Lipoprotein (a) does not participate in the early acute phase response to training or extreme physical activity and is unlikely to enhance any associated immediate cardiovascular risk

The Relationship Between Circulating Fibrinogen and Lipoprotein (a) Levels in Patients With Primary Dyslipidemia

The correlation between 2 predictors of vascular events, plasma fibrinogen and serum lipoprotein (a), was evaluated in patients referred to a specialist clinic because of primary hyperlipidemia. A significant correlation existed between fibrinogen and lipoprotein (a) in nonsmokers but not in smokers. Plasma fibrinogen concentration correlated positively and significantly with serum lipoprotein (a) levels in men nonsmokers without cardiovascular disease and in women nonsmokers with cardiovascular disease. Nonsmoker women without cardiovascular disease had significantly higher plasma fibrinogen (3.63 g/L versus 3.07 g/L, P < .0001) than the corresponding men. Nonsmoker women with and without cardiovascular disease had significantly higher lipoprotein (a) levels than the corresponding groups of men (0.36 versus 0.18 g/L; P = .0015 and 0.40 versus 0.26 g/L; P = .008), respectively. The relationship between fibrinogen and lipoprotein (a) levels alters markedly depending on the population selected. This relationship is influenced by gender, the presence of cardiovascular disease and smoking status.

EFFECT OF PHYSICAL ACTIVITY ON CARDIOMETABOLIC MARKERS IN ADOLESCENTS: SYSTEMATIC REVIEW

ABSTRACT The accumulation of body fat is a major risk factor for cardiometabolic diseases. Obesity can be considered a chronic systemic inflammatory disease in adults and younger people. The control of subclinical inflammation process through the practice of physical activity (PA) can mitigate the effects of risk factors that trigger atherosclerosis that worsens with advancing age. The objective of this study was to conduct a systematic review of the influence of physical activity and/or exercise on cardiometabolic markers and othrer risk factors of cardiovascular disease in adolescents. A systematic review was conducted in electronic databases Scopus, Pubmed, Conchrane Collection and SciELO. The terms used in the search were "cardiovascular diseases AND inflammation AND adolescents AND physical activity OR exercise". A total of 24 original articles were evaluated, being 14 longitudinal and 10 cross-sectional studies. Overall, 16 articles (66.66%) showed that PA, exercise and/or sedentary behavior may have influenced or have been related to the concentration of cardiometabolic markers. All studies that examined lifestyle changes showed reduction of cardiometabolic markers. Some limitations were observed: reduced samples, lack of dietary prescription, evaluation and control of volume and intensity of exercise. Most of the studies analyzed showed that the physical activity could influence and decrease the concentrations of cardiometabolic markers in adolescents. However, studies with representative sample size and precise control in assessing the level of physical activity and/or exercise are required to determine accurately the changes that the more active lifestyle can bring on inflammatory process, as well as other risk factors for cardiometabolic diseases in adolescents.

Lipoprotein a: where are we now?

PURPOSE OF REVIEW

To provide an update of the literature describing the link between lipoprotein a and vascular disease.

RECENT FINDINGS

There is evidence that elevated plasma lipoprotein a levels are associated with coronary heart disease, stroke and other manifestations of atherosclerosis. Several mechanisms may be implicated, including proinflammatory actions and impaired fibrinolysis.

SUMMARY

Lipoprotein a potentially represents a useful tool for risk stratification in the primary and secondary prevention setting. However, there are still unresolved methodological issues regarding the measurement of lipoprotein a levels. Targeting lipoprotein a in order to reduce vascular risk is hampered by the lack of well tolerated and effective pharmacological interventions. Moreover, it has not yet been established whether such a reduction will result in fewer vascular events. The risk attributed to lipoprotein a may be reduced by aggressively tackling other vascular risk factors, such as low-density lipoprotein cholesterol.

Increased stroke risk and lipoprotein(a) in a multiethnic community: the Northern Manhattan Stroke Study

CONTEXT

Elevated lipoprotein(a) [Lp(a)] is associated with ischemic stroke (IS) among Whites, but data is sparse for non-White populations.

OBJECTIVE

Using a population-based case-control study design with subjects from the Northern Manhattan Stroke Study, we assessed whether Lp(a) levels were independently associated with IS risk among Whites, Blacks and Hispanics.

DESIGN AND SETTING

Lp(a) levels were measured in 317 IS cases (mean age 69 +/- 13 years; 56% women; 16% Whites, 31% Blacks and 52% Hispanics) and 413 community-based controls, matched by age, race/ethnicity and gender. In-person assessments included demographics, socioeconomic status, presence of vascular risk factors and fasting lipid levels. Logistic regression was used to determine the independent association of Lp(a) and IS. Stratified analyses investigated gender and race/ethnic differences.

RESULTS

Mean Lp(a) levels were greater among cases than controls (46.3 +/- 41.0 vs. 38.9 +/- 38.2 mg/dl; p < 0.01). After adjusting for stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, cigarette smoking), lipid levels, and socioeconomic status, Lp(a) levels > or =30 mg/dl were independently associated with an increased stroke risk in the overall cohort (adjusted odds ratio, OR, 1.8, 95% confidence interval, CI, 1.20-2.6; p = 0.004). There was a significant linear dose-response relationship between Lp(a) levels and IS risk. The association between IS risk and Lp(a) > or =30 mg/dl was more pronounced among men (adjusted OR 2.0, 95% CI 1.1-3.5; p = 0.02) and among Blacks (adjusted OR 2.7, 95% CI 1.2-6.2; p = 0.02).

CONCLUSION

Elevated Lp(a) levels were significantly and independently associated with increased stroke risk, suggesting that Lp(a) is a risk factor for IS across White, Black and Hispanic race/ethnic groups.

An elevated level of physical activity is associated with normal lipoprotein(a) levels in individuals from Maracaibo, Venezuela

Coronary artery disease is the main cause of death worldwide. Lipoprotein(a) [Lp(a)], is an independent risk factor for coronary artery disease in which concentrations are genetically regulated. Contradictory results have been published about physical activity influence on Lp(a) concentration. This research aimed to determine associations between different physical activity levels and Lp(a) concentration. A descriptive and cross-sectional study was made in 1340 randomly selected subjects (males = 598; females = 712) to whom a complete clinical history, the International Physical Activity Questionnaire, and Lp(a) level determination were made. Statistical analysis was carried out to assess qualitative variables relationship by chi2 and differences between means by one-way analysis of variance considering a P value <0.05 as statistically significant. Results are shown as absolute frequencies, percentages, and mean +/- standard deviation according to case. Physical activity levels were ordinal classified as follows: low activity with 24.3% (n = 318), moderate activity with 35.0% (n = 458), and high physical activity with 40.8% (n = 534). Lp(a) concentration in the studied sample was 26.28 +/- 12.64 (IC: 25.59-26.96) mg/dL. Lp(a) concentration according to low, moderate, and high physical activity levels were 29.22 +/- 13.74, 26.27 +/- 12.91, and 24.53 +/- 11.35 mg/dL, respectively, observing statistically significant differences between low and moderate level (P = 0.004) and low and high level (P < 0.001). A strong association (chi2 = 9.771; P = 0.002) was observed among a high physical activity level and a normal concentration of Lp(a) (less than 30 mg/dL). A lifestyle characterized by high physical activity is associated with normal Lp(a) levels.

Decrease of Lp(a) during weight reduction in obese children is modified by the apo(a) kringle-IV copy number variation

BACKGROUND

Lipoprotein(a) [Lp(a)] is considered an independent risk factor for cardiovascular disease. Its concentration is mainly determined by the kringle-IV repeat copy number variation (CNV) at the apolipoprotein(a) [apo(a)] locus.

OBJECTIVE

We aimed to investigate the immediate effect of weight reduction on plasma Lp(a) levels and its dependency on the apo(a) CNV in obese children.

DESIGN

We performed a prospective longitudinal intervention study of a low-fat hypocaloric diet conducted in a 3-week dietary camp for obese children. In all, 140 obese participants (54 boys and 86 girls) with a mean age of 12.5+/-1.6 years and a mean relative body mass index (BMI) before treatment of 165.6+/-24.7% were included. Body weight and plasma levels of Lp(a), lipids, apolipoproteins A-I and B, insulin, and C-reactive protein were determined before the onset and after the end of the intervention. In addition, the number of apo(a) kringle-IV repeats were determined using sodium dodecyl sulfate agarose gel electrophoresis.

RESULTS

The mean loss of body weight was 5.0+/-1.3 kg (-6.6%), resulting in a mean decrease of the relative BMI of 6.6%. Blood chemistry revealed significant changes in all parameters, especially in Lp(a), with a decrease from 24.4+/-30.6 to 17.9+/-22.6 mg per 100 ml or -19% (P<0.001). The decrease of Lp(a) levels was higher in the group with low compared with high molecular weight apo(a) phenotypes (-23.9 vs -16.6%).

CONCLUSIONS

Weight reduction in obese children is associated with significant changes in Lp(a) levels, especially in subjects with high pre-treatment Lp(a) concentrations. This effect is markedly influenced by the molecular phenotype at the copy-number variable apo(a) locus.

Lipoprotein(a) level and its association with tumor stage in male patients with primary lung cancer

BACKGROUND

Recently, attention has been focused on the effect of lipoprotein(a) [Lp(a)] on tumors because of its possible role in development of tumor angiogenesis. The aim of this study was to investigate Lp(a) serum levels in patients with lung cancer and its association with the stages of disease.

METHODS

Fasting venous blood samples were collected from 418 untreated male patients with stages I-IV lung carcinoma and were analyzed for Lp(a). The results were compared with the data from 65 healthy male controls.

RESULTS

Lp(a) levels were elevated (median 157 mg/L, range 16-1497 mg/L) in patients with lung carcinoma compared to control subjects (median 110 mg/L, range 35-706 mg/L) (p=0.004). Subgroup analysis showed that patients with stages II-IV disease had significantly higher Lp(a) concentrations than did healthy controls (p-0.05). There was an independently positive correlation between tumor stage and Lp(a) levels among patients with stages I-III (r=0.162, p=0.006). However, there was a decrease in Lp(a) in stage IV compared to stage III patients (p=0.03).

CONCLUSIONS

There is a significant association between Lp(a) and the presence and stage of lung cancer. Additional investigations with a larger number of lung cancer patients are needed to confirm these findings.

Increasing physical fitness does not proportionally decrease circulating C-reactive protein level in men with varying fitness

Several studies have shown that low physical fitness is associated with high levels of C-reactive protein (CRP), a marker of future cardiovascular events. However, whether increasing physical fitness proportionally decreases the circulating CRP level has not been evaluated. We first evaluated the basic relationship between physical fitness, assessed by running velocity, and circulating CRP level along with cardiovascular risk factors in 1065 healthy middle-aged men. Afterward, we examined the association between annual change in fitness and changes in CRP level in 482 subjects who had the same parameters measured 1 year later without any intervention. In the cross-sectional study, physical fitness was significantly correlated with circulating CRP level (r=0.28, P<.0001). This significance still remained after adjustment for other cardiovascular risks (beta=-.12, P=.0004). In the follow-up study, several variables, including CRP, were significantly improved (CRP geometric mean, from 0.35 to 0.26 mg/L; P<.001). Improvements in fitness did not reach statistical difference (P=.067). Annual change in CRP was significantly correlated with creatinine kinase level 1 year later (r=0.16, P=.004) and with annual changes in some other risks, but not with annual change in fitness. When follow-up subjects were divided into tertiles according to increase in fitness, the greatest reduction in CRP was found in subjects with mildly increased fitness and favorable risk profiles (n=159; CRP geometric mean, from 0.35 to 0.21 mg/L; P<.0001), but not in those with moderately to highly increased fitness (n=113; geometric mean, from 0.36 to 0.28 mg/L; P=.03). In conclusion, although physical fitness was significantly associated with circulating CRP level in a cross-sectional study, increasing fitness did not proportionally decrease circulating CRP level. Improving coincidental risks, relieving intensity of exercise-induced muscle damage, or both, in addition to increasing fitness, might be important to effectively reduce CRP level.

Does smoking status influence the effect of physical exercise on fibrinolytic function in healthy volunteers?

Exercise has been reported to simultaneously trigger and protect against sudden death, the so-called "The Paradox of Exercise". Differences in fibrinolytic function appear to exist between chronic and acute exercise. The aim of the present study was to assess the fibrinolytic system after strenuous exercise in healthy people and explored the influence of smoking habit.

METHODS

23 healthy male volunteers were studied (14 non-smokers; 9 current smokers). Citrated plasma blood samples were taken before and 30 minutes after a maximal exercise treadmill test, and levels of tissue type plasminogen activator (t-PA) antigen, plasminogen activator inhibitor (PAI-1) antigen and lipoprotein-a, Lp(a), [all ELISA] were measured as indices of fibrinolytic function.

RESULTS

Smokers had higher body mass index and higher heart rate at baseline than non smokers (p = 0.046 and p = 0.001, respectively). At baseline, smokers showed increased plasma Lp(a) levels than non smokers (p = 0.04), with no differences in t-PA and PAI-1 antigen levels. Following the exercise treadmill test, smokers had a shorter exercise duration and lower exercise capacity than non smokers (p = 0.008 and p = 0.004, respectively). This was associated with a reduction in t-PA antigen levels in the whole study population, (p = 0.048) without differences in PAI-1 levels, with no significant differences between smokers and non smokers. Lp(a) levels were also significantly reduced (p = 0.0001).

CONCLUSIONS

Acute exercise alters plasma tPA antigen and Lp(a) levels, but there was no significant effect of smoking status in healthy subjects.

Relationship of C-reactive protein and bone mineral density in community-dwelling elderly females

OBJECTIVE

Inflammatory cytokines have been shown to play an important role in bone remodeling. We hypothesized that higher levels of C-reactive protein (CRP) are associated with low bone mineral density (BMD) in elderly females.

DESIGN

Secondary data analysis of the Third National Health and Nutrition Examination Survey.

PARTICIPANTS

2,807 females 65 years and older.

RESULTS

CRP was associated with BMD in the bivariate sis (p<0.001) but not in the multivariate analysis (p=0.23) Age, ethnicity, body mass index (BMI), hormone replacement therapy (HRT) and immobility were independently associated with BMD.

CONCLUSIONS

CRP may be useful in screening for osteoporosis among community-dwelling elderly females. However, CRP appears to act as a surrogate for other factorsdirectly associated with osteoporosis. Further studies are needed to validate these findings.

Response of lipoprotein(a) levels to therapeutic life-style change in obese African-Americans

Lipoprotein(a) (Lp(a)) is regarded as an independent risk factor for Atherosclerotic cardiovascular disease. The objectives of this study were: to determine the effects of diet and exercise on Lp(a) and to evaluate the relation of Lp(a) with the lipid profile (total serum cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol). Baseline Lp(a), body mass index (BMI) and the lipid profiles were measured in 343 Obese (BMI >30kg/m(2)) African-Americans. After a 3-month intervention of diet and exercise by 105 participants, their lipids were re-measured. Baseline Lp(a) levels ranged from 1.2 to 280mg/dl. Lp(a) was inversely associated with triglyceride (P<0.05). After the intervention, Lp(a) and HDL increased by a mean of 20 and 5%, respectively. Total cholesterol, triglycerides, LDL and BMI decreased by 7, 10, 11 and 8%, respectively. Women taking estrogen replacement had a negligible change in Lp(a) while participants taking HMG-CoA reductase inhibitors had an increase in Lp(a) levels by 30%.

Pentanucleotide TTTTA repeat polymorphism of apolipoprotein(a) gene and plasma lipoprotein(a) are associated with ischemic and hemorrhagic stroke in Chinese: a multicenter case-control study in China

BACKGROUND AND PURPOSE

It is still inconclusive whether high plasma lipoprotein(a) [Lp(a)] level is a risk factor for stroke. Small sample size and different ethnic groups and methodologies might be contributors to the conflicts in study results. The purpose of the present study was to investigate the association between plasma Lp(a) levels, pentanucleotide TTTTA repeat (PNTR) polymorphism of the apolipoprotein(a) [apo(a)] gene, and Chinese stroke in a case-control study.

METHODS

We recruited 1825 cases with stroke (44.3% cerebral atherothrombosis, 28.3% lacunar infarction, and 27.3% intracerebral hemorrhage) and 1817 controls from 7 centers in China. Lp(a) concentrations were quantified by enzyme-linked immunosorbent assay. The PNTR polymorphism of the apo(a) gene was determined by polymerase chain reaction-polyacrylamide gel electrophoresis. Conditional multivariate logistic regression analysis was used to identify independent risk factors for stroke and its subtypes.

RESULTS

Lp(a) levels were significantly higher in cases than in controls (median, 28.5 versus 23.1 mg/dL; P<0.001), leading to a 1.97-fold (95% CI, 1.64 to 2.37) increase in risk for overall stroke, 2.0-fold (95% CI, 1.59 to 2.52) increase for atherothrombotic type, 2.05-fold increase (95% CI, 1.59 to 2.63) for lacunar type, and 1.64-fold increase (95% CI, 1.21 to 2.21) for hemorrhagic type. The number of PNTR negatively correlated with Lp(a) levels. Low-number repeats (sum of both alleles <16) of apo(a) PNTR were associated with both atherothrombotic stroke (odds ratio, 1.41; 95% CI, 1.04 to 1.91) and hemorrhagic stroke (odds ratio, 1.62; 95% CI, 1.09 to 2.37).

CONCLUSIONS

Our results indicate for the first time that low numbers of apo(a) PNTR and plasma Lp(a) levels are independently associated with both ischemic and hemorrhagic stroke in Chinese.