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Burgos-Blasco P, Gonzalez-Cantero A, Hermosa-Gelbard A, Jiménez-Cahue J, Buendía-Castaño D, Berna-Rico E, de Aragon CAJ, Vañó-Galván S, Saceda-Corralo D. Subclinical Atherosclerosis in Alopecia Areata: Usefulness of Arterial Ultrasound for Disease Diagnosis and Analysis of Its Relationship with Cardiometabolic Parameters. J Clin Med 2024; 13:4264. [PMID: 39064304 PMCID: PMC11278048 DOI: 10.3390/jcm13144264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Chronic systemic inflammation is a risk factor that increases the development of atherosclerosis and predisposes to cardiovascular diseases (CVDs). The systemic inflammatory profile of alopecia areata (AA) regarding IFNγ and Th1 cytokine dysregulation has previously been described, suggesting an increased incidence of CVDs in this population. No previous studies investigated the possible relationship between atherosclerosis and AA by cardiovascular imaging techniques. To determine the prevalence, distribution and burden of subclinical atherosclerosis in AA. METHODS We conducted a case-control study in 62 participants, including 31 patients with severe AA (SALT > 75) and 31 healthy controls, matched for age, sex and body mass index (BMI). The participants underwent a detailed history assessment and were subjected to the measurement of weight, height, abdominal circumference and blood pressure. A fasting blood sample was also collected. Subclinical atherosclerosis was evaluated by ultrasonography of the bilateral femoral and carotid arteries. RESULTS The AA patients had an increased prevalence of subclinical atherosclerosis (54.7%) compared to the healthy controls (22.6%, p = 0.010). The prevalence of atheroma plaques was significantly higher in the carotid arteries (41.90% vs. 12.9%, p = 0.009), while no significant differences were found in femoral plaque prevalence. The AA patients with atherosclerotic plaques were older (p < 0.001) and had a longer time since AA diagnosis (p = 0.11) and increased serum levels of glycated hemoglobin (p = 0.029) and triglycerides (p = 0.009). In a regression analysis, duration of disease and neutrophil/lymphocyte ratio were the main predictors of atherosclerosis. CONCLUSIONS AA patients have an increased prevalence of carotid subclinical atherosclerosis. The duration of AA, systemic inflammation and insulin resistance appear to play a role in the development of subclinical atherosclerosis in this population.
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Affiliation(s)
- Patricia Burgos-Blasco
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
- Hair Disorders Unit, Grupo Pedro Jaén, 28006 Madrid, Spain
| | - Alvaro Gonzalez-Cantero
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
- Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
| | - Angela Hermosa-Gelbard
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
- Hair Disorders Unit, Grupo Pedro Jaén, 28006 Madrid, Spain
| | - Juan Jiménez-Cahue
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
- Hair Disorders Unit, Grupo Pedro Jaén, 28006 Madrid, Spain
| | - Diego Buendía-Castaño
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
- Hair Disorders Unit, Grupo Pedro Jaén, 28006 Madrid, Spain
| | - Emilio Berna-Rico
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
| | - Carlota Abbad-Jaime de Aragon
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
| | - Sergio Vañó-Galván
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
- Hair Disorders Unit, Grupo Pedro Jaén, 28006 Madrid, Spain
- Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
| | - David Saceda-Corralo
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Carretera Colmenar Viejo km 9.100, 28034 Madrid, Spain; (A.H.-G.); (J.J.-C.); (D.B.-C.); (E.B.-R.); (C.A.-J.d.A.); (S.V.-G.); (D.S.-C.)
- Hair Disorders Unit, Grupo Pedro Jaén, 28006 Madrid, Spain
- Departamento de Biología de Sistemas, Facultad de Medicina, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
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Marco-Benedí V, Cenarro A, Vila À, Real JT, Tamarit JJ, Walther LAAS, Diaz-Diaz JL, Perea V, Civeira F, Vaz AJV. Impact of conducting a genetic study on the management of familial hypercholesterolemia. J Clin Lipidol 2023; 17:717-731. [PMID: 37813710 DOI: 10.1016/j.jacl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/18/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Clinically diagnosed familial hypercholesterolemia (FH) may require a genetic test (GT) to confirm diagnosis. GT availability/accessibility is resource-dependent and usually restricted to specialized clinics. While GT has a diagnostic value, it has not yet defined its impact on long-term management and prognosis of FH. OBJECTIVE The aim was to identify the clinical characteristics associated with the request for a GT in suspected heterozygous FH. METHODS Retrospective study including adult patients with clinically suspected to be FH. Positive GT (GT+) was defined as having a pathogenic/likely pathogenic variant. Patients were stratified based on whether they had a genetic study conducted, and among those with a genetic study, according to those who did or did not have a GT+. RESULTS From 4854 patients included, 3090 were performed a GT (GT+: 2113). Median follow-up: 6.2 years. A younger age, FH-related physical signs, premature coronary disease, higher low-density lipoprotein cholesterol (LDLc) and lower body mass index and triglycerides, associated higher odds of being conducted a genetic study. These patients had higher baseline LDLc (252 mg/dL vs. 211 mg/dL among clinically diagnosed patients) and experienced larger reductions over the follow-up (157.7 mg/dL vs. 113.5 mg/dL, respectively). A similar pattern was observed among patients with GT+ (vs. negative GT). LDLc target attainment was low but increased to 66-95% when a triple combination with statin/ezetimibe/proprotein convertase subtilisin kexin type 9-inhibitor was used. Cardiovascular events occurred in 3.2% and 3.1% of patients who conducted/not conducted a genetic study. Patients conducted a genetic analysis and those with GT+ tended to present the events earlier. CONCLUSIONS Genetic study, vs. having a clinical-only diagnosis, impacts the management of FH. Cardiovascular prognosis was similar in both groups, perhaps as a result of the more intensive management of patients with a genetic study.
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Affiliation(s)
- Victoria Marco-Benedí
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Zaragoza, Spain (Drs Marco-Benedí, Cenarro, Civeira); Universidad de Zaragoza, Zaragoza, Spain (Drs Marco-Benedí, Civeira).
| | - Ana Cenarro
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Zaragoza, Spain (Drs Marco-Benedí, Cenarro, Civeira); Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain (Dr Cenarro)
| | - Àlex Vila
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital de Figueres, Figueres, Spain (Dr Vila)
| | - José T Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valencia, Departamento de Medicina, Universitat de València, Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain (Dr Real)
| | - Juan J Tamarit
- Consorcio Hospital General Universitario, Valencia, Spain (Dr Tamarit)
| | | | - José Luis Diaz-Diaz
- Unidad de Lípidos, Servicio de Medicina Interna, Complexo Hospitalario Universitario de A Coruña, Spain (Dr Diaz-Diaz)
| | - Verónica Perea
- Hospital Universitari Mútua de Terrassa, Spain (Dr Perea)
| | - Fernando Civeira
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Zaragoza, Spain (Drs Marco-Benedí, Cenarro, Civeira); Universidad de Zaragoza, Zaragoza, Spain (Drs Marco-Benedí, Civeira)
| | - Antonio J Vallejo Vaz
- Departmento de Medicina, Universidad de Sevilla, Sevilla, Spain (Dr Vaz); Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC, Seville, Spain (Dr Vaz)
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Muñoz-Cabrejas A, Laclaustra M, Guallar-Castillón P, Sánchez-Recio R, Jarauta E, Casasnovas JA, Moreno-Franco B. Association of beverage consumption with subclinical atherosclerosis in a Spanish working population. Sci Rep 2023; 13:6509. [PMID: 37081095 PMCID: PMC10119384 DOI: 10.1038/s41598-023-33456-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
Beverages play a substantial role meeting water, calorie, and nutrient requirements; however, they are presented as being major contributors to the current obesity epidemic. Although, the relationship between beverage consumption and metabolic risk factors for cardiovascular disease (CVD) in adults has been frequently studied, its association with subclinical atherosclerosis is of increased interest. We studied the association of beverage consumption with the presence of peripheral subclinical atherosclerosis among Spanish workers. We performed a cross-sectional study of 2089 middle-aged males, with a mean age of 50.9 (SD 3.9), and without CVD, carried out in the Aragon Workers' Health Study (AWHS). A food frequency questionnaire was used to measure beverage consumption of low-fat milk, coffee and tea (unsweetened), whole-fat milk, sugar-sweetened beverages, bottled fruit juice, artificially-sweetened beverages and 100% fruit juice. Atherosclerotic plaques were measured by ultrasound (in carotid arteries, and in femoral arteries). Atherosclerotic plaque was defined as a focal structure protruding ≥ 0.5 mm into the lumen, or reaching a thickness ≥ 50% of the surrounding intima-media thickness. As statistical analysis, we use logistic regression models, simultaneously adjusted for all beverage groups. As results, unsweetened coffee was the beverage most associated with peripheral subclinical atherosclerosis with an odds ratio (OR) of 1.25 (1.10-1.41), and 1.23 (1.09-1.40) 100g/day] for carotid, and femoral territories respectively. Moreover, subclinical atherosclerosis was positively associated with whole-fat milk [OR 1.10 (1.02-1.18) 100 g/day] in the femoral territory. The association was protective for low-fat milk in the carotid territory [OR 0.93 (0.88-0.99) 100g/day]. There was also a protective association with bottled fruit juices in the femoral territory [0.84 (0.74-0.94) 100g/day]. Our results suggest a detrimental association with the consumption of coffee, as well as with whole-fat milk and the presence of subclinical atherosclerosis. Therefore, an element of prudence excluding water and low-fat milk, must be applied when recommending beverage consumption.
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Affiliation(s)
- Ainara Muñoz-Cabrejas
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009, Zaragoza, Spain
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain
| | - Martín Laclaustra
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009, Zaragoza, Spain.
- Department of Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain.
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029, Madrid, Spain.
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, 28029, Madrid, Spain
- CIBERESP (CIBER de Epidemiología y Salud Pública), 28029, Madrid, Spain
- IMDEA-Food Institute. CEI UAM+CSIC, 28049, Madrid, Spain
| | - Raquel Sánchez-Recio
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009, Zaragoza, Spain
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain
| | - Estíbaliz Jarauta
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029, Madrid, Spain
| | - José Antonio Casasnovas
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, Universidad de Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029, Madrid, Spain
| | - Belén Moreno-Franco
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, 50009, Zaragoza, Spain.
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain.
- CIBERCV (CIBER de Enfermedades Cardiovasculares), 28029, Madrid, Spain.
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Paquette M, Carrié A, Bernard S, Cariou B, Hegele RA, Genest J, Trinder M, Brunham LR, Béliard S, Baass A. Effect of the LDL receptor mutation type on incident major adverse cardiovascular events in familial hypercholesterolaemia. Eur J Prev Cardiol 2022; 29:2125-2131. [PMID: 36047048 DOI: 10.1093/eurjpc/zwac188] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/04/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023]
Abstract
AIMS Patients with familial hypercholesterolaemia (FH) are at increased risk of cardiovascular disease (CVD) due to extremely high circulating LDL cholesterol (LDL-C) concentrations. Our objective was to study the effect of the type of LDL receptor (LDLR) mutation on the incidence of major adverse cardiovascular events (MACEs). METHODS AND RESULTS This was a multinational prospective cohort study, which included patients with heterozygous FH aged 18-65 years, without a prior history of CVD, and carrying a pathogenic or likely pathogenic variant in the LDLR gene. A total of 2131 patients (20 535person-years of follow-up) were included in the study, including 1234 subjects carrying a defective mutation in the LDLR and 897 subjects carrying a null mutation. During the follow-up, a first MACE occurred in 79 cases (6%) in the defective group and in 111 cases (12%) in the null group. The mean baseline LDL-C concentration was 17% higher in the null group than in the defective group (7.90 vs. 6.73 mmoL/L, P < 0.0001). In a Cox regression model corrected for traditional cardiovascular risk factors, the presence of a null mutation was associated with a hazard ratio of 2.09 (1.44-3.05), P = 0.0001. CONCLUSION Carriers of a null mutation have an independent ∼2-fold increased risk of incident MACE compared with patients carrying a defective mutation. This study highlights the importance of genetic screening in FH in order to improve patient care.
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Affiliation(s)
- Martine Paquette
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, 110 avenue des Pins Ouest, Montreal, QC H2W 1R7, Canada
| | - Alain Carrié
- Department of Biochemistry, Obesity and Dyslipidemia Genetics Unit, Hôpital de La Pitié-Salpêtrière, Sorbonne University, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), UMR_S1166, APHP, ICAN, 47-83 boulevard de l'hôpital, 75013 Paris, France
| | - Sophie Bernard
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, 110 avenue des Pins Ouest, Montreal, QC H2W 1R7, Canada
- Department of Medicine, Division of Endocrinology, Université de Montreal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada
| | - Bertrand Cariou
- Nantes Université, CHU Nantes, CNRS, Inserm, l'institut du thorax, 8 Quai Moncousu, F-44000 Nantes, France
| | - Robert A Hegele
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
- Robarts Research Institute, Western University, 100 Perth Dr, London, ON N6A 5K8, Canada
| | - Jacques Genest
- Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
| | - Mark Trinder
- Department of Medicine, Faculty of Medicine, University of British Columbia, Centre for Heart and Lung Innovation, University of British Columbia, 1081 Burrard St Room 166, Vancouver, BC V6Z 1Y6, Canada
| | - Liam R Brunham
- Department of Medicine, Faculty of Medicine, University of British Columbia, Centre for Heart and Lung Innovation, University of British Columbia, 1081 Burrard St Room 166, Vancouver, BC V6Z 1Y6, Canada
| | - Sophie Béliard
- Department of Nutrition, Metabolic Diseases, Endocrinology, Aix Marseille University, INSERM, INRAE, C2VN, La Conception Hospital, 27 Bd Jean Moulin, 13005 Marseille, France
| | - Alexis Baass
- Lipids, Nutrition, and Cardiovascular Prevention Clinic of the Montreal Clinical Research Institute, 110 avenue des Pins Ouest, Montreal, QC H2W 1R7, Canada
- Department of Medicine, Divisions of Experimental Medicine and Medical Biochemistry, McGill University, 3605 Rue de la Montagne, Montreal, QC H3G 2M1, Canada
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The intake of flavonoids, stilbenes, and tyrosols, mainly consumed through red wine and virgin olive oil, is associated with lower carotid and femoral subclinical atherosclerosis and coronary calcium. Eur J Nutr 2022; 61:2697-2709. [PMID: 35254491 PMCID: PMC9279214 DOI: 10.1007/s00394-022-02823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/01/2022] [Indexed: 12/04/2022]
Abstract
Purpose It is suggested that polyphenols back the cardiovascular protection offered by the Mediterranean diet. This study evaluates the association of specific types of dietary polyphenols with prevalent subclinical atherosclerosis in middle-aged subjects. Methods Ultrasonography and TC were performed on 2318 men from the Aragon Workers Health Study, recruited between 2011 and 2014, to assess the presence of plaques in carotid and femoral arteries and coronary calcium. Polyphenol intake was assessed using a validated semi-quantitative 136-item food frequency questionnaire. The Phenol Explorer database was used to derive polyphenol class intake. Logistic and linear regressions were used to estimate the cross-sectional association of polyphenols intake with femoral and carotid subclinical atherosclerosis and coronary calcium. Results A higher intake of flavonoids (third vs. first tertile) was associated with a lower risk of both carotid (OR 0.80: CI 95% 0.62–1.02; P trend 0.094) and femoral (0.62: 0.48–0.80, P trend < 0.001) subclinical atherosclerosis. A higher intake of stilbenes was associated with a lower risk of femoral subclinical atherosclerosis (0.62: 0.46–0.83; P trend 0.009) and positive coronary calcium (0.75: 0.55–1.03; P trend 0.131). A higher intake of tyrosols was also associated with a lower risk of positive coronary calcium (0.80: 0.62–1.03; P trend 0.111). The associations remained similar when adjusted for blood lipids and blood pressure. Conclusion Dietary flavonoids, stilbenes, and tyrosols, whose main sources are red wine and virgin olive oil, are associated with lower prevalence of subclinical atherosclerosis in middle-aged subjects. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-022-02823-0.
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van Bergen en Henegouwen K, Hutten BA, Luirink IK, Wiegman A, de Groot E, Kusters DM. Intima-media Thickness in treated and untreated patients with and without Familial Hypercholesterolemia: a Systematic Review and Meta-analysis. J Clin Lipidol 2022; 16:128-142. [DOI: 10.1016/j.jacl.2022.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 12/14/2022]
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Donat-Vargas C, Sandoval-Insausti H, Peñalvo JL, Moreno Iribas MC, Amiano P, Bes-Rastrollo M, Molina-Montes E, Moreno-Franco B, Agudo A, Mayo CL, Laclaustra M, De La Fuente Arrillaga C, Chirlaque Lopez MD, Sánchez MJ, Martínez-Gonzalez MA, Pilar GC. Olive oil consumption is associated with a lower risk of cardiovascular disease and stroke. Clin Nutr 2021; 41:122-130. [PMID: 34872046 DOI: 10.1016/j.clnu.2021.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/13/2021] [Accepted: 11/03/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS The specific association of olive oil consumption with coronary heart disease (CHD) or stroke has not been totally established. OBJECTIVE to examine whether olive oil consumption is associated with subclinical atherosclerosis, the risk of total cardiovascular disease (CVD), CHD, and stroke. METHODS Three cohorts were included: AWHS (2318 men), SUN Project (18,266 men and women), and EPIC-Spain (39,393 men and women). Olive oil consumption was measured at baseline using validated questionnaires. RESULTS In the AWHS, 747 participants had a positive coronary artery calcium score (CACS>0), and the OR (95% CI) was 0.89 (0.72, 1.10) in those with virgin olive oil consumption ≥30 g/day (v. <10 g/day). In the SUN Project (follow-up 10.8 years) 261 total CVD cases occurred, and the HR was 0.57 (0.34, 0.96) for consumptions ≥30 g/day (v. <10 g/day). In the EPIC-Spain (follow-up 22.8 years) 1300 CHD cases and 938 stroke cases occurred; the HRs for stroke according, 0 to <10 (ref), 10 to <20, 20 to <30, and ≥30 g/day of olive oil consumption, were 0.84 (0.70, 1.02), 0.80 (0.66, 0.96), 0.89 (0.74, 1.07). A weaker association was observed for CHD. The association was stronger among those consuming virgin olive oil, instead of common (refined). CONCLUSIONS Olive oil is associated with lower risk of CVD and stroke. The maximum benefit could be obtained with a consumption between 20 and 30 g/day. The association could be stronger for virgin olive oil and might operate from the early stages of the disease.
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Affiliation(s)
- Carolina Donat-Vargas
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Unit of Nutritional and Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Helena Sandoval-Insausti
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - José L Peñalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Maria Concepción Moreno Iribas
- Research Network on Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Pilar Amiano
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastián, Spain; Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain.
| | - Maira Bes-Rastrollo
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, Pamplona, Spain; CIBEROBN (CIBER of Obesity and Nutrition), Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Esther Molina-Montes
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Department of Nutrition and Food Science, University of Granada, Granada, Spain; Biomedical Research Center, Institute of Nutrition and Food Technology (INYTA) "José Mataix", University of Granada, Granada, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.
| | - Belén Moreno-Franco
- University of Zaragoza, Zaragoza, Spain; CIBERCV and Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO), And Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.
| | | | - Martín Laclaustra
- University of Zaragoza, Zaragoza, Spain; CIBERCV and Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Carmen De La Fuente Arrillaga
- University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, Pamplona, Spain; CIBEROBN (CIBER of Obesity and Nutrition), Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Maria Dolores Chirlaque Lopez
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Murcia Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain.
| | - Maria-José Sánchez
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain; Andalusian School of Public Health (EASP), Granada, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.
| | - Miguel Angel Martínez-Gonzalez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; University of Navarra, Department of Preventive Medicine and Public Health, School of Medicine, Pamplona, Spain; CIBEROBN (CIBER of Obesity and Nutrition), Madrid, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
| | - Guallar-Castillón Pilar
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.
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8
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Muñoz-Cabrejas A, Laclaustra M, Guallar-Castillón P, Casasnovas JA, Jarauta E, Sandoval-Insausti H, Donat-Vargas C, Moreno-Franco B. High-quality intake of carbohydrates is associated with lower prevalence of subclinical atherosclerosis in femoral arteries: The AWHS study. Clin Nutr 2021; 40:3883-3889. [PMID: 34134004 DOI: 10.1016/j.clnu.2021.04.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/16/2021] [Accepted: 04/30/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS High-quality of the carbohydrates consumed, apart from their total amount, appear to protect from cardiovascular disease (CVD). However, the relationship between the quality of carbohydrates and the early appearance of atherosclerosis has not yet been described. Our objective was to estimate the association between the quality of dietary carbohydrates and subclinical atherosclerosis in femoral and carotid arteries. METHODS Cross-sectional study of femoral and carotid atherosclerosis assessed using ultrasounds of 2074 middle-aged males, 50.9 (SD 3.9) years old, with no previous CVD, and pertaining to the Aragon Workers' Health Study (AWHS) cohort. Food frequency questionnaires were used to calculate a carbohydrate quality index (CQI) defined as: consumption of dietary fiber, a lower glycemic index, the ratio of whole grains/total grains, and the ratio of solid carbohydrates/total carbohydrates. The presence of plaques across four CQI intervals was studied using adjusted logistic regression models. RESULTS The CQI showed a direct inverse association with subclinical atherosclerosis in femoral territories. Participants with a higher consumption of high-quality carbohydrates (13-15 points) were less likely to have femoral plaques when compared with participants in the lowest index interval (4-6 points) (OR = 0.59; 95% CI = 0.39, 0.89; p = 0.005). No association was found between the CQI and the presence of subclinical atherosclerosis in carotid territories. A lower consumption of high-quality carbohydrates tended to be associated with a greater atherosclerosis extension, considered as the odds for having more affected territories (p = 0.011). CONCLUSIONS Among middle-aged males, a high-quality intake of carbohydrates is associated with a lower prevalence of femoral artery subclinical atherosclerosis when compared with a lower consumption. Thus, indicating an early relationship between the quality of carbohydrates and the development of CVD.
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Affiliation(s)
| | - M Laclaustra
- Agencia Aragonesa para La Investigación y El Desarrollo, ARAID, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain; CIBERCV Instituto de Salud Carlos III. Madrid, Spain.
| | - P Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain; CIBERESP Instituto de Salud Carlos III, Madrid, Spain; IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - J A Casasnovas
- Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E Jarauta
- Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - H Sandoval-Insausti
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - C Donat-Vargas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, Madrid, Spain; CIBERESP Instituto de Salud Carlos III, Madrid, Spain; Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - B Moreno-Franco
- Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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9
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Work Shift, Lifestyle Factors, and Subclinical Atherosclerosis in Spanish Male Workers: A Mediation Analysis. Nutrients 2021; 13:nu13041077. [PMID: 33810210 PMCID: PMC8065668 DOI: 10.3390/nu13041077] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/22/2022] Open
Abstract
(1) Background: Working night shifts has been associated with altered circadian rhythms, lifestyle habits, and cardiometabolic risks. No information on the potential association of working shift and the presence of atherosclerosis is available. The aim of this study was to quantify the association between different work shifts and the presence of subclinical atherosclerosis objectively measured by imaging. (2) Methods: Analyses were conducted on the baseline data of the Aragon Workers Health Study (AWHS) cohort, including information on 2459 middle-aged men. Categories of shift work included central day shift, rotating morning-evening or morning-evening-night shift, and night shift. The presence of atherosclerotic plaques was assessed by 2D ultrasound in the carotid and femoral vascular territories. Multivariable logistic models and mediation analysis were conducted to characterize and quantify the association between study variables. (3) Results: Participants working night or rotating shifts presented an overall worse cardiometabolic risk profile, as well as more detrimental lifestyle habits. Workers in the most intense (morning-evening-night) rotating shift presented higher odds of subclinical atherosclerosis (odds ratio: 1.6; 95% confidence interval: 1.12 to 2.27) compared to workers in the central shift, independently of the presence of lifestyle and metabolic risk factors. A considerable (21%) proportion of this association was found to be mediated by smoking, indicating that altered sleep-wake cycles have a direct relationship with the early presence of atherosclerotic lesions. (4) Conclusions: Work shifts should be factored in during workers health examinations, and when developing effective workplace wellness programs.
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10
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Daily Sitting for Long Periods Increases the Odds for Subclinical Atheroma Plaques. J Clin Med 2021; 10:jcm10061229. [PMID: 33809646 PMCID: PMC8001316 DOI: 10.3390/jcm10061229] [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: 02/03/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
Sedentarism is a risk factor for cardiovascular disease (CVD), but currently it is not clear how a sedentary behavior such as long sitting time can affect atherosclerosis development. This study examined the relationship between sitting time and the prevalence of carotid and femoral subclinical atherosclerosis. A cross-sectional analysis based on a subsample of 2082 participants belonging to the Aragon Workers’ Health Study was carried out. Ultrasonography was used to assess the presence of plaques in carotid and femoral territories; the validated Spanish version of the questionnaire on the frequency of engaging in physical activity used in the Nurses’ Health Study and the Health Professionals’ was used to assess physical activity and sitting time; and demographic, anthropometric, and clinical data were obtained by trained personnel during the annual medical examination. Participants were categorized into <9 h/day and ≥9 h/day sitting time groups. After adjusting for several confounders, compared with participants that remain seated <9 h/day, those participants who remain seated ≥9 h/day had, respectively, OR = 1.25 (95%CI: 1.01, 1.55, p < 0.05) and OR = 1.38 (95%CI: 1.09, 1.74, p < 0.05) for carotid and any-territory plaque presence. Remaining seated ≥9 h/day is associated with higher odds for carotid and any-territory plaque presence independently of physical activity levels and other cardiovascular risk factors.
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11
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Aguilar-Palacio I, Malo S, Jarauta E, Moreno-Franco B, Maldonado L, Compés L, Rabanaque MJ, Casasnovas JA. Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers' Health Study. J Clin Med 2021; 10:jcm10050945. [PMID: 33804382 PMCID: PMC7957801 DOI: 10.3390/jcm10050945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
The objective of this study is to describe the profile of primary preventive treatment for cardiovascular disease in adult males and to analyze the association between treatment profile and subclinical atherosclerosis. We selected male workers who had undergone ultrasound imaging and had no previous history of cardiovascular disease (n = 2138). Data on the consumption of primary cardiovascular drugs from the previous year were obtained. We performed bivariate analyses to compare patient characteristics according to cardiovascular treatment and the presence of subclinical atherosclerosis, and logistic regression models to explore the association between these two variables. Among participants with no personal history of cardiovascular disease, subclinical atherosclerosis was present in 77.7% and 31.2% had received some form of preventive treatment. Of those who received no preventive treatment, 73.6% had subclinical atherosclerosis. Cardiovascular preventive treatment was associated only with CACS > 0 (odds ratio (OR), 1.37; 95% confidence interval (95% CI), 1.06-1.78). Statin treatment was associated with a greater risk of any type of subclinical atherosclerosis (OR, 1.73) and with CACS > 0 (OR, 1.72). Subclinical atherosclerosis existed in almost 75% of men who had no personal history of cardiovascular disease and had not received preventive treatment for cardiovascular disease.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
| | - Sara Malo
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
- Correspondence:
| | - Estibaliz Jarauta
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Hospital Universitario Miguel Servet, IIS Aragón, 50009 Zaragoza, Spain
| | - Belén Moreno-Franco
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
| | - Lina Maldonado
- Department of Economic Structure, Economic History and Public Economics, University of Zaragoza, 50009 Zaragoza, Spain;
| | - Luisa Compés
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
- Dirección General de Salud Pública, Gobierno de Aragón, 50009 Zaragoza, Spain
| | - Mª José Rabanaque
- Preventive Medicine and Public Health Department, University of Zaragoza, 50009 Zaragoza, Spain; (I.A.-P.); (B.M.-F.); (M.J.R.)
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, 50009 Zaragoza, Spain;
| | - José Antonio Casasnovas
- Instituto Aragonés de Ciencias de Salud, IIS Aragón, 50009 Zaragoza, Spain; (E.J.); (J.A.C.)
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12
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Kawasaki H, Kawasaki M, Iki T, Matsuyama R. Genetics education program to help public health nurses improve their knowledge and enhance communities' genetic literacy: a pilot study. BMC Nurs 2021; 20:31. [PMID: 33579269 PMCID: PMC7881575 DOI: 10.1186/s12912-021-00549-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND As human genetics knowledge develops, public genetic literacy needs to be increased, though the educational capacity for this purpose has not yet been fully developed. Under this circumstance, the daily work of public health nurses can be viewed as an opportunity to enhance public genetic literacy. However, in Japan, there is not only a lack of public knowledge of human genomics but also a lack of public health nurses' recognition about genomic literacy. A short-term education program was implemented as a pilot study. This study aimed to examine the effectiveness of the program to support public health nurses' activity aimed at promoting health services-related genetic literacy. METHODS The genetics education program was implemented in December 2019, in Kagoshima, Japan. Twenty-three public health nurses cooperated with the research. The program was composed of a case study on consultation, a lecture on hereditary diseases, and a discussion on the role of public health nurses. Familial hypercholesterolemia was used as the topic of the case study. We evaluated scores for cognition, affect, and psychomotor characteristics related to their learning goals before and after the program using Wilcoxon signed-rank tests. Answers in the consultation were qualitatively analyzed. RESULTS The mean cognitive score, capturing provision of explanations of hereditary disease, was 6.3 before the program but increased significantly to 9.3 after the program (p < 0.001). For the affective score, the goal of which was deepening interest in human genetics, the mean score increased significantly from 8.5 before to 11.0 after (p < 0.001). For the psychomotor score, addressing the need for genetic consultation, the mean score increased significantly from 4.4 before to 8.1 after (p < 0.001). Prominent themes extracted from descriptions on the worksheet post training included, "providing advice and accurate information on genetic disorders" and "referral to a specialized organization." CONCLUSIONS Our findings indicated that this education program helps public health nurses be positively involved in human genetic disorders. Thus, they may connect to their local community to provide accurate genetics knowledge and advice for health management and promoting genetic literacy.
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Affiliation(s)
- Hiromi Kawasaki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Masahiro Kawasaki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Tomoko Iki
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Ryota Matsuyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
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13
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Vlad CE, Foia L, Florea L, Costache II, Covic A, Popescu R, Reurean-Pintilei D, Covic A. Evaluation of cardiovascular risk factors in patients with familial hypercholesterolemia from the North-Eastern area of Romania. Lipids Health Dis 2021; 20:4. [PMID: 33430859 PMCID: PMC7798287 DOI: 10.1186/s12944-020-01428-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background Familial hypercholesterolemia(FH) is one of the most frequent and important monogenic cholesterol pathologies. Traditional and non-traditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease(ASCVD) in this population. The aims of the study were: (a) to identify FH patients in the North-Eastern part of Romania and to analyze demographic, clinical and paraclinical data (b) to evaluate the risk of new cardiovascular events at follow-up in FH patients stratified by lipid-lowering agents. Methods This first prospective study in the North-Eastern part of Romania was carried out between October 2017 and October 2019; out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network(DLCN) and Simon Broome(SM) scores, 61 patients with DLCN score above 3 and possible/probable FH(SM score) were included. Results Nine hundred-eighty patients were examined and 61 (6.2%) were received the clinical diagnosis of FH. The mean age was 48.5±12.5 years, with more female patients than male patients (63.9% versus 36%). Hypertension was the main cardiovascular risk factor for both genders, followed by physical inactivity and obesity for the female group and active smoking for the male group. The measured DLCN score recorded: “possible” FH identified in 39.4%, “probable” FH in 45.9% and “definite” FH in 14.7%. The effective lipid-lowering drugs used were statin alone and statin in association with fenofibrate, which improved both the lipid profile values and the subclinical atherosclerosis markers (ankle-brachial index, carotid intima-media thickness and high-sensitivity C-reactive protein). New ASCVDs that emerged during the study were most commonly represented by coronary heart disease and stroke. At the same time, the new cardiovascular events were delayed in patients receiving the lipid-lowering drugs, without significant differences between them. Conclusions In patients with suspected FH, the lipid-lowering agents during the follow-up period delayed the new cardiovascular events, yet failed to reach the goals proposed by the guidelines.
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Affiliation(s)
- Cristiana-Elena Vlad
- Department of Nephrology-Internal Medicine, "Dr. C. I. Parhon" Clinical Hospital, Iasi, Romania.,Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania
| | - Liliana Foia
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania.
| | - Laura Florea
- Department of Nephrology-Internal Medicine, "Dr. C. I. Parhon" Clinical Hospital, Iasi, Romania.,Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania
| | - Irina-Iuliana Costache
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania
| | - Andreea Covic
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania
| | - Roxana Popescu
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania
| | - Delia Reurean-Pintilei
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania
| | - Adrian Covic
- Department of Nephrology-Internal Medicine, "Dr. C. I. Parhon" Clinical Hospital, Iasi, Romania.,Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania; Universitatii street, 700115, Iasi, Romania.,The Academy of Romanian Scientists, Bucharest, Romania
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14
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Moreno-Franco B, Pérez-Esteban A, Civeira F, Guallar-Castillón P, Casasnovas JA, Mateo-Gállego R, Jarauta E, Malo S, Laclaustra M. Association between alcohol consumption and subclinical femoral atherosclerosis in smoking and non-smoking men: the AWHS study. Addiction 2020; 115:1754-1761. [PMID: 32061175 DOI: 10.1111/add.15012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/23/2019] [Accepted: 02/11/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Many addictive substances, such as tobacco and alcohol, influence atherosclerosis development. Whether or not tobacco's pro-atherosclerotic effect is influenced by alcohol consumption is unknown. We aimed to estimate the impact of alcohol intake on the presence of subclinical atherosclerosis in femoral arteries in smoking and non-smoking middle-aged men. DESIGN, SETTING AND PARTICIPANTS Cross-sectional analysis of a subset of the Aragon Workers Health Study (AWHS), comprising 2099 men with mean age 50.9 years without previous cardiovascular disease. MEASUREMENTS The presence of plaques in femoral arteries was assessed by high-resolution sonography. Self-reported alcohol consumption over the previous year was measured with a food frequency questionnaire. The sample was divided into four groups according to their daily grams of alcohol consumption ≤ 1 (abstainers), ≥ 2 to < 30, ≥ 30 to < 60 and ≥ 60 g/day. Participants were divided on ever-smoking (current and former) versus never-smoking strata in the main analysis. FINDINGS We did not find a significant association between the different levels of alcohol intake and the likelihood of developing femoral artery atherosclerosis in never-smokers. Ever-smoking was positively associated with femoral atherosclerosis overall [odds ratio (OR) = 3.00; 95% confidence interval (CI) = 2.40, 3.74; P < 0.001] and within each level of alcohol consumption. Atherosclerosis was lower in ever-smokers who consumed 2 g/day or more but less than 30 g/day with respect to those ever-smokers who were abstainers (OR = 0.70; 95% CI = 0.49, 0.99; P < 0.05). However, among these ever-smokers, atherosclerosis prevalence was still higher than among never-smokers who consumed alcohol in the same amount (2 g/day or more but less than 30 g/day) (OR = 2.73; 95% CI = 2.07, 3.61; P < 0.001). CONCLUSIONS Among middle-aged men, moderate alcohol consumption appears to be associated with lower prevalence of femoral artery subclinical atherosclerosis compared with alcohol abstinence only in ever-smokers.
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Affiliation(s)
- Belén Moreno-Franco
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBERCV, Zaragoza, Spain
| | | | - Fernando Civeira
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBERCV, Zaragoza, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP, Madrid, Spain.,IMDEA-Food Institute. CEI UAM+CSIC, Madrid, Spain
| | - José Antonio Casasnovas
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBERCV, Zaragoza, Spain
| | - Rocío Mateo-Gállego
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBERCV, Zaragoza, Spain
| | - Estíbaliz Jarauta
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBERCV, Zaragoza, Spain
| | - Sara Malo
- Universidad de Zaragoza, Zaragoza, Spain
| | - Martín Laclaustra
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBERCV, Zaragoza, Spain.,Agencia Aragonesa para la Investigación y el Desarrollo, ARAID, Zaragoza, Spain
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15
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Tran A, Burkhardt B, Tandon A, Blumenschein S, van Engelen A, Cecelja M, Zhang S, Uribe S, Mura J, Greil G, Hussain T. Pediatric heterozygous familial hypercholesterolemia patients have locally increased aortic pulse wave velocity and wall thickness at the aortic root. Int J Cardiovasc Imaging 2019; 35:1903-1911. [PMID: 31209684 DOI: 10.1007/s10554-019-01626-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/10/2019] [Indexed: 01/02/2023]
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant disorder that affects 1 in 250 people. Aortic stiffness, measured by pulse wave velocity (PWV), is an independent predictor for cardiovascular events. Young FH patients are a unique group with early vessel wall disease that may serve to elucidate the determinants of aortic stiffness. We hypothesized that young FH patients would have early changes in aortic stiffness compared to healthy, age- and sex-matched reference values. Thirty-three FH patients ( ≥ 7 years age; mean age 14.6 ± 3.3 years; 26/33 on statin therapy) underwent cardiac MRI. PWV was determined using propagation of flow waveform from aortic arch phase contrast images. Distensibility and aortic wall thickness (AWT) were measured at the ascending, proximal descending, and diaphragmatic aorta. Ventricular volumes and left ventricular (LV) myocardial mass were measured from 2D cine images. These parameters were compared to age- and sex-matched reference values. FH patients had significantly higher PWV (4.5 ± 0.8 vs. 3.5 ± 0.3 m/s; p < 0.001), aortic distensibility, and ascending aortic wall thickness (1.37 ± 0.18 vs. 1.30 ± 0.02 mm; p < 0.05) compared to reference. There was no difference in aortic area or descending aortic wall thickness between groups. Young FH patients had aortic changes with increased aortic pulse wave velocity in the setting of increased aortic distensibility, accompanied by increased thickness of the ascending aortic wall. Presence of these early findings in young patients despite the majority being on statin therapy support enhanced screening and aggressive treatment of familial hypercholesterolemia to prevent potential future cardiovascular events.
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Affiliation(s)
- Andrew Tran
- Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA.
| | | | - Animesh Tandon
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah Blumenschein
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arna van Engelen
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Marina Cecelja
- Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, St Thomas' Hospital, London, UK
| | - Song Zhang
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sergio Uribe
- Radiology Department, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Biomedical Imaging Center, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Millennium Nucleus for Cardiovascular Magnetic Resonance, Ministry of Economy, Development, and Tourism, Santiago, Chile
| | - Joaquin Mura
- Millennium Nucleus for Cardiovascular Magnetic Resonance, Ministry of Economy, Development, and Tourism, Santiago, Chile.,Mechanical Engineering Department, Technical University Federico Santa Maria, Santiago, Chile
| | - Gerald Greil
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Tarique Hussain
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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16
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Gonzalez-Cantero A, Gonzalez-Cantero J, Sanchez-Moya AI, Perez-Hortet C, Arias-Santiago S, Schoendorff-Ortega C, Gonzalez-Calvin JL. Subclinical atherosclerosis in psoriasis. Usefulness of femoral artery ultrasound for the diagnosis, and analysis of its relationship with insulin resistance. PLoS One 2019; 14:e0211808. [PMID: 30735527 PMCID: PMC6368294 DOI: 10.1371/journal.pone.0211808] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Psoriasis is associated with an increased risk of cardiovascular disease (CVD) at younger ages that is not identifiable by traditional risk factors. Screening for subclinical atherosclerosis with ultrasound has only been investigated in carotid arteries. Femoral artery ultrasound has never been considered for this purpose. The link between psoriasis and accelerated atherosclerosis has not yet been established. OBJECTIVE To study the usefulness of femoral artery ultrasound for the detection of subclinical atherosclerosis in psoriasis. We also investigated its possible relationship with changes in insulin resistance. METHODS We conducted a cross-sectional study in 140 participants, 70 patients with moderate-to-severe psoriasis and 70 healthy controls, matched 1:1 for age, sex, and BMI. Femoral and carotid atherosclerotic plaques were evaluated by ultrasonography. Insulin resistance was assessed by the homeostasis model assessment method (HOMA-IR). RESULTS Femoral atherosclerotic plaque prevalence was significantly higher in patients with psoriasis (44.64%) than in controls (19.07%) (p<0.005), but no significant difference was found in carotid plaque prevalence (p<0.3). Femoral plaques were significantly more prevalent than carotid plaques (21.42%) among patients with psoriasis (p<0.001). In the regression analysis, insulin resistance was the most influential determinant of atherosclerosis in psoriasis and C-reactive protein the most significant predictor of insulin resistance. CONCLUSIONS Ultrasound screening for femoral atherosclerotic plaques improves the detection of subclinical atherosclerosis in patients with psoriasis, whereas the study of carotid arteries is not sufficiently accurate. Insulin resistance appears to play a greater role in the development of atherosclerosis in these patients in comparison to other classical CVD risk factors.
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Blasco-Colmenares E, Moreno-Franco B, Latre ML, Mur-Vispe E, Pocovi M, Jarauta E, Civeira F, Laclaustra M, Casasnovas JA, Guallar E. Sleep duration and subclinical atherosclerosis: The Aragon Workers' Health Study. Atherosclerosis 2018; 274:35-40. [PMID: 29751282 DOI: 10.1016/j.atherosclerosis.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/16/2018] [Accepted: 05/01/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Few studies have evaluated the association of sleep duration with subclinical atherosclerosis, and with heterogeneous findings. We evaluated the association of sleep duration with the presence of coronary, carotid, and femoral subclinical atherosclerosis in healthy middle-age men with low prevalence of clinical comorbidities. METHODS We performed a cross-sectional analysis of 1968 men, 40-60 years of age, participating in the Aragon Workers' Health Study (AWHS). Duration of sleep during a typical work week was assessed by questionnaire. Coronary artery calcium scores (CACS) was assessed by computed tomography and the presence of carotid plaque and femoral plaque by ultrasound. RESULTS In fully adjusted models, the odds ratios (95% CI) for CACS >0 comparing sleep durations of ≤5, 6, and ≥8 h with 7 h were 1.34 (0.98-1.85), 1.35 (1.08-1.69) and 1.21 (0.90-1.62), respectively (p = 0.04). A similar U-shaped association was observed for CACS ≥100 and for CACS. The corresponding odds ratios for the presence of at least one carotid plaque were ≤5, 6, and ≥8 h with 7 h were 1.23 (0.88-1.72), 1.09 (0.86-1.38), and 0.86 (0.63-1.17), respectively (p = 0.31), and for the presence of at least one femoral plaque were 1.25 (0.87-1.80), 1.19 (0.93-1.51) and 1.17 (0.86-1.61), respectively (p = 0.39). CONCLUSIONS Middle-aged men reporting 7 h of sleep duration had the lowest prevalence of subclinical coronary atherosclerosis as assessed by CACs. Our results support that men with very short or very long sleep durations are at increased risk of atherosclerosis.
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Affiliation(s)
- Elena Blasco-Colmenares
- Division of Internal Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Belén Moreno-Franco
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain.
| | - Montserrat León Latre
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | | | - Miguel Pocovi
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | - Estíbaliz Jarauta
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain
| | - Fernando Civeira
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | - Martín Laclaustra
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain
| | - José A Casasnovas
- Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, CIBER Cardiovascular, Zaragoza, Spain; Universidad de Zaragoza, Zaragoza, Spain
| | - Eliseo Guallar
- Division of Internal Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Alonso R, Perez de Isla L, Muñiz-Grijalvo O, Diaz-Diaz JL, Mata P. Familial Hypercholesterolaemia Diagnosis and Management. Eur Cardiol 2018; 13:14-20. [PMID: 30310464 DOI: 10.15420/ecr.2018:10:2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Familial hypercholesterolaemia is the most common monogenic disorder associated with premature coronary artery disease. Mutations are most frequently found in the LDL receptor gene. Clinical criteria can be used to make the diagnosis; however, genetic testing will confirm the disorder and is very useful for cascade screening. Early identification and adequate treatment can improve prognosis, reducing negative clinical cardiovascular outcomes. Patients with familial hypercholesterolaemia are considered at high cardiovascular risk and the treatment target is LDL cholesterol <2.6 mmol/l or at least a 50 % reduction in LDL cholesterol. Patients require intensive treatment with statins and ezetimibe and/or colesevelam. Recently, proprotein convertase subtilisin/kexin type 9 inhibitors have been approved for the management of familial hypercholesterolaemia on top of statins.
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Affiliation(s)
- Rodrigo Alonso
- Department of Nutrition, Clínica Las Condes Santiago, Chile
| | - Leopoldo Perez de Isla
- Cardiology Department, Clinical Hospital San Carlos, IDISSC, Complutense University Madrid, Spain
| | | | - Jose Luis Diaz-Diaz
- Department of Internal Medicine, University A Coruña Hospital A Coruña, Spain
| | - Pedro Mata
- Spanish Familial Hypercholesterolemia Foundation Madrid, Spain
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Walsh MT, Hussain MM. Targeting microsomal triglyceride transfer protein and lipoprotein assembly to treat homozygous familial hypercholesterolemia. Crit Rev Clin Lab Sci 2016; 54:26-48. [PMID: 27690713 DOI: 10.1080/10408363.2016.1221883] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Homozygous familial hypercholesterolemia (HoFH) is a polygenic disease arising from defects in the clearance of plasma low-density lipoprotein (LDL), which results in extremely elevated plasma LDL cholesterol (LDL-C) and increased risk of atherosclerosis, coronary heart disease, and premature death. Conventional lipid-lowering therapies, such as statins and ezetimibe, are ineffective at lowering plasma cholesterol to safe levels in these patients. Other therapeutic options, such as LDL apheresis and liver transplantation, are inconvenient, costly, and not readily available. Recently, lomitapide was approved by the Federal Drug Administration as an adjunct therapy for the treatment of HoFH. Lomitapide inhibits microsomal triglyceride transfer protein (MTP), reduces lipoprotein assembly and secretion, and lowers plasma cholesterol levels by over 50%. Here, we explain the steps involved in lipoprotein assembly, summarize the role of MTP in lipoprotein assembly, explore the clinical and molecular basis of HoFH, and review pre-clinical studies and clinical trials with lomitapide and other MTP inhibitors for the treatment of HoFH. In addition, ongoing research and new approaches underway for better treatment modalities are discussed.
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Affiliation(s)
- Meghan T Walsh
- a School of Graduate Studies, Molecular and Cell Biology Program, State University of New York Downstate Medical Center , Brooklyn , NY , USA.,b Department of Cell Biology , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - M Mahmood Hussain
- b Department of Cell Biology , State University of New York Downstate Medical Center , Brooklyn , NY , USA.,c Department of Pediatrics , SUNY Downstate Medical Center , Brooklyn , NY , USA.,d VA New York Harbor Healthcare System , Brooklyn , NY , USA , and.,e Winthrop University Hospital , Mineola , NY , USA
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Femoral and Carotid Subclinical Atherosclerosis Association With Risk Factors and Coronary Calcium. J Am Coll Cardiol 2016; 67:1263-74. [DOI: 10.1016/j.jacc.2015.12.056] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/08/2015] [Accepted: 12/27/2015] [Indexed: 11/23/2022]
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Wiegman A, Gidding SS, Watts GF, Chapman MJ, Ginsberg HN, Cuchel M, Ose L, Averna M, Boileau C, Borén J, Bruckert E, Catapano AL, Defesche JC, Descamps OS, Hegele RA, Hovingh GK, Humphries SE, Kovanen PT, Kuivenhoven JA, Masana L, Nordestgaard BG, Pajukanta P, Parhofer KG, Raal FJ, Ray KK, Santos RD, Stalenhoef AFH, Steinhagen-Thiessen E, Stroes ES, Taskinen MR, Tybjærg-Hansen A, Wiklund O. Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment. Eur Heart J 2015; 36:2425-37. [PMID: 26009596 PMCID: PMC4576143 DOI: 10.1093/eurheartj/ehv157] [Citation(s) in RCA: 546] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/19/2015] [Indexed: 12/27/2022] Open
Abstract
Familial hypercholesterolaemia (FH) is a common genetic cause of premature coronary heart disease (CHD). Globally, one baby is born with FH every minute. If diagnosed and treated early in childhood, individuals with FH can have normal life expectancy. This consensus paper aims to improve awareness of the need for early detection and management of FH children. Familial hypercholesterolaemia is diagnosed either on phenotypic criteria, i.e. an elevated low-density lipoprotein cholesterol (LDL-C) level plus a family history of elevated LDL-C, premature coronary artery disease and/or genetic diagnosis, or positive genetic testing. Childhood is the optimal period for discrimination between FH and non-FH using LDL-C screening. An LDL-C ≥5 mmol/L (190 mg/dL), or an LDL-C ≥4 mmol/L (160 mg/dL) with family history of premature CHD and/or high baseline cholesterol in one parent, make the phenotypic diagnosis. If a parent has a genetic defect, the LDL-C cut-off for the child is ≥3.5 mmol/L (130 mg/dL). We recommend cascade screening of families using a combined phenotypic and genotypic strategy. In children, testing is recommended from age 5 years, or earlier if homozygous FH is suspected. A healthy lifestyle and statin treatment (from age 8 to 10 years) are the cornerstones of management of heterozygous FH. Target LDL-C is <3.5 mmol/L (130 mg/dL) if >10 years, or ideally 50% reduction from baseline if 8–10 years, especially with very high LDL-C, elevated lipoprotein(a), a family history of premature CHD or other cardiovascular risk factors, balanced against the long-term risk of treatment side effects. Identifying FH early and optimally lowering LDL-C over the lifespan reduces cumulative LDL-C burden and offers health and socioeconomic benefits. To drive policy change for timely detection and management, we call for further studies in the young. Increased awareness, early identification, and optimal treatment from childhood are critical to adding decades of healthy life for children and adolescents with FH.
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Affiliation(s)
- Albert Wiegman
- Department of Paediatrics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Samuel S Gidding
- Nemours Cardiac Center, A. I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Gerald F Watts
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, The University of Western Australia, Western Australia, Australia
| | - M John Chapman
- Pierre and Marie Curie University, Paris, France National Institute for Health and Medical Research (INSERM), Pitié-Salpêtrière University Hospital, Paris, France
| | - Henry N Ginsberg
- Columbia University College of Physicians and Surgeons, New York, NY, USA Irving Institute for Clinical and Translational Research, Columbia University Medical Center, New York, USA
| | - Marina Cuchel
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Leiv Ose
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Maurizio Averna
- Department of Internal Medicine, University of Palermo, Italy
| | - Catherine Boileau
- Diderot Medical School, University Paris 7, Paris, France Genetics Department, Bichat University Hospital, Paris, France INSERM U698, Paris, France
| | - Jan Borén
- Department of Medicine, Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden Wallenberg Laboratory for Cardiovascular Research, Gothenburg, Sweden
| | - Eric Bruckert
- Department of Endocrinology and Prevention of Cardiovascular Disease, University Hospital Pitié-Salpêtrière, Paris, France
| | - Alberico L Catapano
- Department of Pharmacology, Faculty of Pharmacy, University of Milano, Milan, Italy Multimedica IRCSS, Milan, Italy
| | - Joep C Defesche
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | - Robert A Hegele
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, University College London, Institute of Cardiovascular Sciences, London, UK
| | | | - Jan Albert Kuivenhoven
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Luis Masana
- Vascular Medicine and Metabolic Unit, Department of Medicine and Surgery, University Rovira and Virgili, Reus-Tarragona, Spain
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Päivi Pajukanta
- Department of Human Genetics, Center for Metabolic Disease Prevention, University of California, Los Angeles, USA
| | - Klaus G Parhofer
- Department of Endocrinology and Metabolism, University of Munich, Munich, Germany
| | - Frederick J Raal
- Carbohydrate & Lipid Metabolism Research Unit; and Division of Endocrinology & Metabolism, University of the Witwatersrand, Johannesburg, South Africa
| | - Kausik K Ray
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Raul D Santos
- Lipid Clinic of the Heart Institute (InCor), University of São Paulo, São Paulo, Brazil Department of Cardiology, University of São Paulo Medical School, São Paulo, Brazil
| | - Anton F H Stalenhoef
- Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Erik S Stroes
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Marja-Riitta Taskinen
- Research Programs Unit, Diabetes & Obesity, University of Helsinki and Heart & Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Section for Molecular Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Olov Wiklund
- Department of Experimental and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Recent advances in the understanding and care of familial hypercholesterolaemia: significance of the biology and therapeutic regulation of proprotein convertase subtilisin/kexin type 9. Clin Sci (Lond) 2015; 129:63-79. [DOI: 10.1042/cs20140755] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Familial hypercholesterolaemia (FH) is an autosomal co-dominant disorder that markedly raises plasma low-density lipoprotein-cholesterol (LDL-C) concentration, causing premature atherosclerotic coronary artery disease (CAD). FH has recently come under intense focus and, although there is general consensus in recent international guidelines regarding diagnosis and treatment, there is debate about the value of genetic studies. Genetic testing can be cost-effective as part of cascade screening in dedicated centres, but the full mutation spectrum responsible for FH has not been established in many populations, and its use in primary care is not at present logistically feasible. Whether using genetic testing or not, cholesterol screening of family members of index patients with an abnormally raised LDL-C must be used to determine the need for early treatment to prevent the development of CAD. The metabolic defects in FH extend beyond LDL, and may affect triacylglycerol-rich and high-density lipoproteins, lipoprotein(a) and oxidative stress. Achievement of the recommended targets for LDL-C with current treatments is difficult, but this may be resolved by new drug therapies. Lipoprotein apheresis remains an effective treatment for severe FH and, although expensive, it costs less than the two recently introduced orphan drugs (lomitapide and mipomersen) for homozygous FH. Recent advances in understanding of the biology of proprotein convertase subtilisin/kexin type 9 (PCSK9) have further elucidated the regulation of lipoprotein metabolism and led to new drugs for effectively treating hypercholesterolaemia in FH and related conditions, as well as for treating many patients with statin intolerance. The mechanisms of action of PCSK9 inhibitors on lipoprotein metabolism and atherosclerosis, as well as their impact on cardiovascular outcomes and cost-effectiveness, remain to be established.
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Mollaki V, Progias P, Drogari E. Familial Hypercholesterolemia in Greek children and their families: genotype-to-phenotype correlations and a reconsideration of LDLR mutation spectrum. Atherosclerosis 2014; 237:798-804. [PMID: 25463123 DOI: 10.1016/j.atherosclerosis.2014.09.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/10/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Familial Hypercholesterolemia (FH) is a common lipid metabolism disease, resulting in premature atherosclerosis, even from childhood. We aimed to define the genetic basis of FH in children and their families, to refine the spectrum of Low-Density Lipoprotein Receptor gene (LDLR) mutations and identify genotype-to-phenotype correlations in patients of Greek origin. METHODS LDLR was analyzed in 561 patients from 262 families, by whole-gene sequencing. RESULTS Children with identified LDLR mutations showed higher lipid levels compared to non-carriers. Molecular analysis identified a mutation in 53.4% of index cases. Twenty six LDLR mutations were identified, including 19 point mutations, 2 nonsense mutations, 3 splice site mutations and 2 small insertions. Amongst patients with common mutations, carriers of c.1646G > A and c.1285G > A showed higher lipid levels, whereas carriers of c.858C > A and c.81C > G showed a milder phenotype. CONCLUSIONS The spectrum of LDLR mutations in Greece is refined and expanded, with more patients analyzed by whole-gene sequencing. Although a quick screening method is feasible for the Greek population, whole-gene sequencing is essential to identify rare variants. Children with border line lipid levels and a family history of hypercholesterolemia should be considered for molecular diagnosis, since carriers of certain mutations show milder phenotypes and may be missed during clinical diagnosis.
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Affiliation(s)
- Vasiliki Mollaki
- Unit of Metabolic Diseases, Choremio Research Laboratory, 1st Department of Paediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Greece.
| | - Pavlos Progias
- Unit of Metabolic Diseases, Choremio Research Laboratory, 1st Department of Paediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Greece
| | - Euridiki Drogari
- Unit of Metabolic Diseases, Choremio Research Laboratory, 1st Department of Paediatrics, University of Athens Medical School, "Aghia Sophia" Children's Hospital, Greece
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Alonso R, Mata P, Zambón D, Mata N, Fuentes-Jiménez F. Early diagnosis and treatment of familial hypercholesterolemia: improving patient outcomes. Expert Rev Cardiovasc Ther 2014; 11:327-42. [DOI: 10.1586/erc.13.7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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de Beer VJ, Merkus D, Bender SB, Tharp DL, Bowles DK, Duncker DJ, Laughlin MH. Familial hypercholesterolemia impairs exercise-induced systemic vasodilation due to reduced NO bioavailability. J Appl Physiol (1985) 2013; 115:1767-76. [PMID: 24157527 DOI: 10.1152/japplphysiol.00619.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hypercholesterolemia impairs endothelial function [e.g., the nitric oxide (NO)-cyclic GMP-phosphodiesterase 5 (PDE5) pathway], limits shear stress-induced vasodilation, and is therefore expected to reduce exercise-induced vasodilation. To assess the actual effects of hypercholesterolemia on endothelial function and exercise-induced vasodilation, we compared the effects of endothelial NO synthase (eNOS) and PDE5 inhibition in chronically instrumented Yucatan (Control) and Rapacz familial hypercholesterolemic (FH) swine, at rest and during treadmill exercise. The increases in systemic vascular conductance produced by ATP (relative to nitroprusside) and exercise were blunted in FH compared with Control swine. The vasoconstrictor response to eNOS inhibition, with nitro-l-arginine (NLA), was attenuated in FH compared with Control swine, both at rest and during exercise. Furthermore, whereas the vasodilator response to nitroprusside was enhanced slightly, the vasodilator response to PDE5 inhibition, with EMD360527, was reduced in FH compared with Control swine. Finally, in the pulmonary circulation, FH resulted in attenuated vasodilator responses to ATP, while maintaining the responses to both NLA and EMD360527. In conclusion, hypercholesterolemia reduces exercise-induced vasodilation in the systemic but not the pulmonary circulation. This reduction appears to be the principal result of a decrease in NO bioavailability, which is mitigated by a lower PDE5 activity.
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Affiliation(s)
- Vincent J de Beer
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research School Erasmus University Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands
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Genetic analysis of familial hypercholesterolaemia in Western Australia. Atherosclerosis 2012; 224:430-4. [DOI: 10.1016/j.atherosclerosis.2012.07.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 01/22/2023]
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Casasnovas JA, Alcaide V, Civeira F, Guallar E, Ibañez B, Borreguero JJ, Laclaustra M, León M, Peñalvo JL, Ordovás JM, Pocovi M, Sanz G, Fuster V. Aragon workers' health study--design and cohort description. BMC Cardiovasc Disord 2012; 12:45. [PMID: 22712826 PMCID: PMC3439398 DOI: 10.1186/1471-2261-12-45] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/23/2012] [Indexed: 01/06/2023] Open
Abstract
Background Spain, a Mediterranean country with relatively low rates of coronary heart disease, has a high prevalence of traditional cardiovascular risk factors and is experiencing a severe epidemic of overweight/obesity. We designed the Aragon Workers’ Health Study (AWHS) to characterize the factors associated with metabolic abnormalities and subclinical atherosclerosis in a middle aged population in Spain free of clinical cardiovascular disease. The objective of this paper is to describe the study design, aims and baseline characteristics of participants in the AWHS. Methods/Design Longitudinal cohort study based on the annual health exams of 5,400 workers of a car assembly plant in Figueruelas (Zaragoza, Spain). Study participants were recruited during a standardized clinical exam in 2009–2010 (participation rate 95.6%). Study participants will undergo annual clinical exams and laboratory assays, and baseline and triennial collection of biological materials for biobanking and cardiovascular imaging exams (carotid, femoral and abdominal ultrasonography, coronary calcium score, and ankle-arm blood pressure index). Participants will be followed-up for 10 years. Results The average (SD) age, body mass index, and waist circumference were 49.3 (8.7) years, 27.7 (3.6) kg/m2 and 97.2 (9.9) cm, respectively, among males (N = 5,048), and 40.8 (11.6) years, 24.4 (3.8) kg/m2, and 81.9 (9.9) cm, among females (N = 351). The prevalence of overweight, obesity, current smoking, hypertension, hypercholesterolemia, and diabetes were 55.0, 23.1, 37.1, 40.3, 75.0, and 7.4%, respectively, among males, and 23.7, 8.3, 45.0, 12.1, 59.5, and 0.6%, respectively, among females. In the initial 587 study participants who completed all imaging exams (94.5% male), the prevalence of carotid plaque, femoral plaque, coronary calcium score >1 to 100, and coronary calcium score >100 was 30.3, 56.9, 27.0, and 8.8%, respectively. 67.7% of study participants had at least one plaque in the carotid or femoral arteries. Discussion Baseline data from the AWHS show a high prevalence of cardiovascular risk factors and of sublinical atherosclerosis. Follow-up of this cohort will allow the assessment of subclinical atherosclerosis progression and the link of disease progression to traditional and emergent risk factors.
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Affiliation(s)
- José A Casasnovas
- Cardiovascular Research Unit, Instituto Aragonés de Ciencias de la Salud (I + CS), Zaragoza, Spain
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Ershova AI, Balakhonova TV, Meshkov AN, Rozhkova TA, Boytsov SA. Ultrasound markers that describe plaques are more sensitive than mean intima-media thickness in patients with familial hypercholesterolemia. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:417-422. [PMID: 22261515 DOI: 10.1016/j.ultrasmedbio.2011.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 05/31/2023]
Abstract
A widely adopted ultrasound surrogate marker for predicting cardiovascular risk is mean intima-medial thickness (mean-IMT). There are, however, certain limitations to this methodology. We compared the severity of carotid atherosclerosis in adult patients with high cardiovascular risk (patients with familial hypercholesterolemia [FH] and without previous statin treatment) and in their adult FH-free first-degree relatives using not only mean-IMT, but also maximum-IMT, plaque number, plaque score and percent area stenosis. Mean-IMT has not differed in both groups (0.64 ± 0.18 mm vs. 0.58 ± 0.13 mm in the control group, p = 0.349). Maximum-IMT (0.99 ± 0.35 vs. 0.76 ± 0.19, p = 0.0057), plaque number (3 ± 3 vs. 1 ± 2, p = 0.0009), plaque score (5.14 ± 4.97 mm vs. 1.58 ± 3.09 mm, p = 0.0009) and percent area stenosis (38% ± 22% vs. 12% ± 20%, p = 0.0004) were significantly higher for FH patients than for their relatives. We have demonstrated that plaque number, plaque score and percent area stenosis markers were more sensitive than mean-IMT for cardiovascular risk estimation in patients with familial hypercholesterolemia.
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Affiliation(s)
- Alexandra I Ershova
- Department of Age-Related Problems of Cardiovascular Diseases, Russian Cardiology Research Center, Moscow, Russia.
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White blood cell count is associated with carotid and femoral atherosclerosis. Atherosclerosis 2012; 221:275-81. [PMID: 22244768 DOI: 10.1016/j.atherosclerosis.2011.12.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 12/06/2011] [Accepted: 12/23/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Chronic low-grade inflammation is associated with atherosclerosis. Ultrasound imaging allows measurement of intima-media thickness (IMT) and plaque. We investigated the association between inflammatory markers and carotid and femoral atherosclerosis. METHODS We studied 554 subjects with primary dyslipidemia (57% men, median age 49 years) and 246 age- and sex-matched normolipidemic subjects. Carotid and femoral arteries were imaged bilaterally with a standardized protocol. Mean and maximum common carotid IMT (CC-IMT and MaxCC-IMT) and common femoral IMT (F-IMT and MaxF-IMT), and carotid and femoral plaque were assessed. Carotid atherosclerosis was defined by CC-IMT and/or plaque height >75th percentile of a reference population. White blood cell count (WBCC) was measured in all subjects. High-sensitivity C-reactive protein (CRP) was measured in 330 dyslipidemic subjects. RESULTS The age- and sex-adjusted probability of carotid atherosclerosis and femoral plaque increased by 20% (odds ratio [OR] 1.20; 95% CI, 1.10-1.31) and 25% (1.25; 1.13-1.38), respectively, for each 1000/mm(3) WBCC increment. WBCC was associated with age- and sex-adjusted CC-IMT and MaxCC-IMT (p<0.05, both), and F-IMT and MaxF-IMT (p<0.001, both). Adjustment for cardiovascular risk factors did not influence these associations. CRP was associated with CC-IMT and MaxCC-IMT (p<0.05, both), but the associations disappeared after adjustment for body mass index. CRP was unrelated to carotid plaque or measures of femoral atherosclerosis. CONCLUSIONS WBCC, but not CRP, related to early and advanced measures of atherosclerosis independently of risk factors. Our findings support using the heretofore undervalued WBCC as an easy-to-measure, low-cost diagnostic marker of atherosclerosis.
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Etxebarria A, Palacios L, Stef M, Tejedor D, Uribe KB, Oleaga A, Irigoyen L, Torres B, Ostolaza H, Martin C. Functional characterization of splicing and ligand-binding domain variants in the LDL receptor. Hum Mutat 2011; 33:232-43. [PMID: 21990180 DOI: 10.1002/humu.21630] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 09/26/2011] [Indexed: 12/11/2022]
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant disorder mostly caused by mutations in the LDLR gene. Although the detection of functional mutations in the LDLR gene provides an unequivocal diagnosis of the FH condition, there are many variants whose pathogenicity is still unknown. The aims of this study were to set up a rapid method to determine the effect of LDLR mutations, thereby providing an accurate diagnosis of FH, and to functionally characterize six LDLR mutations detected at high frequency by the LIPOchip(®) platform (Progenika Biopharma, Spain) in the Spanish population. LDLR expression and activity were analyzed by one-single-step flow cytometry assay and confocal microscopy. Splicing effects were determined by sequencing reverse transcription polymerase chain reaction products. The analysis of three heterozygous variants with a single point mutation within the low-density lipoprotein binding domain allowed us to classify the c.806G>A variant as nonpathogenic, and c.862G>A and c.895G>A variants as causative of FH. The results obtained for three variants affecting donor splice sites of the LDLR mRNA, c.313+2dupT, c.1186+5G>A, and c.1845+1G>C, demonstrated that these mutations are pathogenic. These results expand our knowledge of mutations responsible for FH, providing an accurate diagnosis and leading to early treatment to reduce the risk of premature cardiovascular events.
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Affiliation(s)
- Aitor Etxebarria
- Unidad de Biofísica (Centro Mixto CSIC-UPV/EHU) and Departamento de Bioquímica, Universidad del País Vasco, Apdo. 644, 48080 Bilbao, Spain
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Calandra S, Tarugi P, Speedy HE, Dean AF, Bertolini S, Shoulders CC. Mechanisms and genetic determinants regulating sterol absorption, circulating LDL levels, and sterol elimination: implications for classification and disease risk. J Lipid Res 2011; 52:1885-926. [PMID: 21862702 DOI: 10.1194/jlr.r017855] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This review integrates historical biochemical and modern genetic findings that underpin our understanding of the low-density lipoprotein (LDL) dyslipidemias that bear on human disease. These range from life-threatening conditions of infancy through severe coronary heart disease of young adulthood, to indolent disorders of middle- and old-age. We particularly focus on the biological aspects of those gene mutations and variants that impact on sterol absorption and hepatobiliary excretion via specific membrane transporter systems (NPC1L1, ABCG5/8); the incorporation of dietary sterols (MTP) and of de novo synthesized lipids (HMGCR, TRIB1) into apoB-containing lipoproteins (APOB) and their release into the circulation (ANGPTL3, SARA2, SORT1); and receptor-mediated uptake of LDL and of intestinal and hepatic-derived lipoprotein remnants (LDLR, APOB, APOE, LDLRAP1, PCSK9, IDOL). The insights gained from integrating the wealth of genetic data with biological processes have important implications for the classification of clinical and presymptomatic diagnoses of traditional LDL dyslipidemias, sitosterolemia, and newly emerging phenotypes, as well as their management through both nutritional and pharmaceutical means.
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Affiliation(s)
- Sebastiano Calandra
- Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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Ershova AI, Meshkov AN, Boytsov SA, Balakhonova TV. Modern ultrasound methods and atherosclerosis assessment in patients with familial hypercholesterolemia. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-3-113-122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Familial hypercholesterolemia (FHCH) is characterised by early atherosclerosis development and its fast progression. The prevalence of FHCH inRussiahas been increasing, therefore, it is important to evaluate the potential of various methods for atherosclerosis diagnostics. Arterial ultrasound is an informative, accessible, and safe method for evaluating atherosclerotic vascular changes. The modern ultrasound methods allow describing vascular wall status in detail, including qualitative and quantitative characteristics of its structure and function. At the same time, most ultrasound characteristics of arterial wall are used in research settings or are under development, and not implemented into clinical practice. The most promising parameters, applicable for clinical use in FHCH patients, simultaneously describe atherosclerosis severity and its localization, such as total plaque height, ankle-brachial index, and plaque number.
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Carotid and femoral plaque burden is inversely associated with the α-linolenic acid proportion of serum phospholipids in Spanish subjects with primary dyslipidemia. Atherosclerosis 2011; 214:209-14. [DOI: 10.1016/j.atherosclerosis.2010.10.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/13/2010] [Accepted: 10/26/2010] [Indexed: 11/19/2022]
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Masoura C, Pitsavos C, Aznaouridis K, Skoumas I, Vlachopoulos C, Stefanadis C. Arterial endothelial function and wall thickness in familial hypercholesterolemia and familial combined hyperlipidemia and the effect of statins. A systematic review and meta-analysis. Atherosclerosis 2011; 214:129-38. [DOI: 10.1016/j.atherosclerosis.2010.10.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Revised: 09/23/2010] [Accepted: 10/08/2010] [Indexed: 11/17/2022]
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Oosterveer DM, Versmissen J, Schinkel AFL, Langendonk JG, Mulder M, Sijbrands EJG. Clinical and genetic factors influencing cardiovascular risk in patients with familial hypercholesterolemia. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/clp.10.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Junyent M, Gilabert R, Jarauta E, Núñez I, Cofán M, Civeira F, Pocoví M, Mallén M, Zambón D, Almagro F, Vega J, Tejedor D, Ros E. Impact of low-density lipoprotein receptor mutational class on carotid atherosclerosis in patients with familial hypercholesterolemia. Atherosclerosis 2010; 208:437-41. [DOI: 10.1016/j.atherosclerosis.2009.07.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 07/23/2009] [Accepted: 07/31/2009] [Indexed: 11/25/2022]
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Solanas-Barca M, Mateo-Gallego R, Calmarza P, Jarauta E, Bea AM, Cenarro A, Civeira F. Mutations in HFE causing hemochromatosis are associated with primary hypertriglyceridemia. J Clin Endocrinol Metab 2009; 94:4391-7. [PMID: 19820015 DOI: 10.1210/jc.2009-0814] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Most cases of primary hypertriglyceridemia (HTG) are caused by the interaction of unknown polygenes and environmental factors. Elevated iron storage is associated with metabolic syndrome, diabetes, and obesity, and all of them are associated with HTG. OBJECTIVE The aim of the study was to analyze whether HFE mutations causing hereditary hemochromatosis (HH) are associated with primary HTG. DESIGN Genetic predisposition to HH was analyzed in a case-control study. SETTING The study was conducted at University Hospital Lipid Clinic. PARTICIPANTS We studied two groups: 1) the HTG group, composed of 208 patients; and 2) the control group, composed of 215 normolipemic subjects and 161 familial hypercholesterolemia patients. INTERVENTION Two HFE mutations (C282Y and H63D) were analyzed. MAIN OUTCOME MEASURE We measured HH genetic predisposition difference between groups. RESULTS HH genetic predisposition was 5.9 and 4.4 times higher in the HTG group than in the normolipemic (P = 0.02) and FH (P = 0.05) subjects, respectively. There were 35 cases (16.8%) of iron overload in the primary HTG group, 14 (6.5%) and nine (5.6%) in the normolipidemic and FH groups, respectively. A higher HH genetic predisposition and a different prevalence of iron overload in subjects with HH genetic predisposition among groups contributed to this higher prevalence. None of the four cases with the HFE genotype associated with high risk of HH in the control groups presented iron overload; however, in eight of 11 subjects (72.7%) with primary HTG and HH genetic predisposition, the iron overload was present. CONCLUSION Mutations in HFE gene, favoring iron overload and causing HH, could play an important role in the development of several phenotypes of primary HTG.
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Affiliation(s)
- María Solanas-Barca
- Unidad de Lípidos and Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud (I+CS), 50009 Zaragoza, Spain
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Civeira F, Ros E, Jarauta E, Plana N, Zambon D, Puzo J, Martinez de Esteban JP, Ferrando J, Zabala S, Almagro F, Gimeno JA, Masana L, Pocovi M. Comparison of genetic versus clinical diagnosis in familial hypercholesterolemia. Am J Cardiol 2008; 102:1187-93, 1193.e1. [PMID: 18940289 DOI: 10.1016/j.amjcard.2008.06.056] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 06/17/2008] [Accepted: 06/17/2008] [Indexed: 11/30/2022]
Abstract
Early diagnosis is important in familial hypercholesterolemia (FH), a highly atherogenic condition, but internationally agreed clinical diagnostic criteria are lacking. Genetic testing for low-density lipoprotein (LDL) receptor (LDLR) and apolipoprotein B (APOB) gene defects is the preferable diagnostic method, but the best phenotype indication to proceed with genetic diagnosis has not been established. The aim of this study was to assess the predictive and accuracy values of standard diagnostic criteria for detecting disease-causing mutations in 825 subjects with clinical FH aged > or =14 years from 3 lipid clinics in Spain. All subjects underwent thorough genetic testing for the detection of LDLR and APOB defects using the Lipochip platform. FH-causing mutations were detected in 459 subjects (55.6%). By logistic regression analysis, familial or personal history of tendon xanthoma (TX) and LDL cholesterol were strongly associated with genetic diagnosis (p <0.005, R(2) = 0.41). In subjects without familial or personal histories of TX, the diagnostic criteria for FH of the Make Early Diagnosis to Prevent Early Deaths (MEDPED) project, based on age-specific LDL cholesterol thresholds, showed sensitivity of 72.4%, specificity of 71.1%, and accuracy of 71.6%. LDL cholesterol > or =190 mg/dl in subjects with familial or personal histories of TX and > or =220, > or =225, and > or =235 mg/dl in those without such histories aged <30, 30 to 39, and > or =40 years, respectively, showed sensitivity of 91.1%, specificity of 71.1%, and accuracy of 74.2% for a positive genetic diagnosis. This new set of diagnostic criteria for FH was validated in an independent group of 440 subjects from 6 additional Spanish lipid clinics. In conclusion, TX and age-adjusted LDL cholesterol cut-off values have the highest value for clinical diagnosis and indication of genetic testing in FH.
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Affiliation(s)
- Fernando Civeira
- Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.
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Humphries SE, Norbury G, Leigh S, Hadfield SG, Nair D. What is the clinical utility of DNA testing in patients with familial hypercholesterolaemia? Curr Opin Lipidol 2008; 19:362-8. [PMID: 18607183 DOI: 10.1097/mol.0b013e32830636e5] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Familial hypercholesterolaemia is a common genetic disorder of lipid metabolism in which patients have a significantly elevated risk of early coronary heart disease, which can be substantially lowered by treatment with the statin class of drugs. In many countries in Europe, tracing of relatives using DNA information, once the family mutation has been identified, is being actively carried out. The present review examines the specificity and clinical utility of DNA testing in patients with familial hypercholesterolaemia. RECENT FINDINGS Technological progress has improved the detection rate in patients with the strongest clinical suspicion of familial hypercholesterolaemia to more than 70-80%. Patients carrying a mutation have, on average, higher low-density lipoprotein cholesterol levels and greater risk of early coronary heart disease, and studies have reported the utility of DNA information in the identification of affected relatives. More than 1000 different molecular causes of familial hypercholesterolaemia are documented in the University College London database, and although more than 90% of these clearly cause familial hypercholesterolaemia, the remainder require careful interpretation. SUMMARY DNA testing, as an adjunct to the measurement of plasma low-density lipoprotein cholesterol levels, has clinical utility in providing an unequivocal diagnosis in patients and in identifying affected relatives at an early age so that they can be offered lifestyle advice and appropriate lipid-lowering therapies. Researchers and DNA diagnostic laboratories need to interpret novel sequence changes with caution in order to avoid a false positive diagnosis.
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Affiliation(s)
- Steve E Humphries
- Division of Cardiovascular Genetics, British Heart Foundation Laboratories, Department of Medicine, Royal Free and UCL Medical School, London, UK
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