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Zhou Y, Madsen JM, Özbek BT, Køber L, Bang LE, Lønborg JT, Engstrøm T. The role of remnant cholesterol in patients with ST-segment elevation myocardial infarction. Eur J Prev Cardiol 2024; 31:1227-1237. [PMID: 38447015 DOI: 10.1093/eurjpc/zwae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
AIMS Remnant cholesterol (RC) is the cholesterol content within triglyceride-rich lipoproteins. It promotes atherosclerotic cardiovascular disease beyond LDL cholesterol (LDL-C). The prognostic role of RC in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We aimed to estimate RC-related risk beyond LDL-C in patients with STEMI. METHODS AND RESULTS A total of 6602 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) from 1999 to 2016 were included. Remnant cholesterol was calculated as total cholesterol minus LDL-C minus HDL cholesterol. Adjusted Cox models were used to estimate the association between continuous RC levels and all-cause mortality, cardiovascular death, ischaemic stroke, and recurrent myocardial infarction (MI) at long-term (median follow-up of 6.0 years). Besides, discordance analyses were applied to examine the risk of the discordantly high RC (RC percentile rank minus LDL-C percentile rank > 10 units) compared with the discordantly low RC (LDL-C percentile rank minus RC percentile rank > 10 units). The concordance was defined as the percentile rank difference between RC and LDL-C ≤ 10 units. The median age of patients was 63 years [interquartile range (IQR) 54-72] and 74.8% were men. There were 2441, 1651, and 2510 patients in the discordantly low RC group, concordant group, and discordantly high RC group, respectively. All outcomes in the discordantly high RC group were higher than the other groups, and the event rate of all-cause mortality in this group was 31.87%. In the unadjusted analysis, the discordantly high RC was associated with increased all-cause mortality [hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.63-2.04] and increased cardiovascular death (HR 1.79, 95% CI 1.55-2.06) compared with the discordantly low RC. In an adjusted model, RC was associated with higher all-cause mortality (HR 1.14, 95% CI 1.07-1.22). The discordantly high RC was associated with increased all-cause mortality (adjusted HR 1.55, 95% CI 1.37-1.75) and increased cardiovascular death (adjusted HR 1.47, 95% CI 1.25-1.72) compared with the discordantly low RC. There were no associations between RC and ischaemic stroke or recurrent MI. CONCLUSION In patients with STEMI treated with primary PCI, elevated RC levels beyond LDL-C and discordantly high RC were independently associated with increased all-cause mortality.
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Affiliation(s)
- Yan Zhou
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Graduate School of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Jasmine Melissa Madsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Burcu Tas Özbek
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lia Evi Bang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jacob Thomsen Lønborg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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De Oliveira-Gomes D, Joshi PH, Peterson ED, Rohatgi A, Khera A, Navar AM. Apolipoprotein B: Bridging the Gap Between Evidence and Clinical Practice. Circulation 2024; 150:62-79. [PMID: 38950110 PMCID: PMC11219008 DOI: 10.1161/circulationaha.124.068885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
Despite data suggesting that apolipoprotein B (apoB) measurement outperforms low-density lipoprotein cholesterol level measurement in predicting atherosclerotic cardiovascular disease risk, apoB measurement has not become widely adopted into routine clinical practice. One barrier for use of apoB measurement is lack of consistent guidance for clinicians on how to interpret and apply apoB results in clinical context. Whereas guidelines have often provided clear low-density lipoprotein cholesterol targets or triggers to initiate treatment change, consistent targets for apoB are lacking. In this review, we synthesize existing data regarding the epidemiology of apoB by comparing guideline recommendations regarding use of apoB measurement, describing population percentiles of apoB relative to low-density lipoprotein cholesterol levels, summarizing studies of discordance between low-density lipoprotein cholesterol and apoB levels, and evaluating apoB levels in clinical trials of lipid-lowering therapy to guide potential treatment targets. We propose evidence-guided apoB thresholds for use in cholesterol management and clinical care.
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Affiliation(s)
- Diana De Oliveira-Gomes
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Parag H Joshi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric D Peterson
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anand Rohatgi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Amit Khera
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ann Marie Navar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ahotupa M. Lipid Oxidation Products and the Risk of Cardiovascular Diseases: Role of Lipoprotein Transport. Antioxidants (Basel) 2024; 13:512. [PMID: 38790617 PMCID: PMC11117553 DOI: 10.3390/antiox13050512] [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: 03/12/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Cholesterol has for decades ruled the history of atherosclerotic cardiovascular diseases (CVDs), and the present view of the etiology of the disease is based on the transport of cholesterol by plasma lipoproteins. The new knowledge of the lipoprotein-specific transport of lipid oxidation products (LOPs) has introduced another direction to the research of CVD, revealing strong associations between lipoprotein transport functions, atherogenic LOP, and CVD. The aim of this review is to present the evidence of the lipoprotein-specific transport of LOP and to evaluate the potential consequences of the proposed role of the LOP transport as a risk factor. The associations of cholesterol and lipoprotein LOP with the known risk factors of CVD are mostly parallel, and because of the common transport and cellular intake mechanisms it is difficult to ascertain the independent effects of either cholesterol or LOP. While cholesterol is known to have important physiological functions, LOPs are merely regarded as metabolic residues and able to initiate and boost atherogenic processes. It is therefore likely that with the increased knowledge of the lipoprotein-specific transport of LOP, the role of cholesterol as a risk factor of CVD will be challenged.
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Affiliation(s)
- Markku Ahotupa
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20520 Turku, Finland;
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, 20520 Turku, Finland
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Fu C, Liu D, Liu Q, Wang X, Ma X, Pan H, Feng S, Sun Z, Qiao W, Yang M, Gao S, Ding H, Huang X, Hou J. Revisiting an old relationship: the causal associations of the ApoB/ApoA1 ratio with cardiometabolic diseases and relative risk factors-a mendelian randomization analysis. Cardiovasc Diabetol 2024; 23:51. [PMID: 38310324 PMCID: PMC10838437 DOI: 10.1186/s12933-024-02140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/22/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND It has been confirmed that the ApoB/ApoA1 ratio is closely associated with the incidence of cardiometabolic diseases (CMD). However, due to uncontrolled confounding factors in observational studies, the causal relationship of this association remains unclear. METHODS In this study, we extracted the ApoB/ApoA1 ratio and data on CMD and its associated risk factors from the largest European Genome-Wide Association Study. The purpose was to conduct Mendelian Randomization (MR) analysis. The causal relationship between the ApoB/ApoA1 ratio and CMD was evaluated using both univariable and multivariable MR analyses. Furthermore, bidirectional MR analysis was performed to estimate the causal relationship between the ApoB/ApoA1 ratio and risk factors for CMD. The final verification confirmed whether the ApoB/ApoA1 ratio exhibits a mediating effect in CMD and related risk factors. RESULTS In terms of CMD, a noteworthy correlation was observed between the increase in the ApoB/ApoA1 ratio and various CMD, including ischemic heart disease, major adverse cardiovascular events, aortic aneurysm, cerebral ischemic disease and so on (all PFDR<0.05). Meanwhile, the ApoB/ApoA1 ratio was significantly associated with CMD risk factors, such as hemoglobin A1c, fasting insulin levels, waist-to-hip ratio, sedentary behavior, and various others, demonstrating a notable causal relationship (all PFDR<0.05). Additionally, the ApoB/ApoA1 ratio played a mediating role in CMD and relative risk factors. CONCLUSIONS This MR study provides evidence supporting the significant causal relationship between the ApoB/ApoA1 ratio and CMD and its risk factors. Moreover, it demonstrates the mediating effect of the ApoB/ApoA1 ratio in CMD and its risk factors. These findings suggest that the ApoB/ApoA1 ratio may serve as a potential indicator for identifying the risk of developing CMD in participants.
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Affiliation(s)
- Chao Fu
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Dongbo Liu
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Qi Liu
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Xuedong Wang
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Xiaoxue Ma
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Hong Pan
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Shi Feng
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Zhao Sun
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Weishen Qiao
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Mengyue Yang
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Shuang Gao
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Hongyu Ding
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China
| | - Xingtao Huang
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China.
| | - Jingbo Hou
- Department of Cardiology, The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Chinese Ministry of Education, Harbin, Heilongjiang Province, China.
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Delialis D, Georgiopoulos G, Aivalioti E, Konstantaki C, Oikonomou E, Bampatsias D, Mavraganis G, Vardavas C, Liberopoulos E, Stellos K, Stamatelopoulos K. Remnant cholesterol in atherosclerotic cardiovascular disease: A systematic review and meta-analysis. Hellenic J Cardiol 2023; 74:48-57. [PMID: 37116829 DOI: 10.1016/j.hjc.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Accumulating evidence suggests a substantial contribution of remnant cholesterol (RC) to residual risk for the development or relapse of atherosclerotic cardiovascular disease (ASCVD). We aimed to evaluate the association of RC levels with ASCVD risk by different risk categories and methods of RC assessment. We also assessed available evidence of the effects of lipid-lowering therapies (LLTs) on RC levels. METHODS English-language searches of Medline, PubMed, and Embase (inception to 31 January 2023); ClinicalTrials.gov (October 2022); and reference lists of studies and reviews. Studies reporting on the risk of the composite endpoint [all-cause mortality, cardiovascular mortality, and major adverse cardiac events (MACE)] by RC levels were included. Moreover, we searched for studies reporting differences in RC levels after the administration of LLT(s). RESULTS Among n = 29 studies with 257,387 participants, we found a pooled linear (pooled HR: 1.27 per 1-SD increase, 95% CI: 1.12-1.43, P < 0.001, I2 = 95%, n = 15 studies) and non-linear association (pooled HR: 1.59 per quartile increase, 95% CI: 1.35-1.85, P < 0.001, I2 = 87.9%, n = 15 studies) of RC levels and the risk of M ACE both in patients with and without established ASCVD. Interestingly, the risk of MACE was higher in studies with directly measured vs. calculated RC levels. In a limited number of studies and participants, LLTs reduced RC levels. CONCLUSION RC levels are associated with ASCVD risk both in primary and secondary prevention. Directly measured RC levels are associated with ASCVD risk more evidently. Available LLTs tend to decrease RC levels, although the clinical relevance of RC decrease merits further investigation. PROSPERO REGISTRATION CRD42022371346.
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Affiliation(s)
- Dimitrios Delialis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Evmorfia Aivalioti
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Christina Konstantaki
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ermioni Oikonomou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Bampatsias
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Mavraganis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Constantine Vardavas
- Department of Social Medicine, Faculty of Medicine, University of Crete, University Campus of Voutes, 700 13, Heraklion, Crete, Greece; Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Evangelos Liberopoulos
- 1(st) Department of Propedeutic Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Konstantinos Stellos
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece; Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
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Kim JY, Choi J, Kim SG, Kim NH. Comparison of on-Statin Lipid and Lipoprotein Levels for the Prediction of First Cardiovascular Event in Type 2 Diabetes Mellitus. Diabetes Metab J 2023; 47:837-845. [PMID: 37915183 PMCID: PMC10695724 DOI: 10.4093/dmj.2022.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/06/2022] [Indexed: 11/03/2023] Open
Abstract
BACKGRUOUND A substantial cardiovascular disease risk remains even after optimal statin therapy. Comparative predictiveness of major lipid and lipoprotein parameters for cardiovascular events in patients with type 2 diabetes mellitus (T2DM) who are treated with statins is not well documented. METHODS From the Korean Nationwide Cohort, 11,900 patients with T2DM (≥40 years of age) without a history of cardiovascular disease and receiving moderate- or high-intensity statins were included. The primary outcome was the first occurrence of major adverse cardiovascular events (MACE) including ischemic heart disease, ischemic stroke, and cardiovascular death. The risk of MACE was estimated according to on-statin levels of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), highdensity lipoprotein cholesterol (HDL-C), and non-HDL-C. RESULTS MACE occurred in 712 patients during a median follow-up period of 37.9 months (interquartile range, 21.7 to 54.9). Among patients achieving LDL-C levels less than 100 mg/dL, the hazard ratios for MACE per 1-standard deviation change in ontreatment values were 1.25 (95% confidence interval [CI], 1.07 to 1.47) for LDL-C, 1.31 (95% CI, 1.09 to 1.57) for non-HDL-C, 1.05 (95% CI, 0.91 to 1.21) for TG, and 1.16 (95% CI, 0.98 to 1.37) for HDL-C, after adjusting for potential confounders and lipid parameters mutually. The predictive ability of on-statin LDL-C and non-HDL-C for MACE was prominent in patients at high cardiovascular risk or those with LDL-C ≥70 mg/dL. CONCLUSION On-statin LDL-C and non-HDL-C levels are better predictors of the first cardiovascular event than TG or HDL-C in patients with T2DM.
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Affiliation(s)
- Ji Yoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jimi Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Das P, Ingole N. Lipoproteins and Their Effects on the Cardiovascular System. Cureus 2023; 15:e48865. [PMID: 38106760 PMCID: PMC10724412 DOI: 10.7759/cureus.48865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Coronary heart disease is the foremost leading cause of death across the world. It mainly involves the blood vessels, which supply the heart. Plaque formation due to lipid deposition leads to the narrowing of the vessels, obstructing blood flow. Therefore, lipoproteins such as high-density lipoproteins (HDL), low-density lipoproteins (LDL), very low-density lipoproteins (VLDL), and chylomicrons play a crucial role in cardiovascular diseases. Lipoproteins are carrier molecules made up of proteins and fats. They carry cholesterol through the bloodstream and transport it to the peripheral tissues or the liver. There are several classes of lipoproteins in the blood, namely HDL, LDL, VLDL, and chylomicrons. Depending on the lipoproteins, an excess of them can either harm or benefit the body. Low-density lipoprotein, nicknamed 'the bad cholesterol,' transports fatty molecules from the liver and deposits them in peripheral tissues or central vessels. Thus, excess LDL can cause blockage of the arteries supplying major organs. High-density lipoprotein, nicknamed 'the good cholesterol,' transports the excess fatty molecules to the liver for their metabolism and removal from the body. Hence, high levels of HDL are an indication of a healthy body. Thus, lipoproteins are important molecules, and their proper regulation is essential to maintaining a healthy body. An effective way to maintain a balanced lipoprotein level is to have a properly balanced diet with high protein and low fat. Regular exercise, both indoors and outdoors, is recommended. If cholesterol levels are not maintained by diet and exercise, medication is advised after consulting medical experts. This review aims to inform people about lipoproteins, their importance, and maintaining a healthy lipoprotein level.
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Affiliation(s)
- Pratyush Das
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishikant Ingole
- Pharmacology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Vekic J, Stromsnes K, Mazzalai S, Zeljkovic A, Rizzo M, Gambini J. Oxidative Stress, Atherogenic Dyslipidemia, and Cardiovascular Risk. Biomedicines 2023; 11:2897. [PMID: 38001900 PMCID: PMC10669174 DOI: 10.3390/biomedicines11112897] [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: 09/28/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Oxidative stress is the consequence of an overproduction of reactive oxygen species (ROS) that exceeds the antioxidant defense mechanisms. Increased levels of ROS contribute to the development of cardiovascular disorders through oxidative damage to macromolecules, particularly by oxidation of plasma lipoproteins. One of the most prominent features of atherogenic dyslipidemia is plasma accumulation of small dense LDL (sdLDL) particles, characterized by an increased susceptibility to oxidation. Indeed, a considerable and diverse body of evidence from animal models and epidemiological studies was generated supporting oxidative modification of sdLDL particles as the earliest event in atherogenesis. Lipid peroxidation of LDL particles results in the formation of various bioactive species that contribute to the atherosclerotic process through different pathophysiological mechanisms, including foam cell formation, direct detrimental effects, and receptor-mediated activation of pro-inflammatory signaling pathways. In this paper, we will discuss recent data on the pathophysiological role of oxidative stress and atherogenic dyslipidemia and their interplay in the development of atherosclerosis. In addition, a special focus will be placed on the clinical applicability of novel, promising biomarkers of these processes.
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Affiliation(s)
- Jelena Vekic
- Department of Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, 11000 Belgrade, Serbia; (J.V.); (A.Z.)
| | - Kristine Stromsnes
- Department of Physiology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (K.S.); (S.M.); (J.G.)
| | - Stefania Mazzalai
- Department of Physiology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (K.S.); (S.M.); (J.G.)
| | - Aleksandra Zeljkovic
- Department of Medical Biochemistry, University of Belgrade-Faculty of Pharmacy, 11000 Belgrade, Serbia; (J.V.); (A.Z.)
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Juan Gambini
- Department of Physiology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; (K.S.); (S.M.); (J.G.)
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Reijnders E, van der Laarse A, Jukema JW, Cobbaert CM. High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine. Front Cardiovasc Med 2023; 10:1264319. [PMID: 37908502 PMCID: PMC10613690 DOI: 10.3389/fcvm.2023.1264319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
As time has come to translate trial results into individualized medical diagnosis and therapy, we analyzed how to minimize residual risk of cardiovascular disease (CVD) by reviewing papers on "residual cardiovascular disease risk". During this review process we found 989 papers that started off with residual CVD risk after initiating statin therapy, continued with papers on residual CVD risk after initiating therapy to increase high-density lipoprotein-cholesterol (HDL-C), followed by papers on residual CVD risk after initiating therapy to decrease triglyceride (TG) levels. Later on, papers dealing with elevated levels of lipoprotein remnants and lipoprotein(a) [Lp(a)] reported new risk factors of residual CVD risk. And as new risk factors are being discovered and new therapies are being tested, residual CVD risk will be reduced further. As we move from CVD risk reduction to improvement of patient management, a paradigm shift from a reductionistic approach towards a holistic approach is required. To that purpose, a personalized treatment dependent on the individual's CVD risk factors including lipid profile abnormalities should be configured, along the line of P5 medicine for each individual patient, i.e., with Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive approaches.
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Affiliation(s)
- E. Reijnders
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - A. van der Laarse
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - C. M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
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10
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El Khoudary SR, Chen X, Wang Z, Brooks MM, Orchard T, Crawford S, Janssen I, Everson-Rose SA, McConnell D, Matthews K. Low-density lipoprotein subclasses over the menopausal transition and risk of coronary calcification and carotid atherosclerosis: the SWAN Heart and HDL ancillary studies. Menopause 2023; 30:1006-1013. [PMID: 37738035 PMCID: PMC10539013 DOI: 10.1097/gme.0000000000002245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Perimenopausal women experience a steep increase in low-density lipoprotein cholesterol (LDL-C) that is related to a higher risk of carotid plaque later in life. Low-density lipoprotein subclasses have been linked to cardiovascular diseases beyond LDL-C, promising a better risk stratification. We aim to characterize changes in LDL subclasses and assess their associations with presence of coronary artery calcium (CAC score ≥10) and carotid intima-media thickness (cIMT) over the menopausal transition (MT) and by menopause stage. METHODS Nuclear magnetic resonance spectroscopy LDL subclasses were measured for a maximum of five time points. Coronary artery calcification and cIMT were measured for a maximum of two time points. LOESS (locally weighted regression with scatter smoothing) plots, linear mixed-effects models, and generalized estimating equations were used for analyses. RESULTS The study included 471 women (baseline: age, 50.2 ± 2.7 years; 79.0% premenopausal/early perimenopausal), of whom 221 had data on CAC or cIMT. Low-density lipoprotein subclasses increased over the MT, whereas intermediate density-lipoprotein particles declined. In adjusted models, higher total LDL particles (LDL-P) and apolipoprotein B were associated with greater CAC prevalence and greater cIMT. Although none of the associations were modified by menopause stage, higher LDL-C, apolipoprotein B, and total LDL-P were associated with greater cIMT during the perimenopause or postmenopause stages, whereas higher LDL-C and small LDL-P were associated with greater CAC prevalence, mainly during perimenopause. CONCLUSIONS During the MT, women experience significant increases in LDL subclasses found to be related to greater cIMT levels and CAC prevalence. Whether these changes could better predict future risk of hard cardiovascular disease events beyond LDL-C remains a research question to address.
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Affiliation(s)
| | - Xirun Chen
- University of Pittsburgh, Pittsburgh, PA
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Chiriacò M, Nesti L, Natali A, Santoro N, Caprio S, Tricò D. Proatherogenic changes in lipoprotein particles associated with a high triglyceride to high-density lipoprotein cholesterol ratio in youths. Obesity (Silver Spring) 2023; 31:1894-1902. [PMID: 37227148 PMCID: PMC10330115 DOI: 10.1002/oby.23767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE A high triglyceride (TG) to high-density lipoprotein cholesterol (HDL) ratio (TG/HDL) predicts atherosclerosis and cardiovascular events. This study examined whether a proatherogenic distribution of plasma lipoprotein subclasses is associated with a high TG/HDL ratio in youths with obesity. METHODS Lipoprotein particle concentration and size were measured by proton nuclear magnetic resonance in a multiethnic cohort of 592 adolescents with overweight/obesity (age 13 ± 3 years, 58% females, BMI z score 2.1 ± 0.8) who were phenotyped with a 3-hour oral glucose tolerance test and abdominal magnetic resonance imaging. RESULTS The highest TG/HDL quartile showed a higher particle concentration of very low-density lipoprotein (VLDL; +178%, p < 0.0001), intermediate-density lipoprotein (+338%, p < 0.0001), and low-density lipoprotein (LDL; +42%, p < 0.0001), compared with the lowest quartile. The prevalence of large VLDL, very small LDL, and small HDL progressively increased across TG/HDL quartiles. The TG/HDL ratio correlated positively with the average particle size of VLDL (r = 0.37, p < 0.0001) and negatively with particle size of both LDL (r = -0.51, p < 0.0001) and HDL (r = -0.69, p < 0.0001). These associations were independent of sex, age, race/ethnicity, body mass, fasting plasma glucose, and insulin sensitivity. CONCLUSIONS In youths with obesity, an elevated TG/HDL ratio is associated with high concentrations of proatherogenic lipoprotein subclasses. This phenotype may explain the increased cardiovascular risk associated with a high TG/HDL ratio.
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Affiliation(s)
- Martina Chiriacò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Nesti
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Natali
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Santoro
- Kansas University Medical Center, Kansas City, KS, USA
- Department of Medicine and Health Sciences, “V.Tiberio” University of Molise, Campobasso, Italy
| | - Sonia Caprio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Domenico Tricò
- Metabolism, Nutrition, and Atherosclerosis Laboratory, University of Pisa, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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12
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Ding X, Zhou H, Yue Q, Shu Z, Ma X, Li Y, Wu S. Association of trajectories of non-high-density lipoprotein cholesterol concentration with risk of cardiovascular disease: the Kailuan Study. BMJ Open 2023; 13:e069807. [PMID: 37185179 PMCID: PMC10151948 DOI: 10.1136/bmjopen-2022-069807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES This study aimed to assess the association between longitudinal change in non-high-density lipoprotein cholesterol (non-HDL-C) and subsequent cardiovascular disease (CVD) risk. DESIGN A retrospective study. SETTING Data were obtained from the Kailuan Study, a dynamic cohort study initiated in 2006 in Tangshan, China. PARTICIPANTS The current study included 41 085 participants (mean age 53.9±11.6 years) free of CVD events in or before 2012. The non-HDL-C trajectory was developed according to the repeated measurement during 2006-2012 surveys to predict the CVD risk from 2012 to 2020. PRIMARY OUTCOME MEASURES CVD events included myocardial infarction and stroke. RESULTS 3 discrete non-HDL-C trajectories were identified: low-increasing (n=20 038), moderate-increasing (n=17 987) and high-increasing (n=3060). During 8 years of follow-up, 1797 CVD events were documented. Relative to the low-increasing pattern, adjusted HRs were 1.25 (95% CI: 1.13 to 1.38) for the moderate-increasing pattern and 1.46 (95% CI: 1.24 to 1.71) for the high-increasing pattern after adjustment for potential confounders such as age, sex, education background, smoking status, drinking status, physical activity, body mass index, low-density lipoprotein cholesterol, hypertension, diabetes and lipid-lowering medications. CONCLUSIONS Changes in non-HDL-C were significantly associated with subsequent risk of CVD events, and participants with a high-increasing pattern had a higher CVD risk. Long-term monitoring of non-HDL-C could be useful to improve the prediction of CVD risk. TRIAL REGISTRATION NUMBER ChiCTR-TNC-1100148.
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Affiliation(s)
- Xiong Ding
- School of Public Health, North China University of Science and Technology, Tangshan, People's Republic of China
- School of Public Health, Wuhan University, Wuhan, People's Republic of China
| | - Hui Zhou
- Xiangya School of Nursing, Central South University, Changsha, People's Republic of China
| | - Qing Yue
- School of Public Health, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Zhe Shu
- School of Public Health, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Xiaoxu Ma
- School of Public Health, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Yun Li
- School of Public Health, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, People's Republic of China
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13
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Cholesterol Remnants, Triglyceride-Rich Lipoproteins and Cardiovascular Risk. Int J Mol Sci 2023; 24:ijms24054268. [PMID: 36901696 PMCID: PMC10002331 DOI: 10.3390/ijms24054268] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
Randomized clinical trials with statins and other lipid-lowering drugs have shown the presence of a "residual cardiovascular risk" in those treated to "target" for LDL-cholesterol. This risk is mainly associated to lipid components other than LDL and in particular to remnant cholesterol (RC) and to lipoproteins rich in triglycerides in fasting and non-fasting conditions. During fasting, RCs correspond to the cholesterol content of the VLDL and their partially depleted triglyceride remnant containing apoB-100. Conversely, in non-fasting conditions, RCs include also cholesterol present in chylomicrons containing apoB-48. Therefore, RCs refer to total plasma cholesterol minus HDL-cholesterol and LDL-cholesterol, that is, all the cholesterol present in the VLDL, chylomicrons and in their remnants. A large body of experimental and clinical data suggests a major role of RCs in the development of atherosclerosis. In fact, RCs easily pass the arterial wall and bind to the connective matrix stimulating the progression of smooth muscle cells and the proliferation of resident macrophages. RCs are a causal risk factor for cardiovascular events. Fasting and non-fasting RCs are equivalent for predicting vascular events. Further studies on drugs effect on RC levels and clinical trials to evaluate the efficacy of RC reduction on cardiovascular events are needed.
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Zheng X, Jiang M, Ren X, Han L. The longitudinal association of remnant cholesterol with diabetes in middle-aged and elderly Chinese: A nationwide population-based cohort study. J Diabetes Complications 2023; 37:108360. [PMID: 36459863 DOI: 10.1016/j.jdiacomp.2022.108360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS The association between remnant cholesterol (RC) and diabetes remains unclear in Chinese. METHODS AND RESULTS We used the data of 9464 Chinese adults aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS). Estimated RC level was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. Cox proportional hazard models and restricted cubic spline models were used to assess the relationships between RC and diabetes. RESULTS After 6 years of follow-up, a total of 777 respondents experienced new-onset diabetes. In multivariable-adjusted analyses, the adjusted hazard ratios (95 % confidence intervals) for the highest versus lowest quartile of RC was 1.45 (1.19-1.75) for risk of diabetes, and each 1-SD increase of RC (19.52 mg/dl) was associated with 9 % (HRs = 1.09; 1.03-1.15) increased risk of diabetes. There were also significant linear associations between RC level and diabetes (P for linearity <0.001). CONCLUSION Elevated RC levels were positively associated with increased risk of diabetes in Chinese adult population, suggesting that RC could be considered as a preferential predictor and treatment target of diabetes in Chinese population. Future prospective studies are needed to verify our findings and to assess the effect of RC-lowering interventions in diabetes prevention.
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Affiliation(s)
- Xiaowei Zheng
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China.
| | - Minglan Jiang
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Xiao Ren
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Longyang Han
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
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15
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Agongo G, Raal F, Nonterah EA, Debpuur C, Oduro AR, Ramsay M, Crowther NJ. Non-HDL-C and LDL-C/HDL-C are associated with self-reported cardiovascular disease in a rural West African population: Analysis of an array of lipid metrics in an AWI-Gen sub-study. PLoS One 2022; 17:e0278375. [PMID: 36477684 PMCID: PMC9728928 DOI: 10.1371/journal.pone.0278375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Few studies have compared the utility of serum levels of lipid fractions in cardiovascular disease (CVD) risk assessment in sub-Saharan Africa (SSA). The current study interrogated this question among men and women aged 40-60 years in rural northern Ghana. This was a cross-sectional study in which data was collected on socio-demography, behaviour, health history, anthropometry and lipid levels. Adjusted multivariable logistic regression models were used to assess the association of various lipid metrics with CVD. All tests were considered statistically significant at P<0.05. Data were available for 1839 participants. The prevalence of self-reported CVD was 1.6% (n = 29). Non-HDL-C (median (interquartile range): 2.4 (1.9-3.0) vs 2.0 (1.6-2.5) mmol/L; P = 0.009), LDL-C/HDL-C (1.8 (1.4-2.4) vs 1.5 (1.1-2.6); P = 0.019) and TC/HDL-C (3.3 (2.9-3.9) vs 2.9 (2.4-3.5); P = 0.003) were all significantly higher in participants with self-reported CVD compared to those without. However, after adjusting for socioeconomic status (SES) and meals from vendors in a logistic regression model, only non-HDL-C (odds ratio [95% CIs]): (1.58 [1.05, 2.39]), P = 0.029 and LDL-C/HDL-C levels (odds ratio [95% CIs]): (1.26 [1.00, 1.59]), P = 0.045 remained significantly associated with self-reported CVD. While our findings suggest non-HDL-C and LDL-C/HDL-C measures may be appropriate biomarkers for assessing CVD risk in this population, further studies using established clinical endpoints are required to validate these findings in sub-Saharan Africans.
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Affiliation(s)
- Godfred Agongo
- Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C.K Tedam University of Technology and Applied Sciences, Navrongo, Ghana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- * E-mail:
| | - Frederick Raal
- Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Engelbert A. Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelius Debpuur
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Abraham R. Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J. Crowther
- Department of Chemical Pathology, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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The benefits of measuring the size and number of lipoprotein particles for cardiovascular risk prediction: A systematic review and meta-analysis. CLÍNICA E INVESTIGACIÓN EN ARTERIOSCLEROSIS 2022:S0214-9168(22)00134-6. [PMID: 36522243 DOI: 10.1016/j.arteri.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Cardiovascular risk (CVR) is conventionally calculated by measuring the total cholesterol content of high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The purpose of this systematic review was to assess the CVR associated with LDL and HDL particle size and number as determined by nuclear magnetic resonance (NMR) spectroscopy. MATERIAL AND METHODS A literature search was performed using the electronic databases MEDLINE and Scopus. All cohort and case-control studies published before January 1, 2019 that met the following inclusion criteria were included: HDL-P, LDL-P, HDL-Z and/or LDL-Z measured by NMR spectroscopy; cardiovascular event as an outcome variable; risk of cardiovascular events expressed as odds ratios or hazard ratios; only adult patients. A meta-analysis was performed for each exposure variable (4 for LDL and 5 for HDL) and for each exposure measure (highest versus lowest quartile and 1-standard deviation increment). RESULTS This review included 24 studies. Number of LDL particles was directly associated with CVR: risk increased by 28% with each standard deviation increment. LDL particle size was inversely and significantly associated with CVR: each standard deviation increment corresponded to an 8% risk reduction. CVR increased by 12% with each standard deviation increase in number of small LDL particles. HD, particle number and size were inversely associated with CVR. CONCLUSION Larger particle size provided greater protection, although this relationship was inconsistent between studies. Larger number of LDL particles and smaller LDL particle size are associated with increased CVR. Risk decreases with increasing number and size of HDL particles.
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17
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Uzunget SB, Sahin KE. Atherogenic index of plasma is an independent predictor of mitral annular calcification. BMC Cardiovasc Disord 2022; 22:511. [PMID: 36451082 PMCID: PMC9710030 DOI: 10.1186/s12872-022-02891-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND In the latest reports, atherogenic indices have been related to acute coronary syndromes, stable coronary artery disease, heart failure and future cardiac events. Conventional atherosclerosis risk factors have been associated with mitral annular calcification (MAC), but data on the relationship between atherogenic indices and MAC are lacking. We aimed to investigate a possible relationship between MAC and atherogenic indices. METHODS In total 741 patients (n = 427 with MAC and n = 314 without MAC) who were examined in our cardiology clinic from February 2016 to October 2021 were recruited in the study. Mitral annular calcification was diagnosed by transthoracic 2-dimensional echocardiography. The atherogenic coefficient (AC), Castelli risk index 1 (CRI-1), Castelli risk index 2 (CRI-2) and atherogenic index of plasma (AIP) were calculated by utilizing standard lipid test values. RESULTS There was no statistically significant difference in sex, age, diabetes and hypertension status between the patient and the control groups. Serum triglyceride level, AIP, Hs-CRP, smoking and BMI were independently significantly associated with MAC in multiple regression analysis (p < 0.001). CONCLUSION Higher AIP was related to the existence of MAC and also predict the presence of MAC independently. Studies evaluating the modification of these indices are needed.
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Affiliation(s)
| | - Kader Eliz Sahin
- grid.411126.10000 0004 0369 5557Department of Cardiology, Adiyaman University Education and Research Hospital, Adiyaman, Turkey
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18
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Leatherman S, Ferguson R, Hau C, Harrington K, Granowitz C, Philip S, Toth PP, Bhatt D, Boden W. Increased residual cardiovascular risk in U.S. veterans with moderately-elevated baseline triglycerides and well-controlled LDL-C levels on statins. Front Cardiovasc Med 2022; 9:982815. [PMID: 36407462 PMCID: PMC9673755 DOI: 10.3389/fcvm.2022.982815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background Recent studies have demonstrated a causal role for elevated triglycerides (TG) in incident cardiovascular (CV) events in patients with established coronary heart disease (CHD) and those with CV risk factors alone, particularly diabetes. Objective Using a large cohort of U.S. veterans with statin-controlled LDL-C levels (40–100 mg/dL), we explored residual CV risk among patients with elevated baseline TG levels (150–499 mg/dL) vs. those with normal TG levels (<150 mg/dL). Methods We identified veterans receiving a statin but not a TG-lowering agent from the VA electronic health records database, from 2010 to 2015. We compared composite CV event rates (MI, stroke, unstable angina, coronary revascularization, and CV death) between the elevated TG and normal TG groups. We stratified the study cohort according to 3 CV risk groups: (1) no diabetes and no prior CV event, (2) diabetes and no prior CV event, and (3) prior CV event. We calculated crude event rates, rate ratios, and event rate ratios adjusted for age, sex, systolic blood pressure, estimated glomerular filtration rate, and weight. Results The cohort included 396,189 veterans (predominantly male and white) of whom 109,195 (28%) had elevated TG levels. Those with elevated TG were younger (age 73 vs. 77 years) and had a higher body mass index (31.3 vs. 28.3 Kg/M2). The overall composite crude and adjusted rate ratios comparing the elevated and normal TG groups were 1.10 (1.09, 1.12) and 1.05 (1.03, 1.06), respectively. For CV risk groups 1, 2 and 3, the adjusted rate ratios comparing the elevated and normal TG groups were 0.99 (0.96, 1.02), 1.05 (1.02, 1.08), and 1.07 (1.04, 1.10), respectively. An association of increased rate ratios did not hold for fatal events. Conclusion Those with elevated TG levels and well-controlled LDL-C on statins showed a modest increase in CV events compared to those with normal TG. Elevated TG levels were associated with increased CV events in patients with established CV disease and with diabetes only, suggesting that elevated TG levels are associated with a similar degree of residual risk in high-risk primary prevention and secondary prevention settings.
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Affiliation(s)
- Sarah Leatherman
- VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
- School of Public Health, Boston University, Boston, MA, United States
- *Correspondence: Sarah Leatherman
| | - Ryan Ferguson
- VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
- School of Medicine, Boston University, Boston, MA, United States
| | - Cynthia Hau
- VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
| | - Kelly Harrington
- VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
- School of Medicine, Boston University, Boston, MA, United States
| | | | - Sephy Philip
- Amarin Pharma Inc., Bridgewater, MA, United States
| | | | - Deepak Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Boston, MA, United States
| | - William Boden
- VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
- School of Medicine, Boston University, Boston, MA, United States
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Samson R, Ennezat PV, Le Jemtel TH, Oparil S. Cardiovascular Disease Risk Reduction and Body Mass Index. Curr Hypertens Rep 2022; 24:535-546. [PMID: 35788967 DOI: 10.1007/s11906-022-01213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Anti-hypertensive and lipid lowering therapy addresses only half of the cardiovascular disease risk in patients with body mass index > 30 kg/m2, i.e., obesity. We examine newer aspects of obesity pathobiology that underlie the partial effectiveness of anti-hypertensive lipid lowering therapy for the reduction of cardiovascular disease risk in obesity. RECENT FINDINGS Obesity-related insulin resistance, vascular endothelium dysfunction, increased sympathetic nervous system/renin-angiotensin-aldosterone system activity, and glomerulopathy lead to type 2 diabetes, coronary atherosclerosis, and chronic disease kidney disease that besides hypertension and dyslipidemia increase cardiovascular disease risk. Obesity increases cardiovascular disease risk through multiple pathways. Optimal reduction of cardiovascular disease risk in patients with obesity is likely to require therapy targeted at both obesity and obesity-associated conditions.
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Affiliation(s)
- Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | | | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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20
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Calvo Alén J, Lavin-Gomez BA, Aurrecoechea E, Guerra Ruiz AR, Martínez Taboada V, Gómez Gerique J. TNF Inhibitors Exert a "Hidden" Beneficial Effect in the Cardiovascular Lipoprotein Profile of RA Patients. Biologics 2022; 16:187-197. [PMID: 36281333 PMCID: PMC9587304 DOI: 10.2147/btt.s364191] [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: 02/26/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022]
Abstract
Purpose A high cardiovascular risk has been described in patients with rheumatoid arthritis (RA); the effects of different biological agents have also been described in these patients. The aim of the present study is to examine the effects of tumor necrosis factor inhibitors (TNFi) in the lipoprotein profile of RA patients using a broad laboratory assessment including a large number of non-routine tests. Patients and Methods RA patients treated with and without TNFi (70 patients in each group) were cross-sectionally compared regarding a broad spectrum of lipoprotein parameters including serum levels of total and HDL, LDL and VLDL cholesterol triglycerides, lipoprotein A (LpA), apolipoprotein A1 (Apo A), B100 (Apo B) and paroxonase. For each lipoprotein subfraction (HDL, LDL and VLDL), we assess specific concentrations of cholesterol, triglycerides, phospholipids and proteins and total mass of each one. Additionally, HDL Apo A, LDL and VLDL Apo B concentrations and number of particles of LDL and VLDL were also determined. Exploratory univariate and multivariate analyses of the different variables were performed. Results Seventy patients in each subset were enrolled. Patients on treatment with TNFi showed a trend to be younger and to have a longer disease duration. Regarding the lipoprotein analyses, borderline significant higher levels of serum Apo A were detected and an independent association with lower HDL mass, LDL triglyceride, VLDL cholesterol, VLDL Apo B, VLDL mass, number of VLDL cholesterol molecules and number of particles of VLDL was clearly observed. Conclusion TNFi treatment was associated with beneficial atherogenic effects at the lipoprotein level especially centered in the VLDL-related parameters consistent with a reduction of the atherogenic risk.
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Affiliation(s)
- Jaime Calvo Alén
- Rheumatology Department, Hospital Universitario Araba, Universidad del País Vasco, and Instituto de Investigación Biomédica BIOARABA, Vitoria, Spain,Correspondence: Jaime Calvo Alén, Rheumatology Department, Hospital Universitario Araba, Universidad del País Vasco, C/ Francisco Leandro de Viana s/n, Vitoria, Alava, 01009, Spain, Tel +34 945007576, Email
| | | | - Elena Aurrecoechea
- Rheumatology Division, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Armando Raul Guerra Ruiz
- Clinical Biochemistry Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Víctor Martínez Taboada
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla Universidad de Cantabria, Santander, Spain
| | - Juan Gómez Gerique
- Clinical Biochemistry Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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21
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Fu L, Tai S, Sun J, Zhang N, Zhou Y, Xing Z, Wang Y, Zhou S. Remnant Cholesterol and Its Visit-to-Visit Variability Predict Cardiovascular Outcomes in Patients With Type 2 Diabetes: Findings From the ACCORD Cohort. Diabetes Care 2022; 45:2136-2143. [PMID: 35834242 PMCID: PMC9472497 DOI: 10.2337/dc21-2511] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Remnant cholesterol (remnant-C) predicts atherosclerotic cardiovascular disease, regardless of LDL-cholesterol (LDL-C) levels. This study assessed the associations between remnant-C and cardiovascular outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS This post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial used patient (type 2 diabetes >3 months) remnant-C and major adverse cardiovascular event (MACE) data from the study database. The associations between remnant-C and MACEs were evaluated using Cox proportional hazards regression analyses. We examined the relative MACE risk in remnant-C versus LDL-C discordant/concordant groups using clinically relevant LDL-C targets by discordance analyses. RESULTS The baseline analysis included 10,196 participants, with further visit-to-visit variability analysis including 9,650 participants. During follow-up (median, 8.8 years), 1,815 patients (17.8%) developed MACEs. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in remnant-C was associated with a 7% higher MACE risk (hazard ratio [HR] 1.07, 95% CI 1.02-1.12, P = 0.004). In the fully adjusted model, the visit-to-visit remnant-C variability calculated using logSD (HR 1.41, 95% CI 1.18-1.69, P < 0.001) and logARV (HR 1.45, 95% CI 1.22-1.73, P < 0.001) was associated with MACEs. Residual lipid risk (remnant-C ≥31 mg/dL) recognized individuals at a higher MACE risk, regardless of LDL-C concentrations. Within each LDL-C subgroup (>100 or ≤100 mg/dL), high baseline remnant-C was associated with a higher MACE risk (HR 1.37, 95% CI 1.09-1.73, P = 0.007; HR 1.22, 95% CI 1.04-1.41, P = 0.015, respectively). CONCLUSIONS Remnant-C levels were associated with MACEs in patients with type 2 diabetes independent of LDL-C, and visit-to-visit remnant-C variability helped identify those with higher cardiovascular risk.
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Affiliation(s)
- Liyao Fu
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Tai
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiaxing Sun
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ningjie Zhang
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zhou
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China.,Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhenhua Xing
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yongjun Wang
- Department of Blood Transfusion, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shenghua Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
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22
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Pan X, Hussain MM. Bmal1 regulates production of larger lipoproteins by modulating cAMP-responsive element-binding protein H and apolipoprotein AIV. Hepatology 2022; 76:78-93. [PMID: 34626126 PMCID: PMC8993942 DOI: 10.1002/hep.32196] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS High plasma lipid/lipoprotein levels are risk factors for various metabolic diseases. We previously showed that circadian rhythms regulate plasma lipids and deregulation of these rhythms causes hyperlipidemia and atherosclerosis in mice. Here, we show that global and liver-specific brain and muscle aryl hydrocarbon receptor nuclear translocator-like 1 (Bmal1)-deficient mice maintained on a chow or Western diet developed hyperlipidemia, denoted by the presence of higher amounts of triglyceride-rich and apolipoprotein AIV (ApoAIV)-rich larger chylomicron and VLDL due to overproduction. APPROACH AND RESULTS Bmal1 deficiency decreased small heterodimer partner (Shp) and increased microsomal triglyceride transfer protein (MTP), a key protein that facilitates primordial lipoprotein assembly and secretion. Moreover, we show that Bmal1 regulates cAMP-responsive element-binding protein H (Crebh) to modulate ApoAIV expression and the assembly of larger lipoproteins. This is supported by the observation that Crebh-deficient and ApoAIV-deficient mice, along with Bmal1-deficient mice with knockdown of Crebh, had smaller lipoproteins. Further, overexpression of Bmal1 in Crebh-deficient mice had no effect on ApoAIV expression and lipoprotein size. CONCLUSIONS These studies indicate that regulation of ApoAIV and assembly of larger lipoproteins by Bmal1 requires Crebh. Mechanistic studies showed that Bmal1 regulates Crebh expression by two mechanisms. First, Bmal1 interacts with the Crebh promoter to control circadian regulation. Second, Bmal1 increases Rev-erbα expression, and nuclear receptor subfamily 1 group D member 1 (Nr1D1, Rev-erbα) interacts with the Crebh promoter to repress expression. In short, Bmal1 modulates both the synthesis of primordial lipoproteins and their subsequent expansion into larger lipoproteins by regulating two different proteins, MTP and ApoAIV, through two different transcription factors, Shp and Crebh. It is likely that disruptions in circadian mechanisms contribute to hyperlipidemia and that avoiding disruptions in circadian rhythms may limit/prevent hyperlipidemia and atherosclerosis.
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Affiliation(s)
- Xiaoyue Pan
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, USA
- Department of Cell Biology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - M Mahmood Hussain
- Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, USA
- Department of Cell Biology, SUNY Downstate Medical Center, Brooklyn, NY, USA
- VA New York Harbor Healthcare System, Brooklyn, NY, USA
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23
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Zhou L, Liu J, An Y, Wang Y, Wang G. Plasma Homocysteine Level Is Independently Associated With Conventional Atherogenic Lipid Profile and Remnant Cholesterol in Adults. Front Cardiovasc Med 2022; 9:898305. [PMID: 35770226 PMCID: PMC9234129 DOI: 10.3389/fcvm.2022.898305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHomocysteine (Hcy) is an independent risk factor for cardiovascular disease, while mechanisms are unclear. Despite inconsistent and limited, epidemiological and experimental studies indicated that hyperhomocysteinemia (HHcy) affected lipid metabolism. This study aims to investigate the association of plasma Hcy with traditional lipid profiles and remnant cholesterol (RC) in Chinese adults.MethodsIn total, 7,898 subjects aged 20–79 years who underwent a physical examination at Beijing Chao-Yang Hospital in Beijing were included in this study. Fasting plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), lipoprotein (a) [Lp(a)], Hcy, and other metabolic risk factors were measured by routine automated laboratory methods. RC was calculated as TC minus HDL-C and LDL-C. The linear regression model and logistic regression model were used to assess the relationship between Hcy and lipids after adjusting potential confounders.ResultsOf the subjects, the median level of plasma Hcy was 13.0 μmol/L and 32.3% had HHcy. Plasma Hcy was negatively associated with HDL-C, ApoA1, and Lp(a) and positively associated with TG levels after adjusting age, sex, body mass index, blood pressure, alanine transaminase, aspartate transaminase, creatinine, uric acid, and glucose. HHcy significantly increased the risk of low HDL-C [odds ratio (OR) 1.26; 95%CI (1.11–1.44); p < 0.001]. The net mediation effects of ApoA1 on the relationship between Hcy and HDL-C before and after adjusting confounders were 46.9 and 30.6%, respectively. More interestingly, the RC level was significantly elevated in subjects with HHcy after adjusting other influencing factors (p = 0.025). Hcy presented a positive correlation with RC levels after adjusting the above confounding factors (β = 0.073, p = 0.004), and the correlation was still significant even after controlling other lipids, including TG, LDL-C, HDL-C, ApoA1, ApoB, and Lp(a).ConclusionOur study showed that plasma Hcy was not only significantly associated with conventional atherogenic lipids but also independently correlated with RC levels beyond other lipids after controlling potential confounders. This finding proposes that identifying Hcy-related dyslipidemia risk, both traditional lipids and RC residual risk, is clinically relevant as we usher in a new era of targeting Hcy-lowering therapies to fight against dyslipidemia or even cardiovascular disease.
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Affiliation(s)
- Liyuan Zhou
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yu An
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Medical Examination Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Ying Wang,
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Guang Wang,
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24
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Gao S, Xu H, Ma W, Yuan J, Yu M. Remnant Cholesterol Predicts Risk of Cardiovascular Events in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries. J Am Heart Assoc 2022; 11:e024366. [PMID: 35535621 PMCID: PMC9238562 DOI: 10.1161/jaha.121.024366] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Background Remnant cholesterol (RC) has been reported to promote atherosclerotic cardiovascular disease. Yet little is known regarding the RC-related residual risk in patients with myocardial infarction (MI) with nonobstructive coronary arteries. Methods and Results A total of 1179 patients with MI with nonobstructive coronary arteries were enrolled and divided according to median level of RC calculated as non-high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. The primary end point was a composite of major adverse cardiovascular events (MACEs), including all-cause death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, and receiver-operating characteristic analyses were used. Patients with higher median level of RC had a significantly higher incidence of MACEs (16.9% versus 11.5%; P=0.009) over the median follow-up of 41.7 months. High RC levels were significantly associated with an increased risk of MACEs after adjustment for multiple clinically relevant variables (per 1 SD increase, hazard ratio, 0.61; 95% CI, 1.12-2.31; P=0.009). Elevated RC also contributed to residual risk beyond conventional lipid parameters. Moreover, RC had an area under the curve of 0.61 for MACE prediction. When adding RC to the Thrombolysis in Myocardial Infarction risk score, the combined model yielded a significant improvement in discrimination for MACEs. Conclusions Elevated RC was closely associated with poor outcomes after MI with nonobstructive coronary arteries independent of traditional risk factors, indicating the utility of RC for risk stratification and a rationale for targeted RC-lowering trials in patients with MI with nonobstructive coronary arteries.
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Affiliation(s)
- Side Gao
- Department of CardiologyBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Haobo Xu
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wenjian Ma
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiansong Yuan
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mengyue Yu
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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25
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The association of Helicobacter Pylori infection with dyslipidaemia and other atherogenic factors in dyspeptic patients at St. Paul's Hospital Millennium Medical College. Heliyon 2022; 8:e09430. [PMID: 35600431 PMCID: PMC9120239 DOI: 10.1016/j.heliyon.2022.e09430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/15/2022] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Studies showed that more than half of Ethiopians were presumed to be chronically infected with H. pylori. Nowadays, evidence has come to the literature strongly suggesting the potential association between H. pylori and extra gastric disorders including atherosclerosis. Objective To assess the association of helicobacter pylori infection with dyslipidaemia and other atherogenic factors in dyspeptic patients at St. Paul's Hospital Millennium Medical College, from November 2019 to June 2020. Materials and methods This institution-based cross-sectional study was examining 346 dyspeptic patients at SPHMMC from November 2019 to June 2020. A structured questionnaire was used to collect socio-demography data and anthropometric measurement was taken. Biochemical parameters were measured in serum samples by using Cobas 6000 clinical chemistry analyzer. Data were coded and entered into a statistical package for social sciences (SPSS) version 23 for analysis. Risk factors were identified using logistic regression. Hence, a bivariate logistic regression analysis test was conducted and variables with a p < 0.25 were included in the multivariate logistic regression model. P-values ≤0.05 were considered as a cut point for statistical significance in the final model. Results An overall prevalence of dyslipidemia among study participants was 253 (73.12 %). Among those who tested positive for H. pylori, 119/174 (68.39 %) had dyslipidemia in at least one lipid profile, while 8 (4.60%) had dyslipidemia in all four lipid profiles. After adjusting for traditional dyslipidemia risk factors, age >45 (AOR 4.864, 95% CI 2.281–4.080, P < 0.001), systolic blood pressure >120mmHg (AOR 1.036, 95% CI 1.009–1.065, P = 0.036) and being H. Pylori seropositive (AOR 0.555, 95% CI 0.318–0.967, P = 0.038) were an independent predictors of dyslipidemia. Conclusion This study reported that more than two-thirds of the H. pylori seropositive groups had exhibited dyslipidemia in at least one lipid profile, which can accelerate the incidence of atherosclerosis process.
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26
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Olaniyi KS, Areloegbe SE. Suppression of PCSK9/NF-kB-dependent pathways by acetate ameliorates cardiac inflammation in a rat model of polycystic ovarian syndrome. Life Sci 2022; 300:120560. [PMID: 35452635 DOI: 10.1016/j.lfs.2022.120560] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/14/2022]
Abstract
AIM Endocrinometabolic disorders in women of reproductive age, including polycystic ovarian syndrome (PCOS) has contributed to increased prevalence of cardiovascular disease (CVD) risk and its attendant complications. Acetate, the most abundant endogenously produced short chain fatty acid has been linked to metabolic health. However, the impact of acetate on CVD-driven pathologies in PCOS is unknown. The present study therefore investigated the effects of acetate on cardiometabolic abnormalities associated with PCOS in rat model, and the possible involvement of PCSK9/NF-kB-dependent pathways. MATERIALS AND METHODS Eight-week-old female Wistar rats were allotted into four groups (n = 6) and the groups received vehicle, acetate (200 mg/kg), letrozole (1 mg/kg) and letrozole plus acetate respectively. The administrations were done once daily by oral gavage and lasted for 21 days. KEY FINDINGS In letrozole-induced PCOS rats characterized with insulin resistance, glucose dysregulation, elevated plasma testosterone and decreased 17-β estradiol as well as degenerated ovarian follicles, there was a significant increase in plasma and cardiac lipid/lipoproteins, lipid peroxidation, inflammatory mediators (NF-kB and TNF-α), γ-glutamyl transferase/lactate dehydrogenase and lactate content, PCSK9 and reduction in plasma and cardiac antioxidants (glutathione peroxidase and reduced glutathione) and plasma nitric oxide synthesis (eNOS and NO) compared with the control rats. In addition, immunohistochemical assessment of cardiac tissue showed severe expression of inflammasome in letrozole-induced PCOS rats compared with the control rats. Nevertheless, supplementation with acetate significantly attenuated these alterations. SIGNIFICANCE The present results suggest that acetate protects against cardiac inflammation in a rat model of PCOS by suppression of PCSK9 and NF-kB-dependent mechanisms.
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Affiliation(s)
- Kehinde S Olaniyi
- Cardio/Repro-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria.
| | - Stephanie E Areloegbe
- Cardio/Repro-metabolic and Microbiome Research Unit, Department of Physiology, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti 360101, Nigeria
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27
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Hussain A, Sun C, Selvin E, Nambi V, Coresh J, Jia X, Ballantyne CM, Hoogeveen RC. Triglyceride-rich lipoproteins, apolipoprotein C-III, angiopoietin-like protein 3, and cardiovascular events in older adults: Atherosclerosis Risk in Communities (ARIC) study. Eur J Prev Cardiol 2022; 29:e53-e64. [PMID: 33580780 PMCID: PMC8277878 DOI: 10.1093/eurjpc/zwaa152] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 12/14/2022]
Abstract
AIMS Despite statin and antihypertensive therapies, older Americans have high atherosclerotic cardiovascular disease (ASCVD) risk. Novel measures of triglyceride-rich lipoproteins, low-density lipoprotein triglycerides (LDL-TG), and remnant-like particle cholesterol (RLP-C), are associated with ASCVD in middle-aged adults. Polymorphisms in genes encoding angiopoietin-related protein 3 (ANGPTL3) and apolipoprotein C-III (apoC-III), two proteins involved in triglyceride catabolism, are associated with increased risk for hypertriglyceridaemia and ASCVD and are potential therapeutic targets. We examined associations of LDL-TG, RLP-C, apoC-III, and ANGPTL3 levels with ASCVD events in older adults in the Atherosclerosis Risk in Communities (ARIC) study. METHODS AND RESULTS In 6359 participants (mean age 75.8 ± 5.3 years) followed for ASCVD events [coronary heart disease (CHD) or ischaemic stroke] up to 6 years, associations between LDL-TG, RLP-C, apoC-III, and ANGPTL3 and ASCVD events were assessed using Cox regression. With adjustment for age, sex, and race, RLP-C, LDL-TG, apoC-III, and ANGPTL3 (as continuous variables) were significantly associated with CHD. However, after adjustment for traditional risk factors and lipid-lowering medications, only LDL-TG and ANGPTL3 were significantly associated with ASCVD events [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.25-2.37 per log unit increase in LDL-TG; HR 1.63, 95% CI 1.17-2.28 per log unit increase in ANGPTL3]. CONCLUSIONS In older adults, LDL-TG, RLP-C, apoC-III, and ANGPTL3 were associated with CHD events in minimally adjusted models; LDL-TG and ANGPTL3 remained independent predictors of ASCVD events with further adjustment. Future studies should assess potential benefit of lowering hepatic apoC-III or ANGPTL3 expression in patients with elevated triglyceride-rich lipoproteins.
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Affiliation(s)
- Aliza Hussain
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Department of Medicine, Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
| | - Caroline Sun
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Department of Medicine, Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
| | - Elizabeth Selvin
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Baltimore, Maryland (MD), 21287, Baltimore, MD, USA
| | - Vijay Nambi
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Department of Medicine, Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, Texas (TX), 77030, USA
| | - Josef Coresh
- Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Baltimore, Maryland (MD), 21287, Baltimore, MD, USA
| | - Xiaoming Jia
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Department of Medicine, Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
| | - Ron C Hoogeveen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
- Department of Medicine, Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, 6565 Fannin Street, MS F701, Houston, TX 77030, USA
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28
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Arrieta F, Pedro-Botet J, Iglesias P, Obaya JC, Montanez L, Maldonado GF, Becerra A, Navarro J, Perez JC, Petrecca R, Pardo JL, Ribalta J, Sánchez-Margalet V, Duran S, Tébar FJ, Aguilar M. Diabetes mellitus and cardiovascular risk: an update of the recommendations of the Diabetes and Cardiovascular Disease Working Group of the Spanish Society of Diabetes (SED, 2021). CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2022; 34:36-55. [PMID: 34330545 DOI: 10.1016/j.arteri.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
This document is an update to the clinical practice recommendations for the management of cardiovascular risk factors (CVRF) in diabetes mellitus. The consensus has been developed by a multidisciplinary team made up of members of the Cardiovascular Risk Group of the Spanish Diabetes Society (SED). The work is a necessary update as, since the last review three years ago, there have been many clinical trials that have studied the cardiovascular outcomes of numerous drugs in the diabetic population. We believe that this guideline update may be of interest to all clinicians treating patients with diabetes.
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Affiliation(s)
- Francisco Arrieta
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España.
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España
| | - Pedro Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, España
| | - Juan Carlos Obaya
- Centro de Salud CHOPERA, Atención Primaria Alcobendas, Gdt Enfermedades Cardiovasculares Semfyc, Madrid, España
| | - Laura Montanez
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | | | - Antonio Becerra
- Servicio de Endocrinología y Nutrición, Hospital Ramón y Cajal, Madrid, España
| | - Jorge Navarro
- Hospital Clínico Universitario de Valencia, Gdt Diabetes Semfyc, Valencia, España
| | - J C Perez
- Centro de Salud Rincón de la Victoria, Atención Primaria, Málaga, España
| | - Romina Petrecca
- Unidad de Nutrición y dietética, Hospital de la Princesa, Madrid, España
| | - José Luis Pardo
- Centro de Salud Orihuela I. Médico de Familia, Atención Primaria Alicante, Alicante, España
| | - Josep Ribalta
- Universidad Rovira i Vigili, IISPV, CIBERDEM, Tarragona, España
| | | | - Santiago Duran
- Servicio de Endocrinología y Nutrición, Hospital Virgen de Valme, Sevilla, España
| | - Francisco Javier Tébar
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Manuel Aguilar
- Servicio de Endocrinología y Nutrición, Hospital Puerta del Mar, Cádiz, España
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29
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Puig-Jové C, Castelblanco E, Falguera M, Hernández M, Soldevila B, Julián MT, Teis A, Julve J, Barranco-Altirriba M, Franch-Nadal J, Puig-Domingo M, Ortega E, Amigó N, Alonso N, Mauricio D. Advanced lipoprotein profile in individuals with normal and impaired glucose metabolism. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:22-30. [PMID: 33785266 DOI: 10.1016/j.rec.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/18/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Several types of lipoproteins beyond low-density lipoproteins (LDL) are causally related to cardiovascular disease. We aimed to analyze an advanced lipoprotein profile in individuals with normal and impaired glucose metabolism from different cohorts of a Mediterranean region. METHODS Cross-sectional study in 929 participants (463 normoglycemia, 250 prediabetes, and 216 type 2 diabetes mellitus) with normal renal function, free from cardiovascular disease, and without lipid-lowering treatment. Conventional and advanced (nuclear magnetic resonance [NMR] spectroscopy) lipoprotein profiles were analyzed. RESULTS Compared with men, normoglycemic women showed lower serum triglyceride and LDL cholesterol concentrations, lower total LDL particles (P) as well as their subclasses and their cholesterol and triglyceride content, higher high-density lipoproteins (HDL)-P and all HDL-related variables (P≤ .05 for all comparisons). Compared with normoglycemic participants, diabetic participants showed higher large and small very LDL-P concentrations (P <.05) and lower total HDL-P and medium HDL-P concentrations (P <.05). Waist circumference and Fatty Liver Index were positively associated with a proatherogenic profile. CONCLUSIONS Women had a better advanced lipoprotein profile than did men. Adiposity indexes related to insulin-resistance were positively associated with a proatherogenic lipid profile. NMR revealed altered lipoprotein particles other than LDL in participants with diabetes, frequently associated with an increased cardiovascular risk. Our findings support the usefulness of extended lipoprotein analysis by NMR spectroscopy to uncover new therapeutic targets to prevent cardiovascular events in at-risk participants.
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Affiliation(s)
- Carlos Puig-Jové
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Esmeralda Castelblanco
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau e Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Mireia Falguera
- Instituto de Investigación Biomédica y Universidad de Lleida, Centro de Atención Primaria Cervera, Gerencia de Atención Primaria, Institut Català de la Salut, Lleida, Spain
| | - Marta Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Arnau de Vilanova e Instituto de Investigación Biomédica de Lleida (IRBLleida), Lleida, Spain
| | - Berta Soldevila
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - María Teresa Julián
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Albert Teis
- Servicio de Cardiología, Institut del Cor (iCor), Hospital Universitario Germans Trias i Pujol, Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Josep Julve
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - María Barranco-Altirriba
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau e Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Josep Franch-Nadal
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Manel Puig-Domingo
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
| | - Emilio Ortega
- Servicio de Endocrinología y Nutrición, Hospital Cínico de Barcelona, Institut d'investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Núria Amigó
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Departamento de Ingeniería Electrónica y Automática, Universidad Rovira i Virgili, Instituto de Investigación Sanitaria Pere Virgili (IISPV), Tarragona, Spain
| | - Núria Alonso
- Servicio de Endocrinología y Nutrición, Hospital Universitario e Instituto de Investigación en Ciencias de la Salud Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Departamento de Medicina, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
| | - Didac Mauricio
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain; Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau e Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain; Facultad de Medicina, Universidad de Vic - Universidad Central de Cataluña (UVic/UCC), Vic, Barcelona, Spain
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Afsin A, Kaya H, Suner A, Uzel KE, Bursa N, Hosoglu Y, Yavuz F, Asoglu R. Plasma atherogenic indices are independent predictors of slow coronary flow. BMC Cardiovasc Disord 2021; 21:608. [PMID: 34930134 PMCID: PMC8686646 DOI: 10.1186/s12872-021-02432-5] [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: 09/08/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although the pathophysiology of coronary slow flow (CSF) has not been fully elucidated, emerging data increasingly support potential role for subclinical diffuse atherosclerosis in the etiology of CSF. We aimed to investigate relationship between atherogenic indices and CSF. Methods 130 patients with CSF diagnosed according to Thrombolysis in Myocardial Infarction (TIMI)-frame count (TFC) method and 130 controls who had normal coronary flow (NCF) were included in this retrospective study. Atherogenic indices (atherogenic index of plasma [AIP], Castelli risk indices I and II [CRI-I and II]) were calculated using conventional lipid parameters. Results The logistic regression analyses demonstrated that AIP (OR, 5.463; 95% confidence interval [CI], 1.357–21.991; p = 0.017) and CRI-II (OR, 1.624; 95% CI, 1.138–2.319; p = 0.008) were independent predictors of CSF. Receiver operating characteristic analysis showed that the optimal cutoff value to predict the occurrence of CSF was 0.66 for AIP (sensitivity, 59%; specificity, 73%; area under curve [AUC], 0.695; p < 0.001) and 3.27 for CRI-II (sensitivity, 60%; specificity, 79%; AUC, 0.726; p < 0.001). Conclusions AIP and CRI-II levels were independent predictors of CSF. Prospective studies in larger cohorts of patients may elucidate the role of atherogenic dyslipidemia in the pathophysiology of CSF.
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Affiliation(s)
- Abdulmecit Afsin
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Hakan Kaya
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Arif Suner
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Kader Eliz Uzel
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Nurbanu Bursa
- Department of Statistics, Faculty of Science, Hacettepe University, Ankara, Turkey
| | - Yusuf Hosoglu
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Fethi Yavuz
- Department of Cardiology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Ramazan Asoglu
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
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Quispe R, Martin SS, Michos ED, Lamba I, Blumenthal RS, Saeed A, Lima J, Puri R, Nomura S, Tsai M, Wilkins J, Ballantyne CM, Nicholls S, Jones SR, Elshazly MB. Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: a primary prevention study. Eur Heart J 2021; 42:4324-4332. [PMID: 34293083 PMCID: PMC8572557 DOI: 10.1093/eurheartj/ehab432] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/05/2021] [Accepted: 06/23/2021] [Indexed: 01/04/2023] Open
Abstract
AIMS Emerging evidence suggests that remnant cholesterol (RC) promotes atherosclerotic cardiovascular disease (ASCVD). We aimed to estimate RC-related risk beyond low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) in patients without known ASCVD. METHODS AND RESULTS We pooled data from 17 532 ASCVD-free individuals from the Atherosclerosis Risk in Communities study (n = 9748), the Multi-Ethnic Study of Atherosclerosis (n = 3049), and the Coronary Artery Risk Development in Young Adults (n = 4735). RC was calculated as non-high-density lipoprotein cholesterol (non-HDL-C) minus calculated LDL-C. Adjusted Cox models were used to estimate the risk for incident ASCVD associated with log RC levels. We also performed discordance analyses examining relative ASCVD risk in RC vs. LDL-C discordant/concordant groups using difference in percentile units (>10 units) and clinically relevant LDL-C targets. The mean age of participants was 52.3 ± 17.9 years, 56.7% were women and 34% black. There were 2143 ASCVD events over the median follow-up of 18.7 years. After multivariable adjustment including LDL-C and apoB, log RC was associated with higher ASCVD risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.45-1.89]. Moreover, the discordant high RC/low LDL-C group, but not the low RC/high LDL-C group, was associated with increased ASCVD risk compared to the concordant group (HR 1.21, 95% CI 1.08-1.34). Similar results were shown when examining discordance across clinical cutpoints. CONCLUSIONS In ASCVD-free individuals, elevated RC levels were associated with ASCVD independent of traditional risk factors, LDL-C, and apoB levels. The mechanisms of RC association with ASCVD, surprisingly beyond apoB, and the potential value of targeted RC-lowering in primary prevention need to be further investigated.
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Affiliation(s)
- Renato Quispe
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth Shay Martin
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erin Donelly Michos
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Isha Lamba
- Department of Medicine, New York Presbyterian Hospital-Cornell, 525 East 68th Street, New York, NY, USA
| | - Roger Scott Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anum Saeed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joao Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Nomura
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Michael Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - John Wilkins
- Division of Cardiology and the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christie Mitchell Ballantyne
- Department of Cardiovascular Medicine, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Stephen Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Australia
| | - Steven Richard Jones
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamed Badreldin Elshazly
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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ACC inhibitor alone or co-administered with a DGAT2 inhibitor in patients with non-alcoholic fatty liver disease: two parallel, placebo-controlled, randomized phase 2a trials. Nat Med 2021; 27:1836-1848. [PMID: 34635855 DOI: 10.1038/s41591-021-01489-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 08/03/2021] [Indexed: 02/08/2023]
Abstract
Alterations in lipid metabolism might contribute to the pathogenesis of non-alcoholic fatty liver disease (NAFLD). However, no pharmacological agents are currently approved in the United States or the European Union for the treatment of NAFLD. Two parallel phase 2a studies investigated the effects of liver-directed ACC1/2 inhibition in adults with NAFLD. The first study ( NCT03248882 ) examined the effects of monotherapy with a novel ACC1/2 inhibitor, PF-05221304 (2, 10, 25 and 50 mg once daily (QD)), versus placebo at 16 weeks of treatment; the second study ( NCT03776175 ) investigated the effects of PF-05221304 (15 mg twice daily (BID)) co-administered with a DGAT2 inhibitor, PF-06865571 (300 mg BID), versus placebo after 6 weeks of treatment. The primary endpoint in both studies was percent change from baseline in liver fat assessed by magnetic resonance imaging-proton density fat fraction. Dose-dependent reductions in liver fat reached 50-65% with PF-05221304 monotherapy doses ≥10 mg QD; least squares mean (LSM) 80% confidence interval (CI) was -7.2 (-13.9, 0.0), -17.1 (-22.7, -11.1), -49.9 (-53.3, -46.2), -55.9 (-59.0, -52.4) and -64.8 (-67.5, -62.0) with 16 weeks placebo and PF-05221304 2, 10, 25 and 50 mg QD, respectively. The overall incidence of adverse events (AEs) did not increase with increasing PF-05221304 dose, except for a dose-dependent elevation in serum triglycerides (a known consequence of hepatic acetyl-coenzyme A carboxylase (ACC) inhibition) in 23/305 (8%) patients, leading to withdrawal in 13/305 (4%), and a dose-dependent elevation in other serum lipids. Co-administration of PF-05221304 and PF-06865571 lowered liver fat compared to placebo (placebo-adjusted LSM (90% CI) -44.6% (-54.8, -32.2)). Placebo-adjusted LSM (90% CI) reduction in liver fat was -44.5% (-55.0, -31.7) and -35.4% (-47.4, -20.7) after 6 weeks with PF-05221304 or PF-06865571 alone. AEs were reported for 10/28 (36%) patients after co-administered PF-05221304 and PF-06865571, with no discontinuations due to AEs, and the ACC inhibitor-mediated effect on serum triglycerides was mitigated, suggesting that PF-05221304 and PF-06865571 co-administration has the potential to address some of the limitations of ACC inhibition alone.
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Colivicchi F, Di Fusco SA, Arca M, Leggio M, Caldarola P, Murrone A, Valente S, Urbinati S, Roncon L, Amodeo V, Aspromonte N, Cipriani M, Domenicucci S, Francese GM, Imazio M, di Uccio FS, Di Lenarda A, Gulizia MM, Gabrielli D. Non-high-density lipoprotein cholesterol versus low-density lipoprotein cholesterol in clinical practice: ANMCO position paper. J Cardiovasc Med (Hagerstown) 2021; 22:609-617. [PMID: 33651721 DOI: 10.2459/jcm.0000000000001175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bloodstream cholesterol is a central contributor to atherosclerotic cardiovascular diseases. For several decades, low-density lipoprotein cholesterol (LDL-C) has been the main biomarker for the prediction of cardiovascular events and therapeutic target of lipid-lowering treatments. More recently, several findings have supported the greater reliability of non-high-density lipoprotein cholesterol (non-HDL-C) as a predictive factor and possible therapeutic target in refining antiatherogenic treatments, especially among patients with lower LDL-C and higher triglyceride values. This article discusses the limits of current standard methods for assessing LDL-C levels and emphasizes the persistent residual cardiovascular risk in patients treated with lipid-lowering agents on the basis of recommended LDL-C targets. It highlights that patients with controlled LDL-C and non-targeted non-HDL-C have a higher cardiovascular risk. The article focuses on the role of non-HDL-C as a better predictor of atherosclerotic disease as compared with LDL-C and as a therapeutic target. Finally, this article includes an executive summary aimed at refining preventive approaches in atherosclerotic cardiovascular disease.
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Affiliation(s)
- Furio Colivicchi
- Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital ASL Roma 1, Rome
| | | | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Roma, Rome
| | - Massimo Leggio
- Clinical and Rehabilitative Cardiology Unit, San Filippo Neri Hospital ASL Roma 1, Rome
| | | | - Adriano Murrone
- Cardilogy-Intensive Care Unit, Ospedali di Città di Castello e Gubbio - Gualdo Tadino, Azienda USL Umbria 1, Perugia
| | | | | | - Loris Roncon
- Cardiology Unit, Ospedale Santa Maria della Misericordia, Rovigo
| | - Vincenzo Amodeo
- Cardilogy-Intensive Care Unit, Santa Maria degli Ungheresi Hospital, Polistena, Reggio Calabria
| | - Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Manlio Cipriani
- Cardiology Unit 2, ASST Grande Ospedale Metropolitano Niguarda Cà Granda, Milan
| | | | - Giuseppina Maura Francese
- Cardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione 'Garibaldi' Catania, Catania
| | - Massimo Imazio
- Cardilogy Unit, Presidio Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino
| | | | - Andrea Di Lenarda
- Cardiovascular Center, University Hospital and Health Services of Trieste, Trieste
| | - Michele Massimo Gulizia
- Cardiology Division, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione 'Garibaldi' Catania, Catania
- Presidente Fondazione per il Tuo cuore, Heart Care Foundation, Florence
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Jo SH, Nam H, Lee J, Park S, Lee J, Kyoung DS. Fenofibrate Use Is Associated With Lower Mortality and Fewer Cardiovascular Events in Patients With Diabetes: Results of 10,114 Patients From the Korean National Health Insurance Service Cohort. Diabetes Care 2021; 44:1868-1876. [PMID: 34158362 DOI: 10.2337/dc20-1533] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 05/13/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated the long-term clinical efficacy of fenofibrate use with regard to mortality and cardiovascular outcomes in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We performed a population-based cohort study using data of the South Korean National Health Insurance Service from 2003 to 2014. Of 63,727 participants with diabetes aged 40-79 years, 5,057 users of fenofibrate only were compared with 5,057 nonusers of fenofibrate and/or omega-3 fatty acid with 1:1 propensity matching. The primary end point was a composite of myocardial infarction, stroke, percutaneous coronary revascularization, and cardiac death for a median of 3 years. RESULTS The primary end point was significantly lower in fenofibrate users compared with those using neither fenofibrate nor omega-3 fatty acid (13.4 vs. 15.5 per 1,000 person-years; hazard ratio [HR] 0.76; 95% CI 0.62-0.94; P = 0.010). Cardiac death (1.8 vs. 3.1 per 1,000 person-years; HR 0.59; 95% CI 0.352-0.987; P = 0.0446), all-cause death (7.6 vs. 15.3 per 1,000 person-years; HR 0.437; 95% CI 0.340-0.562; P < 0.0001), and stroke (6.5 vs. 8.6 per 1,000 person-years; HR 0.621; 95% CI 0.463-0.833; P = 0.0015) were significantly lower in the fenofibrate group. When the duration of fenofibrate use was stratified by quartile, the risk decreased in quartile 4, with an HR of 0.347 (95% CI 0.226-0.532; P < 0.0001). In subgroup analysis, the favorable effect of fenofibrate was sustained consistently across all subsets of patients, including those classified by LDL cholesterol, HDL cholesterol, and triglyceride levels. CONCLUSIONS Use of fenofibrate was associated with a lower rate of total and cardiac mortality and cardiovascular events in patients with type 2 diabetes during a 3-year follow-up in real-world large populations.
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Affiliation(s)
- Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Hyewon Nam
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea
| | - Jeongwoo Lee
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea
| | - Dae-Sung Kyoung
- Data Science Team, Hanmi Pharmaceutical Co., Ltd., Seoul, South Korea
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Ma S, Xia M, Gao X. Biomarker Discovery in Atherosclerotic Diseases Using Quantitative Nuclear Magnetic Resonance Metabolomics. Front Cardiovasc Med 2021; 8:681444. [PMID: 34395555 PMCID: PMC8356911 DOI: 10.3389/fcvm.2021.681444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022] Open
Abstract
Despite great progress in the management of atherosclerosis (AS), its subsequent cardiovascular disease (CVD) remains the leading cause of morbidity and mortality. This is probably due to insufficient risk detection using routine lipid testing; thus, there is a need for more effective approaches relying on new biomarkers. Quantitative nuclear magnetic resonance (qNMR) metabolomics is able to phenotype holistic metabolic changes, with a unique advantage in regard to quantifying lipid-protein complexes. The rapidly increasing literature has indicated that qNMR-based lipoprotein particle number, particle size, lipid components, and some molecular metabolites can provide deeper insight into atherogenic diseases and could serve as novel promising determinants. Therefore, this article aims to offer an updated review of the qNMR biomarkers of AS and CVD found in epidemiological studies, with a special emphasis on lipoprotein-related parameters. As more researches are performed, we can envision more qNMR metabolite biomarkers being successfully translated into daily clinical practice to enhance the prevention, detection and intervention of atherosclerotic diseases.
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Affiliation(s)
- Shuai Ma
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Mingfeng Xia
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- Fudan Institute for Metabolic Diseases, Shanghai, China
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37
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Duran EK, Pradhan AD. Triglyceride-Rich Lipoprotein Remnants and Cardiovascular Disease. Clin Chem 2021; 67:183-196. [PMID: 33409533 DOI: 10.1093/clinchem/hvaa296] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Triglycerides, cholesterol, and their metabolism are linked due to shared packaging and transport within circulating lipoprotein particles. While a case for a causal role of cholesterol-carrying low-density lipoproteins (LDLs) in atherosclerosis is well made, the body of scientific evidence for a causal role of triglyceride-rich lipoproteins (TRLs) is rapidly growing, with multiple lines of evidence (old and new) providing robust support. CONTENT This review will discuss current perspectives and accumulated evidence that an overabundance of remnant lipoproteins stemming from intravascular remodeling of nascent TRLs-chylomicrons and very low-density lipoproteins (VLDL)-results in a proatherogenic milieu that augments cardiovascular risk. Basic mechanisms of TRL metabolism and clearance will be summarized, assay methods reviewed, and pivotal clinical studies highlighted. SUMMARY Remnant lipoproteins are rendered highly atherogenic by their high cholesterol content, altered apolipoprotein composition, and physicochemical properties. The aggregate findings from multiple lines of evidence suggest that TRL remnants play a central role in residual cardiovascular risk.
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Affiliation(s)
- Edward K Duran
- Cardiovascular Division, University of Minnesota Medical Center, Minneapolis, MN
| | - Aruna D Pradhan
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Division of Cardiovascular Medicine, VA Boston Medical Center, Boston, MA
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Langlois MR, Nordestgaard BG, Langsted A, Chapman MJ, Aakre KM, Baum H, Borén J, Bruckert E, Catapano A, Cobbaert C, Collinson P, Descamps OS, Duff CJ, von Eckardstein A, Hammerer-Lercher A, Kamstrup PR, Kolovou G, Kronenberg F, Mora S, Pulkki K, Remaley AT, Rifai N, Ros E, Stankovic S, Stavljenic-Rukavina A, Sypniewska G, Watts GF, Wiklund O, Laitinen P. Quantifying atherogenic lipoproteins for lipid-lowering strategies: consensus-based recommendations from EAS and EFLM. Clin Chem Lab Med 2021; 58:496-517. [PMID: 31855562 DOI: 10.1515/cclm-2019-1253] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 12/15/2022]
Abstract
The joint consensus panel of the European Atherosclerosis Society (EAS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) recently addressed present and future challenges in the laboratory diagnostics of atherogenic lipoproteins. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), LDL cholesterol (LDLC), and calculated non-HDLC (=total - HDLC) constitute the primary lipid panel for estimating risk of atherosclerotic cardiovascular disease (ASCVD) and can be measured in the nonfasting state. LDLC is the primary target of lipid-lowering therapies. For on-treatment follow-up, LDLC shall be measured or calculated by the same method to attenuate errors in treatment decisions due to marked between-method variations. Lipoprotein(a) [Lp(a)]-cholesterol is part of measured or calculated LDLC and should be estimated at least once in all patients at risk of ASCVD, especially in those whose LDLC declines poorly upon statin treatment. Residual risk of ASCVD even under optimal LDL-lowering treatment should be also assessed by non-HDLC or apolipoprotein B (apoB), especially in patients with mild-to-moderate hypertriglyceridemia (2-10 mmol/L). Non-HDLC includes the assessment of remnant lipoprotein cholesterol and shall be reported in all standard lipid panels. Additional apoB measurement can detect elevated LDL particle (LDLP) numbers often unidentified on the basis of LDLC alone. Reference intervals of lipids, lipoproteins, and apolipoproteins are reported for European men and women aged 20-100 years. However, laboratories shall flag abnormal lipid values with reference to therapeutic decision thresholds.
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Affiliation(s)
- Michel R Langlois
- Department of Laboratory Medicine, AZ St-Jan, Ruddershove 10, 8000 Brugge, Belgium.,University of Ghent, Ghent, Belgium
| | - Børge G Nordestgaard
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Langsted
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M John Chapman
- National Institute for Health and Medical Research (INSERM), Paris, France.,Endocrinology-Metabolism Service, Pitié-Salpetriere University Hospital, Paris, France
| | - Kristin M Aakre
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Hannsjörg Baum
- Institute for Laboratory Medicine, Mikrobiologie und Blutdepot, Regionale Kliniken Holding RKH GmbH, Ludwigsburg, Germany
| | - Jan Borén
- Institute of Medicine, Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric Bruckert
- Department of Endocrinology and Prevention of Cardiovascular Disease, Pitié-Salpetriere University Hospital, Paris, France
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.,IRCCS Multimedica, Milan, Italy
| | - Christa Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Collinson
- Department of Clinical Blood Sciences, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK.,Department of Cardiology, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK
| | - Olivier S Descamps
- Department of Internal Medicine, Centres Hospitaliers Jolimont, Haine-Saint-Paul, Belgium.,Department of Cardiology, UCL Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christopher J Duff
- Department of Clinical Biochemistry, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | | | | | - Pia R Kamstrup
- Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Genovefa Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Florian Kronenberg
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Samia Mora
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kari Pulkki
- Department of Clinical Chemistry, University of Turku and Turku University Hospital, Turku, Finland
| | - Alan T Remaley
- Lipoprotein Metabolism Section, Cardiovascular-Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nader Rifai
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emilio Ros
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer, Hospital Clínic, Barcelona, Spain.,Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Grazyna Sypniewska
- Department of Laboratory Medicine, Collegium Medicum, NC University, Bydgoszcz, Poland
| | - Gerald F Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Olov Wiklund
- Institute of Medicine, Sahlgrenska Academy at Göteborg University, Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Päivi Laitinen
- Department of Clinical Chemistry, HUSLAB, Helsinki University Hospital, Helsinki, Finland
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Lawler PR, Kotrri G, Koh M, Goodman SG, Farkouh ME, Lee DS, Austin PC, Udell JA, Ko DT. Real-world risk of cardiovascular outcomes associated with hypertriglyceridaemia among individuals with atherosclerotic cardiovascular disease and potential eligibility for emerging therapies. Eur Heart J 2021; 41:86-94. [PMID: 31733058 DOI: 10.1093/eurheartj/ehz767] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/09/2019] [Accepted: 10/26/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS Hypertriglyceridaemia in patients with atherosclerotic cardiovascular disease (ASCVD) has been in focus following the REDUCE-IT trial showing benefit with icosapent ethyl. Among individuals with prevalent ASCVD, we sought to quantify the contemporary, real-world risk of ASCVD events associated with hypertriglyceridaemia, as well as estimate icosapent ethyl eligibility and compare trial participants with REDUCE-IT-like individuals in the population. METHODS AND RESULTS We examined data from 2 424 865 adults with lipid panels in the Ontario population. Among those with prevalent ASCVD, we examined adjusted associations between triglyceride (TG) and ASCVD events (first occurrence of myocardial infarction, unstable angina, stroke or transient ischaemic attack, coronary revascularization, or cardiovascular death). The proportion of patients with ASCVD potentially eligible for icosapent ethyl was estimated as those with TG 135-499 mg/dL (1.52-5.63 mmol/L) and low-density lipoprotein cholesterol (LDLc) 41-100 mg/dL (1.06-2.59 mmol/L), similar to the lipid cut-offs in REDUCE-IT, and their demographics and event rates examined. Among 196 717 individuals with ASCVD, median age was 69 years and 30% were female. A total of 24 097 composite ASCVD events occurred over a mean (standard deviation) 2.9 (0.5) years of follow-up. Increasing TG was associated with a graded, progressively higher hazard of ASCVD events. Twenty-five percent (49 886) of individuals with ASCVD had hypertriglyceridaemia and controlled LDLc; these patients were demographically similar to those in REDUCE-IT with comparable event rates. CONCLUSIONS Among patients with ASCVD, hypertriglyceridaemia is common, and is associated with higher ASCVD risk across a range of TG. It is possible that as many as one in four patients with ASCVD may be candidates for emerging therapies.
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Affiliation(s)
- Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada.,University of Toronto, 27 King's College Cir, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research, 661 University Avenue, 14th Floor, Toronto, Ontario, Canada
| | - Gynter Kotrri
- University of Toronto, 27 King's College Cir, Toronto, Ontario, Canada
| | - Maria Koh
- ICES, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - Shaun G Goodman
- University of Toronto, 27 King's College Cir, Toronto, Ontario, Canada.,St Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada.,University of Toronto, 27 King's College Cir, Toronto, Ontario, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada.,University of Toronto, 27 King's College Cir, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research, 661 University Avenue, 14th Floor, Toronto, Ontario, Canada.,ICES, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | | | - Jacob A Udell
- Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada.,University of Toronto, 27 King's College Cir, Toronto, Ontario, Canada.,ICES, 2075 Bayview Avenue, Toronto, Ontario, Canada.,Women's College Hospital, 76 Grenville St, Toronto, Ontario, Canada
| | - Dennis T Ko
- Peter Munk Cardiac Centre, University Health Network, 200 Elizabeth St, Toronto, Ontario, Canada.,University of Toronto, 27 King's College Cir, Toronto, Ontario, Canada.,ICES, 2075 Bayview Avenue, Toronto, Ontario, Canada
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40
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Abstract
PURPOSE OF REVIEW The functions, genetic variations and impact of apolipoprotein E on lipoprotein metabolism in general are placed in the context of clinical practice dealing with moderate dyslipidaemia as well as dysbetalipoproteinemia, a highly atherogenic disorder and lipoprotein glomerulopathy. RECENT FINDINGS Additional variants of apolipoprotein E and participation of apolipoprotein E in inflammation are of interest. The mostly favourable effects of apolipoprotein E2 as well as the atherogenic nature of apolipoproteinE4, which has an association with cognitive impairment, are confirmed. The contribution of remnant lipoproteins of triglyceride-rich lipoproteins, of which dysbetalipoproteinemia represents an extreme, is explored in atherosclerosis. Mimetic peptides may present new therapeutic approaches. Apolipoprotein E is an important determinant of the lipid profile and cardiovascular health in the population at large and can precipitate dysbetalipoproteinemia and glomerulopathy. Awareness of apolipoprotein E polymorphisms should improve medical care.
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41
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Qian S, You S, Sun Y, Wu Q, Wang X, Tang W, Dong X, Liu CF, Xu T, Cao Y, Zhong C. Remnant Cholesterol and Common Carotid Artery Intima-Media Thickness in Patients With Ischemic Stroke. Circ Cardiovasc Imaging 2021; 14:e010953. [PMID: 33832329 DOI: 10.1161/circimaging.120.010953] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Remnant cholesterol makes great contribution to residual risk of cardiovascular disease, but population-based evidence on the relationship between remnant cholesterol and atherosclerosis is rare. Common carotid artery intima-media thickness (cIMT) is an imaging marker of subclinical atherosclerosis. We aimed to explore the association between remnant cholesterol levels and cIMT in patients with ischemic stroke. METHODS One thousand four hundred ninety-six ischemic stroke patients with baseline serum lipids and carotid artery imaging data were included in this analysis. Fasting remnant cholesterol was calculated as total cholesterol minus HDL (high-density lipoprotein) cholesterol minus LDL (low-density lipoprotein) cholesterol. Abnormal cIMT was defined as mean cIMT and maximum cIMT value ≥1 mm. Logistic regression and restricted cubic spline models were used to assess the relationships between remnant cholesterol levels and abnormal cIMT. RESULTS The multivariable-adjusted odds ratios (95% CIs) for the highest versus lowest quartile of remnant cholesterol were 2.06 (1.46-2.91) for abnormal mean cIMT and 1.70 (1.23-2.35) for abnormal maximum cIMT. There were linear associations between remnant cholesterol levels and both abnormal mean cIMT (P for linearity, <0.001) and abnormal maximum cIMT (P for linearity, 0.003). Moreover, the remnant cholesterol-cIMT association remained significant in the subsample of patients with optimal LDL cholesterol levels (n=179). CONCLUSIONS Elevated fasting remnant cholesterol levels were positively associated with mean cIMT and maximum cIMT in patients with ischemic stroke, even in patients with optimal LDL cholesterol levels. Future prospective studies are needed to verify our findings and to assess the effect of remnant cholesterol-lowering interventions in patients with ischemic stroke.
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Affiliation(s)
- Sifan Qian
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (S.Q., T.X., C.Z.)
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y., C.L., Y.C.)
| | - Yaming Sun
- Department of Neurology, Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Suzhou, China (Y.S.)
| | - Qiuyi Wu
- Department of Neurology, Zhangjiagang First People's Hospital, Suzhou, China (Q.W.)
| | - Xianhui Wang
- Department of Neurology, Taicang First People's Hospital, Suzhou, China (X.W.)
| | - Weiting Tang
- Department of Neurology, Changshu Second People's Hospital, Suzhou, China (W.T.)
| | - Xiaofeng Dong
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, China (X.D.)
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y., C.L., Y.C.)
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (S.Q., T.X., C.Z.)
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China (S.Y., C.L., Y.C.)
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (S.Q., T.X., C.Z.)
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Johansen MØ, Vedel-Krogh S, Nielsen SF, Afzal S, Davey Smith G, Nordestgaard BG. Per-Particle Triglyceride-Rich Lipoproteins Imply Higher Myocardial Infarction Risk Than Low-Density Lipoproteins: Copenhagen General Population Study. Arterioscler Thromb Vasc Biol 2021; 41:2063-2075. [PMID: 33827253 DOI: 10.1161/atvbaha.120.315639] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Mia Ø Johansen
- Department of Clinical Biochemistry (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, CopenhagenUniversity Hospital, Denmark.,The Copenhagen General Population Study (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.)
| | - Signe Vedel-Krogh
- Department of Clinical Biochemistry (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, CopenhagenUniversity Hospital, Denmark.,The Copenhagen General Population Study (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.)
| | - Sune F Nielsen
- Department of Clinical Biochemistry (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, CopenhagenUniversity Hospital, Denmark.,The Copenhagen General Population Study (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.)
| | - Shoaib Afzal
- Department of Clinical Biochemistry (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, CopenhagenUniversity Hospital, Denmark.,The Copenhagen General Population Study (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.)
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, United Kingdom (G.D.S.).,Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom (G.D.S.)
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, CopenhagenUniversity Hospital, Denmark.,The Copenhagen General Population Study (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.), Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (M.O.J., S.V.-K., S.F.N., S.A., B.G.N.)
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Coelewij L, Waddington KE, Robinson GA, Chocano E, McDonnell T, Farinha F, Peng J, Dönnes P, Smith E, Croca S, Bakshi J, Griffin M, Nicolaides A, Rahman A, Jury EC, Pineda-Torra I. Serum Metabolomic Signatures Can Predict Subclinical Atherosclerosis in Patients With Systemic Lupus Erythematosus. Arterioscler Thromb Vasc Biol 2021; 41:1446-1458. [PMID: 33535791 PMCID: PMC7610443 DOI: 10.1161/atvbaha.120.315321] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/12/2020] [Indexed: 12/19/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Leda Coelewij
- Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London W1CE 6JF, U.K
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Kirsty E Waddington
- Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London W1CE 6JF, U.K
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - George A Robinson
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Elvira Chocano
- Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London W1CE 6JF, U.K
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Thomas McDonnell
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Filipa Farinha
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Junjie Peng
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
- Centre for Adolescent Rheumatology Versus Arthritis, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Pierre Dönnes
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
- Scicross AB, Skövde, Sweden
| | - Edward Smith
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Sara Croca
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Jyoti Bakshi
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Maura Griffin
- Vascular Screening and Diagnostic Centre, Weymouth Street, London, UK
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, Weymouth Street, London, UK
- St Georges London/Nicosia Medical School, University of Nicosia, Cyprus
| | - Anisur Rahman
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Elizabeth C Jury
- Centre for Rheumatology Research, Department of Medicine, University College London, London W1CE 6JF, U.K
| | - Ines Pineda-Torra
- Centre for Cardiometabolic and Vascular Science, Department of Medicine, University College London, London W1CE 6JF, U.K
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Akoumianakis I, Zvintzou E, Kypreos K, Filippatos TD. ANGPTL3 and Apolipoprotein C-III as Novel Lipid-Lowering Targets. Curr Atheroscler Rep 2021; 23:20. [PMID: 33694000 DOI: 10.1007/s11883-021-00914-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Despite significant progress in plasma lipid lowering strategies, recent clinical trials highlight the existence of residual cardiovascular risk. Angiopoietin-like protein 3 (ANGPTL3) and apolipoprotein C-III (Apo C-III) have been identified as novel lipid-lowering targets. RECENT FINDINGS Apo C-III and ANGPTL3 have emerged as novel regulators of triglyceride (TG) and low-density lipoprotein-cholesterol (LDL-C) levels. ANGPTL3 is an inhibitor of lipoprotein lipase (LPL), reducing lipolysis of Apo B-containing lipoproteins. Loss-of-function ANGPLT3 mutations are associated with reduced plasma cholesterol and TG, while novel ANGPLT3 inhibition strategies, including monoclonal antibodies (evinacumab), ANGPLT3 antisense oligonucleotides (IONIS-ANGPTL3-LRx), and small interfering RNA (siRNA) silencing techniques (ARO-ANG3), result in increased lipolysis and significant reductions of LDL-C and TG levels in phase I and II clinical trials. Similarly, Apo C-III inhibits LPL while promoting the hepatic secretion of TG-rich lipoproteins and preventing their clearance. Loss-of-function APOC3 mutations have been associated with reduced TG levels. Targeting of Apo C-III with volanesorsen, an APOC3 siRNA, results in significant reduction in plasma TG levels but possibly also increased risk for thrombocytopenia, as recently demonstrated in phase I, II, and III clinical trials. ARO-APOC3 is a novel siRNA-based agent targeting Apo C-III which is currently under investigation with regard to its lipid-lowering efficiency. ANGPTL3 and Apo C-III targeting agents have demonstrated striking lipid-lowering effects in recent clinical trials; however, more thorough safety and efficacy data are required. Here, we evaluate the role of ANGPLT3 and Apo C-III in lipid metabolism, present the latest clinical advances targeting those molecules, and outline the remaining scientific challenges on residual lipid-associated cardiovascular risk.
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Affiliation(s)
- Ioannis Akoumianakis
- Department of Internal Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece.,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Evangelia Zvintzou
- Department of Medicine, Pharmacology Laboratory, School of Health Sciences, University of Patras, Achaias, Rio, Greece
| | - Kyriakos Kypreos
- Department of Medicine, Pharmacology Laboratory, School of Health Sciences, University of Patras, Achaias, Rio, Greece.,Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Theodosios D Filippatos
- Department of Internal Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Crete, Greece. .,Metabolic Diseases Research Unit, Internal Medicine Laboratory, School of Sciences, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete, Greece.
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45
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Tranæs K, Ding C, Chooi YC, Chan Z, Choo J, Leow MKS, Magkos F. Dissociation Between Insulin Resistance and Abnormalities in Lipoprotein Particle Concentrations and Sizes in Normal-Weight Chinese Adults. Front Nutr 2021; 8:651199. [PMID: 33718425 PMCID: PMC7952320 DOI: 10.3389/fnut.2021.651199] [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: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022] Open
Abstract
Insulin resistance in obesity coincides with abnormalities in lipid profile and lipoprotein subclass distribution and size even before abnormalities in glucose homeostasis manifest. We aimed to assess this relationship in the absence of obesity. Insulin sensitivity (3-h intravenous glucose tolerance test and minimal modeling) and lipoprotein particle concentrations and sizes (proton nuclear magnetic resonance spectroscopy) were evaluated in 15 insulin-resistant and 15 insulin-sensitive lean Asians of Chinese descent with normal glucose tolerance, matched on age, sex, and body mass index. Despite a ~50% lower insulin sensitivity index (Si) in insulin-resistant than in insulin-sensitive subjects, which was accompanied by significantly greater acute insulin response to glucose (AIRg) and fasting insulin concentration but not different fasting glucose concentration, there were no significant differences between groups in the blood lipid profile (p ≥ 0.44) or the lipoprotein subclass concentrations (p ≥ 0.30) and particle sizes (p ≥ 0.43). We conclude that, contrary to observations in subjects with obesity, insulin resistance is not accompanied by unfavorable changes in the plasma lipid profile and lipoprotein particle concentrations and sizes in lean Asians with normal glucose tolerance. Therefore, insulin resistance at the level of glucose metabolism is mechanistically or temporally dissociated from lipid and lipoprotein metabolism. Trial Registration:clinicaltrials.gov, NCT03264001.
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Affiliation(s)
- Kaare Tranæs
- Section for Obesity Research, Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Cherlyn Ding
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR) and National University Health System, Singapore, Singapore
| | - Yu Chung Chooi
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR) and National University Health System, Singapore, Singapore
| | - Zhiling Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR) and National University Health System, Singapore, Singapore
| | - John Choo
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR) and National University Health System, Singapore, Singapore
| | - Melvin K-S Leow
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR) and National University Health System, Singapore, Singapore.,Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore.,Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Faidon Magkos
- Section for Obesity Research, Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR) and National University Health System, Singapore, Singapore
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Si S, Li J, Li Y, Li W, Chen X, Yuan T, Liu C, Li H, Hou L, Wang B, Xue F. Causal Effect of the Triglyceride-Glucose Index and the Joint Exposure of Higher Glucose and Triglyceride With Extensive Cardio-Cerebrovascular Metabolic Outcomes in the UK Biobank: A Mendelian Randomization Study. Front Cardiovasc Med 2021; 7:583473. [PMID: 33553250 PMCID: PMC7863795 DOI: 10.3389/fcvm.2020.583473] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The causal evidence of the triglyceride-glucose (TyG) index, as well as the joint exposure of higher glucose and triglyceride on the risk of cardio-cerebrovascular diseases (CVD), was lacking. Methods: A comprehensive factorial Mendelian randomization (MR) was performed in the UK Biobank cohort involving 273,368 individuals with European ancestry to assess and quantify these effects. The factorial MR, MR-PRESSO, MR-Egger, meta-regression, sensitivity analysis, positive control, and external verification were utilized. Outcomes include major outcomes [overall CVD, ischemic heart diseases (IHD), and cerebrovascular diseases (CED)] and minor outcomes [angina pectoris (AP), acute myocardial infarction (AMI), chronic IHD (CIHD), heart failure (HF), hemorrhagic stroke (HS), and ischemic stroke (IS)]. Results: The TyG index significantly increased the risk of overall CVD [OR (95% CI): 1.20 (1.14-1.25)], IHD [OR (95% CI): 1.22 (1.15-1.29)], CED [OR (95% CI): 1.14 (1.05-1.23)], AP [OR (95% CI): 1.29 (1.20-1.39)], AMI [OR (95% CI): 1.27 (1.16-1.39)], CIHD [OR (95% CI): 1.21 (1.13-1.29)], and IS [OR (95% CI): 1.22 (1.06-1.40)]. Joint exposure to genetically higher GLU and TG was significantly associated with a higher risk of overall CVD [OR (95% CI): 1.17 (1.12-1.23)] and IHD [OR (95% CI): 1.22 (1.16-1.29)], but not with CED. The effect of GLU and TG was independent of each other genetically and presented dose-response effects in bivariate meta-regression analysis. Conclusions: Lifelong genetic exposure to higher GLU and TG was jointly associated with higher cardiac metabolic risk while the TyG index additionally associated with several cerebrovascular diseases. The TyG index could serve as a more sensitive pre-diagnostic indicator for CVD while the joint GLU and TG could offer a quantitative risk for cardiac metabolic outcomes.
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Affiliation(s)
- Shucheng Si
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Institute for Medical Dataology, Shandong University, Jinan, China.,National Institute of Health Data Science of China, Jinan, China
| | - Jiqing Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yunxia Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenchao Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaolu Chen
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tonghui Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Congcong Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hongkai Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Institute for Medical Dataology, Shandong University, Jinan, China.,National Institute of Health Data Science of China, Jinan, China
| | - Lei Hou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bojie Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Institute for Medical Dataology, Shandong University, Jinan, China.,National Institute of Health Data Science of China, Jinan, China
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47
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Si S, Hou L, Chen X, Li W, Liu X, Liu C, Li Y, Yuan T, Li J, Wang B, Li H, Xue F. Exploring the causal roles of circulating remnant lipid profile on cardiovascular and cerebrovascular diseases: Mendelian randomization study. J Epidemiol 2021; 32:205-214. [PMID: 33441507 PMCID: PMC8979919 DOI: 10.2188/jea.je20200305] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Causal evidence of circulating lipids especially the remnant cholesterol with cardiovascular and cerebrovascular disease (CVD) is lacking. This research aimed to explore the causal roles of extensive lipid traits especially the remnant lipids in CVD. Methods Two-sample Mendelian randomization (TSMR) analysis was performed based on large-scale meta-analysis datasets in European ancestry. The causal effect of 15 circulating lipid profiles including 6 conventional lipids and 9 remnant lipids on coronary heart disease (CHD) and ischemic stroke (IS), as well as the subtypes, was assessed. Results Apolipoprotein B (Apo B), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) were still important risk factors for CHD and myocardial infarction (MI) but not for IS. Apo B is the strongest which increased the CHD and MI risk by 44% and 41%, respectively. The odds ratios (ORs) of total TG on CHD and MI were 1.25 (95% confidence interval [CI], 1.13–1.38) and 1.24 (95% CI, 1.11–1.38), respectively. A one standard deviation difference increased TG in medium very-low-density lipoproteins (M.VLDL.TG), TG in small VLDL (S.VLDL.TG), TG in very small VLDL (XS.VLDL.TG), TG in intermediate-density lipoproteins (IDL.TG), TG in very large HDL (XL.HDL.TG), and TG in small HDL (S.HDL.TG) particles also robustly increased the risk of CHD and MI by 9–28% and 9–27%, respectively. TG in very/extremely large VLDL (XXL.VLDL.TG and XL.VLDL.TG) were insignificant or even negatively associated with CHD (in multivariable TSMR), and negatively associated with IS as well. Conclusion The remnant lipids presented heterogeneity and two-sided effects for the risk of CHD and IS that may partially rely on the particle size. The findings suggested that the remnant lipids were required to be intervened according to specific components. This research confirms the importance of remnant lipids and provides causal evidence for potential targets for intervention.
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Affiliation(s)
- Shucheng Si
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Lei Hou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Xiaolu Chen
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Wenchao Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Xinhui Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Congcong Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Yunxia Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Tonghui Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Jiqing Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Bojie Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University
| | - Hongkai Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University.,Institute for Medical Dataology, Shandong University
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University.,Institute for Medical Dataology, Shandong University.,National Institute of Health Data Science of China
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Björnsson E, Thorleifsson G, Helgadóttir A, Guðnason T, Guðbjartsson T, Andersen K, Grétarsdóttir S, Ólafsson Í, Tragante V, Ólafsson ÓH, Jónsdóttir B, Eyjólfsson GI, Sigurðardóttir Ó, Thorgeirsson G, Guðbjartsson DF, Thorsteinsdóttir U, Hólm H, Stefánsson K. Association of Genetically Predicted Lipid Levels With the Extent of Coronary Atherosclerosis in Icelandic Adults. JAMA Cardiol 2021; 5:13-20. [PMID: 31746962 PMCID: PMC6902100 DOI: 10.1001/jamacardio.2019.2946] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Genetic studies have evaluated the influence of blood lipid levels on the risk of coronary artery disease (CAD), but less is known about how they are associated with the extent of coronary atherosclerosis. Objective To estimate the contributions of genetically predicted blood lipid levels on the extent of coronary atherosclerosis. Design, Setting, and Participants This genetic study included Icelandic adults who had undergone coronary angiography or assessment of coronary artery calcium using cardiac computed tomography. The study incorporates data collected from January 1987 to December 2017 in Iceland in the Swedish Coronary Angiography and Angioplasty Registry and 2 registries of individuals who had undergone percutaneous coronary interventions and coronary artery bypass grafting. For each participant, genetic scores were calculated for levels of non-high-density lipoprotein cholesterol (non-HDL-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides, based on reported effect sizes of 345 independent, lipid-associated variants. The genetic scores' predictive ability for lipid levels was assessed in more than 87 000 Icelandic adults. A mendelian randomization approach was used to estimate the contribution of each lipid trait. Exposures Genetic scores for levels of non-HDL-C, LDL-C, HDL-C, and triglycerides. Main Outcomes and Measures The extent of angiographic CAD and coronary artery calcium quantity. Results A total of 12 460 adults (mean [SD] age, 65.1 [10.7] years; 8383 men [67.3%]) underwent coronary angiography, and 4837 had coronary artery calcium assessed by computed tomography. A genetically predicted increase in non-HDL-C levels by 1 SD (38 mg/dL [to convert to millimoles per liter, multiply by 0.0259]) was associated with greater odds of obstructive CAD (odds ratio [OR], 1.83 [95% CI, 1.63-2.07]; P = 2.8 × 10-23). Among patients with obstructive CAD, there were significant associations with multivessel disease (OR, 1.26 [95% CI, 1.11-1.44]; P = 4.1 × 10-4) and 3-vessel disease (OR, 1.47 [95% CI, 1.26-1.72]; P = 9.2 × 10-7). There were also significant associations with the presence of coronary artery calcium (OR, 2.04 [95% CI, 1.70-2.44]; P = 5.3 × 10-15) and loge-transformed coronary artery calcium (effect, 0.70 [95% CI, 0.53-0.87]; P = 1.0 × 10-15). Genetically predicted levels of non-HDL-C remained associated with obstructive CAD and coronary artery calcium extent even after accounting for the association with LDL-C. Genetically predicted levels of HDL-C and triglycerides were associated individually with the extent of coronary atherosclerosis, but not after accounting for the association with non-HDL cholesterol. Conclusions and Relevance In this study, genetically predicted levels of non-HDL-C were associated with the extent of coronary atherosclerosis as estimated by 2 different methods. The association was stronger than for genetically predicted levels of LDL-C. These findings further support the notion that non-HDL-C may be a better marker of the overall burden of atherogenic lipoproteins than LDL-C.
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Affiliation(s)
- Eythór Björnsson
- deCODE genetics/Amgen Inc, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Division of Cardiology, Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | | | | | - Thórarinn Guðnason
- Division of Cardiology, Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | - Tómas Guðbjartsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Division of Cardiothoracic Surgery, Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | - Karl Andersen
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Division of Cardiology, Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | | | - Ísleifur Ólafsson
- Department of Clinical Biochemistry, Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | - Vinicius Tragante
- deCODE genetics/Amgen Inc, Reykjavík, Iceland.,Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ólafur Hreiðar Ólafsson
- deCODE genetics/Amgen Inc, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | | | | | | | - Guðmundur Thorgeirsson
- deCODE genetics/Amgen Inc, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Division of Cardiology, Landspítali-The National University Hospital of Iceland, Reykjavík, Iceland
| | - Daníel F Guðbjartsson
- deCODE genetics/Amgen Inc, Reykjavík, Iceland.,School of Engineering and Natural Sciences, University of Iceland, Reykjavík, Iceland
| | - Unnur Thorsteinsdóttir
- deCODE genetics/Amgen Inc, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Hilma Hólm
- deCODE genetics/Amgen Inc, Reykjavík, Iceland
| | - Kári Stefánsson
- deCODE genetics/Amgen Inc, Reykjavík, Iceland.,Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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49
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Srisawasdi P, Rodcharoen P, Vanavanan S, Chittamma A, Sukasem C, Na Nakorn C, Dejthevaporn C, Kroll MH. Association of CETP Gene Variants with Atherogenic Dyslipidemia Among Thai Patients Treated with Statin. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:1-13. [PMID: 33447072 PMCID: PMC7802592 DOI: 10.2147/pgpm.s278671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022]
Abstract
Objective Patients treated with statins for dyslipidemia may still have a residual risk of atherosclerotic cardiovascular disease (ASCVD). To determine whether genetic variants in the cholesteryl ester transport protein (CETP), rs3764261 (C>A), rs708272 (G>A), and rs12149545 (G>A) affect ASCVD risk, we studied the association of these variants with dyslipidemia in statin-treated patients. Patients and Methods We included 299 adult Thai patients treated with a statin (95 men and 204 women). Genotyping was performed by conducting a TaqMan real-time polymerase chain reaction-based analysis. We used logistic regression models adjusted for potential confounders of age, body mass index, blood pressure, insulin resistance, and statin dosage to analyze the association between CETP variants and atherogenic lipoprotein patterns. Results CETP polymorphisms of rs3764261 and rs708272, but not rs12149545, were significantly associated with high-density lipoprotein cholesterol (HDL-C), apoA-I, triglycerides, very low-density lipoprotein (VLDL)-C, and large LDL (LDL1-C) levels as well as mean LDL particle size (all p < 0.020). However, no significant difference was observed in total cholesterol, LDL-C, or apoB levels by CETP variants. Regardless of sex, the combination of rs3764261 (CC genotype) and rs708272 (GG or GA genotypes) showed a stronger association with atherogenic dyslipidemia, including features of decreased HDL-C, elevated triglycerides, and LDL subclass pattern B (odds ratio [OR] = 2.99, 95% confidence interval [CI]: 1.78–5.02) compared with the single variant rs3764261 (OR = 2.11, 95% CI: 1.27–3.50) or rs708272 (OR = 2.12, 95% CI: 1.29–3.49). Conclusion The polymorphisms of CETP rs3764261 (CC genotype) and rs708272 (GG and GA genotypes) may have a higher susceptibility to atherogenic dyslipidemia. Testing for CETP rs3764261 and rs708272 may serve as a surrogate marker for lipid management in statin-treated patients, which may help individualize treatment for reducing the residual risk of ASCVD.
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Affiliation(s)
- Pornpen Srisawasdi
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Punyanuch Rodcharoen
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somlak Vanavanan
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anchalee Chittamma
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chalitpon Na Nakorn
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Charungthai Dejthevaporn
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Martin H Kroll
- Quest Diagnostics, Secaucus, NJ 07094, United States of America
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50
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Duran EK, Aday AW, Cook NR, Buring JE, Ridker PM, Pradhan AD. Triglyceride-Rich Lipoprotein Cholesterol, Small Dense LDL Cholesterol, and Incident Cardiovascular Disease. J Am Coll Cardiol 2020; 75:2122-2135. [PMID: 32354380 DOI: 10.1016/j.jacc.2020.02.059] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/16/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Elevated triglyceride-rich lipoprotein (TRL) and small-dense low-density lipoprotein (sdLDL) particles are hallmarks of atherogenic dyslipidemia, and their cholesterol content is hypothesized to drive atherosclerotic risk. Prospective epidemiological data pertaining to cholesterol content of TRLs and sdLDL in primary prevention populations are mostly limited to coronary heart disease. OBJECTIVES The purpose of this study was to prospectively evaluate whether triglyceride-rich lipoprotein cholesterol (TRL-C) and small-dense low-density lipoprotein cholesterol (sdLDL-C) concentrations associate with composite and individual incident cardiovascular disease (CVD) outcomes including myocardial infarction (MI), ischemic stroke (IS), and peripheral artery disease (PAD). METHODS In a prospective case-cohort study within the Women's Health Study, TRL-C and sdLDL-C (mg/dl) were directly measured in baseline blood specimens of case subjects (n = 480) and the reference subcohort (n = 496). Risk associations were evaluated for total CVD (MI, IS, PAD, and CVD death), coronary and cerebrovascular disease (MI, IS, CVD death), and individual outcomes (MI, IS, and PAD). Models were adjusted for traditional risk factors, low-density lipoprotein cholesterol, and high-sensitivity C-reactive protein. RESULTS The risk of both composite outcomes significantly increased across quartiles of TRL-C and sdLDL-C. TRL-C was significantly associated with MI and PAD (MI hazard ratio [HR]Q4: 3.05 [95% confidence interval (CI): 1.46 to 6.39]; ptrend = 0.002; PAD HRQ4: 2.58 [95% CI: 1.18 to 5.63]; ptrend = 0.019), whereas sdLDL-C was significantly associated with MI alone (HRQ4: 3.71 [95% CI: 1.59 to 8.63]; ptrend < 0.001). Both markers weakly associated with IS. Association patterns were similar for continuous exposures and, for TRL-C, among subjects with low atherogenic particle concentrations (apolipoprotein B <100 mg/dl). CONCLUSIONS TRL-C strongly associates with future MI and PAD events, whereas sdLDL-C strongly associates with MI alone. These findings signal that the cholesterol content of TRLs and sdLDL influence atherogenesis independently of low-density lipoprotein cholesterol, and high sensitivity C-reactive protein, with potentially different potency across vascular beds. (Women's Health Study; NCT00000479).
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Affiliation(s)
- Edward K Duran
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/EKDuranMD
| | - Aaron W Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. https://twitter.com/AaronAdayMD
| | - Nancy R Cook
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aruna D Pradhan
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, VA Boston Medical Center, Boston, Massachusetts.
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