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Sereni A, Sticchi E, Gori AM, Magi A, Della Latta D, Volta A, Murri A, Jamagidze G, Chiappino D, Abbate R, Gensini GF, Marcucci R, Sofi F, Giusti B. Genetic and nutritional factors determining circulating levels of lipoprotein(a): results of the "Montignoso Study". Intern Emerg Med 2020; 15:1239-1245. [PMID: 31993950 DOI: 10.1007/s11739-020-02276-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 01/10/2020] [Indexed: 01/02/2023]
Abstract
Increasing evidence shows an association between high lipoprotein(a) [Lp(a)] levels and atherothrombotic diseases. Lp(a) trait is largely controlled by kringle-IV type 2 (KIV-2) size polymorphism in LPA gene, encoding for apo(a). Environmental factors are considered to determinate minor phenotypic variability in Lp(a) levels. In the present study, we investigated the possible gene-environment interaction between KIV-2 polymorphism and Mediterranean diet adherence or fish weekly intake in determining Lp(a) levels. We evaluated Lp(a), KIV-2 polymorphism, fish intake and Mediterranean diet adherence in 452 subjects [median age (range) 66 (46-80)years] from Montignoso Heart and Lung Project (MEHLP) population. In subjects with high KIV-2 repeats number, influence of Mediterranean diet adherence in reducing Lp(a) levels was observed (p = 0.049). No significant difference in subjects with low KIV-2 repeats according to diet was found. Moreover, in high-KIV-2-repeat subjects, we observed a trend towards influence of fish intake on reducing Lp(a) levels (p = 0.186). At multivariate linear regression analysis, high adherence to Mediterranean diet remains a significant and independent determinant of lower Lp(a) levels (β = - 64.97, standard error = 26.55, p = 0.015). In conclusion, this study showed that only subjects with high KIV-2 repeats can take advantage to lower Lp(a) levels from correct nutritional habits and, in particular, from Mediterranean diet.
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Affiliation(s)
- Alice Sereni
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Elena Sticchi
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Alberto Magi
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | | | - Andrea Volta
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandra Murri
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giuli Jamagidze
- Gabriele Monasterio Foundation, Regione Toscana CNR, Pisa, Italy
| | - Dante Chiappino
- Gabriele Monasterio Foundation, Regione Toscana CNR, Pisa, Italy
| | - Rosanna Abbate
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Gian Franco Gensini
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Clinical Nutrition, Careggi Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Largo Brambilla 3, 50134, Florence, Italy
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Wang H, Zhao J, Gui Y, Yan H, Yan Z, Zhang P, Liu L, Chang L, Zhang J. Elevated Lipoprotein (a) and Risk of Poor Functional Outcome in Chinese Patients with Ischemic Stroke and Type 2 Diabetes. Neurotox Res 2017; 33:868-875. [PMID: 29264843 DOI: 10.1007/s12640-017-9850-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the short-term prognostic value of early measurement of serum lipoprotein (a) [Lp(a)] levels in Chinese patients with type 2 diabetes (T2D) and acute ischemic stroke (AIS). The study population comprised 232 consecutive patients with an AIS diagnosis complicated with T2D. Functional outcome was obtained on month 3 according to the modified Rankin Scale (mRS). Unfavorable functional outcome was defined as a mRS score of 3 to 6 points. The prognostic value of Lp(a) at admission to predict the unfavorable functional outcome 3 months after stroke onset was compared with the National Institutes of Health Stroke Scale score and other known outcome predictors. The Lp(a) levels in those patients were obtained with a median value of 16.8 mg/dl (IQR, 9.5-34.4 mg/dl). At 3-month follow-up, an unfavorable functional outcome was found in 86 patients (37.1%). In multivariate models comparing the second (Q2), third, and fourth quartiles against the first quartile of Lp(a), concentrations of Lp(a) in Q2, Q3, and Q4 were associated with unfavorable outcome, and increased risk of unfavorable outcome by 42, 131, and 211%. Interestingly, an elevated Lp(a, > 30 mg/dl) was also associated with unfavorable outcome, and with adjusted OR of 2.25 (95% CI 1.39-3.68). The AUC was significantly increased by adding Lp(a) to established risk factors (difference, 0.041 [95% CI, 0.034-0.053]; P = 0.02). The addition of Lp(a) to established risk factors significantly improved net reclassification improvement and integrated discrimination improvement. Higher Lp(a) levels at admission were associated with increased risk of unfavorable functional outcome and might be useful in identifying stroke patients with T2D at risk for unfavorable functional outcome for early prevention strategies.
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Affiliation(s)
- Haoliang Wang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jun Zhao
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yongkun Gui
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Haiqing Yan
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Zhixin Yan
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Ping Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
| | - Li Liu
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Li Chang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jianlong Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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3
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Kakarmath SS, Zack RM, Leyna GH, Fahimi S, Liu E, Fawzi WW, Lukmanji Z, Killewo J, Sacks F, Danaei G. Dietary determinants of serum total cholesterol among middle-aged and older adults: a population-based cross-sectional study in Dar es Salaam, Tanzania. BMJ Open 2017; 7:e015028. [PMID: 28588111 PMCID: PMC5663012 DOI: 10.1136/bmjopen-2016-015028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the dietary determinants of serum total cholesterol. DESIGN Cross-sectional population-based study. SETTING Peri-urban region of Dar es Salaam, Tanzania. PARTICIPANTS 347 adults aged 40 years and older from the Dar es Salaam Urban Cohort Hypertension Study. MAIN OUTCOME MEASURE Serum total cholesterol measured using a point-of-care device. RESULTS Mean serum total cholesterol level was 204 mg/dL (IQR 169-236 mg/dL) in women and 185 mg/dL (IQR 152-216 mg/dL) in men. After adjusting for demographic, socioeconomic, lifestyle and dietary factors, participants who reported using palm oil as the major cooking oil had serum total cholesterol higher by 15 mg/dL (95% CI 1 to 29 mg/dL) compared with those who reported using sunflower oil. Consumption of one or more servings of meat per day (p for trend=0.017) and less than five servings of fruits and vegetables per day (p for trend=0.024) were also associated with higher serum total cholesterol. A combination of using palm oil for cooking, eating more than one serving of meat per day and fewer than five servings of fruits and vegetables per day, was associated with 46 mg/dL (95% CI 16 to 76 mg/dL) higher serum total cholesterol. CONCLUSIONS Using palm oil for cooking was associated with higher serum total cholesterol levels in this peri-urban population in Dar es Salaam. Reduction of saturated fat content of edible oil may be considered as a population-based strategy for primary prevention of cardiovascular diseases.
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Affiliation(s)
- Sujay S Kakarmath
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel M Zack
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Germana H Leyna
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Saman Fahimi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Enju Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Zohra Lukmanji
- World food program, Dar es Salaam and Tumaini Hospital, Dar es Salaam, Tanzania
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Frank Sacks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Affiliation(s)
- Ingrid Undeland
- Department of Chemistry and Bioscience-Food Science, Chalmers University of Technology, Göteborg, Sweden
| | - Lars Ellegård
- Department of Clinical Nutrition, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ann-Sofie Sandberg
- Department of Chemistry and Bioscience-Food Science, Chalmers University of Technology, Göteborg, Sweden
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Severe coronary disease in an adult considered at low cardiovascular disease risk with a healthy lifestyle. J Clin Lipidol 2013; 7:526-30. [PMID: 24079291 DOI: 10.1016/j.jacl.2013.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 05/21/2013] [Accepted: 05/21/2013] [Indexed: 11/20/2022]
Abstract
Lipoprotein(a) [Lp(a)] is a lipoprotein subclass well-known among the lipid community to accelerate atherosclerosis and promote thrombosis through incompletely understood mechanism. We report a case of a young man with a healthy lifestyle and no major coronary or vascular risk factors who presented to the emergency department with an acute coronary syndrome and was ultimately found to have severe coronary artery disease. A diagnostic workup revealed elevated Lp(a). He was treated with consequent reduction in Lp(a) concentration. This case highlights the need to better understand atypical lipoproteins, how they relate to cardiovascular disease, the implications for screening family members, and the need to standardize patient management guidelines for the purpose of mortality risk reduction.
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Unal E, Mungan S, Bilen S, Karadag Y, Oztekin N, Bakir F, Ak F. The effects of lipoprotein(a) and homocysteine on prognosis and risk factors in acute ischemic stroke. Int J Neurosci 2013; 123:532-6. [DOI: 10.3109/00207454.2013.772609] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Elif Unal
- 1Neurology Department of Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Semra Mungan
- 1Neurology Department of Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Sule Bilen
- 1Neurology Department of Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Yesim Karadag
- 1Neurology Department of Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nese Oztekin
- 1Neurology Department of Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Fatih Bakir
- 2Biochemistry Department of Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Fikri Ak
- 1Neurology Department of Ankara Numune Education and Research Hospital, Ankara, Turkey
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7
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Patel JV, Tracey I, Hughes EA, Lip GY. Omega-3 polyunsaturated acids and cardiovascular disease: notable ethnic differences or unfulfilled promise? J Thromb Haemost 2010; 8:2095-104. [PMID: 20561183 DOI: 10.1111/j.1538-7836.2010.03956.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The consumption of long chain omega-3 polyunsaturated acids (PUFA) is considered to protect against cardiovascular disease and promote longevity following a heart attack. Historically, research in this area was fuelled by compelling reports of the cardiovascular benefits of omega-3 PUFA in select populations and cultures. More recent studies, in wider populations, suggest discordant findings: differences that are difficult to reconcile as the mechanism of action of omega-3 PUFA are poorly understood. As such, the use of this 'natural treatment' for cardiovascular disease is increasingly controversial, and potentially one of unfulfilled promise. To what extent does ethnicity influence the impact that omega-3 PUFA have on cardiovascular disease and its associated complications? We were interested to review the benefits of omega-3 PUFA in the management of cardiovascular risk amongst diverse ethnic groups. Using a systematic review of literature relating to omega-3 PUFA and cardiovascular disease, we found ethnicity to be a factor that accounts for inconsistency between studies. Some of the effects of omega-3 PUFA are limited to cultures with a very high omega-3 intake, and in turn, ethnicity moderates the efficiency with which PUFA are derived from the diet. Moreover, omega-3 PUFA are an important health care intervention in the current climate of globalization, where supplementation is likely to give protection to cultural groups undergoing dietary transition. Future epidemiological research into the efficacy of omega-3 PUFA in cardiovascular disease should consider the influence of ethnicity.
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Affiliation(s)
- J V Patel
- Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England, UK.
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8
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Leptin is associated with the size of the apolipoprotein(a) particle in African tribal populations living on fish or vegetarian diet. Atherosclerosis 2010; 211:303-7. [DOI: 10.1016/j.atherosclerosis.2010.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 01/18/2010] [Accepted: 01/27/2010] [Indexed: 11/18/2022]
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10
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Beavers KM, Beavers DP, Bowden RG, Wilson RL, Gentile M. Effect of Over-the-Counter Fish-Oil Administration on Plasma Lp(a) Levels in an End-Stage Renal Disease Population. J Ren Nutr 2009; 19:443-9. [DOI: 10.1053/j.jrn.2009.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Indexed: 11/11/2022] Open
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11
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Anuurad E, Rubin J, Chiem A, Tracy RP, Pearson TA, Berglund L. High levels of inflammatory biomarkers are associated with increased allele-specific apolipoprotein(a) levels in African-Americans. J Clin Endocrinol Metab 2008; 93:1482-8. [PMID: 18252779 PMCID: PMC2291489 DOI: 10.1210/jc.2007-2416] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A role of inflammation for cardiovascular disease (CVD) is established. Lipoprotein(a) [Lp(a)] is an independent CVD risk factor where plasma levels are determined by the apolipoprotein(a) [apo(a)] gene, which contains inflammatory response elements. DESIGN We investigated the effect of inflammation on allele-specific apo(a) levels in African-Americans and Caucasians. We determined Lp(a) levels, apo(a) sizes, allele-specific apo(a) levels, fibrinogen and C-reactive protein (CRP) levels in 167 African-Americans and 259 Caucasians. RESULTS Lp(a) levels were increased among African-Americans with higher vs. lower levels of CRP [<3 vs. > or =3 mg/liter (143 vs. 108 nmol/liter), P = 0.009] or fibrinogen (<340 vs. > or =340 mg/liter, P = 0.002). We next analyzed allele-specific apo(a) levels for different apo(a) sizes. No differences in allele-specific apo(a) levels across CRP or fibrinogen groups were seen among African-Americans or Caucasians for small apo(a) sizes (<22 kringle 4 repeats). Allele-specific apo(a) levels for medium apo(a) sizes (22-30 kringle 4 repeats) were significantly higher among African-Americans, with high levels of CRP or fibrinogen compared with those with low levels (88 vs. 67 nmol/liter, P = 0.014, and 91 vs. 59 nmol/liter, P < 0.0001, respectively). No difference was found for Caucasians. CONCLUSIONS Increased levels of CRP or fibrinogen are associated with higher allele-specific medium-sized apo(a) levels in African-Americans but not in Caucasians. These findings indicate that proinflammatory conditions result in a selective increase in medium-sized apo(a) levels in African-Americans and suggest that inflammation-associated events may contribute to the interethnic difference in Lp(a) levels between African-Americans and Caucasians.
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Affiliation(s)
- Erdembileg Anuurad
- Department of Medicine, University of California, Davis, Sacramento, California 95817, USA
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12
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Sofi F, Fatini C, Sticchi E, Lenti M, Gori AM, Giusti B, Fedi S, Casini A, Abbate R, Gensini GF. Fish intake and LPA 93C>T polymorphism: gene-environment interaction in modulating lipoprotein (a) concentrations. Atherosclerosis 2007; 195:e147-54. [PMID: 17603063 DOI: 10.1016/j.atherosclerosis.2007.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 05/18/2007] [Accepted: 05/22/2007] [Indexed: 11/17/2022]
Abstract
High plasma lipoprotein (a) [Lp(a)] concentrations are an independent risk factor for atherosclerotic diseases. To date, no effective intervention strategies on reducing Lp(a) concentrations have been reported. The aim of the study was to evaluate the possible modulation of two polymorphisms of LPA gene (LPA 93C>T and LPA 121G>A) and nutritional habits on Lp(a) concentrations. We studied 647 healthy Italian subjects (260 M; 387 F) with a median age of 48 years (range: 19-78) enrolled in an epidemiological study conducted in Florence, Italy. A linear regression analysis showed a significant negative influence of fish intake (beta=-0.174+/-0.084; p=0.04) on Lp(a) concentrations, after adjustment for smoking habit, C-reactive protein serum concentrations, dietary habits and LDL-cholesterol concentrations. With regard to LPA polymorphisms, LPA 93C>T polymorphism resulted to significantly affect Lp(a) circulating concentrations in a dose-dependent manner, with lower concentrations shown by subjects carrying the T rare allele, whereas no significant influence of LPA 121G>A polymorphism on Lp(a) concentrations was observed. Moreover, by analyzing the possible interplay between LPA 93C>T and dietary fish intake, a significant interaction between these two determinants in lowering Lp(a) concentrations was reported. In addition, lower Lp(a) concentrations were observed in subjects carrying the T allele of the LPA 93C>T polymorphism and consuming a high intake of fish with respect to those being in the highest tertile of fish consumption but homozygotes for the common allele of the polymorphism. In conclusion, this study reported a significant interaction of daily fish intake and LPA 93C>T polymorphism in decreasing Lp(a) concentrations.
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Affiliation(s)
- Francesco Sofi
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Italy.
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13
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Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)--a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon 2006; 52:5-50. [PMID: 16549089 DOI: 10.1016/j.disamonth.2006.01.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Enas A Enas
- CADI Research Foundation, Lisle, Illinois, USA
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Schmidt K, Kraft HG, Parson W, Utermann G. Genetics of the Lp(a)/apo(a) system in an autochthonous Black African population from the Gabon. Eur J Hum Genet 2005; 14:190-201. [PMID: 16267501 DOI: 10.1038/sj.ejhg.5201512] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Plasma lipoprotein(a) (Lp(a)) is a quantitative trait associated with atherothrombotic disease in European and Asian populations. Lp(a) concentrations vary widely within and between populations, with Africans exhibiting on average two- to threefold higher Lp(a) levels and a different distribution compared to Europeans. The apo(a) gene locus on chromosome 6q26-27 (LPA, MIM 152200) has been identified as the major quantitative trait locus (QTL) for Lp(a) concentrations in Europeans and populations of African descent (North American and South African Blacks) but data on autochthonous Black Africans are lacking.Here, we have analysed Lp(a) plasma concentrations, apo(a) isoforms in plasma and four polymorphisms in the LPA gene in 31 African families with 54 children from Gabon. Weighted midparent-offspring regression estimated a heritability h2=0.76. The correlation of Lp(a) levels associated with LPA alleles identical by descent (IBD) resulted in a heritability estimate of 0.801. Our data demonstrate that Lp(a) concentrations are highly heritable in a Central African population without admixture and high Lp(a) (median 43 mg/dl). LPA is the major QTL, explaining most or all of the heritability of Lp(a) in this population.
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Affiliation(s)
- Konrad Schmidt
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
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Shai I, Schulze MB, Manson JE, Stampfer MJ, Rifai N, Hu FB. A prospective study of lipoprotein(a) and risk of coronary heart disease among women with type 2 diabetes. Diabetologia 2005; 48:1469-76. [PMID: 15971061 DOI: 10.1007/s00125-005-1814-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Accepted: 03/09/2005] [Indexed: 11/24/2022]
Abstract
AIMS We examined the association between lipoprotein (Lp)(a) and CHD among women with type 2 diabetes. METHODS Of 32,826 women from the Nurses' Health Study who provided blood at baseline, we followed 921 who had a confirmed diagnosis of type 2 diabetes. RESULTS During 10 years of follow-up (6,835 person-years), we documented 122 incident cases of CHD. After adjustment for age, smoking, BMI, glycosylated HbA(1)c, triglycerides (TGs), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and other cardiovascular risk factors, the relative risk (RR) comparing extreme quintiles of Lp(a) was 1.95 (95% CI 1.07-3.56). The association was not appreciably altered after further adjustment for apolipoprotein B(100) or several inflammatory biomarkers. Increasing levels of Lp(a) were associated with lower levels of TGs. The probability of developing CHD over 10 years was higher among diabetic women with substantially higher levels of both Lp(a) (>1.07 micromol/l) and TGs (>2.26 mmol/l) than among diabetic women with lower levels (22 vs 10%, p log-rank test=0.049). Diabetic women with a higher level of only Lp(a) or TGs had a similar (14%) risk. In a multivariate model, diabetic women with higher levels of Lp(a) and TGs had an RR of 2.46 (95% CI 1.21-5.01) for developing CHD, as compared with those with lower levels of both biomarkers (p for interaction=0.413). The RRs for women with a higher level of either Lp(a) (RR=1.22, 95% CI 0.77-1.92) or TGs (RR=1.39, 95% CI 0.78-2.42) were comparable. CONCLUSIONS/INTERPRETATION Increased levels of Lp(a) were independently associated with risk of CHD among diabetic women.
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Affiliation(s)
- I Shai
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
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16
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Casiglia E, Basso G, Guglielmi F, Martini B, Mazza A, Tikhonoff V, Scarpa R, Saugo M, Caffi S, Pessina AC. German Origin Clusters for High Cardiovascular Risk in an Italian Enclave. Int Heart J 2005; 46:489-500. [PMID: 16043944 DOI: 10.1536/ihj.46.489] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mortality and morbidity appear to be higher in a Cimbrian population representing an enclave of people who migrated from medieval Germany to the secluded Leogra valley in Italy. A population-based study was organized, recruiting 881 elderly subjects of Cimbrian origin and comparing them with a standard control population (SCP, n = 3,282) having comparable general characteristics and lifestyle. Serum lipids and glucose, blood pressure, heart rate, respiratory function, ECG abnormalities, and historical events were used as risk indicators. Age-adjusted systolic and pulse pressure were higher in the Cimbrians than in the SCP, while diastolic blood pressure was comparable. The prevalences of arterial hypertension, isolated systolic hypertension, and pulse hypertension were significantly more represented among Cimbrians than SCP. The prevalences of diabetes, hypercholesterolemia, and hypertriglyceridemia were higher among the former than the latter. The ratio between apolipoproteins B and A1 was also higher, while the HDL fraction was significantly lower in Cimbrians than in the SCP. In Cimbrians, the relative risk (RR) for ischemic heart disease was 1.92 (1.57-2.34) in women, 2.30 (1.54-3.43) in men and 1.03 (1.00-1.06) in women for stroke, 2.43 (1.54-3.83) in men and 1.45 (1.01-1.12) in women for atrial fibrillation, 3.85 (2.83-5.24) in men and 1.39 (1.20-1.60) in women for respiratory disease, 1.97 (1.32-2.94) in men and 6.81 (4.38-10.60) in women for intermittent claudication, and 3.31 (2.44-4.50) in men and 2.30 (1.76-3.01) in women for left ventricular hypertrophy. The subjects living in the secluded Leogra valley are at higher cardiovascular risk than the standard controls. Whether this depends on genetic factors, lifestyle, or both will need to be clarified by further analysis.
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Affiliation(s)
- Edoardo Casiglia
- Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
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17
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Wang Y, Crawford MA, Chen J, Li J, Ghebremeskel K, Campbell TC, Fan W, Parker R, Leyton J. Fish consumption, blood docosahexaenoic acid and chronic diseases in Chinese rural populations. Comp Biochem Physiol A Mol Integr Physiol 2004; 136:127-40. [PMID: 14527635 DOI: 10.1016/s1095-6433(03)00016-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Chinese traditional diet is low in fat. However, there is regional variability in the amount, type of fat consumed and the pattern of chronic diseases. An epidemiological survey of 65 rural counties in China (6500 subjects) was conducted in the 1980s. We have re-examined the red blood cell fatty acid and antioxidant composition, with fish consumption. Fish consumption correlated significantly with the levels of docosahexaenoic acid (DHA) in red blood cells (RBC) (r=0.640, P<0.001), selenium (r=0.467, P<0.001) and glutathione peroxidase (r=0.333, P<0.01) in plasma. The proportion of DHA in RBC was inversely associated with total plasma triglyceride concentrations. A strong inverse correlation between DHA in RBC and cardiovascular disease (CVD) was found. The strongest correlation was the combination of DHA and oleic acid. RBC docosahexaenoic acid itself also correlated negatively and significantly with most chronic diseases and appeared to be more protective than either eicosapentaenoic or the omega3 docosapenataenoic acids. These results demonstrate the protective nature of fish consumption and DHA, found in high fat Western diets, operates at a low level of fat. This finding suggests the protective effect of fish consumption as validated by red cell DHA is universal. The protective effect is, therefore, most likely to be due to the fundamental properties of docosahexaenoic acid in cell function.
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Affiliation(s)
- Yiqun Wang
- Institute of Brain Chemistry and Human Nutrition, London Metropolitan University, North Campus,166-222 Holloway Road, N7 8DB, London, UK
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18
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Abstract
This article has considered a vast literature attesting to the efficacy of dietary intervention on risk factors for CHD and on vascular outcomes. Rather than relying solely on pharmacotherapy to improve risk factors and vascular outcomes, physicians, nurses, dietitians, pharmacists, and medical providers should emphasize the benefits of a well-balanced, nutritionally sound dietary program. The diet should be low in saturated fatty acids, controlled in calories to avoid (or reduce) obesity, and rich in fruits, vegetables, whole grain products, and good sources of protein. Emphasis on foods rich in n-3 fatty acids shows promise for reducing cardiovascular outcomes, particularly sudden death.
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Affiliation(s)
- Neil J Stone
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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19
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Abstract
Lipoprotein(a) is a cholesterol-enriched lipoprotein, consisting of a covalent linkage joining the unique and highly polymorphic apolipoprotein(a) to apolipoprotein B100, the main protein moiety of low-density lipoproteins. Although the concentration of lipoprotein(a) in humans is mostly genetically determined, acquired disorders might influence synthesis and catabolism of the particle. Raised concentration of lipoprotein(a) has been acknowledged as a leading inherited risk factor for both premature and advanced atherosclerosis at different vascular sites. The strong structural homologies with plasminogen and low-density lipoproteins suggest that lipoprotein(a) might represent the ideal bridge between the fields of atherosclerosis and thrombosis in the pathogenesis of vascular occlusive disorders. Unfortunately, the exact mechanisms by which lipoprotein(a) promotes, accelerates, and complicates atherosclerosis are only partially understood. In some clinical settings, such as in patients at exceptionally low risk for cardiovascular disease, the potential regenerative and antineoplastic properties of lipoprotein(a) might paradoxically counterbalance its athero-thrombogenicity, as attested by the compatibility between raised plasma lipoprotein(a) levels and longevity.
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Affiliation(s)
- Giuseppe Lippi
- Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologiche e Biomediche, Università degli Studi di Verona, Verona, Italy
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20
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Abstract
Elevated concentrations of circulating apolipoprotein B (apoB)-containing lipoproteins, other than low-density lipoprotein (LDL), have been implicated as causative agents for the development of atherosclerosis. A form of dyslipidemia, the atherogenic lipoprotein profile, that consists of elevated intermediate-density lipoprotein (IDL), triglycerides (TGs), dense LDL and dense very low density lipoprotein (VLDL), and low high density lipoprotein-2, occurs in 40% to 50% of patients with coronary artery disease (CAD). The recently released Adult Treatment Panel III guidelines suggest that because elevated TGs are an independent CAD risk factor, some TG-rich lipoproteins, commonly called remnant lipoproteins, must be atherogenic. Relevant to this series on diabetes, a number of studies have shown that in type 2 diabetes, the severity of CAD is positively related to the numbers of TG-rich particles in the plasma. Although less clear, other studies in type 2 diabetes suggest that elevated levels of lipoprotein (a) [Lp(a)] may also be independently associated with CAD. In this article, we summarize evidence for the role of apoB-containing lipoprotein particles other than LDL in the development of atherosclerosis and discuss methods of quantification and possible pharmacologic interventions for lowering their plasma concentrations. The particles reviewed include the TG-rich lipoproteins: VLDL and its remnants, chylomicron remnants and IDL, and the C-rich lipoprotein: Lp(a).
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Affiliation(s)
- Jere P Segrest
- Atherosclerosis Research Unit, Department of Medicine and Biochemistry and Molecular Biology, 630 Boshell Building, University of Alabama Medical Center, Birmingham, AL 35294-0012, USA.
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21
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Abstracts of Original Communications. Proc Nutr Soc 2001. [DOI: 10.1017/s0029665101000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Hernández C, Chacón P, García-Pascual L, Simó R. Differential influence of LDL cholesterol and triglycerides on lipoprotein(a) concentrations in diabetic patients. Diabetes Care 2001; 24:350-5. [PMID: 11213891 DOI: 10.2337/diacare.24.2.350] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the relationship between plasma lipid profiles and lipoprotein(a) [Lp(a)] concentrations in diabetic patients, taking into account the Lp(a) phenotype. RESEARCH DESIGN AND METHODS We included 191 consecutive diabetic outpatients (69 type 1 and 122 type 2 diabetic patients) in a cross-sectional study Serum Lp(a) was determined by enzyme-linked immunosorbent assay, and Lp(a) phenotypes were assessed by SDS-PAGE followed by immunoblotting. The statistical methods included a stepwise multiple regression analysis using the Lp(a) serum concentration as the dependent variable. The lipid profile consisted of total cholesterol, HDL cholesterol, LDL cholesterol, corrected LDL cholesterol, triglycerides, and apolipoproteins AI and B. RESULTS In the multiple regression analysis, LDL cholesterol (positively) and triglycerides (negatively) were independently related to the Lp(a) concentration, and they explained the 6.6 and 7.8% of the Lp(a) variation, respectively. After correcting LDL cholesterol, the two variables explained 3.8 and 6.4% of the Lp(a) variation, respectively. In addition, we observed that serum Lp(a) concentrations were significantly lower in patients with type IV hyperlipidemia (mean 1.0 mg/dl [range 0.5-17], n = 16) than in normolipidemic patients (6.5 mg/dl [0.5-33.5], n = 117) and in type II hyperlipidemic patients (IIa 15.5 mg/dl [3.5-75], n = 13; IIb 9 mg/dl [1-80], n = 45); P < 0.001 by analysis of variance. CONCLUSIONS Lp(a) concentrations were directly correlated with LDL cholesterol and negatively correlated with triglyceride levels in diabetic patients. Therefore, our results suggest that the treatment of diabetic dyslipemia may indirectly affect Lp(a) concentrations.
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Affiliation(s)
- C Hernández
- Diabetes Unit, Hospital General Vall d'Hebron, Barcelona, Spain
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23
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Abstract
The effects of fish oils, fish, and omega-3 (n-3) fatty acids on cardiovascular functions and outcomes in recently published studies are reviewed. The original hypothesis that eating fish is protective has been largely sustained but refined to indicate benefit mainly in those who are at increased risk. Biologic plausibility has been extended from the established benefit of lipid-lowering to improvements in vascular and arterial functions. A major intervention trial in patients with cardiovascular disease has confirmed the benefits of moderate amounts of long-chain n-3 fatty acids. Thus, the triad of evidence comprising epidemiology, biologic plausibility, and interventional success through a randomized, controlled trial has been established.
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Affiliation(s)
- P Nestel
- Baker Medical Research Institute, PO Box 6492, St. Kilda Road, Central Melbourne 8008, Australia.
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24
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Abstract
Functional foods are foods that, by virtue of physiologically active food components, provide health benefits beyond basic nutrition. Many functional foods have been found to be potentially beneficial in the prevention and treatment of cardiovascular disease, the leading cause of mortality in the United States. These foods include soybeans, oats, psyllium, flaxseed, garlic, tea, fish, grapes, nuts, and stanol- and sterol ester enhanced margarine. When eaten in adequate amounts on a consistent basis, these foods may aid in decreasing the risk of cardiovascular disease by several potential mechanisms: lowering blood lipid levels, improving arterial compliance, reducing low-density lipoprotein oxidation, decreasing plaque formation, scavenging free radicals, and inhibiting platelet aggregation.
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Affiliation(s)
- C M Hasler
- Functional Foods for Health Program, University of Illinois, 1302 West Pennsylvania Avenue, Room 103 Agricultural Bioprocess Laboratory; M/C 640, Urbana, IL 61801, USA.
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25
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Abstract
n-3 Polyunsaturated fatty acids, mainly those contained in fish oils, are candidates for inclusion in secondary prevention programmes for coronary heart disease, based on the results of recent randomized trials in humans. Marine n-3 polyunsaturated fatty acids retard coronary atherosclerosis and appear to prevent fatal arrhythmias; and they decrease mortality subsequent to myocardial infarction.
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Affiliation(s)
- P Angerer
- Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
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26
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Kiortsis DN, Elisaf MS. Correlates of lipoprotein(a) levels in a biracial cohort of young girls. J Pediatr 2000; 137:438. [PMID: 10969276 DOI: 10.1067/mpd/2000.107615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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27
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Abstract
n-3 Polyunsaturated fatty acids, mainly those contained in fish oils, are candidates for inclusion in secondary prevention programmes for coronary heart disease, based on the results of recent randomized trials in humans. Marine n-3 polyunsaturated fatty acids retard coronary atherosclerosis and appear to prevent fatal arrhythmias; and they decrease mortality subsequent to myocardial infarction.
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Affiliation(s)
- P Angerer
- Medizinische Klinik Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
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28
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Samman S. Nutrition and metabolism. Curr Opin Lipidol 2000; 11:83-5. [PMID: 10750698 DOI: 10.1097/00041433-200002000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Harjai KJ. Potential new cardiovascular risk factors: left ventricular hypertrophy, homocysteine, lipoprotein(a), triglycerides, oxidative stress, and fibrinogen. Ann Intern Med 1999; 131:376-86. [PMID: 10475891 DOI: 10.7326/0003-4819-131-5-199909070-00009] [Citation(s) in RCA: 109] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The 1996 Bethesda Conference acknowledged left ventricular hypertrophy, hyperhomocysteinemia, lipoprotein(a) excess, hypertriglyceridemia, oxidative stress, and hyperfibrinogenemia as possible new cardiac risk factors. This review summarizes the current literature that supports these conditions as cardiac risk factors. Left ventricular hypertrophy is an independent risk factor for vascular disease. Improvement or progression of left ventricular hypertrophy influences subsequent cardiovascular complications. Clinical trials are under way to assess the potential benefit of decreasing homocysteine levels. The role of lipoprotein(a) excess in vascular disease is controversial. The atherogenic potential of lipoprotein(a) seems to be neutralized by effective reduction of low-density lipoprotein cholesterol levels. Increasing evidence supports an independent role of hypertriglyceridemia in cardiovascular disease and a possible clinical benefit from decreasing triglyceride levels. Among antioxidant micronutrients, supplementation with vitamin E has been shown to be beneficial in primary and secondary prevention studies. Data supporting the use of other antioxidants are much weaker. Preliminary evidence suggests that reducing fibrinogen levels in patients with high baseline levels and coronary disease may be beneficial. Despite the potential relation between new risk factors and cardiovascular disease, routine clinical application of these conditions as cardiovascular risk factors would be premature. Evidence is needed that these conditions extend prognostic ability beyond conventional risk factors and that modification of these conditions can reduce the risk for cardiovascular events.
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Affiliation(s)
- K J Harjai
- Department of Cardiology, Ochsner Clinic, New Orleans, Louisiana 70121, USA.
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