associated with an increased risk of long-term bleeding events (continuous RC hazard ratio [HR]: 0.47, 95% confidence interval [CI]: 0.26-0.85; Q4 vs. Q1 HR: 0.66, 95% CI: 0.45-0.98), whereas lower LDL-C concentrations did not show a similar association. Additionally, a non-linear relationship was observed between RC concentrations and the risk of ICH (P for non-linear trend = 0.014), but no such relationship was found for LDL-C concentrations. These results provided insights into the safety of LDL-C-lowering therapy and emphasized the significance of RC concentrations in lipid management.
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Affiliation(s)
- Jiawen Li
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yulong Li
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Pei Zhu
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jingjing Xu
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaofang Tang
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shubin Qiao
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Weixian Yang
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yuejin Yang
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Runlin Gao
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jinqing Yuan
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xueyan Zhao
- Department of Cardiology, Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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3
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Al-Shoaibi AAA, Li Y, Song Z, Chiang C, Hirakawa Y, Saif-Ur-Rahman KM, Shimoda M, Nakano Y, Matsunaga M, Aoyama A, Tamakoshi K, Ota A, Yatsuya H. Association of Low-Density Lipoprotein Cholesterol with Risk of Coronary Heart Disease and Stroke among Middle-Aged Japanese Workers: An Analysis using Inverse Probability Weighting. J Atheroscler Thromb 2022; 30:455-466. [PMID: 35831131 PMCID: PMC10164596 DOI: 10.5551/jat.63519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS The associations between low-density lipoprotein cholesterol (LDL-C) and the risk of cardiovascular disease (CVD) subtypes are not well established among the Japanese population. This study used longitudinal data from the Aichi Workers' Cohort Study to explore the association between LDL-C levels and the risk of coronary heart disease (CHD) and stroke subtypes. METHODS Pooled data of 8966 adults (7093men and 1903 women) who were recruited between (2002) and (2008) were used for the current analysis. Propensity scores for the LDL-C categories were generated using multinomial logistic regression. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from the inverse probability weighted Cox proportional hazards model for LDL-C category associations with risks of CHD, stroke subtypes, and CVD. RESULTS During a median follow-up of 12 years, 122 strokes (57 ischemic strokes, 25 intracerebral hemorrhage, and 40 unknown subtypes) and 82 cases of CHD were observed. LDL-C 160- mg/dL compared to LDL-C 100-119 mg/dL was positively and significantly associated with the risk of CHD (HR: 4.56; 95% CI: 1.91-10.9) but not with ischemic stroke (HR: 0.99; 95% CI: 0.44-2.22). LDL-C was inversely associated with the risk of intracerebral hemorrhage (P for trend=0.009). CONCLUSION In middle-aged Japanese workers, LDL-C was significantly and positively associated with CHD, but not with ischemic stroke. LDL-C was inversely significantly associated with intracerebral hemorrhage.
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Affiliation(s)
| | - Yuanying Li
- Department of Public Health, Fujita Health University School of Medicine
| | - Zean Song
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine.,Health Systems and Population Studies Division, ICDDRB.,College of Medicine, Nursing and Health Sciences, National University of Ireland Galway
| | - Masako Shimoda
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Yoshihisa Nakano
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine
| | - Masaaki Matsunaga
- Department of Public Health, Fujita Health University School of Medicine
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine.,Nagoya University of Arts and Sciences
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine.,Department of Public Health, Fujita Health University School of Medicine
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O’Donnell MJ, McQueen M, Sniderman A, Pare G, Wang X, Hankey GJ, Rangarajan S, Chin SL, Rao-Melacini P, Ferguson J, Xavier D, Lisheng L, Zhang H, Pais P, Lopez-Jaramillo P, Damasceno A, Langhorne P, Rosengren A, Dans AL, Elsayed A, Avezum A, Mondo C, Judge C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Nilanont Y, Yusuf S. Association of Lipids, Lipoproteins, and Apolipoproteins with Stroke Subtypes in an International Case Control Study (INTERSTROKE). J Stroke 2022; 24:224-235. [PMID: 35677977 PMCID: PMC9194539 DOI: 10.5853/jos.2021.02152] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose The association of dyslipidemia with stroke has been inconsistent, which may be due to differing associations within etiological stroke subtypes. We sought to determine the association of lipoproteins and apolipoproteins within stroke subtypes.Methods Standardized incident case-control STROKE study in 32 countries. Cases were patients with acute hospitalized first stroke, and matched by age, sex and site to controls. Concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (apoA1), and apoB were measured. Non-HDL-C was calculated. We estimated multivariable odds ratio (OR) and population attributable risk percentage (PAR%). Outcome measures were all stroke, ischemic stroke (and subtypes), and intracerebral hemorrhage (ICH).Results Our analysis included 11,898 matched case-control pairs; 77.3% with ischemic stroke and 22.7% with ICH. Increasing apoB (OR, 1.10; 95% confidence interval [CI], 1.06 to 1.14 per standard deviation [SD]) and LDL-C (OR, 1.06; 95% CI, 1.02 to 1.10 per SD) were associated with an increase in risk of ischemic stroke, but a reduced risk of ICH. Increased apoB was significantly associated with large vessel stroke (PAR 13.4%; 95% CI, 5.6 to 28.4) and stroke of undetermined cause. Higher HDL-C (OR, 0.75; 95% CI, 0.72 to 0.78 per SD) and apoA1 (OR, 0.63; 95% CI, 0.61 to 0.66 per SD) were associated with ischemic stroke (and subtypes). While increasing HDL-C was associated with an increased risk of ICH (OR, 1.20; 95% CI, 1.14 to 1.27 per SD), apoA1 was associated with a reduced risk (OR, 0.80; 95% CI, 0.75 to 0.85 per SD). ApoB/A1 (OR, 1.38; 95% CI, 1.32 to 1.44 per SD) had a stronger magnitude of association than the ratio of LDL-C/HDL-C (OR, 1.26; 95% CI, 1.21 to 1.31 per SD) with ischemic stroke (<i>P</i><0.0001). Conclusions The pattern and magnitude of association of lipoproteins and apolipoproteins with stroke varies by etiological stroke subtype. While the directions of association for LDL, HDL, and apoB were opposing for ischemic stroke and ICH, apoA1 was associated with a reduction in both ischemic stroke and ICH. The ratio of apoB/A1 was the best lipid predictor of ischemic stroke risk.
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Affiliation(s)
- Martin J. O’Donnell
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland
- Correspondence: Martin J. O’Donnell Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Newcastle Rd., Galway, Ireland Tel: +353-91-494-098 Fax: +353-905-297-3781 E-mail:
| | - Matthew McQueen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Allan Sniderman
- Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
| | - Guillaume Pare
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Xingyu Wang
- National Center of Cardiovascular Disease, Beijing, China
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Siu Lim Chin
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - John Ferguson
- Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland
| | - Denis Xavier
- St John’s Medical College and Research Institute, Bangalore, India
| | - Liu Lisheng
- National Center of Cardiovascular Disease, Beijing, China
| | - Hongye Zhang
- Beijing Hypertension League Institute, Beijing, China
| | - Prem Pais
- St John’s Medical College and Research Institute, Bangalore, India
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander-Clinica Carlos Ardila Lulle (FOSCAL), Bucaramanga, Colombia
| | | | - Peter Langhorne
- Department of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy and University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Antonio L. Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | - Ahmed Elsayed
- Department of Surgery, Al Shaab Teaching Hospital, Khartoum, Sudan
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
| | - Charles Mondo
- Department of Cardiology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Conor Judge
- Department of Medicine, HRB-Clinical Research Facility, NUI Galway, Galway, Ireland
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Department of Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | | | - Anna Czlonkowska
- Department of Neurology, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Nana Pogosova
- National Research Center for Preventive Medicine, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Christian Weimar
- Institute for Medical Informatics, Department of Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Romana Iqbal
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Rafael Diaz
- Estudios Clínicos Latino America (ECLA), Instituto Cardiovascular de Rosario (ICR), Rosario, Argentina
| | - Khalid Yusoff
- University College Sedaya International (UCSI) University, Kuala Lumpur, Malaysia
| | - Afzalhussein Yusufali
- Department of Medicine, Hatta Hospital, Dubai Health Authority, Dubai Medical College, Dubai, United Arab Emirates
| | - Aytekin Oguz
- Department of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Fernando Lanas
- Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Okechukwu S. Ogah
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | - Yongchai Nilanont
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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5
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The Association between Low Levels of Low Density Lipoprotein Cholesterol and Intracerebral Hemorrhage: Cause for Concern? J Clin Med 2022; 11:jcm11030536. [PMID: 35159988 PMCID: PMC8836670 DOI: 10.3390/jcm11030536] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/27/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
Excessive levels of low-density lipoprotein cholesterol (LDL-C) in the blood are a known risk factor for atherosclerosis, and a common target of treatment for primary and secondary prevention of cerebrocardiovascular disease. As lipid lowering agents including statins, ezetimibe and anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have shown good therapeutic results, the guidelines are constantly lowering the "optimal" LDL-C goals. However, old and new data point towards an association between low LDL-C and total cholesterol and intracerebral hemorrhage (ICH). In this review we aimed to shed light on this troubling association and identify the potential risk factors of such a potential adverse reaction. With respect to the data presented, we concluded that in patients with high risk of ICH, a cautious approach and individualized therapy strategy are advised when considering aggressive LDL reduction.
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6
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Long-term risk of a major cardiovascular event by apoB, apoA-1, and the apoB/apoA-1 ratio-Experience from the Swedish AMORIS cohort: A cohort study. PLoS Med 2021; 18:e1003853. [PMID: 34851955 PMCID: PMC8635349 DOI: 10.1371/journal.pmed.1003853] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Elevated apolipoprotein B (apoB) and elevated apoB/apoA-1 ratio increase the risk of myocardial infarction (MI) and stroke, whereas high apoA-1 is protective. We study how these apolipoproteins are associated with major adverse cardiovascular events (MACEs), whether apoA-1 contributes to this association, and whether abnormal values occur decades before such events develop. METHODS AND FINDINGS In the Swedish AMORIS (Apolipoprotein-related MOrtality RISk) cohort study, 137,100 men and women aged 25-84 years were followed an average 17.8 years. ApoB, apoA-1, and the apoB/apoA-1 ratio were analysed in relation to MACEs (non-fatal MI, stroke, and cardiovascular [CV] mortality), yielding 22,473 events. Hazard ratios (HRs) were estimated using Cox regression. Kaplan-Meier estimates were used to investigate the relationship of MACEs with increasing quintiles of the apoB/apoA-1 ratio in all age groups for both sexes. In nested case-control analyses, cases were randomly matched to age- and sex-matched controls, yielding population trajectories for apolipoproteins. Increased level of apoB and increased apoB/apoA-1 ratio were associated with risk of MACE and all clinical sub-components in both men and women across all ages (10th versus first decile in both sexes combined: HR 1.7 for MACE and 2.7 for non-fatal MI). Decreased values of apoA-1 potentiated the impact of apoB at all levels of apoB (on average across apoB range: 40% increase in HR for MACE and 72% increase in HR for non-fatal MI), indicating that the apoB/apoA-1 ratio covers a broader range of persons with dyslipidaemia at risk than apoB alone. In both men and women, MACEs occurred earlier on average for each increasing quintile of the apoB/apoA-1 ratio. Individuals with the highest levels of apoB/apoA-1 ratio experienced CV events on average several years earlier than those with lower ratios. Higher apoB/apoA-1 ratio in cases of MACE versus controls was seen already about 20 years before the event. A limitation of this study was that adjustment for tobacco smoking and hypertension was only possible in a small validation study. CONCLUSIONS An imbalance between apoB and apoA-1 resulting in an increased apoB/apoA-1 ratio is strongly associated with the outcome MACE and its sub-components, in both men and women of all ages. An increased apoB/apoA-1 ratio already 2 decades before events calls for early recognition and primary prevention. Simple evidence-based cut values should be considered in future cardiovascular guidelines.
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Koch M, Aroner SA, Fitzpatrick AL, Longstreth WT, Furtado JD, Mukamal KJ, Jensen MK. HDL (High-Density Lipoprotein) Subspecies, Prevalent Covert Brain Infarcts, and Incident Overt Ischemic Stroke: Cardiovascular Health Study. Stroke 2021; 53:1292-1300. [PMID: 34645286 DOI: 10.1161/strokeaha.121.034299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Whether HDL (high-density lipoprotein) is associated with risk of vascular brain injury is unclear. HDL is comprised of many apo (apolipoprotein) species, creating distinct subtypes of HDL. METHODS We utilized sandwich ELISA to determine HDL subspecies from plasma collected in 1998/1999 from 2001 CHS (Cardiovascular Health Study) participants (mean age, 80 years). RESULTS In cross-sectional analyses, participants with higher apoA1 in plasma and lower apoE in HDL were less likely to have prevalent covert magnetic resonance imaging-defined infarcts: odds ratio for apoA1 Q4 versus Q1, 0.68 (95% CI, 0.50-0.93), and odds ratio for apoE Q4 versus Q1, 1.36 (95% CI, 1.01-1.84). Similarly, apoA1 in the subspecies of HDL that lacked apoC3, apoJ, or apoE was inversely related to covert infarcts, and apoE in the subspecies of HDL that lacked apoC3 or apoJ was directly related to covert infarcts in prospective analyses. In contrast, the concentrations of apoA1 and apoE in the complementary subspecies of HDL that contained these apos were unrelated to covert infarcts. Patterns of associations between incident overt ischemic stroke and apoA1, apoE, and apoA1 and apoE in subspecies of HDL were similar to those observed for covert infarcts but less pronounced. CONCLUSIONS This study highlights HDL subspecies defined by apo content as relevant biomarkers of covert and overt vascular brain injury.
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Affiliation(s)
- Manja Koch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.)
| | - Sarah A Aroner
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.).,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (S.A.A.)
| | - Annette L Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle. (A.L.F.).,Department of Epidemiology, University of Washington, Seattle. (A.L.F.).,Department of Global Health, University of Washington, Seattle. (A.L.F.)
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle. (W.T.L.).,Department of Epidemiology, University of Washington, Seattle. (W.T.L.)
| | - Jeremy D Furtado
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.)
| | - Kenneth J Mukamal
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.).,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (M.K., S.A.A., J.D.F., K.J.M., M.K.J.).,Department of Public Health, Section of Epidemiology, University of Copenhagen, Denmark (M.K.J.)
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8
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Santaolalla A, Sollie S, Rislan A, Josephs DH, Hammar N, Walldius G, Garmo H, Karagiannis SN, Van Hemelrijck M. Association between serum markers of the humoral immune system and inflammation in the Swedish AMORIS study. BMC Immunol 2021; 22:61. [PMID: 34488637 PMCID: PMC8420021 DOI: 10.1186/s12865-021-00448-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/07/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although the onset of inflammatory cascades may profoundly influence the nature of antibody responses, the interplay between inflammatory and humoral (antibody) immune markers remains unclear. Thus, we explored the reciprocity between the humoral immune system and inflammation and assessed how external socio-demographic factors may influence these interactions. From the AMORIS cohort, 5513 individuals were identified with baseline measurements of serum humoral immune [immunoglobulin G, A & M (IgG, IgA, IgM)] and inflammation (C-reactive protein (CRP), albumin, haptoglobin, white blood cells (WBC), iron and total iron-binding capacity) markers measured on the same day. Correlation analysis, principal component analysis and hierarchical clustering were used to evaluate biomarkers correlation, variation and associations. Multivariate analysis of variance was used to assess associations between biomarkers and educational level, socio-economic status, sex and age. RESULTS Frequently used serum markers for inflammation, CRP, haptoglobin and white blood cells, correlated together. Hierarchical clustering and principal component analysis confirmed the interaction between these main biological responses, showing an acute response component (CRP, Haptoglobin, WBC, IgM) and adaptive response component (Albumin, Iron, TIBC, IgA, IgG). A socioeconomic gradient associated with worse health outcomes was observed, specifically low educational level, older age and male sex were associated with serum levels that indicated infection and inflammation. CONCLUSIONS These findings indicate that serum markers of the humoral immune system and inflammation closely interact in response to infection or inflammation. Clustering analysis presented two main immune response components: an acute and an adaptive response, comprising markers of both biological pathways. Future studies should shift from single internal marker assessment to multiple humoral and inflammation serum markers combined, when assessing risk of clinical outcomes such as cancer.
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Affiliation(s)
- Aida Santaolalla
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK. .,Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Sam Sollie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
| | - Ali Rislan
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
| | - Debra H Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.,Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, UK
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Goran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Garmo
- Regional Cancer Center, Uppsala/Örebro, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sophia N Karagiannis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, Guy's Hospital, London, UK.,Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.,Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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9
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Zhang N, Wu X, Tian M, Wang X, Ding J, Tian Y, Liang C, Zeng Z, Xiang H, Tan H. Additive interaction between potentially modifiable risk factors and ethnicity among individuals in the Han, Tujia and Miao populations with first-ever ischaemic stroke. BMC Public Health 2021; 21:1059. [PMID: 34082746 PMCID: PMC8173719 DOI: 10.1186/s12889-021-11115-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 05/23/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND As a country with one-fifth of the global population, China has experienced explosive growth in ischaemic stroke (IS) burden with significant ethnic and geographic disparities. The aim of this study was to examine the differences in potentially modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao). METHODS A case-control study was conducted with 324 cases of first-ever ischaemic stroke from the hospitals of the Xiangxi Tujia and Miao Autonomous Prefecture and 394 controls from communities covering the same area between May 1, 2018, and April 30, 2019. Structured questionnaires were administered, and physical examinations were performed in the same manner for cases and controls. Univariate and multivariate logistic regression analyses with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were used to examine the association between risk factors and ischaemic stroke. An additive model was used to study the interaction between the modifiable risk factors and ethnicity with R software. RESULTS Higher high-sensitivity C-reactive protein levels (OR 50.54, 95%CI 29.76-85.85), higher monthly family income (4.18, 2.40-7.28), increased frequency of hot pot consumption (2.90, 1.21-6.93), diabetes mellitus (2.62, 1.48-4.62), a higher apolipoprotein (Apo)B/ApoA1 ratio (2.60, 1.39-4.85), hypertension (2.52, 1.45-4.40) and moderate-intensity physical activity (0.50, 0.28-0.89) were associated with ischaemic stroke. There was an additive interaction between the ApoB/ApoA1 ratio and ethnicity in the Tujia and Miao populations with first-ever ischaemic stroke (the relative excess risk due to the interaction was 5.75, 95% CI 0.58 ~ 10.92; the attributable proportion due to the interaction was 0.65, 95% CI 0.38 ~ 0.91; the synergy index was 3.66, 95% CI 1.35 ~ 9.93). CONCLUSIONS This is the first case-control study examining modifiable risk factors for ischaemic stroke among the Han population and two ethnic minorities (Tujia and Miao) in China. Some differences were observed in the impact of risk factors among these ethnic groups. Our results may help interpret health-related data, including surveillance and research, when developing strategies for stroke prevention.
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Affiliation(s)
- Na Zhang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Hunan Provincial Institute of Geriatrics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Xinrui Wu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Mengyuan Tian
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xiaolei Wang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jian Ding
- Hunan Provincial Institute of Geriatrics, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Yong Tian
- Department of Neurology, the First Affiliated Hospital of Jishou University, the Tujia-Miao autonomous prefecture of Xiangxi, Hunan, China
| | - Chengcai Liang
- Department of Neurology, the First Affiliated Hospital of Jishou University, the Tujia-Miao autonomous prefecture of Xiangxi, Hunan, China
| | - Zhi Zeng
- Department of Neurology, the First Affiliated Hospital of Jishou University, the Tujia-Miao autonomous prefecture of Xiangxi, Hunan, China
| | - Hua Xiang
- Interventional Radiology Center, Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China.
| | - Hongzhuan Tan
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China. .,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
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10
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Qie R, Liu L, Zhang D, Han M, Wang B, Zhao Y, Liu D, Guo C, Li Q, Zhou Q, Tian G, Huang S, Wu X, Qin P, Li J, Cao J, Zhang M, Huang J, Lu J, Hu D. Dose-Response Association Between High-Density Lipoprotein Cholesterol and Stroke: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Prev Chronic Dis 2021; 18:E45. [PMID: 33988499 PMCID: PMC8139481 DOI: 10.5888/pcd18.200278] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Studies investigating the effect of high-density lipoprotein cholesterol (HDL-C) on stroke and stroke subtypes have reached inconsistent conclusions. The purpose of our study was to clarify the dose-response association between HDL-C level and risk of total stroke and stroke subtypes by a systematic review and meta-analysis. METHODS We performed a systematic search of PubMed, Embase, and Web of Science databases through July 30, 2020, for prospective cohort studies that reported the HDL-C-stroke association and extracted the estimate that was adjusted for the greatest number of confounding factors. Restricted cubic splines were used to evaluate the linear and nonlinear dose-response associations. RESULTS We included 29 articles, which reported on 62 prospective cohort studies including 900,501 study participants and 25,678 with stroke. The summary relative risk per 1-mmol/L increase in HDL-C level for total stroke was 0.82 (95% CI, 0.76-0.89; I2 = 42.9%; n = 18); ischemic stroke (IS), 0.75 (95% CI, 0.69-0.82; I2 = 50.1%; n = 22); intracerebral hemorrhage (ICH), 1.21 (95% CI, 1.04-1.42; I2 = 33.4%; n = 10); and subarachnoid hemorrhage (SAH), 0.98 (95% CI, 0.96-1.00; I2 = 0%; n = 7). We found a linear inverse association between HDL-C level and risk of total stroke and SAH, a nonlinear inverse association for IS risk, but a linear positive association for ICH risk. The strength and the direction of the effect size estimate for total stroke, IS, ICH, and SAH remained stable for most subgroups. We found no publication bias with Begg's test and Egger's test for the association of HDL-C level with risk of total stroke, IS, and ICH. CONCLUSION A high HDL-C level is associated with reduced risk of total stroke and IS and an increased risk of ICH.
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Affiliation(s)
- Ranran Qie
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Leilei Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongdong Zhang
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Minghui Han
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bingyuan Wang
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dechen Liu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chunmei Guo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Qionggui Zhou
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shengbing Huang
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xiaoyan Wu
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Pei Qin
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Jianxin Li
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Cao
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ming Zhang
- School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China
| | - Jianfeng Huang
- Study Team of Shenzhen's Sanming Project, The Affiliated Luohu Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong, People's Republic of China.,Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100, Kexue Avenue, Gaoxin District, Zhengzhou, Henan 450001, People's Republic of China.
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11
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Investigation of brain damage mechanism in middle cerebral artery occlusion/reperfusion rats based on i-TRAQ quantitative proteomics. Exp Brain Res 2021; 239:1247-1260. [PMID: 33599834 DOI: 10.1007/s00221-021-06054-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/01/2021] [Indexed: 01/04/2023]
Abstract
The objective of this study is to analyze the differential protein expression profile in cerebral cortex of rats with middle cerebral ischemia/reperfusion (MCAO/R), explore the brain damage mechanism of MCAO/R at protein level, and provide experimental foundation for searching specific marker proteins of MCAO/R. Rat model of MCAO/R was established by modified suture-occluded method, and the model was evaluated by the results of brain 2,3,5-triphenyltetrazolium chloride (TTC) and hematoxylin-eosin (HE) staining. Cerebral cortex of rats from sham-operated group (Sham) and MCAO/R groups was used for FASP enzymatic hydrolysis, i-TRAQ quantitative labeling, and reverse-phase liquid chromatography purification and separation. Orbitrap Q Exactive mass spectrometry was used for qualitative and quantitative analyses of total differential protein expression profiles. MCAO/R rats had obvious cerebral infarction lesions, and the relative surface area of cerebral infarction was significantly different compared with sham rats, suggesting that MCAO/R rat model was successfully prepared. There were 199 significant difference proteins (MCAO/R vs Sham, p < 0.05, |fold change|> 1.2), including 104 up-regulated proteins and 95 down-regulated proteins. Gene ontology (GO) enrichment analysis showed that the up-regulated proteins were mainly concentrated in the biological processes of positive regulation of NF-κB transcription and I-κB kinase-NF-κB, etc. Down-regulated proteins were mainly concentrated in long-term synaptic potentiation, cellular response to DNA damage stimulus, etc. KEGG pathway analysis showed that the pathway involved in differential proteins includes oxidative phosphorylation, metabolic pathway, and Ras signaling pathway. Network analysis of differential proteins showed that Alb, ndufb5, ndufs7, ApoB, Cdc42, Ndufa3, Igf1r, P4hb, Mbp, Gc, Nme1, Akt2, and other proteins may play an important role in regulating oxidative stress, apoptosis, and inflammatory response in MCAO/R. Quantitative proteomics based on i-TRAQ labeling reveals the effect of inflammation and apoptosis in brain damage mechanism of MCAO/R. Besides, this research provide some experimental foundation for search and determination of potential therapeutic targets of MCAO/R.
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12
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Chou YC, Chan PC, Yang T, You SL, Bai CH, Sun CA. Apolipoprotein B Level and the Apolipoprotein B/Apolipoprotein A-I Ratio as a Harbinger of Ischemic Stroke: A Prospective Observation in Taiwan. Cerebrovasc Dis 2020; 49:487-494. [PMID: 32950994 DOI: 10.1159/000509452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022] Open
Abstract
AIM Prospective studies indicate that apolipoprotein (apo) measurements predict coronary heart disease risk. However, few population-based follow-up studies have addressed the predictive value of apo measurements in stroke risk. The aims of the present study were to analyze the predictive ability of apo measurements in the risk of ischemic stroke. METHODS Serum apo A-I and apo B levels and calculated apo B/apo A-I ratio were measured at baseline in 2002 in a cohort of 4,204 participants who were followed for a mean of 4.61 years for a stroke event. RESULTS After adjustment for potential confounders, a significantly stepwise increase in the incidence rate of stroke across quartiles of both apo B and the apo B/apo A-I ratio was evident in both genders and across age-groups. The predictive ability of apo B to detect ischemic stroke was comparable with that of the apo B/apo A-I ratio. Furthermore, both apo B and the apo B/apo A-I ratio were better predictors of the risk of ischemic stroke than total cholesterol (TC), low-density lipoprotein cholesterol, and the TC/high-density lipoprotein cholesterol ratio. CONCLUSIONS This cohort study demonstrates that apo B and the apo B/apo A-I ratio were a significant risk predictor of stroke. Furthermore, the predictive ability of apo B and the apo B/apo A-I ratio in stroke risk was better than routine clinical lipid measurements. Thus, measurements of apolipoproteins have superior clinical utility over traditional lipid measurements in identifying subjects at risk for ischemic stroke.
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Affiliation(s)
- Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Po-Chi Chan
- Department of Neurology, Show-Chwan Memorial Hospital, Changhua County, Taiwan
| | - Tsan Yang
- Department of Health Business Administration, Meiho University, Pingtung County, Taiwan
| | - San-Lin You
- Department of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chyi-Huey Bai
- Department of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan
| | - Chien-An Sun
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, .,Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan,
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13
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Sollie S, Santaolalla A, Michaud DS, Sarker D, Karagiannis SN, Josephs DH, Hammar N, Walldius G, Garmo H, Holmberg L, Jungner I, Van Hemelrijck M. Serum Immunoglobulin G Is Associated With Decreased Risk of Pancreatic Cancer in the Swedish AMORIS Study. Front Oncol 2020; 10:263. [PMID: 32185133 PMCID: PMC7059192 DOI: 10.3389/fonc.2020.00263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Emerging evidence points to potential roles of the humoral immune responses in the development of pancreatic cancer. Epidemiological studies have suggested involvement of viral and bacterial infections in pancreatic carcinogenesis. Experimental studies have reported high expression levels of antigens in pancreatic cancer cells. Therefore, we aimed to investigate the role of different components of humoral immunity in the context of pancreatic cancer. We evaluated associations between pre-diagnostic serum markers of the overall humoral immune system [immunoglobulin A (IgA), immunoglobulin G (IgG) and immunoglobulin M (IgM)], and the risk of pancreatic cancer in the Swedish Apolipoprotein-related MORtality RISk (AMORIS) study. Methods: We selected all participants (≥20 years old) with baseline measurements of IgA, IgG or IgM (n = 41,900, 136,221, and 29,919, respectively). Participants were excluded if they had a history of chronic pancreatitis and individuals were free from pancreatic cancer at baseline. Multivariate Cox proportional hazards regression was used to estimate risk of pancreatic cancer for medical cut-offs of IgA, IgG, and IgM. Results: Compared to the reference level of 6.10–14.99 g/L, risk of pancreatic cancer was elevated among those with IgG levels <6.10 g/L [HR: 1.69 (95% CI 0.99–2.87)], and an inverse association was observed among those with IgG levels ≥15.00 g/L [0.82 (95% CI 0.64–1.05); Ptrend = 0.027]. The association appeared to be stronger for women than men [HR: 0.64 (95% CI 0.43–0.97) and 0.95 (95% CI 0.69–1.29), respectively]. No associations were observed with IgA or IgM. Conclusion: An inverse association was observed between pre-diagnostic serum levels of IgG and risk of pancreatic cancer. Our findings highlight the need to further investigate the role of immune response in pancreatic cancer etiology.
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Affiliation(s)
- Sam Sollie
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Aida Santaolalla
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Debashis Sarker
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Sophia N Karagiannis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, Guy's Hospital, London, United Kingdom
| | - Debra H Josephs
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Goran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Garmo
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Lars Holmberg
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Ingmar Jungner
- Clinical Epidemiological Unit, Department of Medicine, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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14
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Ma C, Na M, Neumann S, Gao X. Low-Density Lipoprotein Cholesterol and Risk of Hemorrhagic Stroke: a Systematic Review and Dose-Response Meta-analysis of Prospective Studies. Curr Atheroscler Rep 2019; 21:52. [PMID: 31748963 DOI: 10.1007/s11883-019-0815-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To systematically examine the association between low-density lipoprotein cholesterol (LDL-C) and risk of hemorrhagic stroke. RECENT FINDINGS A previous meta-analysis of prospective studies published in 2013 showed that higher concentrations of LDL-C were associated with lower risk of hemorrhagic stroke. Recently, seven large cohort studies were published examining LDL-C and risk of hemorrhagic stroke in different populations. Twelve prospective studies with 476,173 participants and 7587 hemorrhagic stroke cases were included in the current meta-analysis. The results showed that a 10 mg/dL increase in LDL-C was associated with 3% lower risk of hemorrhagic stroke (pooled relative risk [RR] 0.97, 95% confidence interval [CI] 0.95-0.98). The association appeared to be more pronounced in Asians (pooled RR 0.95, 95% CI 0.92-0.98), relative to Caucasians (pooled RR 0.98, 95% CI 0.97-1.00), with a p heterogeneity of 0.05 between two ethnic groups. Further genetic studies and clinical trials with a stricter safety monitoring strategy are warranted to understand the underlying pathogenesis and determine the treatment target of LDL-C range with the lowest risk of hemorrhagic stroke in different population groups.
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Affiliation(s)
- Chaoran Ma
- Department of Nutritional Sciences, Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
| | - Muzi Na
- Department of Nutritional Sciences, Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA
| | - Samantha Neumann
- Eberly College of Science, Pennsylvania State University, University Park, PA, 16802, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, 110 Chandlee Lab, University Park, PA, 16802, USA.
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15
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Kessler A, Sollie S, Karagiannis SN, Walldius G, Hammar N, Van Hemelrijck M. Serum IgG Is Associated With Risk of Melanoma in the Swedish AMORIS Study. Front Oncol 2019; 9:1095. [PMID: 31737561 PMCID: PMC6828930 DOI: 10.3389/fonc.2019.01095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Relatively little is known about the role of the humoral immune system in melanoma. Tumor infiltrating B cells in melanoma patients have been associated with increased T cell activation in tumors as well as improved patient survival. Immunoglobulins may play an important part in the anti-tumor immune response. We hypothesized that increased levels of pre-diagnostic serum Ig may be protective against melanoma development. Hence, we evaluated associations between pre-diagnostic serum markers of the immunoglobulin A (IgA), IgG and IgM, and risk of developing melanoma in the Swedish Apolipoprotein-related MORtality RISk (AMORIS) study. Methods: Study participants aged ≥20 years with baseline measurements of IgG, IgA and IgM taken between 1985 and 1996 were selected (n = 29,876). All individuals were free from melanoma at baseline and 162 study participants developed melanoma during follow up. Cox proportional hazards regression was carried out for medical cut-offs of IgA, IgG, and IgM. Results: Compared to the reference level of 6.10–14.99 g/l, we observed a positive but not significant association with risk of melanoma for those with IgG levels <6.10 g/L [HR: 1.05 (95% CI 0.39–2.86)] and an inverse association for those with IgG levels ≥15.00 g/L [HR: 0.60 (95% CI 0.34–1.05); Ptrend = 0.08]. No associations with serum IgA or IgM were identified. Conclusions: The humoral response might provide a protective role against the development of melanoma, mediated through IgG. Further research is needed to characterize this response which may be exploitable for development of future therapies.
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Affiliation(s)
- Anna Kessler
- Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sam Sollie
- Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sophia N Karagiannis
- School of Basic and Medical Biosciences, St John's Institute of Dermatology, King's College London, Guy's Hospital, London, United Kingdom
| | - Goran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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16
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Sollie S, Michaud DS, Sarker D, Karagiannis SN, Josephs DH, Hammar N, Santaolalla A, Walldius G, Garmo H, Holmberg L, Jungner I, Van Hemelrijck M. Chronic inflammation markers are associated with risk of pancreatic cancer in the Swedish AMORIS cohort study. BMC Cancer 2019; 19:858. [PMID: 31464604 PMCID: PMC6716919 DOI: 10.1186/s12885-019-6082-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/23/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Nested case-control studies examining the association between serum markers of chronic inflammation, focused on three specific biomarkers (CRP, IL-8 and TNF-α), and risk of pancreatic cancer have reported no associations. In this study, we evaluated associations between standard pre-diagnostic serum markers of chronic inflammation (CRP, albumin, haptoglobin and leukocytes) and pancreatic cancer risk in the Swedish Apolipoprotein-related MORtality RISk (AMORIS) prospective cohort study. METHODS We selected all participants (≥20 years old) with baseline measurements of CRP, albumin, haptoglobin and leukocytes between 1985 and 1996 (n = 61,597). Participants were excluded if they had a history of chronic pancreatitis and all individuals were free from pancreatic cancer at baseline. Cox proportional multivariable hazards regression analysis was carried out for medical cut-offs of CRP, albumin, haptoglobin and leukocytes. RESULTS We observed an increased risk of pancreatic cancer for those individuals with higher levels of serum haptoglobin (≥1.4 g/L), CRP (≥10 mg/L) and leukocytes (≥10 × 109 cells/L) compared to those with haptoglobin levels < 1.4 g/L, CRP levels < 10 mg/L and Leukocyte levels < 10 × 109 cells/L [haptoglobin HR: 2.23 (95% CI 1.72-2.88), CRP HR: 1.32 (95% CI 1.00-1.74), leukocytes HR: 2.20 (95% CI 1.52-3.18)]. No associations were noted for serum albumin. CONCLUSIONS We found an increased risk of pancreatic cancer associated with pre-diagnostic serum levels of haptoglobin, CRP and leukocytes. Our finding suggests a possible role of chronic inflammation in the aetiology of pancreatic cancer and highlight the need to further investigate this association.
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Affiliation(s)
- Sam Sollie
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), 3rd Floor, Bermondsey Wing, Guy’s Hospital London, London, SE1 9RT UK
| | - Dominique S. Michaud
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI USA
| | - Debashis Sarker
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), 3rd Floor, Bermondsey Wing, Guy’s Hospital London, London, SE1 9RT UK
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Sophia N. Karagiannis
- St John’s Institute of Dermatology, School of Basics and Medical Biosciences, King’s College London, Guy’s Hospital, London, UK
| | - Debra H. Josephs
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), 3rd Floor, Bermondsey Wing, Guy’s Hospital London, London, SE1 9RT UK
- Department of Medical Oncology, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aida Santaolalla
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), 3rd Floor, Bermondsey Wing, Guy’s Hospital London, London, SE1 9RT UK
| | - Goran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Garmo
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), 3rd Floor, Bermondsey Wing, Guy’s Hospital London, London, SE1 9RT UK
| | - Lars Holmberg
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), 3rd Floor, Bermondsey Wing, Guy’s Hospital London, London, SE1 9RT UK
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- King’s College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR), 3rd Floor, Bermondsey Wing, Guy’s Hospital London, London, SE1 9RT UK
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Ma C, Gurol ME, Huang Z, Lichtenstein AH, Wang X, Wang Y, Neumann S, Wu S, Gao X. Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study. Neurology 2019; 93:e445-e457. [PMID: 31266905 PMCID: PMC6693427 DOI: 10.1212/wnl.0000000000007853] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To prospectively examine the association between low-density lipoprotein (LDL) cholesterol (LDL-C) concentrations and intracerebral hemorrhage (ICH) risk. METHODS The current cohort study included 96,043 participants (mean age 51.3 years) who were free of stroke, myocardial infarction, and cancer at baseline (2006). Serum LDL-C concentrations were assessed in 2006, 2008, 2010, and 2012. Cumulative average LDL-C concentrations were calculated from all available LDL-C data during that period. Incident ICH was confirmed by review of medical records. RESULTS We identified 753 incident ICH cases during 9 years of follow-up. The ICH risk was similar among participants with LDL concentrations of 70 to 99 mg/dL and those with LDL-C concentrations ≥100 mg/dL. In contrast, participants with LDL-C concentrations <70 mg/dL had a significantly higher risk of developing ICH than those with LDL-C concentrations of 70 to 99 mg/dL; adjusted hazard ratios were 1.65 (95% confidence interval [CI] 1.32-2.05) for LDL-C concentrations of 50 to 69 mg/dL and 2.69 (95% CI 2.03-3.57) for LDL-C concentrations <50 mg/dL. CONCLUSIONS We observed a significant association between lower LDL-C and higher risk of ICH when LDL-C was <70 mg/dL, and the association became nonsignificant when LDL-C ≥70 mg/dL. These data can help determination of the ideal LDL range in patients who are at increased risk of both atherosclerotic disease and hemorrhagic stroke and guide planning of future lipid-lowering studies.
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Affiliation(s)
- Chaoran Ma
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - M Edip Gurol
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Zhe Huang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Alice H Lichtenstein
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Xiuyan Wang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Yuzhen Wang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Samantha Neumann
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Shouling Wu
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA.
| | - Xiang Gao
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA.
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18
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Shen H, Tu X, Luan X, Zeng Y, He J, Tang W. Serum lipid profiles and post-stroke depression in acute ischemic stroke patients. Neuropsychiatr Dis Treat 2019; 15:1573-1583. [PMID: 31354274 PMCID: PMC6589522 DOI: 10.2147/ndt.s204791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 05/13/2019] [Indexed: 01/18/2023] Open
Abstract
Purpose: Post-stroke depression (PSD) is a psychiatric complication after stroke that leads to poorer stroke outcomes. Recent observational studies have indicated that lipid profiles were associated with a higher risk of stroke and depression. This study aims to further explore the possible relationship between serum lipid profiles and the development of PSD. Methods: A total of 373 acute ischemic stroke patients were examined. Serum lipid profiles including high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), apolipoprotein A1 (Apo A1) and apolipoprotein B (Apo B) were measured within 24 hrs of admission. Depression symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17) at the one-month follow-up, and HAMD scores ≥7 indicated a diagnosis of PSD. Results: A total of 114 patients were diagnosed with PSD at the one-month follow-up, for a percentage of 30.6%. There were significant differences in HDL-C levels (P<0.001), LDL-C levels (P=0.002) and the LDL/HDL ratio (P<0.001) between the PSD and non-PSD groups, but no differences were observed in TGs, TC, Apo A1 or Apo B. Low serum HDL-C levels (r = -0.157, P<0.001) and elevated LDL-C levels (r =0.139, P=0.002) and the LDL/HDL ratio (r =0.227, P<0.001) were associated with HAMD scores. After adjusting for the NIHSS score, BI score, mRS score and alcohol consumption in the logistic analysis, low HDL-C levels and the highest quartile (≥3.07) of the LDL/HDL ratio were independently associated with the development of PSD (OR =0.250, 95% CI, 0.077-0.813, P=0.021 and OR =1.874, 95% CI, 1.050-3.347, P=0.034, respectively). Conclusion: Decreased levels of HDL-C and elevated levels of LDL/HDL ratio are associated with PSD. HDL-C and the LDL/HDL ratio are independent predictors of PSD.
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Affiliation(s)
- Huiping Shen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China.,First School of Clinical Medicie, Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Xinjie Tu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Yaying Zeng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China.,First School of Clinical Medicie, Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Wenjie Tang
- First School of Clinical Medicie, Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
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19
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Cheng KH, Lin JR, Anderson CS, Lai WT, Lee TH. Lipid Paradox in Statin-Naïve Acute Ischemic Stroke But Not Hemorrhagic Stroke. Front Neurol 2018; 9:541. [PMID: 30210423 PMCID: PMC6124481 DOI: 10.3389/fneur.2018.00541] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Low lipid level is associated with better cardiovascular outcome. However, lipid paradox indicating low lipid level having worse outcomes could be seen under acute injury in some diseases. The present study was designed to clarify the prognostic significance of acute-phase lipid levels within 1 day after admission for stroke on mortality in first-ever statin-naïve acute ischemic stroke (IS) and hemorrhagic stroke (HS). Methods: This observational study was conducted using the data collected from Stroke Registry In Chang-Gung Healthcare System (SRICHS) between 2009 and 2012. Patients with recurrent stroke, onset of symptoms >1 day, and history of the use of lipid-lowering agents prior to index stroke were excluded. Stroke was classified into IS and hypertension-related HS. The primary outcomes were 30-day and 1-year mortality identified by linkage to national death registry for date and cause of death. Receiver operating characteristic (ROC) curve analysis and multivariate Cox proportional hazard models were used to examine the association of lipid profiles on admission with mortality. Results: Among the 18,268 admitted stroke patients, 3,746 IS and 465 HS patients were eligible for analysis. In IS, total cholesterol (TC) <163.5 mg/dL, triglyceride (TG) <94.5 mg/dL, low-density lipoprotein (LDL) <100 mg/dL, non-high-density lipoprotein cholesterol (non-HDL-C) <130.5 mg/dL, and TC/HDL ratio <4.06 had significantly higher risk for 30-day/1-year mortality with hazard ratio (HR) of 2.05/1.37, 1.65/1.31, 1.68/1.38, 1.80/1.41, and 1.58/1.38, respectively, compared with high TC, TG, LDL, non-HDL-C, and TC/HDL ratio (p < 0.01 in all cases). In HS, lipid profiles were not associated with mortality, except HDL for 30-day mortality (p = 0.025) and high uric acid (UA) concentrations for 30-day and 1-year mortality (p = 0.002 and 0.012, respectively). High fasting glucose and high National Institute of Health Stroke Scale (NIHSS) score at admission were associated with higher 30-day and 1-year mortality in both IS and HS and low blood pressure only in IS (p < 0.05). Synergic effects on mortality were found when low lipids were incorporated with high fasting glucose, low blood pressure, and high NIHSS score in IS (p < 0.05). Conclusions: Lipid paradox showing low acute-phase lipid levels with high mortality could be seen in statin-naïve acute IS but not in HS. The mortality in IS was increased when low lipids were incorporated with high fasting glucose, low blood pressure, and high NIHSS score.
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Affiliation(s)
- Kai-Hung Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Craig S Anderson
- Neurological and Mental Health Division, The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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20
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Liu X, Yu S, Mao Z, Li Y, Zhang H, Yang K, Zhang H, Liu R, Qian X, Li L, Bie R, Wang C. Dyslipidemia prevalence, awareness, treatment, control, and risk factors in Chinese rural population: the Henan rural cohort study. Lipids Health Dis 2018; 17:119. [PMID: 29788966 PMCID: PMC5964901 DOI: 10.1186/s12944-018-0768-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of dyslipidemia continue to increase in recent decades in China, however, little is known about the recent prevalence, awareness, treatment, control, and potential risk factors of dyslipidemia in the rural areas of China. METHODS A total of 39,207 participants aged 18-79 years were recruited for the epidemiological research from the Henan Rural Cohort study. The age- and sex-adjusted means (95% confidence intervals, CI) of serum lipid levels or percentages of prevalence, awareness, treatment, and control overall and in various population subgroups were estimated and compared by multiple linear regression or logistic regression. The multivariable logistic regression model was used to explore the associations between the socio-demographic factors and the prevalence, awareness, treatment and control of dyslipidemia. RESULTS The age- and sex-adjusted mean levels (95%CI) of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were 4.76(4.75-4.77), 1.68(1.67-1.69),1.33(1.32-1.33), and 2.87 (2.86-2.88) mmol/L, respectively. Overall, the age-standardized prevalence of dyslipidemia was 32.21% (42.85% in men vs. 26.16% in women) in Chinese rural adults, with 5.11, 16.00, 19.27, and 4.76% for high TC, high TG, low HDL-C and high LDL-C, respectively. The age-standardized awareness, treatment and control of dyslipidemia were 15.07, 7.23, and 3.25%, respectively, which were higher in women than men, and increased steeply with age (P trend < 0.05). The proportion of prevalence, awareness, treatment, control of dyslipidemia differed significantly among various subpopulations while the awareness, treatment, and control rates were universally low in all subgroups (< 54, 36, and 15%, respectively). Increasing age, men, unhealthy lifestyles, positive family history of dyslipidemia, abnormal weight, type 2 diabetes mellitus and hypertension were independent risk factors of dyslipidemia. CONCLUSION Dyslipidemia was common with unacceptably low awareness, treatment and control rates in rural China. Therefore, effective strategies are necessary for improving the status of the prevention, diagnosis, treatment, control of dyslipidemia in Chinese rural residents. TRIAL REGISTRATION ChiCTR-OOC-15006699.
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Affiliation(s)
- Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Songcheng Yu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Kaili Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Honglei Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Ruihua Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Xinling Qian
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China
| | - Ronghai Bie
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, People's Republic of China.
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Lindbohm J, Korja M, Jousilahti P, Salomaa V, Kaprio J. Adverse lipid profile elevates risk for subarachnoid hemorrhage: A prospective population-based cohort study. Atherosclerosis 2018; 274:112-119. [PMID: 29772479 DOI: 10.1016/j.atherosclerosis.2018.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Studies report that both high and low total cholesterol (TC) elevates SAH risk. There are few prospective studies on high-density lipoproteins (HDL-C) and low-density lipoproteins (LDL-C), and apparently none concerns apolipoproteins A and B. We aimed to clarify the association between lipid profile and SAH risk. METHODS The National FINRISK study provided risk-factor data recorded at enrolment between 1972 and 2007. During 1.52 million person-years of follow-up until 2014, 543 individuals suffered from incident hospitalized SAH or outside-hospital-fatal SAH. Cox proportional hazards model was used to calculate the hazard ratios and multiple imputation predicted ApoA1, ApoB, and LDL-C values for cohorts from a time before apolipoprotein-measurement methods were available. RESULTS One SD elevation (1.28 mmol/l) in TC elevated SAH risk in men (hazard ratio (HR) 1.15 (95% CIs 1.00-1.32)). Low HDL-C levels increased SAH risk, as each SD decrease (0.37 mmol/l) in HDL-C raised the risk in women (HR 1.29 (95% CIs 1.07-1.55)) and men (HR 1.20 (95% CIs 1.14-1.27)). Each SD increase (0.29 g/l) in ApoA1 decreased SAH risk in women (HR 0.85 (95% CIs 0.74-0.97)) and men (HR 0.88 (95% CIs 0.76-1.02)). LDL-C (SD 1.07 mmol/l) and ApoB (SD 0.28 g/l) elevated SAH risk in men with HR 1.15 (95% CIs 1.01-1.31) and HR 1.26 (95% CIs 1.10-1.44) per one SD increase. Age did not change these findings. CONCLUSIONS An adverse lipid profile seems to elevate SAH risk similar to its effect in other cardiovascular diseases, especially in men. Whether SAH incidence diminishes with increasing statin use remains to be studied.
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Affiliation(s)
- Joni Lindbohm
- Department of Public Health, University of Helsinki, P.O. Box 20, FI-00014, Helsinki, Finland; Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland.
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, FI-00029, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Health, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Veikko Salomaa
- Department of Health, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, P.O. Box 20, FI-00014, Helsinki, Finland; Institute for Molecular Medicine FIMM, P.O. Box 20, FI-00014, Helsinki, Finland
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22
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Yiu A, Van Hemelrijck M, Garmo H, Holmberg L, Malmström H, Lambe M, Hammar N, Walldius G, Jungner I, Wulaningsih W. Circulating uric acid levels and subsequent development of cancer in 493,281 individuals: findings from the AMORIS Study. Oncotarget 2018; 8:42332-42342. [PMID: 28418841 PMCID: PMC5522070 DOI: 10.18632/oncotarget.16198] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/06/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives Serum uric acid has been suggested to be associated with cancer risk. We aimed to study the association between serum uric acid and cancer incidence in a large Swedish cohort. Results A positive association was found between uric acid levels and overall cancer risk, and results were similar with adjustment for glucose, triglycerides and BMI. Hazard ratio (HR) for overall cancer for the 4th quartile of uric acid compared to the 1st was 1.08 (95% CI: 1.05–1.11) in men and 1.12 (1.09 – 1.16) in women. Site-specific analysis showed a positive association between uric acid and risk of colorectal, hepatobiliary, kidney, non-melanoma skin, and other cancers in men and of head and neck and other cancers in women. An inverse association was observed for pulmonary and central nervous system (CNS) cancers in men and breast, lymphatic and haematological, and CNS malignancies in women. Materials and Methods We included 493,281 persons aged 20 years and older who had a measurement of serum uric acid and were cancer-free at baseline in the AMORIS study. Multivariable Cox proportional hazards regression was used to investigate sex-specific quartiles of serum uric acid in relation to cancer risk in men and women. Analysis was further adjusted for serum glucose, triglycerides and, where available, BMI. Site-specific analysis was performed for major cancers. Conclusions Altered uric acid levels were associated with risk of overall and some specific cancers, further indicating the potential role of uric acid metabolism in carcinogenesis.
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Affiliation(s)
- Andrew Yiu
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK
| | - Mieke Van Hemelrijck
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.,Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hans Garmo
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.,Regional Cancer Centre, Uppsala, Sweden
| | - Lars Holmberg
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.,Regional Cancer Centre, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Håkan Malmström
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,AstraZeneca R&D, Mölndal, Sweden
| | - Göran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Wahyu Wulaningsih
- King's College London, Division of Cancer Studies, Cancer Epidemiology Group, London, UK
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23
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Rygiel K. Hypertriglyceridemia - Common Causes, Prevention and Treatment Strategies. Curr Cardiol Rev 2018; 14:67-76. [PMID: 29366425 PMCID: PMC5872265 DOI: 10.2174/1573403x14666180123165542] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Prevention and treatment of dyslipidemias represent the key issues of Cardiovascular Disease (CVD) prophylaxis. Consequently, the effective management of different types of lipid disorders, including hypertriglyceridemia, should be a priority for the healthcare practitioners (e.g.: cardiology and endocrinology specialists, primary care physicians, dietitians, and pharmacists), who provide medical care, as well as for the patients, who receive this care, and need to be directly engaged in it, in order to improve their outcomes. The aim of this review is to facilitate the translation of current trends in hypertriglyceridemia management into a daily practice. The article focuses on the common causes and consequences of hypertriglyceridemia, and discusses diagnostic evaluation and therapeutic options for patients with high Triglyceride (TG) levels and CVD risk. CONCLUSION This review presents the main practice-related strategies, based on the current guidelines for the management of dyslipidemias and CVD risk, according to the European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS), and the American College of Cardiology (ACC)/American Heart Association (AHA), including both non-pharmacological, and pharmacological approaches. It also addresses the beneficial impact of pharmaceutical Care (PC) interventions on clinical outcomes of patients with lipid disorders and CVD risk (in light of Randomized Controlled Trials (RCT) data), and underlines the importance of close cooperation between physicians and pharmacists, who manage such patients.
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Affiliation(s)
- Katarzyna Rygiel
- Department of Family Practice, Medical University of Silesia (SUM), Katowice-Zabrze, Poland
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24
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Yin ZG, Wang QS, Yu K, Wang WW, Lin H, Yang ZH. Sex differences in associations between blood lipids and cerebral small vessel disease. Nutr Metab Cardiovasc Dis 2018; 28:28-34. [PMID: 29162363 DOI: 10.1016/j.numecd.2017.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/31/2017] [Accepted: 10/01/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Dyslipidemia predicts higher risk of coronary events and stroke and might be associated with cerebral small vessel disease (SVD). Previous studies linking blood lipids and SVD have yielded inconsistent results, which may be attributable to sex differences in lipids metabolism. The aim of this study was to investigate the relationships between blood lipids and SVD in neurologically healthy men and women. METHODS AND RESULTS Consecutive 817 people aged 50 years or more were enrolled and underwent magnetic resonance imaging scans to evaluate the periventricular white matter lesions (PVWMLs), deep white matter lesions (DWMLs) and silent brain infarction (SBI). Fasting total cholesterol, triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, apolipoprotein A-1 (apoA-1) and apolipoprotein B were assessed. Multivariable logistic regression analyses were performed to determine the associations of blood lipids with PVWMLs, DWMLs and SBI. HDL-C (for PVWMLs: OR 0.36, 95% CI 0.19-0.71; for DWMLs: OR 0.35, 95% CI 0.20-0.63) and apoA-1 (for PVWMLs: OR 0.27, 95% CI 0.11-0.66; for DWMLs: OR 0.22, 95% CI 0.10-0.48) were inversely associated with the severity of PVWMLs and DWMLs in women but not in men after adjustment for age, hypertension, diabetes, current smoking, daily drinking, body mass index and uric acid. Additionally, no blood lipids were significantly associated with SBI. CONCLUSIONS Our findings demonstrate that sex differences may exist in the associations between lipids and SVD. HDL-C and apoA-1 levels were inversely associated with the severity of PVWMLs and DWMLs in women.
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Affiliation(s)
- Z-G Yin
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - Q-S Wang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China.
| | - K Yu
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - W-W Wang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - H Lin
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
| | - Z-H Yang
- Department of Neurology, Chengdu Military General Hospital, 270 Rongdu Road, Jinniu District, Chengdu, Sichuan Province, 610083, China
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25
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Ledda C, Iavicoli I, Bracci M, Avola R, Senia P, Santarelli L, Pomara C, Rapisarda V. Serum lipid, lipoprotein and apolipoprotein profiles in workers exposed to low arsenic levels: Lipid profiles and occupational arsenic exposure. Toxicol Lett 2017; 282:49-56. [PMID: 29054558 DOI: 10.1016/j.toxlet.2017.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/09/2017] [Accepted: 10/15/2017] [Indexed: 12/15/2022]
Abstract
Epidemiologic studies have reported that exposure to arsenic (As) is associated with higher risk of cardiovascular disease (i.e., coronary heart disease and peripheral arterial heart disease) and mortality. This cross-sectional study aimed to compare serum lipid, lipoprotein, and apolipoprotein profiles in workers exposed to As. The subjects of this study included 57 workers exposed to As and 57 controls. Demographic characteristics and occupational information were collected through questionnaires. Exposure to As was assessed in indoor air of a workplace and determined using the creatinine values in the urine. Blood samples were collected using immunochemistry and nephelometry to measure the levels of total cholesterol (CHOL), triglycerides (TRIG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipoprotein(a) (Lp(a)), apolipoprotein-A1 (Apo-A1), and apolipoprotein-B (Apo-B). No significant difference in the demographic data was detected between the two groups. Urinary As concentration was significantly (p<0.001) higher in exposed subjects than in the controls (13.4±6.1 and 4.4±6.1μg/gCreat, respectively). No statistically significant differences were observed in CHOL, TRIG, HDL, and LDL concentrations between the two groups. Lp(a), Apo-B, and Apo-B/Apo-A1 ratio values were significantly higher and the Apo-A1 level was significantly lower in the exposed group than in the control subjects. Regression analysis highlighted a significant (p<0.001) association between urinary As and Lp(a), Apo-A1, and Apo-B concentration, and Apo-B/Apo-A1 ratio. This study revealed the influence of As on apolipoproteins, suggesting a potential risk of cardiovascular diseases in subjects exposed to low levels of As.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Ivo Iavicoli
- Occupational Medicine, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Massimo Bracci
- Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Roberto Avola
- Biochemistry, Department of Biomedical Sciences and Biotechnology, University of Catania, Catania, Italy
| | - Paola Senia
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Lory Santarelli
- Occupational Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Cristoforo Pomara
- Megal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; Department of Anatomy, University of Malta, Msida, Malta
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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26
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Melvin JC, Garmo H, Holmberg L, Hammar N, Walldius G, Jungner I, Lambe M, Van Hemelrijck M. Glucose and lipoprotein biomarkers and breast cancer severity using data from the Swedish AMORIS cohort. BMC Cancer 2017; 17:246. [PMID: 28376727 PMCID: PMC5381045 DOI: 10.1186/s12885-017-3232-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 03/24/2017] [Indexed: 12/27/2022] Open
Abstract
Background The lipid and glucose metabolisms are postulated as possible intermediary mechanisms in linking obesity and breast cancer (BC). Links between serum lipid and glucose biomarkers and BC risk has been observed in the Swedish Apolipoprotein MORtality RISk (AMORIS) cohort. We conducted a follow-up analysis including information on tumour characteristics. Methods One thousand eight hundred twenty-four women diagnosed with BC, with serum biomarker levels of glucose, triglycerides, cholesterol (total, HDL, and LDL), and apolipoproteins A-1 and B recorded in a routine health check at baseline were included. BC severity was split into categories (good, moderate, and poor prognosis) based on ER status, TNM stage, and age at diagnosis. Proportional odds models were used to obtain odds ratios (ORs) and 95% confidence intervals (CI), with the interval time between baseline measurement and BC diagnosis accounted for. Results Serum glucose and the ApoB/ApoA-1 ratio showed a non-statistically significant positive association with BC severity (proportional OR: 1.25 (95%CI: 0.92–1.70) for glucose (</≥ 5.60 mmol/L) and 1.31 (95%CI: 0.97–1.76) for ApoB/A-1 ratio (</≥ 1). The proportion of severe and moderate BC was modestly greater across all abnormal serum biomarker groups. Conclusions Despite the size and detail of data in AMORIS, we only found a modest positive association between serum levels of glucose, apoB/ApoA-1 and BC severity, suggesting that these factors are not the main players in linking obesity and BC aggressiveness. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3232-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer C Melvin
- King's College London, Division of Cancer Studies, Translational Oncology and Urology Research (TOUR), Research Oncology, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
| | - Hans Garmo
- King's College London, Division of Cancer Studies, Translational Oncology and Urology Research (TOUR), Research Oncology, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.,Regional Cancer Centre, Uppsala/Ӧrebro, Uppsala, Sweden
| | - Lars Holmberg
- King's College London, Division of Cancer Studies, Translational Oncology and Urology Research (TOUR), Research Oncology, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK
| | - Niklas Hammar
- Unit of Epidemiology, Insitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,AstraZeneca R&D, Mölndal, Sweden
| | - Göran Walldius
- Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala/Ӧrebro, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- King's College London, Division of Cancer Studies, Translational Oncology and Urology Research (TOUR), Research Oncology, Guy's Hospital, 3rd Floor, Bermondsey Wing, London, SE1 9RT, UK.
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27
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Walldius G, Malmström H, Jungner I, de Faire U, Lambe M, Van Hemelrijck M, Hammar N. Cohort Profile: The AMORIS cohort. Int J Epidemiol 2017; 46:1103-1103i. [DOI: 10.1093/ije/dyw333] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 01/22/2023] Open
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28
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Affiliation(s)
- Awadhesh Kumar Singh
- Department of Endocrinology, GD Hospital and Diabetes Institute, Kolkata, West Bengal, India
| | - Ritu Singh
- Department of Endocrinology, GD Hospital and Diabetes Institute, Kolkata, West Bengal, India
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29
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Ryu WS, Schellingerhout D, Jeong SW, Nahrendorf M, Kim DE. Association between Serum Lipid Profiles and Early Neurological Deterioration in Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:2024-30. [PMID: 27256172 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Dyslipidemia is associated with chronic cardiovascular disease. However, the effect of dyslipidemia on acute ischemic stroke is unclear. We hypothesized that dyslipidemia could contribute to early neurological deterioration (END) after ischemic stroke. METHODS A total of 410 acute ischemic stroke patients who were admitted to our stroke center within 24 hours after ictus were consecutively included in this study. END was defined as any new neurological symptoms/signs or any neurological worsening occurring during the admission and/or within 3 weeks after the index stroke. Multivariable logistic regression was used to examine the independent association between lipid indices and END. RESULTS Mean age was 68.2 ± 13.3 years, 241 (58.8%) were male, and 78 (19.0%) experienced END. Almost END occurred within 3 days after admission (n = 70, 89.7%), and the majority of END was stroke progression (n = 68, 87.1%). In univariate analysis, high-density lipoprotein (HDL)-cholesterol levels (per 1 mmol/L; odds ratio [OR] .37; 95% CI .17-.80; P = .012) and apolipoprotein B (apoB)/apoA-I ratio (per 1 increase; OR 3.71; 95% CI 1.48-9.29; P = .005) were associated with END. In the multivariable analysis, adjusted ORs of END for the highest quartile of HDL-cholesterol and apoB/apoA-I ratio were .42 (95% CI .19-.94; P = .034) and 2.37 (95% CI 1.02-5.53; P = .045), respectively. The ratio of apoB/apoA-I was associated with END in large artery atherosclerosis stroke but not in other stroke subtypes. CONCLUSIONS Independent association of low HDL-cholesterol and high apoB/apoA-I ratio with END warrants further research to investigate if correction of the lipid profile during the acute period of ischemic stroke could reduce the risk of END.
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Affiliation(s)
- Wi-Sun Ryu
- Department of Neurology, Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
| | - Dawid Schellingerhout
- Departments of Radiology and Experimental Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sang-Wook Jeong
- Department of Neurology, Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Matthias Nahrendorf
- Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Dong-Eog Kim
- Department of Neurology, Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
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30
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Vijayakumar M, Vasudevan DM, Sundaram KR, Krishnan S, Vaidyanathan K, Nandakumar S, Chandrasekhar R, Mathew N. A randomized study of coconut oil versus sunflower oil on cardiovascular risk factors in patients with stable coronary heart disease. Indian Heart J 2016; 68:498-506. [PMID: 27543472 PMCID: PMC4990731 DOI: 10.1016/j.ihj.2015.10.384] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/28/2015] [Indexed: 01/08/2023] Open
Abstract
Background and rationale Coronary artery disease (CAD) and its pathological atherosclerotic process are closely related to lipids. Lipids levels are in turn influenced by dietary oils and fats. Saturated fatty acids increase the risk for atherosclerosis by increasing the cholesterol level. This study was conducted to investigate the impact of cooking oil media (coconut oil and sunflower oil) on lipid profile, antioxidant mechanism, and endothelial function in patients with established CAD. Design and methods In a single center randomized study in India, patients with stable CAD on standard medical care were assigned to receive coconut oil (Group I) or sunflower oil (Group II) as cooking media for 2 years. Anthropometric measurements, serum, lipids, Lipoprotein a, apo B/A-1 ratio, antioxidants, flow-mediated vasodilation, and cardiovascular events were assessed at 3 months, 6 months, 1 year, and 2 years. Results Hundred patients in each arm completed 2 years with 98% follow-up. There was no statistically significant difference in the anthropometric, biochemical, vascular function, and in cardiovascular events after 2 years. Conclusion Coconut oil even though rich in saturated fatty acids in comparison to sunflower oil when used as cooking oil media over a period of 2 years did not change the lipid-related cardiovascular risk factors and events in those receiving standard medical care.
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Affiliation(s)
- Maniyal Vijayakumar
- Professor of Cardiology, Amrita Institute of Medical Sciences and Research Centre (Amrita Vishwa Vidyapeetham University), AIMS Ponekkara P.O., Kochi, Kerala, India.
| | - D M Vasudevan
- Professor Biochemistry, Amrita Institute of Medical Sciences and Research Centre (Amrita Vishwa Vidyapeetham University), AIMS Ponekkara P.O., Kochi, Kerala, India
| | - K R Sundaram
- Professor Biostatistics, Amrita Institute of Medical Sciences and Research Centre (Amrita Vishwa Vidyapeetham University), AIMS Ponekkara P.O., Kochi, Kerala, India
| | - Sajitha Krishnan
- Professor Biochemistry, Amrita Institute of Medical Sciences and Research Centre (Amrita Vishwa Vidyapeetham University), AIMS Ponekkara P.O., Kochi, Kerala, India
| | - Kannan Vaidyanathan
- Associate Professor, Department of Biochemistry, Amrita Institute of Medical Sciences and Research Center (Amrita Vishwa Vidaypeetham University), India
| | - Sandya Nandakumar
- Research Fellow, Amrita Institute of Medical Sciences and Research Centre (Amrita Vishwa Vidyapeetham University), AIMS Ponekkara P.O., Kochi, Kerala, India
| | - Rajiv Chandrasekhar
- Professor of Cardiology, Amrita Institute of Medical Sciences and Research Centre (Amrita Vishwa Vidyapeetham University), AIMS Ponekkara P.O., Kochi, Kerala, India
| | - Navin Mathew
- Professor of Cardiology, Amrita Institute of Medical Sciences and Research Centre (Amrita Vishwa Vidyapeetham University), AIMS Ponekkara P.O., Kochi, Kerala, India
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31
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Dong H, Chen W, Wang X, Pi F, Wu Y, Pang S, Xie Y, Xia F, Zhang Q. Apolipoprotein A1, B levels, and their ratio and the risk of a first stroke: a meta-analysis and case-control study. Metab Brain Dis 2015; 30:1319-30. [PMID: 26363640 DOI: 10.1007/s11011-015-9732-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/07/2015] [Indexed: 02/05/2023]
Abstract
The associations of levels of apolipoprotein A1 (ApoA1) and apolipoprotein B and ApoB/A1 ratio and risk of a first stroke have not been reliably documented. We performed a meta-analysis to summarize the relationships and confirmed them in a case-control study. We identified relevant publications in PubMed and Embase databases up to June 1, 2015. A Dersimonian-Laird random effects model was used to compute summary relative risks (RRs) and 95 % confidence intervals (CIs). A case-control study was conducted in a southern Chinese population. We included 8 cohort and 4 case-control studies (222,774 subjects; 10,032 first stroke events) in the meta-analysis. Reduced ApoA1 level and increased ApoB level and ApoB/A1 ratio was associated with a first stroke in cohort studies (RR 0.86 [95 % CI 0.79-0.94], 1.66 [1.62-1.69], and 1.66 [1.63-1.70], respectively) and reduced ApoA1 level and increased ApoB/A1 ratio in case-control studies (0.68 [0.47-0.99] and 1.76 [1.50-2.06], respectively). When stratified by stroke type in cohort studies, the RR for ischemic stroke was 0.83 (0.76-0.90), 1.36 (1.32-1.40), and 1.38 (1.35-1.42) for the 3 factors, respectively. In our case-control study (1013 cases; 1029 controls), the OR for a first ischemic stroke was 0.83 (0.74-0.92), 1.33 (1.18-1.48) and 2.10 (1.76-2.51), respectively, with increased ApoA1 level associated with hemorrhagic stroke (1.37 [1.06-1.78]). Meta-analysis suggests that reduced ApoA1 level and increased ApoB level and ApoB/A1 ratio are risk factors for a first ischemic but not hemorrhagic stroke. Elevated ApoA1 level may be a risk factor for a first hemorrhagic stroke.
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Affiliation(s)
- Hongli Dong
- Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Wei Chen
- Department of Neurology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xiangyu Wang
- Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Fuhua Pi
- Department of Sports, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Yubin Wu
- Department of Neurology, The Chaonan Minsheng Hospital, Shantou, Guangdong, 515144, China
| | - Shaojie Pang
- Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Yuqing Xie
- Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Fangfang Xia
- Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China
| | - Qingying Zhang
- Department of Preventive Medicine, Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, Shantou, Guangdong, 515041, People's Republic of China.
- Department of Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, 515041, China.
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32
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Ye F, Liu J, Yang S, Guo FQ. Higher apolipoprotein B levels are associated with earlier onset of first-ever atherosclerotic stroke. Int J Neurosci 2014; 125:186-90. [PMID: 25120028 DOI: 10.3109/00207454.2014.951042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many studies have revealed apolipoproteins are risk factors for ischemic stroke, but the influence of apolipoproteins on onset age of first-ever atherosclerotic stroke has not been well investigated. METHODS We recruited 357 qualified participants from consecutive patients with acute ischemic stroke who came to the stroke registry center in Sichuan Provincial People's Hospital, Chengdu, China. Patients were stratified into tertiles according to the distributions of apoB levels for large artery atherosclerosis (LAA) and small artery atherosclerosis (SAA) groups. The onset age of stroke was analyzed tripartitely in terms of early-onset group, the middling-onset group and the late-onset group. Multinomial logistical regression was used to analyze the associations between the two. RESULTS The risk of early-onset stroke increased monotonically with higher apoB levels (the second tertile, adjusted OR = 2.61, 95% CI 1.18-5.79 (p = 0.018); the third tertile, adjusted OR = 19.52, 95% CI 5.93-64.31 (p < 0.001)), and patients with the highest tertile of apoB levels had a 9.20 times (95% CI, 2.97-28.53, p < 0.001) increased risk of middling-onset stroke in reference to late onset of stroke. CONCLUSIONS The present study suggests the higher the apolipoprotein B levels are, the earlier an atherosclerotic stroke might occur in a Chinese population.
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Affiliation(s)
- Fang Ye
- Department of Neurology, Sichuan Provincial Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
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33
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Yin ZG, Li L, Cui M, Zhou SM, Yu MM, Zhou HD. Inverse relationship between apolipoprotein A-I and cerebral white matter lesions: a cross-sectional study in middle-aged and elderly subjects. PLoS One 2014; 9:e97113. [PMID: 24820970 PMCID: PMC4018273 DOI: 10.1371/journal.pone.0097113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/14/2014] [Indexed: 12/19/2022] Open
Abstract
Background Apolipoprotein A-I (apoA-I), the major protein for high density lipoprotein, is essential for reverse cholesterol transport. Decreased serum levels of apoA-I have been reported to correlate with subcortical infarction and dementia, both of which are highly related to white matter lesions (WMLs). However, the association between apoA-I and WMLs has never been investigated. In this study, we sought to investigate the association between apoA-I and the presence of WMLs in middle-aged and elderly subjects. Methods Consecutive patients aged 50 years and older of our department were prospectively enrolled in this study (n = 1282, 606 men and 676 women, 65.9±9.4 years). All participants underwent MRI scans to assess the presence and severity of WMLs. Multivariate logistic regression analyses were performed to examine the association of apoA-I with WMLs. Results Patients with WMLs were older and showed significantly higher proportion of male sex, hypertension, diabetes mellitus, previous stroke, and coronary heart disease whereas levels of total cholesterol, high density lipoprotein cholesterol, and apoA-I were lower. After adjustment for potential confounders, the lowest apoA-I quartile was independently associated with an increased risk of WMLs (odds ratio: 1.87, 95% confidence interval: 1.29–2.72). In sex-specific analyses, this relationship was observed only in women. Conclusions Our findings demonstrated that apoA-I was inversely associated with the presence of WMLs in middle-aged and elderly subjects. This results suggest that therapies which increase apoA-I concentration may be beneficial to reduce the risk of WMLs, dementia and stroke.
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Affiliation(s)
- Ze-Gang Yin
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Ling Li
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Min Cui
- Department of Neurology, Wuhan General Hospital of PLA, Wuhan, Hubei, China
| | - Shi-Ming Zhou
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Ming-Ming Yu
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
| | - Hua-Dong Zhou
- Department of Neurology, Daping Hospital and Institute of Field Surgery, Third Military Medical University, Chongqing, China
- * E-mail:
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Schmidt C, Bergström G. Apolipoprotein B/apolipoprotein A-I ratio and apolipoprotein B: long-term predictors of myocardial infarction in initially healthy middle-aged men--a 13-year follow-up. Angiology 2013; 65:901-5. [PMID: 24277914 DOI: 10.1177/0003319713511849] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We investigated whether serum concentrations of apolipoprotein (apo) B and apoA-I and the apoB/apoA-I ratio provided predictive information on myocardial infarction (MI) and ischemic stroke during 13 years of follow-up in a group of initially clinically healthy 58-year-old men, free from previous cardiovascular disease, diabetes, other established disease, or treatment with cardiovascular drugs. Multivariate logistic regression analysis showed that the apoB/apoA-I ratio and apoB were significant and independent determinants of MI (exponentiation of the B coefficient [Exp(β)] 3.1, 95% confidence interval [CI] 1.6-6.3, P=.001, Exp(β) 2.8, 95% CI 1.1-7.7, P=.045, respectively). The area under the receiver-operating characteristics curve as a relative measure of test efficiency was highest and significant for both apoB/apoA-I ratio and apoB (area under the curve=0.75, P<.001). In conclusion, the apoB/apoA-I ratio and apoB are independent risk factors for MI and has the highest efficiencies for predicting MI in initially healthy middle-aged men.
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Affiliation(s)
- Caroline Schmidt
- Department of Molecular and Clinical Medicine, The Wallenberg Laboratory for Cardiovascular Research, Institution for Medicine, Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden
| | - Göran Bergström
- Department of Molecular and Clinical Medicine, The Wallenberg Laboratory for Cardiovascular Research, Institution for Medicine, Sahlgrenska Academy at Gothenburg University, Göteborg, Sweden
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Wei Q, Wang H, Tian Y, Xu F, Chen X, Wang K. Reduced serum levels of triglyceride, very low density lipoprotein cholesterol and apolipoprotein B in Parkinson's disease patients. PLoS One 2013; 8:e75743. [PMID: 24086623 PMCID: PMC3784418 DOI: 10.1371/journal.pone.0075743] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 08/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies have shown a lower incidence of stroke in Parkinson's disease (PD) patients. The role of the lipids and lipoproteins as risk factors for stroke is uncertain in the lower prevalence of stroke in PD patients. OBJECTIVES To explore the lipids and lipoproteins serum levels in PD patients. METHODS A retrospective study was performed on 110 PD patients (PD group), 130 controls with non-cerebrovascular neurological diseases (OD group), 140 acute intracerebral hemorrhage patients (ICH group) and 140 acute cerebral infarction patients (CI group). The records about serum levels of lipids and lipoproteins were analyzed. RESULTS There were significant differences for the serum level of triglyceride (F = 5.031, p=0.002), very low density lipoprotein cholesterol (F = 5.313, p=0.001), apolipoprotein B (F = 16.038, p<0.0001) in the four groups. PD group had a significantly lower serum level of triglyceride (TG) than the OD (p=0.032), ICH (p=0.00047) and CI (p=0.001) groups. Very low density lipoprotein cholesterol (VLDL-C) serum level was significantly lower in PD group than in OD (p=0.039), ICH (p=0.00021) and CI (p=0.001) groups. There was a significantly lower serum level of apolipoprotein B (apo B) in PD group than in OD (p=0.002), ICH (p<0.0001) and CI (p<0.0001) groups. CONCLUSIONS There are reduced serum levels of TG, VLDL-C and apo B in PD patients, which may be related to the decreased prevalence of stroke in PD patients.
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Affiliation(s)
- Qiang Wei
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Honghao Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yanghua Tian
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Fangcheng Xu
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Xianwen Chen
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
- * E-mail:
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Wulaningsih W, Michaelsson K, Garmo H, Hammar N, Jungner I, Walldius G, Lambe M, Holmberg L, Van Hemelrijck M. Serum calcium and risk of gastrointestinal cancer in the Swedish AMORIS study. BMC Public Health 2013; 13:663. [PMID: 23866097 PMCID: PMC3729677 DOI: 10.1186/1471-2458-13-663] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/19/2013] [Indexed: 12/14/2022] Open
Abstract
Background Observational studies have indicated that high calcium intake may prevent colorectal cancer, but as for randomized trials the results are inconclusive. Meanwhile, limited data on the link between serum calcium and cancer risk is available. We investigated the relation between serum calcium and risk of different gastrointestinal cancers in a prospective study. Methods A cohort based on 492,044 subjects with baseline information on calcium (mmol/L) and albumin (g/L) was selected from the Swedish Apolipoprotein MOrtality RISk (AMORIS) study. Multivariable Cox proportional hazard models were used to analyse associations between standardised levels, quartiles and age/sex-specific categories of serum calcium and risk of oesophageal, stomach, colon, rectal cancer and also colorectal cancer combined, while taking into account serum albumin and other comorbidities. Results During 12 years of follow-up, we identified 323 incident oesophageal cancers, 782 stomach cancers, 2519 colon cancers, and 1495 rectal cancers. A positive association was found between albumin-adjusted serum calcium and risk of oesophageal [HR: 4.82 (95% CI: 2.07 – 11.19) for high compared to normal age-specific calcium levels] and colon cancer [e.g. HR: 1.07 (95% CI: 1.00 – 1.14) for every SD increase of calcium] as well as colorectal cancer [e.g. HR: 1.06 (95% CI: 1.02-1.11) for every SD increase of calcium] in women. In men there were similar but weaker non-statistically significant trends. Conclusion The positive relation between serum calcium, oesophageal cancer and colorectal cancer calls for further studies including calcium regulators to evaluate whether there is a true link between calcium metabolism and development of gastrointestinal cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mieke Van Hemelrijck
- King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
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Protection from age-related increase in lipid biomarkers and inflammation contributes to cardiovascular protection in Gilbert's syndrome. Clin Sci (Lond) 2013; 125:257-64. [PMID: 23566065 DOI: 10.1042/cs20120661] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recent epidemiological and clinical data show protection from CVD (cardiovascular disease), all-cause mortality and cancer in subjects with GS (Gilbert's syndrome), which is characterized by a mildly elevated blood bilirubin concentration. The established antioxidant effect of bilirubin, however, contributes only in part to this protection. Therefore we investigated whether mildly elevated circulating UCB (unconjugated bilirubin) is associated with altered lipid metabolism. The study was performed on GS and age- and gender-matched healthy subjects (n=59 per group). Full lipoprotein profile, TAG (triacylglycerols), Apo (apolipoprotein)-A1, Apo-B, lipoprotein(a), the subfractions of LDL (low-density lipoprotein) and selected pro-inflammatory mediators were analysed. A hyperbilirubinaemic rodent model (Gunn rats, n=40) was investigated to further support the presented human data. GS subjects had significantly (P<0.05) improved lipid profile with reduced total cholesterol, LDL-C (LDL-cholesterol), TAG, low- and pro-atherogenic LDL subfractions (LDL-1+LDL-2), Apo-B, Apo-B/Apo-A1 ratio and lower IL-6 (interleukin 6) and SAA (serum amyloid A) concentrations (P=0.094). When the control and GS groups were subdivided into younger and older cohorts, older GS subjects demonstrated reduced lipid variables (total cholesterol and LDL-C, TAG and LDL-C subfractions, Apo-B/Apo-A1 ratio; P<0.05; Apo-B: P<0.1) compared with controls. These data were supported by lipid analyses in the rodent model showing that Gunn rat serum had lower total cholesterol (2.29±0.38 compared with 1.27±0.72 mM; P<0.001) and TAG (1.66±0.67 compared with 0.99±0.52 mM; P<0.001) concentrations compared with controls. These findings indicate that the altered lipid profile and the reduced pro-inflammatory status in hyperbilirubinaemic subjects, particularly in the older individuals, probably contribute additionally to the commonly accepted beneficial antioxidant effects of bilirubin in humans.
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Wulaningsih W, Michaelsson K, Garmo H, Hammar N, Jungner I, Walldius G, Holmberg L, Van Hemelrijck M. Inorganic phosphate and the risk of cancer in the Swedish AMORIS study. BMC Cancer 2013; 13:257. [PMID: 23706176 PMCID: PMC3664604 DOI: 10.1186/1471-2407-13-257] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 05/21/2013] [Indexed: 01/08/2023] Open
Abstract
Background Both dietary and serum levels of inorganic phosphate (Pi) have been linked to development of cancer in experimental studies. This is the first population-based study investigating the relation between serum Pi and risk of cancer in humans. Methods From the Swedish Apolipoprotein Mortality Risk (AMORIS) study, we selected all participants (> 20 years old) with baseline measurements of serum Pi, calcium, alkaline phosphatase, glucose, and creatinine (n = 397,292). Multivariable Cox proportional hazards regression analyses were used to assess serum Pi in relation to overall cancer risk. Similar analyses were performed for specific cancer sites. Results We found a higher overall cancer risk with increasing Pi levels in men ( HR: 1.02 (95% CI: 1.00-1.04) for every SD increase in Pi), and a negative association in women (HR: 0.97 (95% CI: 0.96-0.99) for every SD increase in Pi). Further analyses for specific cancer sites showed a positive link between Pi quartiles and the risk of cancer of the pancreas, lung, thyroid gland and bone in men, and cancer of the oesophagus, lung, and nonmelanoma skin cancer in women. Conversely, the risks for developing breast and endometrial cancer as well as other endocrine cancer in both men and women were lower in those with higher Pi levels. Conclusions Abnormal Pi levels are related to development of cancer. Furthermore, the in verse association between Pi levels and risk of breast, endometrial and other endocrine cancers may indicate the role of hormonal factors in the relation between Pi metabolism and cancer.
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Affiliation(s)
- Wahyu Wulaningsih
- King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Unit, London, UK
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Gaur A, Collins H, Wulaningsih W, Holmberg L, Garmo H, Hammar N, Walldius G, Jungner I, Van Hemelrijck M. Iron metabolism and risk of cancer in the Swedish AMORIS study. Cancer Causes Control 2013; 24:1393-402. [PMID: 23649231 PMCID: PMC3675271 DOI: 10.1007/s10552-013-0219-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/26/2013] [Indexed: 01/14/2023]
Abstract
Objectives Pre-clinical studies have shown that iron can be carcinogenic, but few population-based studies investigated the association between markers of the iron metabolism and risk of cancer while taking into account inflammation. We assessed the link between serum iron (SI), total-iron binding capacity (TIBC), and risk of cancer by levels of C-reactive protein (CRP) in a large population-based study (n = 220,642). Methods From the Swedish Apolipoprotein Mortality Risk (AMORIS) study, we selected all participants (>20 years old) with baseline measurements of serum SI, TIBC, and CRP. Multivariate Cox proportional hazards regression was carried out for standardized and quartile values of SI and TIBC. Similar analyses were performed for specific cancers (pancreatic, colon, liver, respiratory, kidney, prostate, stomach, and breast cancer). To avoid reverse causation, we excluded those with follow-up <3 years. Results We found a positive association between standardized TIBC and overall cancer [HR 1.03 (95 % CI 1.01–1.05)]. No statistically significant association was found between SI and cancer risk except for postmenopausal breast cancer [HR for standardized SI 1.09 (95 % CI 1.02–1.15)]. The association between TIBC and specific cancer was only statistically significant for colon cancer [i.e., HR for standardized TIBC: 1.17 (95 % CI 1.08–1.28)]. A borderline interaction between SI and levels of CRP was observed only in stomach cancer. Conclusions As opposed to pre-clinical findings for serum iron and cancer, this population-based epidemiological study showed an inverse relation between iron metabolism and cancer risk. Minimal role of inflammatory markers observed warrants further study focusing on developments of specific cancers.
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Affiliation(s)
- Anjali Gaur
- Division of Cancer Studies, Research Oncology, School of Medicine, King's College London, Guy's Hospital, London, UK.
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Kakehi E, Kotani K, Ishikawa S, Gotoh T, Kayaba K, Nakamura Y, Kajii E. Serum non-high-density lipoprotein cholesterol levels and the incidence of ischemic stroke in a Japanese population: the Jichi Medical School cohort study. Asia Pac J Public Health 2013; 27:NP535-43. [PMID: 23430886 DOI: 10.1177/1010539513475649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The predictive value of serum non-high-density lipoprotein cholesterol (non-HDL-C) levels for the incidence of ischemic stroke and its subtypes has not yet been established. The present cohort study investigated their relationships in a Japanese population. The first incidence of ischemic stroke and its subtypes was documented as the primary outcome. A total of 249 ischemic stroke patients (men/women = 145/104) were identified during a follow-up period of 10.7 years among 10 760 community-dwelling subjects (men/women = 4212/6548). Cox proportional hazard model analyses revealed that when compared with the lowest tertile of non-HDL-C, multivariate-adjusted hazard ratios for the highest tertile were 0.55 (95% confidence interval = 0.32-0.95, P = .03) on ischemic stroke and 0.29 (95% confidence interval = 0.08-1.05, P = .06) on cardioembolic infarction in women. Men did not show such significant relationships. Low serum non-HDL-C levels may be a predictive marker associated with an increase in the incidence of ischemic stroke and possibly of cardioembolic infarction in Japanese women.
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Affiliation(s)
| | | | | | - Tadao Gotoh
- Wara National Health Insurance Clinic, Gifu, Japan
| | | | | | - Eiji Kajii
- Jichi Medical University, Tochigi, Japan
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Wulaningsih W, Holmberg L, Garmo H, Zethelius B, Wigertz A, Carroll P, Lambe M, Hammar N, Walldius G, Jungner I, Van Hemelrijck M. Serum glucose and fructosamine in relation to risk of cancer. PLoS One 2013; 8:e54944. [PMID: 23372798 PMCID: PMC3556075 DOI: 10.1371/journal.pone.0054944] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 12/18/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Impaired glucose metabolism has been linked with increased cancer risk, but the association between serum glucose and cancer risk remains unclear. We used repeated measurements of glucose and fructosamine to get more insight into the association between the glucose metabolism and risk of cancer. METHODS We selected 11,998 persons (>20 years old) with four prospectively collected serum glucose and fructosamine measurements from the Apolipoprotein Mortality Risk (AMORIS) study. Multivariate Cox proportional hazards regression was used to assess standardized log of overall mean glucose and fructosamine in relation to cancer risk. Similar analyses were performed for tertiles of glucose and fructosamine and for different types of cancer. RESULTS A positive trend was observed between standardized log overall mean glucose and overall cancer risk (HR= 1.08; 95% CI: 1.02-1.14). Including standardized log fructosamine in the model resulted in a stronger association between glucose and cancer risk and aninverse association between fructosamine and cancer risk (HR = 1.17; 95% CI: 1.08-1.26 and HR: 0.89; 95% CI: 0.82-0.96, respectively). Cancer risks were highest among those in the highest tertile of glucose and lowest tertile of fructosamine. Similar findings were observed for prostate, lung, and colorectal cancer while none observed for breast cancer. CONCLUSION The contrasting effect between glucose, fructosamine, and cancer risk suggests the existence of distinct groups among those with impaired glucose metabolism, resulting in different cancer risks based on individual metabolic profiles. Further studies are needed to clarify whether glucose is a proxy of other lifestyle-related or metabolic factors.
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Affiliation(s)
- Wahyu Wulaningsih
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Lars Holmberg
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Regional Cancer Centre, Uppsala, Sweden
| | - Hans Garmo
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
- Regional Cancer Centre, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
- Medical Products Agency/Epidemiology, Uppsala, Sweden
| | | | - Paul Carroll
- Department of Endocrinology, Guy’s & St Thomas’ NHS Foundation Trust, St. Thomas’ Hospital, London, United Kingdom
| | - Mats Lambe
- Regional Cancer Centre, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Department of Epidemiology, Insitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- AstraZeneca Sverige, Södertalje, Sweden
| | - Göran Walldius
- Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
- * E-mail:
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Park JH, Hong KS, Lee J, Kim YJ, Song P. Deep subcortical infarct burden in relation to apolipoprotein B/AI ratio in patients with intracranial atherosclerotic stenosis. Eur J Neurol 2012; 20:671-80. [PMID: 23121297 DOI: 10.1111/ene.12021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 09/18/2012] [Indexed: 01/23/2023]
Affiliation(s)
- J.-H. Park
- Department of Neurology; Kwandong University Myongji Hospital; Goyang Korea
| | - K.-S. Hong
- Department of Neurology; Inje University Ilsan Paik Hospital; Goyang Korea
| | - J. Lee
- Department of Biostatistics; College of Medicine; Korea University; Seoul Korea
| | - Y.-J. Kim
- Stroke Center; Ewha Womans University Mokdong Hospital; Seoul Korea
| | - P. Song
- Department of Neurology; Inje University Ilsan Paik Hospital; Goyang Korea
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Serum Lipids and the Risk of Gastrointestinal Malignancies in the Swedish AMORIS Study. J Cancer Epidemiol 2012; 2012:792034. [PMID: 22969802 PMCID: PMC3437288 DOI: 10.1155/2012/792034] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/17/2012] [Indexed: 12/16/2022] Open
Abstract
Background. Metabolic syndrome has been linked to an increased cancer risk, but the role of dyslipidaemia in gastrointestinal malignancies is unclear. We aimed to assess the risk of oesophageal, stomach, colon, and rectal cancers using serum levels of lipid components. Methods. From the Swedish Apolipoprotein Mortality Risk (AMORIS) study, we selected 540,309 participants (> 20 years old) with baseline measurements of total cholesterol (TC), triglycerides (TG), and glucose of whom 84,774 had baseline LDL cholesterol (LDL), HDL cholesterol (HDL), apolipoprotein B (apoB), and apolipoprotein A-I (apoA-I). Multivariate Cox proportional hazards regression was used to assess glucose and lipid components in relation to oesophageal, stomach, colon, and rectal cancer risk. Results. An increased risk of oesophageal cancer was observed in persons with high TG (e.g. HR: 2.29 (95% CI: 1.42–3.68) for the 4th quartile compared to the 1st) and low LDL, LDL/HDL ratio, TC/HDL ratio, log (TG/HDL), and apoB/apoA-I ratio. High glucose and TG were linked with an increased colon cancer risk, while high TC levels were associated with an increased rectal cancer risk. Conclusion. The persistent link between TC and rectal cancer risk as well as between TG and oesophageal and colon cancer risk in normoglycaemic individuals may imply their substantiality in gastrointestinal carcinogenesis.
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Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. High blood hemoglobin concentration as risk factor of major atherosclerotic cardiovascular events in 114,159 healthy men and women in the apolipoprotein mortality risk study (AMORIS). Ann Med 2012; 44:476-86. [PMID: 21585246 DOI: 10.3109/07853890.2011.573804] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have tested differences in relationships between hemoglobin (Hb) and long-term risk of major cardiovascular diseases according to age and gender in healthy subjects as opposed to anemia. AIMS Such relationships were examined and risk-tested in relation to Hb values in the Apolipoprotein MOrtality RISk (AMORIS) Study. METHODS Using data from AMORIS and the Swedish hospital discharge and mortality registers, a prospective cohort study of 114,159 subjects with mean follow-up of 11.8 years, the association between Hb and risk of acute myocardial infarction (AMI), ischemic stroke (IS), and congestive heart failure (CHF) by Cox regression analysis according to age and gender was studied. RESULTS Elevated Hb levels were associated to acute myocardial infarction (AMI) (HR 1.10 (1.06-1.13) per SD change), mostly confined to men and younger subjects but with greater sex similarity trends for CHF. Slightly increased risks were seen for the lowest Hb levels in the elderly and in females. IS risk was positively and more linearly associated to Hb. INTERPRETATION In AMORIS the highest AMI and CHF risks were found in the upper region of the distribution, but different shapes of relationships according to age and gender were found. IS associated positively with Hb. Key words:
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Affiliation(s)
- Ingar Holme
- Department of Preventive Cardiology, Centre of Preventive Medicine, Oslo University, Hospital, Ulleval, Oslo, Norway.
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Serum calcium and incident and fatal prostate cancer in the Swedish AMORIS study. Cancer Causes Control 2012; 23:1349-58. [DOI: 10.1007/s10552-012-0015-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
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Sandvei MS, Lindekleiv H, Romundstad PR, Müller TB, Vatten LJ, Ingebrigtsen T, Njølstad I, Mathiesen EB, Vik A. Risk factors for aneurysmal subarachnoid hemorrhage - BMI and serum lipids: 11-year follow-up of the HUNT and the Tromsø Study in Norway. Acta Neurol Scand 2012; 125:382-8. [PMID: 21793808 DOI: 10.1111/j.1600-0404.2011.01578.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Life-style factors have been associated with the risk for aneurysmal subarachnoid hemorrhage (aSAH), but it is not clear whether body mass index (BMI) and serum lipids are associated with risk. We prospectively assessed these associations in two large population studies. METHODS A total of 65,526 participants in the Nord-Trøndelag Health Study (1995-1997) and 26,882 participants in the Tromsø Study (1994-1995) were included. Studies included measurements of body weight and height, serum lipids, and self-administered questionnaires. Participants who experienced aSAH were identified, and hazard ratios (HRs) were estimated using Cox regression analysis. RESULTS During 11 years of follow-up, aSAH was diagnosed in 122 participants. Overweight (BMI 25-29.9) was negatively associated with the risk of aSAH (HR 0.7, 95% CI 0.4-1.0). There was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH, but in participants younger than 50 years, HDL cholesterol was inversely associated with the risk (HR per standard deviation increase 0.6, 95% CI 0.4-0.9). CONCLUSIONS Overweight may be associated with reduced risk of aSAH, but there was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH in this prospective study.
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Affiliation(s)
- M S Sandvei
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Wallström P, Sonestedt E, Hlebowicz J, Ericson U, Drake I, Persson M, Gullberg B, Hedblad B, Wirfält E. Dietary fiber and saturated fat intake associations with cardiovascular disease differ by sex in the Malmö Diet and Cancer Cohort: a prospective study. PLoS One 2012; 7:e31637. [PMID: 22384046 PMCID: PMC3288044 DOI: 10.1371/journal.pone.0031637] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 01/10/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of the study was to examine associations between intake of macronutrients and dietary fiber and incident ischemic cardiovascular disease (iCVD) in men and women. METHODS We used data from 8,139 male and 12,535 female participants (aged 44-73 y) of the Swedish population-based Malmö Diet and Cancer cohort. The participants were without history of CVD and diabetes mellitus, and had reported stable dietary habits in the study questionnaire. Diet was assessed by a validated modified diet history method, combining a 7-d registration of cooked meals and cold beverages, a 168-item food questionnaire (covering other foods and meal patterns), and a 1-hour diet interview. Sociodemographic and lifestyle data were collected by questionnaire. iCVD cases, which included coronary events (myocardial infarctions or deaths from chronic ischemic heart disease) and ischemic strokes, were ascertained via national and local registries. Nutrient-disease associations were examined by multivariate Cox regressions. RESULTS During a mean follow-up of 13.5 years, we identified 1,089 male and 687 female iCVD cases. High fiber intakes were associated with lower incidence rates of iCVD in women and of ischemic stroke in men. In post-hoc analysis, we discovered statistically significant interactions between intake of fiber and saturated fat; these interactions also differed between men and women (p<0.001). CONCLUSIONS In this well-defined population, a high fiber intake was associated with lower risk of iCVD, but there were no robust associations between other macronutrients and iCVD risk. Judging from this study, gender-specific nutrient analysis may be preferable in epidemiology.
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Affiliation(s)
- Peter Wallström
- Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Park JH, Hong KS, Lee EJ, Lee J, Kim DE. High Levels of Apolipoprotein B/AI Ratio Are Associated With Intracranial Atherosclerotic Stenosis. Stroke 2011; 42:3040-6. [DOI: 10.1161/strokeaha.111.620104] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jong-Ho Park
- From the Stroke Center (J.-H.P.) and the Department of Diagnostic Neuroradiology (E.-J.L.), Kwandong University Myongji Hospital, Goyang, Korea; the Department of Neurology (K.-S.H.), Inje University Ilsan Paik Hospital, Goyang, Korea; the Department of Biostatistics (J.L.), College of Medicine, Korea University, Seoul, Korea; and the Department of Neurology (D.-E.K.), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Keun-Sik Hong
- From the Stroke Center (J.-H.P.) and the Department of Diagnostic Neuroradiology (E.-J.L.), Kwandong University Myongji Hospital, Goyang, Korea; the Department of Neurology (K.-S.H.), Inje University Ilsan Paik Hospital, Goyang, Korea; the Department of Biostatistics (J.L.), College of Medicine, Korea University, Seoul, Korea; and the Department of Neurology (D.-E.K.), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Eun-Ja Lee
- From the Stroke Center (J.-H.P.) and the Department of Diagnostic Neuroradiology (E.-J.L.), Kwandong University Myongji Hospital, Goyang, Korea; the Department of Neurology (K.-S.H.), Inje University Ilsan Paik Hospital, Goyang, Korea; the Department of Biostatistics (J.L.), College of Medicine, Korea University, Seoul, Korea; and the Department of Neurology (D.-E.K.), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Juneyoung Lee
- From the Stroke Center (J.-H.P.) and the Department of Diagnostic Neuroradiology (E.-J.L.), Kwandong University Myongji Hospital, Goyang, Korea; the Department of Neurology (K.-S.H.), Inje University Ilsan Paik Hospital, Goyang, Korea; the Department of Biostatistics (J.L.), College of Medicine, Korea University, Seoul, Korea; and the Department of Neurology (D.-E.K.), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dong-Eog Kim
- From the Stroke Center (J.-H.P.) and the Department of Diagnostic Neuroradiology (E.-J.L.), Kwandong University Myongji Hospital, Goyang, Korea; the Department of Neurology (K.-S.H.), Inje University Ilsan Paik Hospital, Goyang, Korea; the Department of Biostatistics (J.L.), College of Medicine, Korea University, Seoul, Korea; and the Department of Neurology (D.-E.K.), Dongguk University Ilsan Hospital, Goyang, Korea
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Van Hemelrijck M, Garmo H, Hammar N, Jungner I, Walldius G, Lambe M, Holmberg L. The interplay between lipid profiles, glucose, BMI and risk of kidney cancer in the Swedish AMORIS study. Int J Cancer 2011; 130:2118-28. [PMID: 21630265 DOI: 10.1002/ijc.26212] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 05/05/2011] [Indexed: 01/14/2023]
Abstract
With exception of cholesterol and total fat intake, associations between lipid biomarkers and kidney cancer have not often been researched. We aimed to assess possible links between lipid profiles and kidney cancer risk in a large prospective cohort study, while also taking into account glucose levels and BMI. A cohort based on 542,924 persons with baseline information on glucose, triglycerides (TGs), total cholesterol (TC) and creatinine was selected from the Swedish Apolipoprotein Mortality Risk study. A subgroup of 85,621 also had baseline measurements of HDL, LDL, apolipoprotein A-I and apoB. Multivariate Cox proportional hazard models were used to analyze associations between quartiles and dichotomized values of these lipid components and kidney cancer risk. During a mean follow-up of 13 years, 958 persons developed kidney cancer. TGs were the only lipid component for which a statistically significant association was found with kidney cancer risk when using both quartiles and a clinical cutoff (hazard ratio: 1.25 (95% CI: 0.99-1.60), 1.29 (1.01-1.66) and 1.66 (1.30-2.13) for the 2nd, 3rd and 4th quartile, compared to the 1st, with p-value for trend: <0.001). The association remained after exclusion of the 95% percentile of TG. Quartiles of glucose were also positively associated with kidney cancer risk, whereas quartiles of TC were negatively associated with kidney cancer risk. This detailed analysis of lipid components only showed a consistent relation between TG levels and kidney cancer risk. Further mechanistic studies are required to assess links between lipid abnormalities and kidney cancer.
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Affiliation(s)
- Mieke Van Hemelrijck
- King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
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Alkhouri N, Carter-Kent C, Elias M, Feldstein AE. Atherogenic dyslipidemia and cardiovascular risk in children with nonalcoholic fatty liver disease. CLINICAL LIPIDOLOGY 2011; 6:305-314. [PMID: 22162978 PMCID: PMC3234131 DOI: 10.2217/clp.11.19] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Nonalcoholic fatty liver disease is now regarded as the most common form of chronic liver disease in adults and children. The close association between nonalcoholic fatty liver disease (NAFLD) and the metabolic syndrome has been extensively described. Moreover, a growing body of evidence suggest that NAFLD by itself confers a substantial cardiovascular risk independent of the other components of the metabolic syndrome. Given the significant potential for morbidity and mortality in these patients, and the large proportion of both pediatric and adult population affected, it is important that we clearly define the overall risk, identify early predictors for cardiovascular disease progression, and establish management strategies. In this article, we will focus on current data linking NAFLD and the severity of liver damage present in children with cardiovascular risk.
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Affiliation(s)
- Naim Alkhouri
- Pediatric Gastroenterology, Lerner Research Institute Cleveland Clinic College of Medicine of CWRU, OH, USA
- Department of Pediatric Gastroenterology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Christine Carter-Kent
- Pediatric Gastroenterology, Lerner Research Institute Cleveland Clinic College of Medicine of CWRU, OH, USA
| | - Michael Elias
- Pediatric Gastroenterology, Lerner Research Institute Cleveland Clinic College of Medicine of CWRU, OH, USA
| | - Ariel E Feldstein
- Pediatric Gastroenterology, Lerner Research Institute Cleveland Clinic College of Medicine of CWRU, OH, USA
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