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Ghaemi F, Rabizadeh S, Yadegar A, Mohammadi F, Asadigandomani H, Bafrani MA, Reyhan SK, Esteghamati A, Nakhjavani M. ApoA1/HDL-C ratio as a predictor for coronary artery disease in patients with type 2 diabetes: a matched case-control study. BMC Cardiovasc Disord 2024; 24:317. [PMID: 38914982 PMCID: PMC11194875 DOI: 10.1186/s12872-024-03986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION This study investigated the possible relationship between the Apo lipoprotein A1 /high-density lipoprotein cholesterol (ApoA1/HDL-C) ratio and coronary artery disease (CAD) in patients with type 2 diabetes (T2D). METHODS This was a matched case-control study of 482 patients with T2D in two groups of CAD and (n = 241) non-CAD (n = 241). The patients were classified into four quartiles according to the ApoA1/HDL-C ratio, and multivariate logistic regression analysis was performed to assess the relationship between ApoA1/HDL-C and CAD. ROC analysis was also conducted. RESULTS This study showed that the ApoA1/HDL-C ratio has an independent association with CAD in individuals with T2D. The CAD group exhibited a significantly higher ApoA1/HDL-C ratio than those without CAD (p-value = 0.004). Moreover, the risk of CAD increased significantly across the ApoA1/HDL-C ratio quartiles, with the highest odds in the fourth quartile. The second quartile showed an odds ratio (OR) of 2.03 (p-value = 0.048) compared to the first. Moving to the third quartile, the OR increased to 2.23 (p-value = 0.023). The highest OR was noted in the fourth, reaching 3.41 (p-value = 0.001). Employing a cut-off value of 2.66 and an area under the curve (AUC) of 0.885, the ApoA1/HDL-C ratio predicts CAD among patients with T2D with a sensitivity of 75% and a specificity of 91% (p-value < 0.001). CONCLUSION The current study revealed an independent association between ApoA1/HDL-C ratio and CAD in patients with T2D. This ratio can be a promising tool for predicting CAD during the follow-up of patients with T2D, aiding in identifying those at higher risk for CAD.
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Affiliation(s)
- Farzaneh Ghaemi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghra Rabizadeh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Yadegar
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammadi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Asadigandomani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Melika Arab Bafrani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Karimpour Reyhan
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Mujammami M, Rafiullah M, Akkour K, Alfadda AA, Masood A, Joy SS, Alhalal H, Arafah M, Alshehri E, Alanazi IO, Benabdelkamel H. Plasma Proteomic Signature of Endometrial Cancer in Patients with Diabetes. ACS OMEGA 2024; 9:4721-4732. [PMID: 38313512 PMCID: PMC10831832 DOI: 10.1021/acsomega.3c07992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Abstract
The incidence and mortality of endometrial cancer (EC) have increased in recent years. There is mounting evidence that diabetes may play a role in the greater incidence of EC. The molecular mechanisms of the interaction between type 2 diabetes and EC are not yet clearly understood yet. The present study was undertaken to investigate the plasma proteomics of EC patients with diabetes in comparison to those of EC patients without diabetes. Plasma samples were obtained from age-matched patients (EC diabetic and EC nondiabetic). Untargeted proteomic analysis was carried out using a two-dimensional differential gel electrophoresis coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Of the 33 proteins identified, which significantly differed in the plasma abundance between groups, 17 were upregulated and 16 were downregulated. The majority of the altered proteins are involved in the acute phase reaction, cholesterol metabolism, scavenging of heme from plasma, and plasma lipoprotein assembly and mobilization. α-2-macroglobulin, Ras association domain-containing protein 3, apolipoprotein A-I, α-1B-glycoprotein, and zinc-α-2-glycoprotein were significantly upregulated. The significantly downregulated proteins included haptoglobin, apolipoprotein A-IV, hemopexin, and α-1-antichymotrypsin. The differential expression of proteins found in patients who had EC and diabetes indicated severe disease and a poor prognosis. The protein interaction analysis showed dysregulation of cholesterol metabolism and heme scavenging pathways in these patients.
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Affiliation(s)
- Muhammad Mujammami
- University
Diabetes Center, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
- Department
of Medicine, College of Medicine, King Saud
University, Riyadh 11461, Saudi Arabia
| | - Mohamed Rafiullah
- Strategic
Center for Diabetes Research, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Khalid Akkour
- Obstetrics
and Gynecology Department, College of Medicine, King Saud University Medical City,King Saud University, Riyadh 12372, Kingdom of Saudi Arabia
| | - Assim A. Alfadda
- Department
of Medicine, College of Medicine, King Saud
University, Riyadh 11461, Saudi Arabia
- Strategic
Center for Diabetes Research, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
- Proteomics
Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Afshan Masood
- Proteomics
Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Salini Scaria Joy
- Strategic
Center for Diabetes Research, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Hani Alhalal
- Obstetrics
and Gynecology Department, College of Medicine, King Saud University Medical City,King Saud University, Riyadh 12372, Kingdom of Saudi Arabia
| | - Maria Arafah
- Department
of Pathology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh 11461, Saudi Arabia
| | - Eman Alshehri
- Obstetrics
and Gynecology Department, College of Medicine, King Saud University Medical City,King Saud University, Riyadh 12372, Kingdom of Saudi Arabia
| | - Ibrahim O. Alanazi
- Proteomics
Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
- Healthy
Aging Research Institute, King Abdulaziz
City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Hicham Benabdelkamel
- Proteomics
Resource Unit, Obesity Research Center, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
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Dong H, Wang J, Hu P, Lu N. Association of Apolipoprotein A1, High Density Lipoprotein Cholesterol, and Their Ratio with Inflammatory Marker in Chinese Adults with Coronary Artery Disease. Angiology 2022:33197221121002. [PMID: 36065748 DOI: 10.1177/00033197221121002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sparse data assessed the association of apolipoprotein A1 (ApoA1) and high density lipoprotein cholesterol (HDL-C) with inflammation. We investigated this association in a hospital-based cross-sectional pilot study that included 7296 patients with coronary artery disease (CAD). In multivariate analysis, negative associations of ApoA1 and HDL-C with C-reactive protein (CRP), high sensitivity CRP (hsCRP), and tumor necrosis factor-α (TNF-α) were shown. The corresponding CRP, hsCRP, and TNF-α values were 5.28 (vs 11.70 mg/L), 4.50 (vs 11.50 mg/L), and 7.68 (vs 10.90 pg/mL) for ApoA1, and 7.13 (vs 10.60 mg/L), 6.27 (vs 9.19 mg/L), and 8.11 (vs 11.86 pg/mL) for HDL-C in the fourth quartiles compared with the first quartiles. ApoA1/HDL-C ratio was inversely associated with hsCRP and interleukin-6 (IL-6). No significant associations of ApoA1 and HDL-C with IL-6 and IL-8, and of ApoA1/HDL-C ratio with CRP, IL-8, and TNF-α were observed. In path analyses, there was no evidence of mediating effects of body mass index on the "ApoA1 and HDL-C-inflammation" relationship. Generally, our study of CAD patients identified graded and inverse associations of ApoA1, HDL-C, and ApoA1/HDL-C ratio with inflammatory marker (CRP, hsCRP, IL-6, IL-8, or TNF-α) levels.
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Affiliation(s)
- Hongli Dong
- Scientific Education Section and Department of Child Healthcare, Affiliated Maternal & Child Care Hospital of Nantong University, Nantong, China
| | - Jie Wang
- Image Center, Wuhan Asia Heart Hospital, Wuhan, China
| | - Ping Hu
- Image Center, Wuhan Asia Heart Hospital, Wuhan, China
| | - Nan Lu
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
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Nurtazina A, Kozhakhmetova D, Dautov D, Shakhanova A, Chattu VK. Apolipoprotein B/A1 Ratio as a Diagnostic Alternative to Triglycerides and HDL-Cholesterol for the Prediction of Metabolic Syndrome among Hypertensives in Kazakhstan. Diagnostics (Basel) 2020; 10:E510. [PMID: 32717783 PMCID: PMC7459610 DOI: 10.3390/diagnostics10080510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022] Open
Abstract
Apolipoproteins (Apo) are known atherogenic factors that play important roles in many mechanisms related to coronary heart disease. The ApoB/ApoA1 ratio is a promising diagnostic tool for metabolic syndrome (MS) in different populations, though its use is not established in Kazakhstan. This study aimed to assess the relationship between MS and the ApoB/ApoA1 ratio among hypertensive patients and to evaluate its diagnostic use for identifying MS as an alternative to triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). A cross-sectional study was conducted in 800 eligible men and women with primary hypertension from April 2015 to December 2016. Data were collected on socio-demographics, lifestyle parameters, family history of cardiovascular disease, and hypertension. Dietary Quality Score (DQS), anthropometric data, and blood pressure were recorded; ApoA1 and ApoB levels were measured in blood samples. We found a significant positive association between MS and the ApoB/ApoA1 ratio by multiple logistic regression, as shown by a linear trend of increase of the odds ratio (OR) for MS across the quartiles of ApoB/ApoA1 (p < 0.0001). ROC analysis revealed diagnostic significance of the ApoB/ApoA1 ratio for MS, and comparative ROC analysis demonstrated equal diagnostic value of ApoB/ApoA1 ratio and TG levels (AUC = 0.71 (95% CI 0.69; 0.74) and 0.72 (95% CI 0.69, 0.76), respectively), which was significantly higher than those of HDL, ApoA1, ApoB (AUC = 0.27 (95% CI 0.23; 0.31), AUC = 0.37 (95% CI 0.33; 0.41), AUC = 0.67, (95% CI 0.63; 0.71), respectively). The diagnostic value of the ApoB/ApoA1 ratio in Kazakhs with MS appeared to equal that of TG and was significantly higher than that of HDL-C. Adjusting for gender, smoking, and DQS significantly strengthened the association between MS and the ApoB/ApoA1 ratio in the Kazakh population.
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Affiliation(s)
- Alma Nurtazina
- Department of Epidemiology and Biostatistics, Semey Medical University, Semey 071400, Kazakhstan
| | - Dana Kozhakhmetova
- Department of Propedeutics of Internal Diseases, Semey Medical University, Semey 071400, Kazakhstan; (D.K.); (A.S.)
| | - Daulet Dautov
- Department of Propedeutics of Internal Diseases, Kazakh National Medical University, Almaty 050000, Kazakhstan;
| | - Aizhan Shakhanova
- Department of Propedeutics of Internal Diseases, Semey Medical University, Semey 071400, Kazakhstan; (D.K.); (A.S.)
| | - Vijay Kumar Chattu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Poteryaeva ON, Usynin IF. [Antidiabetic role of high density lipoproteins]. BIOMEDIT︠S︡INSKAI︠A︡ KHIMII︠A︡ 2019; 64:463-471. [PMID: 30632974 DOI: 10.18097/pbmc20186406463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Disturbance in lipid metabolism can be both a cause and a consequence of the development of diabetes mellitus (DM). One of the most informative indicator of lipid metabolism is the ratio of atherogenic and antiatherogenic fractions of lipoproteins and their protein components. The review summarizes literature data and own results indicating the important role of high-density lipoprotein (HDL) and their main protein component, apolipoprotein A-I (apoA-I), in the pathogenesis of type 2 DM. On the one hand, HDL are involved in the regulation of insulin secretion by b-cells and insulin-independent absorption of glucose. On the other hand, insulin resistance and hyperglycemia lead to a decrease in HDL levels and cause modification of their protein component. In addition, HDL, possessing anti-inflammatory and mitogenic properties, provide anti-diabetic protection through systemic mechanisms. Thus, maintaining a high concentration of HDL and apoA-I in blood plasma and preventing their modification are important issues in the context of prevention and treatment of diabetes.
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Affiliation(s)
- O N Poteryaeva
- Institute of Biochemistry, Federal Research Center of Fundamental and Translation Medicine, Novosibirsk, Russia
| | - I F Usynin
- Institute of Biochemistry, Federal Research Center of Fundamental and Translation Medicine, Novosibirsk, Russia
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Brahimaj A, Ligthart S, Ikram MA, Hofman A, Franco OH, Sijbrands EJG, Kavousi M, Dehghan A. Serum Levels of Apolipoproteins and Incident Type 2 Diabetes: A Prospective Cohort Study. Diabetes Care 2017; 40:346-351. [PMID: 28031419 DOI: 10.2337/dc16-1295] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/11/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to investigate the role of serum levels of various apolipoproteins on the risk for type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS We used data from 971 individuals from the prospective population-based Rotterdam Study. We studied the association of HDL cholesterol (HDL-C), apoA1, apoCIII, apoD, and apoE as well as the ratios of apolipoproteins with apoA1 with the risk of T2D. All apolipoproteins, ratios, and HDL-C levels were naturally log-transformed to reach normal distribution. First, their cross-sectional associations with fasting glucose and insulin were investigated by using linear regression. Second, Cox proportional hazard models were used to examine whether apolipoproteins predict the risk for T2D among individuals free of diabetes at baseline. We also studied the apolipoproteins jointly by calculating the apolipoproteinic score from the first step and then performing Cox regression with it. RESULTS During a median follow-up of 13.5 years, diabetes developed in 110 individuals. After adjustment for age, sex, BMI, parental history of diabetes, hypertension, alcohol use, smoking, prevalent cardiovascular disease, and serum lipid-reducing agents, HDL-C (per 1 SD naturally log-transformed hazard ratio 0.74 [95% CI 0.57, 0.97], apoCIII (1.65 [1.42, 1.91]), apoE (1.36 [1.18, 1.55]), apoCIII-to-apoA1 ratio (1.72 [1.51, 1.95]), apoE-to-apoA1 ratio (1.28 [1.13, 1.45]), and apolipoproteinic score (1.60 [1.39, 1.83]) remained significant. Only apoCIII (1.42 [1.03, 1.96]) and apoCIII-to-apoA1 ratio (1.56 [1.04, 2.36]) survived the adjustment for triglycerides in the last model. CONCLUSIONS Serum apoCIII levels as well as apoCIII-to-apoA1 ratio are associated with incident T2D. They are associated independent of known risk factors and stronger than HDL-C levels.
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Affiliation(s)
- Adela Brahimaj
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Symen Ligthart
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Harvard School of Public Health, Boston, MA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Abstract
The ratio of ApoB/apolipoprotein A1 (ApoA1) has been found to be associated with type 2 diabetes, and it was proposed as a new biomarker for type 2 diabetes predictions. Previous studies have assumed that the association between apoB/apoA1 and type 2 diabetes was linear. However, the linearity assumption has rarely been examined. In the present study, we aimed to examine whether this association showed a linear trend in a nationally representative population.Participants aged 18 years and over (n = 8220) were selected from the China Health Nutrition Survey (CHNS). We used restricted cubic spline to model the association between ApoB/ApoA1 ratio and type 2 diabetes using logistic regression models. Additionally, we categorized the ApoB/ApoA1 ratio according to quartiles to compare with previous results. Age, gender, education, smoking status, high sensitivity C-reactive protein (hsCRP), lipid, body mass index (BMI), and hypertension were controlled as potential confounders.We found that the association between apoB/apoA1 ratio and type 2 diabetes may be nonlinear after adjusting for multiple potential confounders. Compared with the lowest quartile of apoB/apoA1 ratio, participants in the fourth quartile had a higher odds of type 2 diabetes [odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.01-1.81].Our results suggest that, higher apoB/apoA1 ratio was associated with higher prevalence of type 2 diabetes. However, the association may be nonlinear.
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Affiliation(s)
- Yong Mao
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang
- Department of Dermatology, Linyi People's Hospital, Linyi, China
| | - Yang Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang
- Department of Dermatology, Linyi People's Hospital, Linyi, China
| | - Leihong Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang
- Department of Dermatology, Linyi People's Hospital, Linyi, China
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Fizelova M, Miilunpohja M, Kangas AJ, Soininen P, Kuusisto J, Ala-Korpela M, Laakso M, Stančáková A. Associations of multiple lipoprotein and apolipoprotein measures with worsening of glycemia and incident type 2 diabetes in 6607 non-diabetic Finnish men. Atherosclerosis 2015; 240:272-7. [PMID: 25818853 DOI: 10.1016/j.atherosclerosis.2015.03.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/16/2015] [Accepted: 03/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We investigated the association of various lipoprotein traits, apolipoproteins and their ratios with the deterioration of glycemia, incident type 2 diabetes, insulin resistance and insulin secretion in a large population-based Metabolic Syndrome Men (METSIM) Study. RESEARCH DESIGN AND METHODS The METSIM Study includes 10,197 Finnish men, aged 45-73 years, and examined in 2005-2010. From 6607 non-diabetic participants without statin treatment at baseline, 386 developed incident type 2 diabetes during a 5.9-year follow-up. A total of 3330 non-diabetic participants without statin treatment had both baseline and follow-up visit data, and were included in statistical analyses of the worsening of glycemia. RESULTS Compared to single lipid and lipoprotein measurements, lipoprotein and apolipoprotein ratios were better predictors of the glucose area under the curve and incident type 2 diabetes after adjustment for confounding factors. The apolipoprotein B/LDL cholesterol ratio was the strongest predictor of the worsening of glycemia, whereas the apolipoprotein A1/HDL cholesterol ratio was the strongest predictor of incident type 2 diabetes. The associations of lipoprotein traits, apolipoproteins and their ratios with insulin sensitivity were stronger than those with insulin secretion. CONCLUSIONS The apolipoprotein B/LDL cholesterol and apolipoprotein A1/HDL cholesterol ratios were the strongest predictors of the worsening of glycemia and incident type 2 diabetes, respectively.
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Affiliation(s)
- Maria Fizelova
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Antti J Kangas
- Computational Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Pasi Soininen
- Computational Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland; NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland; Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Mika Ala-Korpela
- Computational Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland; NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Oulu University Hospital, Oulu, Finland; Computational Medicine, School of Social and Community Medicine and the Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland; Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Alena Stančáková
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland.
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