1
|
Nouri M, Davies IG, Webb RJ, Mazidi M, Makhtoomi M, Rezaianzadeh A, Johari MG, Faghih S. The association between ultra-processed foods and conventional markers of cardiovascular risk in an adult Iranian population. Nutr Metab Cardiovasc Dis 2023; 33:1951-1959. [PMID: 37543517 DOI: 10.1016/j.numecd.2023.06.009] [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: 10/26/2022] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND AIMS According to the NOVA classification system, ultra-processed foods result from extensive industrial processing and use ingredients derived from food and non-food products, which can negatively impact on cardiovascular disease risk factors. Despite this, few studies have investigated UPFs in Middle Eastern populations regardless of high consumption in this region. METHODS AND RESULTS This cross-sectional study was conducted on data from the Prospective Epidemiological Research Studies in Iran Kharemeh cohort (n = 6611). Food frequency questionnaires were assessed and the ratio of total UPFs energy/total energy intake was calculated. Data was categorized into tertiles of UPF consumption using the NOVA classification system. Kruskal-Wallis tests were used to assess differences in nutrient and food intakes between tertiles and logistic regression analysis was applied to assess the associations between UPFs and CVD risk factors. After adjustment for potential confounders the logistic regression analysis revealed significant positive relationships between intakes of UPFs and waist circumference (WC) (T2: OR; 1.34, 95% CI; 1.13-1.60 - T3: OR; 1.41, 95% CI; 1.18-1.69, P ˂0.001), low-density lipoprotein cholesterol (LDL-C) (T2: OR; 1.20, 95% CI; 1.05-1.37 - T3: OR; 1.27, 95% CI; 1.11-1.45, P ˂0.001), non-high-density lipoprotein cholesterol (non-HDL) (T2: OR; 1.21, 95% CI; 1.07-1.37 - T3: OR; 1.24, 95% CI; 1.10-1.41, P ˂0.001) and LDL-C to HDL-C ratio (T2: OR; 1.15, 95% CI; 1.02-1.31 - T3: OR; 1.21, 95% CI; 1.07-1.38, P = 0.002). CONCLUSION The consumption of UPFs was positively associated with WC and atherogenic blood lipids. However, increased intakes of fiber and unsaturated fats were also found in those consuming more UPFs, which was not expected. These findings offer insights into an understudied population and warrant further research.
Collapse
Affiliation(s)
- Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran; Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran; Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Richard J Webb
- School of Health and Sport Sciences, Liverpool Hope University, Taggart Avenue, Liverpool L16 9JD, UK
| | - Mohsen Mazidi
- Nuffield Department of Population Health, Richard Doll Building, Old Road Campus, University of Oxford, Oxford OX3 7LF, UK
| | - Maede Makhtoomi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran; Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran; Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
2
|
Li C, He K, Yang Y, Li K, Chen M, Wang L, Gao Y, Xu X. Discordance of Circulating Non-HDL Cholesterol with LDL Cholesterol Concerning Long-Term Prognosis in Statin-Treated Individuals with Acute Coronary Syndrome and Previous Coronary Artery Bypass Grafting Undergoing Percutaneous Coronary Intervention. Rev Cardiovasc Med 2023; 24:263. [PMID: 39076405 PMCID: PMC11270103 DOI: 10.31083/j.rcm2409263] [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: 12/23/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 07/31/2024] Open
Abstract
Background Some individuals who maintain desirable low-density lipoprotein cholesterol (LDL-C) levels still experience the progression of atherosclerosis, which may eventually lead to cardiovascular events. Non-high-density lipoprotein cholesterol (non-HDL-C) levels are quantified to assess residual risk in statin-treated patients with coronary heart disease. The study aimed to estimate the predictive performance of discordance between non-HDL-C and LDL-C on clinical prognosis in statin-treated patients with previous coronary artery bypass grafting (CABG). Methods 468 statin-treated patients with previous CABG undergoing percutaneous coronary intervention (PCI) as a secondary coronary treatment due to acute coronary syndrome (ACS) were retrospectively enrolled in this study. The definition of major adverse cardiovascular events (MACEs) was a composite endpoint of cardiovascular death, recurring myocardial infarction, and a need for repeat revascularization. Cox proportional hazards modeling, restricted cubic splines regression, and discordance analysis were conducted to the association between all lipid parameters and the occurrence of MACEs. Discordant values were defined as LDL-C concentrations ≤ 1.8 mmol/L accompanied by non-HDL-C > 2.6 mmol/L. Results MACEs occurred in 95 patients over a median follow-up period of 744.5 days. Cox models demonstrated that increased concentrations of non-HDL-C and LDL-C levels were independent risk indicators of MACEs (p < 0.001). The restricted cubic spline analysis revealed a linear relationship between non-HDL-C concentrations and MACEs (p-nonlinear: 0.26), whereas a nonlinear relationship was observed between LDL-C concentrations and MACEs (p < 0.01). In the subgroup analysis, the spline curves revealed that the odds of the individuals with desirable LDL-C levels suffering MACEs emerged when non-HDL-C levels were above 2.07 mmol/L. Individuals who exhibited discordance involving high non-HDL-C/low LDL-C levels had an elevated risk of experiencing MACEs compared to those with concordantly low LDL-C and low non-HDL-C levels [hazard ratios (HRs) = 2.44, 95% confidence interval (CI) = 1.14-5.22, p = 0.02]. Conclusions Non-HDL-C levels could predict the residual risk of MACEs in ACS patients with previous CABG and statin therapy that underwent percutaneous coronary intervention. A discordance between non-HDL-C and LDL-C in individuals with desirable LDL-C levels could be useful in identifying those with a residual risk of cardiovascular complications.
Collapse
Affiliation(s)
- Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| | - Kuizheng He
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| | - Yixing Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| | - Kuibao Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| | - Mulei Chen
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| | - Lefeng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| | - Yuanfeng Gao
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| | - Xiaorong Xu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China
| |
Collapse
|
3
|
Nouri M, Eskandarzadeh S, Makhtoomi M, Rajabzadeh-Dehkordi M, Omidbeigi N, Najafi M, Faghih S. Association between ultra-processed foods intake with lipid profile: a cross-sectional study. Sci Rep 2023; 13:7258. [PMID: 37142735 PMCID: PMC10160124 DOI: 10.1038/s41598-023-34451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023] Open
Abstract
The purpose of this cross-sectional study was to examine the association between ultra-processed foods (UPFs) intake and lipid profile in Iranian people. The study was performed on 236 individuals with the age range of 20-50 years in Shiraz, Iran. Food intakes of the participants were evaluated using a 168-item food frequency questionnaire (FFQ) which was previously validated in Iranian populations. In order to estimate the ultra-processed foods intake, classification of NOVA food group was used. Serum lipids including total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were measured. The results showed that mean of age and body mass index (BMI) of the participants were 45.98 years and 28.28 kg/m2, respectively. Logistic regression was used to evaluation the relation between UPFs intake and lipid profile. Higher UPFs intake was associated with increased OR of TG and HDL abnormality in both crude (OR 3.41; 95% CI 1.58, 7.34; P-trend = 0.001 and OR 2.99; 95% CI 1.31, 6.82; P-trend = 0.010) and adjusted models (OR 3.69; 95% CI 1.67, 8.16; P-trend = 0.001 and OR 3.38 95% CI 1.42, 8.07; P-trend = 0.009). But, there were no association between UPFs intake and other indices of lipid profile. Also, we found significant associations between UPFs intake and dietary nutrient profiles. In conclusion, UPFs consumption could worsen the nutritional profile of the diet and lead to negative changes in some indices of the lipid profile.
Collapse
Affiliation(s)
- Mehran Nouri
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran
- Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sevda Eskandarzadeh
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Maede Makhtoomi
- Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Rajabzadeh-Dehkordi
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran
- Students' Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Omidbeigi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Najafi
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Faghih
- Department of Community Nutrition, School of Nutrition and Food Science, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
4
|
Luo Y, Peng D. Residual Atherosclerotic Cardiovascular Disease Risk: Focus on Non-High-Density Lipoprotein Cholesterol. J Cardiovasc Pharmacol Ther 2023; 28:10742484231189597. [PMID: 37641208 DOI: 10.1177/10742484231189597] [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] [Indexed: 08/31/2023]
Abstract
Cardiovascular disease (CVD) caused by atherosclerosis is the leading cause of death worldwide. The level of low-density lipoprotein cholesterol (LDL-C), considered as the initiator of atherosclerosis, is the most widely used predictor for CVD risk and LDL-C has been the primary target for lipid-lowering therapies. However, residual CVD risk remains high even with very low levels of LDL-C. This residual CVD risk may be due to remnant cholesterol, high triglyceride levels, and low high-density lipoprotein cholesterol (HDL-C). Non-high density lipoprotein cholesterol (non-HDL-C), which is calculated as total cholesterol minus HDL-C (and represents the cholesterol content of all atherogenic apolipoprotein B-containing lipoproteins), has emerged as a better risk predictor for CVD than LDL-C and an alternative target for CVD risk reduction. Major international guidelines recommend evaluating non-HDL-C as part of atherosclerotic CVD risk assessment, especially in people with high triglycerides, diabetes, obesity, or very low LDL-C. A non-HDL-C target of <130 mg/dL (3.4 mmol/L) has been recommended for patients at very high risk, which is 30 mg/dL (0.8 mmol/L) higher than the corresponding LDL-C target goal. Non-HDL-C lowering approaches include reducing LDL-C and triglyceride levels, increasing HDL-C, or targeting multiple risk factors simultaneously. However, despite the growing evidence for the role of non-HDL-C in residual CVD risk, and recommendations for its assessment in major guidelines, non-HDL-C testing is not routinely done in clinical practice. Thus, there is a need for increased awareness of the need for non-HDL-C testing for ascertaining CVD risk and concomitant prevention of CVD.
Collapse
Affiliation(s)
- Yonghong Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Daoquan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
5
|
Impact of Traditional and Non-Traditional Lipid Parameters on Outcomes after Intravenous Thrombolysis in Acute Ischemic Stroke. J Clin Med 2022; 11:jcm11237148. [PMID: 36498722 PMCID: PMC9737232 DOI: 10.3390/jcm11237148] [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: 11/14/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Contradicting evidence exists regarding the role of lipids in outcomes following intravenous (IV) thrombolysis with tissue plasminogen activator (tPA). Restricted cubic spline curves and adjusted logistic regression were used to evaluate associations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and LDL-C/HDL-C ratio with poor functional outcome, symptomatic intracranial hemorrhage (SICH) and 90-day mortality, among 1004 acute ischemic stroke (AIS) patients who received IV tPA in a comprehensive stroke center. Quartile (Q) 1, Q2 and Q3 of HDL-C were associated with increased odds of poor functional outcome (adjusted odds ratio (adjOR) 1.66, 95% CI 1.06-2.60, p = 0.028, adjOR 1.63, 95% CI 1.05-2.53, p = 0.027, adjOR 1.56, 95% CI 1.01-2.44, p = 0.048) compared to Q4. Q2 and Q4 of non-HDL-C were associated with increased odds of SICH (adjOR 4.28, 95% CI 1.36-18.90, p = 0.025, adjOR 5.17, 95% CI 1.64-22.81, p = 0.011) compared to Q3. Q1 and Q2 of LDL-C was associated with increased odds of mortality (adjOR 2.57, 95% CI 1.27-5.57, p = 0.011 and adjOR 2.28, 95% CI 1.10-5.02, p = 0.032) compared to Q3. In AIS patients who received IV tPA, low LDL-C was associated with increased odds of mortality while HDL-C may be protective against poor functional outcome.
Collapse
|
6
|
Non-High-Density Lipoprotein Cholesterol and Cardiovascular Outcomes in Chronic Kidney Disease: Results from KNOW-CKD Study. Nutrients 2022; 14:nu14183792. [PMID: 36145167 PMCID: PMC9505887 DOI: 10.3390/nu14183792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 02/07/2023] Open
Abstract
As non-high-density lipoprotein cholesterol (non-HDL-C) levels account for all atherogenic lipoproteins, serum non-HDL-C level has been suggested to be a marker for cardiovascular (CV) risk stratification. Therefore, to unveil the association of serum non-HDL-C levels with CV outcomes in patients with non-dialysis chronic kidney disease (ND-CKD), the patients at stages 1 to 5 (n = 2152) from the Korean Cohort Study for Outcomes in Patients with Chronic Kidney Disease (KNOW-CKD) were prospectively analyzed. The subjects were divided into quintiles by serum non-HDL-C level. The primary outcome was a composite of all-cause death or non-fatal CV events. The median duration of follow-up was 6.940 years. The analysis using the Cox proportional hazard model unveiled that the composite CV event was significantly increased in the 5th quintile (adjusted hazard ratio 2.162, 95% confidence interval 1.174 to 3.981), compared to that of the 3rd quintile. A fully adjusted cubic spline model depicted a non-linear, J-shaped association between non-HDL-C and the risk of a composite CV event. The association remained robust in a series of sensitivity analyses, including the analysis of a cause-specific hazard model. Subgroup analyses reveled that the association is not significantly altered by clinical conditions, including age, gender, body mass index, estimated glomerular filtration rate, and albuminuria. In conclusion, high serum non-HDL-C level increased the risk of adverse CV outcomes among the patients with ND-CKD. Further studies are warranted to define the optimal target range of non-HDL-C levels in this population.
Collapse
|
7
|
Martinez-Sanchez FD, Medina-Urrutia AX, Jorge-Galarza E, Martínez-Alvarado MDR, Reyes-Barrera J, Osorio-Alonso H, Arellano-Buendía AS, Del Carmen González-Salazar M, Posadas-Sánchez R, Vargas-Alarcón G, Posadas-Romero C, Juárez-Rojas JG. Effect of metabolic control on recurrent major adverse cardiovascular events and cardiovascular mortality in patients with premature coronary artery disease: Results of the Genetics of Atherosclerotic Disease study. Nutr Metab Cardiovasc Dis 2022; 32:2227-2237. [PMID: 35843799 DOI: 10.1016/j.numecd.2022.06.008] [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: 03/28/2022] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Coronary artery disease (CAD) is the leading cause of death around the world, and its rate of presentation is increasing at young ages. Despite the evidence that secondary prevention in CAD reduces the risk of recurrent major adverse cardiovascular events (MACE), no studies have analyzed the composite control of blood pressure, lipids, and glucose control in premature CAD. METHODS AND RESULTS This was a real-world prospective cohort study of patients with premature CAD. The composite control in blood pressure <140/80 mmHg, LDL-C <70 mg/dL, non-HDL-C <100 mg/dL, and Hemoglobin A1c <8% was considered as metabolic control. The primary endpoint was the occurrence of non-fatal and fatal MACE. The data included 1042 patients with premature CAD. The mean age of the patients was 54.1 ± 8.1 years, 18.5% were women, and had a median follow-up of 59.1 ± 11.8 months. Of them, 7% had non-fatal MACE, and 4% had a fatal MACE. Overall, 21.3% achieved metabolic control, and 3.0% did not achieve any target. Cox regression analysis showed that percutaneous coronary intervention (Hazzard ratio = 1.883 [95% CI, 1.131-3.136]), C-reactive protein (1.046 [1.020-1.073]), blood pressure >140/90 mmHg (2.686 [1.506-4.791]), fibrates (2.032 [1.160-3.562]), calcium channel blockers (2.082 [1.158-3.744]) had greater risk to present a recurrent non-fatal MACE; whereas familial history of premature CAD (2.419 [1.240-4.721]), heart failure (2.139 [1.032-4.433]), LDL-C >70 mg/dL (4.594 [1.401-15.069]), and diuretics (3.328 [1.677-6.605]) were associated with cardiovascular mortality. CONCLUSIONS The composite goal achievement in lipids, blood pressure and glucose, reduced the risk for recurrent MACE in 80%.
Collapse
Affiliation(s)
- F D Martinez-Sanchez
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - A X Medina-Urrutia
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - E Jorge-Galarza
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | | | - J Reyes-Barrera
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - H Osorio-Alonso
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - A S Arellano-Buendía
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | | | - R Posadas-Sánchez
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - G Vargas-Alarcón
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - C Posadas-Romero
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| | - J G Juárez-Rojas
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
| |
Collapse
|
8
|
Apolipoprotein B/A1 Ratio Is Associated with Severity of Coronary Artery Stenosis in CAD Patients but Not in Non-CAD Patients Undergoing Percutaneous Coronary Intervention. DISEASE MARKERS 2021; 2021:8959019. [PMID: 34961824 PMCID: PMC8710153 DOI: 10.1155/2021/8959019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/09/2021] [Accepted: 11/03/2021] [Indexed: 12/30/2022]
Abstract
Background and Aims Lipid metabolism plays important roles in atherosclerosis. Several studies have found that lipoprotein is associated with coronary artery disease (CAD) and hyperlipidemia. Although the roles of the apolipoprotein B/A1 ratio (ApoB/A1) were originally thought to be atherosclerotic, few studies have focused on the specific relationship between ApoB/A1 and severity of coronary artery stenosis with or without the presence of CAD. Methods A total of 6956 consecutive patients aged 21–98 years with suspected CAD who had undergone coronary angiography were enrolled. The severity of coronary lesions was evaluated using the Gensini score (GS). The relationships between ApoB/A1 and severity of coronary artery stenosis were evaluated. Results A total of 1795 non-CAD patients and 5161 CAD patients were included in the observational analysis. Patients with CAD had higher ApoB/A1 than individuals without CAD (0.67 (0.53-0.82) vs. 0.61 (0.49-0.75), p < 0.001). In CAD patients, the higher the ApoB/A1 was, the higher the proportion of patients with MI, triple-vessel lesions, and higher Gensini scores. ApoB/A1 was significantly positively correlated with HbA1c and Gensini scores in CAD patients but not in non-CAD patients (all p < 0.001). Logistic analyses showed that ApoB/A1 could be a risk factor for multivessel disease (OR: 2.768, 95% CI: 1.868-4.103, p < 0.001). ApoB/A1 was found to be significantly positively correlated with the Gensini score in CAD patients. Conclusions ApoB/A1 is highly associated with the presence and severity of coronary artery stenosis in patients with CAD but not in non-CAD patients.
Collapse
|
9
|
He Q, Zhang P, Li Y, Cai C, Wang C. The application of Gensini score and IL-1ra in assessing the condition and prognosis of patients with coronary artery disease. Am J Transl Res 2021; 13:10421-10427. [PMID: 34650711 PMCID: PMC8506997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to investigate the value of Gensini score and interleukin-1 receptor antagonist (IL-1ra) in assessing the condition and prognosis of patients with coronary heart disease (CHD). METHODS According to their condition, 175 patients were divided into stable angina group (SA, 60 cases), unstable angina group (UA, 60 cases) and acute myocardial infarction group (AMI, 55 cases). The Gensini score, GRACE score, IL-1ra and troponin (Tn) were compared in the three groups. The correlation between Gensini score and GRACE score, IL-1ra and Tn, were explored. The patients were divided into death group (21 cases), adverse cardiovascular events group (MACE, 50 cases) and good prognosis group (104 cases) according to clinical outcomes. The ROC curve with regard to Gensini score, IL-1ra and the clinical outcome was plotted. RESULTS With the exacerbation of the disease, the Gensini score, GRACE score, IL-1ra and Tn were significantly higher in patients with CHD (P<0.05). Correlation analysis showed a positive association between Gensini score and GRACE score (r=0.9751, P<0.05). IL-1ra showed a positive association with Tn level (r=0.9731, P<0.05); Gensini score and IL-1ra had an area under the curve (AUC) of 0.9350 and 0.9499 for adverse CHD outcome, respectively (P<0.001). CONCLUSION Gensini score and IL-1ra reflect better the severity of CHD in patients with CHD, and also the AUC of 0.9350 and 0.9499 (P<0.001). It can be used in the prognostic evaluation of patients with CHD.
Collapse
Affiliation(s)
- Qian He
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Pu Zhang
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Yu Li
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Chao Cai
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Chongquan Wang
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| |
Collapse
|
10
|
Karabulut U, Çakır Ü. Non-HDL cholesterol is an independent predictor of long-term cardiovascular events in patients with dyslipidemia after renal transplantation. Int J Clin Pract 2021; 75:e14465. [PMID: 34107128 DOI: 10.1111/ijcp.14465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Posttransplant dyslipidemia is a common condition in renal transplantation recipients (RTR) and is related to poor cardiac outcomes. We aimed to demonstrate the value of non-high-density lipoprotein cholesterol (non-HDL-C) in predicting long-term major cardiovascular and cerebrovascular events (MACCE) in RTR with dyslipidemia. METHODS Patients who had undergone renal transplantation between 2011 and 2019 were retrospectively analysed and were classified as normal non-HDL-C and high non-HDL-C groups based on first year levels. Development of high non-HDL-C levels was used to predict the occurrence of MACCE (a combination of cardiac death, nonfatal myocardial infarction, unstable angina, and nonfatal stroke) and all-cause death during the long-term follow-up. RESULTS Overall, 674 patients were included, of whom 470 (69.7%) were male; the mean age was 43.6 ± 13.2 years. The mean follow-up duration was 5.5 ± 2.29 years 1 year after the transplant. MACCE occurred during the follow-up in 102 (61.8%) patients in the high non-HDL-C group and 13 (2.6%) patients in the normal non-HDL-C group (P < .001). High non-HDL-C was a predictor of MACCE in the multivariate analysis (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.02, P < .001). Smoking (HR: 1.92, 95% CI 1.16-3.20, P < .001), cadaver graft (HR: 2.55, 95% CI 1.52-4.26, P < .001), and left ventricular ejection fraction (HR: 0.96, 95% CI 0.94-0.98, P < .001) were also predictors of MACCE. Kaplan-Meier analysis revealed that all MACCE components and all-cause mortality were significantly higher in the high non-HDL-C group (P < .001). CONCLUSION Non-HDL-C was closely related to long-term cardiac outcomes in RTR with dyslipidemia. Non-HDL-C should be among the primary goals in lipid-lowering treatment in post-transplant dyslipidemia.
Collapse
Affiliation(s)
- Umut Karabulut
- Department of Cardiology, Acıbadem International Hospital, İstanbul, Turkey
| | - Ülkem Çakır
- Department of Nephrology, Facult of Medicine, Acıbadem University, İstanbul, Turkey
| |
Collapse
|
11
|
Aggarwal DJ, Kathariya MG, Verma DPK. LDL-C, NON-HDL-C and APO-B for cardiovascular risk assessment: Looking for the ideal marker. Indian Heart J 2021; 73:544-548. [PMID: 34627566 PMCID: PMC8514398 DOI: 10.1016/j.ihj.2021.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/10/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
The traditional approach to the management of coronary artery disease (CAD) focuses mainly on low density lipoprotein cholesterol (LDL-C) which is often considered a crucial risk factor for the progression of atherosclerosis. Despite its extensive use in predicting CAD risk, it has become a sub-optimal marker owing to several limitations. Recently, non-high density lipoprotein cholesterol (non-HDL-C) and apolipoprotein-B (Apo-B) have been substantiated to be more reliable predictors of CAD risk. On the basis of available evidence, it is fair to say that non-HDL-C is a more realistic primary target of therapy and can be used for initial screening. In the current scenario, India being a developing country, the population would not be burdened with additional cost of Apo-B estimation as non-HDL-C can be estimated in the non-fasting state which makes it both patient and clinician friendly. Considering this fact, the aim of the present review article is to highlight the reliability and efficacy of non-HDL-Cholesterol and hence make recommendations to incorporate non-HDL-C in routine lipid panel for better assessment of CAD.
Collapse
|
12
|
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.
Collapse
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
| | | |
Collapse
|
13
|
Li Y, Chen X, Li S, Ma Y, Li J, Lin M, Wan J. Non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio serve as a predictor for coronary collateral circulation in chronic total occlusive patients. BMC Cardiovasc Disord 2021; 21:311. [PMID: 34162320 PMCID: PMC8223315 DOI: 10.1186/s12872-021-02129-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/18/2021] [Indexed: 12/11/2022] Open
Abstract
Objective The present study investigated the potential correlation between non-high-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (non-HDL-C/HDL) and the formation of coronary collateral circulation (CCC) in coronary artery disease cases with chronic total occlusive (CTO) lesions. Methods Two experienced cardiologists identified and selected patients with CTO lesions for retrospective analysis. The 353 patients were divided into a CCC poor formation group (Rentrop 0–1 grade, n = 209) and a CCC good formation group (Rentrop 2–3 grade, n = 144) based on the Cohen-Rentrop standard. A comparison of non-HDL-C/HDL ratios between the two groups was performed. The Spearman test was used to obtain the correlation between the cholesterol ratio and Rentrop grade. Independent predictors of CCC were analyzed using logistic regression. Receiver operating characteristic (ROC) curve analysis was also performed to quantify the predictive value of research indicator. Results The non-HDL-C/HDL ratio in the CCC poor formation group was elevated markedly compared to the CCC good formation group [( 3.86 ± 1.40) vs ( 3.31 ± 1.22), P = 0.000]. The Spearman test results indicated that non-HDL-C/HDL negatively correlated with Rentrop grade (r = − 0.115, P = 0.030). Multivariate logistic regression analysis showed that non-HDL-C/HDL ratio was an independent predictor of CCC formation (OR = 1.195, 95%CI = 1.020–1.400, P = 0.027). The area under the curve of ROC for detecting CCC poor formation was 0.611 (95% CI: 0.551–0.671, P = 0.000) with an optimal cut-off value of 2.77. Conclusion Non-HDL-C/HDL negatively correlated with the formation of CCC and served as an independent predictor of CCC formation, which may be used as a biomarker for the evaluation of CCC.
Collapse
Affiliation(s)
- Ya Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Xin Chen
- Department of Cardiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, 445000, China
| | - Shu Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Yulin Ma
- Department of Cardiology, Hubei Jianghan Oilfield General Hospital, Qianjiang, 433100, China
| | - Jialing Li
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Mingying Lin
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China
| | - Jing Wan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, No 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei Province, China.
| |
Collapse
|
14
|
Eren M, Kurmus O, Aslan T, Akbuga K, Tolunay H. Relationship between Discordance of Low-Density Lipoprotein and Non-High-Density Lipoprotein Cholesterol and Risk Stratification in Acute Myocardial Infarction. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
15
|
Zhang N, Shi F, Liang H, Wang H. The feasibility of using Hcy, CRP, and Cys-C to analyze AMI patients' disease conditions and prognoses. Am J Transl Res 2021; 13:2724-2730. [PMID: 34017434 PMCID: PMC8129397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study was conducted to investigate the feasibility of using the serum homocysteine (Hcy), C-reactive protein (CRP), and cystatin C (Cys-C) levels to evaluate the conditions and prognoses of acute myocardial infarction (AMI) patients. METHODS One hundred and twenty patients with AMI were enrolled as an observation group (the AMI group). Eighty patients with stable angina pectoris were included in a control group (the SA group). Eighty healthy volunteers were enrolled as a healthy control group (the NCHD group). The AMI patients were divided into groups of >20 (n = 32), 10-20 (n = 45) and <10 (n = 43) according to their APACHE-II scores. The groups were divided into a death group (n = 23) and a survival group (n = 97) according to the patients' 1-year follow-up outcomes. The differences in the serum Hcy, CRP, and Cys-C levels among the different groups, and the correlations between the serum levels were calculated. RESULTS The serum Hcy, CRP, and Cys-C levels in the AMI group were significantly higher than they were in the SA and NCHD groups (P<0.05), and the serum levels in the APACHE-II score >20 group were significantly higher than the serum levels in the 10-20 group. The dead group exhibited higher serum Hcy, CRP, and Cys-C levels than the survival group (P<0.05), and our Spearman's correlation analysis showed that the serum Hcy, CRP and Cys-C levels were positively correlated with the APACHE II scores (r = 0.9157, r = 0.8519, r = 0.8598, P<0.001). The area under curve of Hcy, CRP, and Cys-C for the AMI diagnoses were 0.9638 (95% CI: 0.9183-1.000), 0.8125 (95% CI: 0.6652-0.9598), and 0.7515 (95% CI: 0.5847-0.9184), respectively. CONCLUSION Serum Hcy, CRP, and Cys-C levels can reflect the severity of the patients' conditions.
Collapse
Affiliation(s)
- Na Zhang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
| | - Fei Shi
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
| | - Hao Liang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
| | - Hong Wang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
| |
Collapse
|
16
|
Ghoshal K, Chatterjee T, Chowdhury S, Sengupta S, Bhattacharyya M. Adiponectin Genetic Variant and Expression Coupled with Lipid Peroxidation Reveal New Signatures in Diabetic Dyslipidemia. Biochem Genet 2021; 59:781-798. [PMID: 33543406 DOI: 10.1007/s10528-021-10030-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023]
Abstract
Increasing burden of non-communicable diseases like diabetes and cardiovascular disorders has made the global health scenario more challenging. Dyslipidemia in diabetes is a compounding risk factor for cardiovascular diseases, but there is dearth of identifying appropriate signatures to address this issue. The protein, adiponectin, is actively involved in regulating glucose levels as well as fatty acid breakdown playing crucial role in dyslipidemia and vascular complications. To identify the underlying genetic and molecular profile of adiponectin metabolic pathway in diabetic dyslipidemia and to correlate it with known biochemical and oxidative stress parameters of T2DM, we performed a case-control study in a total 264 individuals belonging to three categories such as diabetes with dyslipidemia (n = 88), diabetes without dyslipidemia (n = 86) and normal healthy controls (n = 90). Expression of adiponectin (ADIPOQ) and its receptors (ADIPOR1 and ADIPOR2) were measured in visceral and subcutaneous adipose tissues. A significant downregulated expression of ADIPOQ and its receptors in adipose tissues and PBMCs were linked with diabetic dyslipidemic condition. A multiple linear regression followed by MDR analysis implicated the elevated plasma malondialdehyde and decreased adiponectin level to be correlated with diabetic dyslipidemia. More interestingly, two single nucleotide polymorphisms of ADIPOQ (rs2241766 and rs1501299) were genetically associated with the risk of developing dyslipidemia. Other important biochemical factors found to be increased in diabetic dyslipidemic conditions included plasma C-reactive protein and 4-hydroxynonenal adducts. Our results explore, a complex interplay of genetic and biochemical parameters in diabetic dyslipidemia which is significant from the perspective of risk stratification and novel therapeutic strategy development.
Collapse
Affiliation(s)
- Kakali Ghoshal
- Department of Biochemistry, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, India
| | - Tanima Chatterjee
- Department of Biochemistry, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, India
| | - Subhankar Chowdhury
- Institute of Postgraduate Medical Education and Research, Government of West Bengal, 224, Acharyya Jagadish Chandra Bose Road, Kolkata, 700020, India
| | - Sanghamitra Sengupta
- Department of Biochemistry, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, India.
| | - Maitree Bhattacharyya
- Department of Biochemistry, University of Calcutta, 35, Ballygunge Circular Road, Kolkata, 700019, India.
| |
Collapse
|
17
|
Paul P, George N, Shan BP. Cardiovascular Risk Prediction using JBS3 Tool: A Kerala based Study. Curr Med Imaging 2021; 16:1300-1322. [DOI: 10.2174/1573405616666200103144559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/21/2019] [Accepted: 11/25/2019] [Indexed: 01/10/2023]
Abstract
Background:
Accuracy of Joint British Society calculator3 (JBS3) cardiovascular (CV)
risk assessment tool may vary across the Indian states, which is not verified in south Indian, Kerala
based population.
Objectives:
To evaluate the traditional risk factors (TRFs) based CV risk estimation done in Kerala
based population.
Methods:
This cross-sectional study uses details of 977 subjects aged between 30 and 80 years,
recorded from the medical archives of clinical locations at Ernakulum district, in Kerala. The risk
categories used are Low (<7.5%), Intermediate (≥7.5% and <20%), and High (≥20%) 10-year risk
classifications. The lifetime classifications are Low lifetime (≤39%) and High lifetime (≥40%) are
used. The study evaluated using statistical analysis; the Chi-square test was used for dependent and
categorical CV risk variable comparisons. A multivariate ordinal logistic regression analysis for the
10-year risk and odds logistic regression analysis for the lifetime risk model identified the
significant risk variables.
Results:
The mean age of the study population is 52.56±11.43 years. With 39.1% in low, 25.0% in
intermediate, and 35.9% has high 10-year risk. Low lifetime risk with 41.1%, the high lifetime risk
has 58.9% subjects. The intermediate 10-year risk category shows the highest reclassifications to
High lifetime risk. The Hosmer-Lemeshow goodness-of-fit statistics indicates a good model fit.
Conclusion:
Timely interventions using risk predictions can aid in appropriate therapeutic and lifestyle
modifications useful for primary prevention. Precaution to avoid short-term incidences and
reclassifications to a high lifetime risk can reduce the CVD related mortality rates.
Collapse
Affiliation(s)
- Paulin Paul
- Sathyabama Institute of Science and Technology, Chennai, India
| | - Noel George
- Department of Biostatistics, St. Thomas College, Pala, Mahatma Gandhi University, Kottayam, India
| | - B. Priestly Shan
- School of Electrical, Electronics and Communication Engineering, Galgotias University, Delhi, India
| |
Collapse
|
18
|
Kurmus O, Erkan AF, Ekici B, Aslan T, Eren M. Discordance of Low-Density Lipoprotein Cholestrol and Non-High-Density Lipoprotein Cholestrol and Coronary Artery Disease Severity. Arq Bras Cardiol 2020; 114:469-475. [PMID: 32049158 PMCID: PMC7792727 DOI: 10.36660/abc.20190091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A sizeable proportion of patients have discordant low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). OBJECTIVES We assessed the relationship between discordance of LDL-C and non-HDL-C and coronary artery disease (CAD) severity. METHODS We retrospectively evaluated the data of 574 consecutive patients who underwent coronary angiography. Fasting serum lipid profiles were recorded, SYNTAX and Gensini scores were calculated to establish CAD complexity and severity. We determined the medians for LDL-C and non-HDL-C to examine the discordance between LDL-C and non-HDL-C. Discordance was defined as LDL-C greater than or equal to the median and non-HDL-C less than median; or LDL-C less than median and non-HDL-C greater than or equal to median. A p value < 0.05 was accepted as statistically significant. RESULTS LDL-C levels were strongly and positively correlated with non-HDL-C levels (r = 0.865, p < 0.001) but 15% of patients had discordance between LDL-C and non-HDL-C. The percentage of patients with a Gensini score of zero or SYNTAX score of zero did not differ between discordant or concordant groups (p = 0.837, p = 0.821, respectively). Mean Gensini and SYNTAX scores, percentage of patients with Gensini score ≥20 and SYNTAX score >22 were not different from group to group (p = 0.635, p = 0.733, p = 0.799, p = 0.891, respectively). Also, there was no statistically significant correlation between LDL-C and Gensini or SYNTAX scores in any of the discordant or concordant groups. Additionally, no correlation was found between non-HDL-C and Gensini or SYNTAX score. CONCLUSIONS While there was discordance between LDL-C and non-HDL-C (15% of patients), there is no difference regarding CAD severity and complexity between discordant and concordant groups.
Collapse
Affiliation(s)
- Ozge Kurmus
- Ufuk University Faculty of Medicine - Cardiology, Ankara - Turkey
| | | | - Berkay Ekici
- Ufuk University Faculty of Medicine - Cardiology, Ankara - Turkey
| | - Turgay Aslan
- Ufuk University Faculty of Medicine - Cardiology, Ankara - Turkey
| | - Murat Eren
- Ufuk University Faculty of Medicine - Cardiology, Ankara - Turkey
| |
Collapse
|
19
|
Wongcharoen W, Tantisirivit N, Norasetthada L, Gunaparn S, Phrommintikul A. Anti-Factor Xa Activity of Fixed-Dose Fondaparinux in Low-Body-Weight Patients With Acute Coronary Syndrome. Ann Pharmacother 2020; 54:1083-1089. [PMID: 32462894 DOI: 10.1177/1060028020930186] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fixed-dose 2.5 mg of fondaparinux subcutaneous injection once daily has been recommended in treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) irrespective of body weight (BW). However, data on anti-factor Xa (anti-FXa) activity of fondaparinux are scarce in low-BW patients. OBJECTIVE We aimed to assess anti-FXa activity of fondaparinux in low-BW patients (BW < 50 kg) compared with normal-BW patients (BW ≥ 50 kg) who presented with NSTE-ACS. METHODS This is a prospective cohort study of patients with NSTE-ACS receiving fondaparinux. Anti-FXa activity was measured 4 hours after 2.5 mg subcutaneous injection of fondaparinux after the first 2 doses. RESULTS Among 87 enrolled patients, 18 (21%) had BW <50 kg. Patients in the low-BW group were older and had lower creatinine clearance. Median duration of fondaparinux therapy was 3 (IQR 2-4) days. Anti-FXa activity after the first dose of fondaparinux was similar between the low-BW and normal-BW groups (0.40 ± 0.15 vs 0.40 ± 0.17 mg/L, P = 0.914). However, anti-FXa activity after the second dose of fondaparinux was significantly higher in the low-BW group as compared with the normal-BW group (0.53 ± 0.10 vs 0.44 ± 0.16 mg/L, P = 0.011). Multivariate analysis showed that BW was the only independent factor that inversely correlated with anti-FXa activity. There was only 1 bleeding event during hospitalization in the normal-BW group and none in the low-BW group. CONCLUSION AND RELEVANCE Anti-FXa activity of the second dose of fondaparinux was higher in low-BW patients but still within the expected range.
Collapse
|
20
|
Relationship between non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and coronary heart disease. Coron Artery Dis 2020; 31:623-627. [PMID: 32168053 PMCID: PMC7531502 DOI: 10.1097/mca.0000000000000881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the association between non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and degree of coronary artery stenosis proven by coronary angiography. METHODS A total of 1867 patients were enrolled into this study and analyzed retrospectively. Three hundred eighty-five non-coronary artery disease hospitalized patients were selected as control group, 1482 patients diagnosed as coronary artery disease were classified into three subgroups according to the tertiles of their SYNTAX score. We compared the level of non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio among the three subgroups. The Spearman correlation was used to analyze the correlation between non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio and SYNTAX, logistic regression was used for analyzing independent predictors of coronary artery disease. RESULTS The level of non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio was higher in coronary artery disease group compared with non-coronary artery disease group (P < 0.01). The Spearman correlation analysis showed that non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were significantly correlated with SYNTAX score (r = 0.081, P < 0.001; r = 0.216, P < 0.001). In multivariate logistic regression analysis showed that non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were independent predictors of coronary artery disease (odds ratio = 3.645, 95% confidence interval, 1.267-10.486; OR = 2.096, 95% confidence interval, 1.438-3.054). CONCLUSION Non-high-density lipoprotein cholesterol/apolipoprotein A-I and monocyte/high-density lipoprotein cholesterol ratio were associated with the severity of coronary artery lesions, which can be used as a biomarker for the evaluation of severity of coronary artery disease.
Collapse
|
21
|
Poudel I, Tejpal C, Rashid H, Jahan N. Major Adverse Cardiovascular Events: An Inevitable Outcome of ST-elevation myocardial infarction? A Literature Review. Cureus 2019; 11:e5280. [PMID: 31423405 PMCID: PMC6695291 DOI: 10.7759/cureus.5280] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
Major adverse cardiovascular events (MACE) remain the major cause of mortality and morbidity in patients with STEMI (ST-elevation myocardial infarction). The current literature is aimed to analyze the occurrence of MACE following STEMI irrespective of treatment provided, and follow up after the first diagnosis of STEMI. A PubMed search for Studies of STEMI identified 24,244 articles. After applying our inclusion/exclusion criteria, we found out 75 articles of relevance wherein MACE and its components were considered to be the primary endpoint. These 75 articles included eight Cohort Studies, 13 clinical trials including five randomized controlled trials (RCT), one case-control Study, one cross-sectional study, one review article, and 51 other observational studies. Our analysis shows that MACE remains one of the strongest adverse outcomes among STEMI patients. The current literature review found out the incidence of MACE was 4.2 % to 51% irrespective of the mode of treatment, and follow-ups lasting up to 10 years from the time of STEMI diagnosis.
Collapse
Affiliation(s)
- Ishan Poudel
- Internal Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Chavi Tejpal
- Family Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hamza Rashid
- Internal Medicine: Critical Care, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Nusrat Jahan
- Internal Medicine, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| |
Collapse
|
22
|
Su X, Luo M, Tang X, Luo Y, Zheng X, Peng D. Goals of non-high density lipoprotein cholesterol need to be adjusted in Chinese acute coronary syndrome patients: Findings from the CCC-ACS project. Clin Chim Acta 2019; 496:48-54. [PMID: 31255567 DOI: 10.1016/j.cca.2019.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Guidelines recommended non-high density lipoprotein cholesterol (non-HDL-C) as a co-primary target, and set non-HDL-C goals as 30 mg/dl higher than low-density lipoprotein cholesterol (LDL-C) goals. However, the value is largely uncertain in Chinese patients. METHODS We assigned non-HDL-C values at the same percentiles correspondent to LDL-C goals for patients from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) Project. We calculated the differences between non-HDL-C and LDL-C and proposed appropriate adding values according to LDL-C and TG concentrations. RESULTS Among 73,495 patients, 17.7% used lipid-lowering agents before admission. Of these, 27.2% achieved LDL-C <70 mg/dl while 39.4% achieved non-HDL-C <100 mg/dl. The mean difference between non-HDL-C and LDL-C was 23.2 mg/dl, which could be affected by LDL-C and TG concentrations. Importantly, of patients with LDL-C concentrations ≤100 mg/dl, the mean differences were 19.1 mg/dl in patients with TG ≤150 mg/dl and 24.6 mg/dl in patients with TG >150 mg/dl. CONCLUSIONS There are significant differences between LDL-C and non-HDL-C in Chinese ACS patients. For secondary prevention, on average, the adding values should be 20 mg/dl for patients with TG ≤150 mg/dl and 25 mg/dl for patients with TG >150 mg/dl when LDL-C goals of 70 mg/dl is achieved.
Collapse
Affiliation(s)
- Xin Su
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mengdie Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoyu Tang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yonghong Luo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoyan Zheng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Daoquan Peng
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | -
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| |
Collapse
|
23
|
Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: part A: mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment. J Hypertens 2019; 36:1427-1440. [PMID: 29634663 DOI: 10.1097/hjh.0000000000001730] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
: Obesity is a key factor for cardiovascular diseases and complications. Obesity is associated with hypertension, dyslipidemia and type II diabetes, which are the major predictors of cardiovascular disease in the future. It predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke that are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications.Epidemiology and mechanisms of obesity-induced hypertension, diabetes and dyslipidemia will be reviewed and the role of lifestyle modification and treatment strategies in obesity will be updated and analyzed. The best treatment options for people with obesity, hypertension, diabetes and dyslipidemia will discussed.
Collapse
|
24
|
Su X, Kong Y, Peng D. Evidence for changing lipid management strategy to focus on non-high density lipoprotein cholesterol. Lipids Health Dis 2019; 18:134. [PMID: 31170997 PMCID: PMC6554877 DOI: 10.1186/s12944-019-1080-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022] Open
Abstract
Low-density lipoprotein cholesterol (LDL-C) has been recommended as the primary treatment target on lipid management in coronary heart disease (CHD) patients for past several decades. However, even by aggressive LDL-C lowering treatment, patients still present a significant residual risk of major adverse cardiovascular events (MACE). Non-high-density lipoprotein cholesterol (non-HDL-C) contained all the atherogenic lipoproteins, such as chylomicron, very-low density lipoprotein (VLDL), LDL, intermediate density lipoprotein (IDL). Many prospective observation studies have found that non-HDL-C was better than LDL-C in predicting risks of MACE. Since non-HDL-C appears to be superior for risk prediction beyond LDL-C, current guidelines have emphasize the importance of non-HDL-C for guiding cardiovascular prevention strategies and have flagged non-HDL-C as a co-primary therapeutic target. The goals of non-HDL-C were recommended as 30 mg/dl higher than the corresponding LDL-C goals, but the value seemed inappropriate. This review provide evidence for changing lipid management strategy to focus on non-HDL-C and appropriate values for adding to LDL-C goals would be proposed.
Collapse
Affiliation(s)
- Xin Su
- Department of Cardiovascular Medicine, the Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Yi Kong
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Daoquan Peng
- Department of Cardiovascular Medicine, the Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Changsha, 410011, Hunan, China.
| |
Collapse
|
25
|
Kachekouche Y, Dali-Sahi M, Bendaoud R, Dennouni-Medjati N, Abderahim M. Predictive value of non-HDL cholesterol for cardiovascular disease in a population in far western Algeria with type 2 diabetes. Diabetes Metab Syndr 2019; 13:826-829. [PMID: 30641816 DOI: 10.1016/j.dsx.2018.12.002] [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: 11/14/2018] [Accepted: 12/07/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Non high density lipoprotein cholesterol (non-HDL-C) is a risk factor for cardiovascular disease (CVD) in people with type 2 diabetes. The aim of our study is to estimate the relative multivariate risk of non-HDL-C in the occurrence of CVD in a population in the extreme western Algeria with type 2 diabetes mellitus (T2DM). METHODS Our study was carried out in western Algeria on a population of 1111 subjects, 371 cardiopaths with T2DM and 740 controls. The biochemical balance was established using standard enzymatic procedures (SFBC or IFCC recommendations) on the Beckman CX7® PLC (Beckman-Coulter®, NY, USA). Information on the pathologies was collected by means of a questionnaire. RESULTS The logistic model retained the two levels of non-HDL-C: 130 mg/dl < non-HDL-C≤160 mg/dl (OR = 0.11; 95% CI = 0.03-0,47, P = 0.003) and 160 mg/dl < non-HDL-C≤190 mg/dl (OR = 5.02; 95% CI = 1.1-22.87, P = 0.037) and smoking (OR = 19.27; 95% CI = 3.39-109.63, P = 0.001), inbreeding (OR = 3.65; 95% CI = 1.12-11,85, P = 0.031) and the two age groups 60-70 years (OR = 2.36; 95% CI = 1.32-4.2, P<<0.01) and 70 years and over (OR = 2.26; 95% CI = 1.19-4.29, P<<0.05). CONCLUSIONS Non-HDL-C is a powerful risk factor for the occurrence of cardiovascular disease in type 2 diabetics in the extreme western Algeria.
Collapse
Affiliation(s)
- Youssouf Kachekouche
- Department of Biology, Analytical Chemistry and Electrochemistry Laboratory, University of Tlemcen, 13000, Algeria.
| | - Majda Dali-Sahi
- Department of Biology, Analytical Chemistry and Electrochemistry Laboratory, University of Tlemcen, 13000, Algeria
| | - Rachid Bendaoud
- Department of Biology, Analytical Chemistry and Electrochemistry Laboratory, University of Tlemcen, 13000, Algeria
| | - Nouria Dennouni-Medjati
- Department of Biology, Analytical Chemistry and Electrochemistry Laboratory, University of Tlemcen, 13000, Algeria
| | - Meziane Abderahim
- Department of Cardiology, University Hospital Center of Tlemcen, 13000, Algeria
| |
Collapse
|
26
|
Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile. J Pediatr (Rio J) 2019; 95:112-118. [PMID: 29306717 DOI: 10.1016/j.jped.2017.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess whether the indicators of weight status body mass index and waist-to-height ratio are similar to body fat percentage to identify obese children and adolescents with unfavorable lipid profile. METHODS This was a cross-sectional study involving 840 children and adolescents (6-18 years). The same individuals were classified as non-obese (<P95) or obese (≥P95) according to body fat percentage and indicators of weight status, body mass index, and waist-to-height ratio. Body fat percentage was obtained by multi-frequency bioelectrical impedance. Linear association between obesity and increased lipid fractions was tested by ANCOVA. Normal distribution curves of non-HDL cholesterol were designed for obese and non-obese. To provide the proportion of obese individuals with elevated non-HDL-c across all indicators, Z-score was calculated. RESULTS Obese boys presented higher non-HDL cholesterol when compared with those non-obese, classified by body mass index (107±28 vs. 94±25mg/dL, p=0.001), waist-to-height ratio (115±29 vs. 94±25mg/dL, p<0.001) and body fat percentage (119±33 vs. 94±24mg/dL, p<0.001). Differently, obese girls presented with higher non-HDL cholesterol when compared with those non-obese only according to the body fat percentage classification (118±24 vs. 96±26mg/dL, p=0.001). A large shift to the right in the distribution curve of non-HDL cholesterol among obese girls compared with non-obese was observed only when body fat percentage was used to discriminate between obese and non-obese. CONCLUSION Body fat percentage was better than the indicators of weight status to identify children and adolescents with unfavorable lipid profile, mainly among girls.
Collapse
|
27
|
Oliosa PR, Zaniqueli D, Alvim RDO, Barbosa MCR, Mill JG. Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
28
|
Cheng KH, Lin JR, Anderson CS, Lai WT, Lee TH. Lipid Paradox in Statin-Naïve Acute Ischemic Stroke But Not Hemorrhagic Stroke. Front Neurol 2018; 9:541. [PMID: 30210423 PMCID: PMC6124481 DOI: 10.3389/fneur.2018.00541] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Low lipid level is associated with better cardiovascular outcome. However, lipid paradox indicating low lipid level having worse outcomes could be seen under acute injury in some diseases. The present study was designed to clarify the prognostic significance of acute-phase lipid levels within 1 day after admission for stroke on mortality in first-ever statin-naïve acute ischemic stroke (IS) and hemorrhagic stroke (HS). Methods: This observational study was conducted using the data collected from Stroke Registry In Chang-Gung Healthcare System (SRICHS) between 2009 and 2012. Patients with recurrent stroke, onset of symptoms >1 day, and history of the use of lipid-lowering agents prior to index stroke were excluded. Stroke was classified into IS and hypertension-related HS. The primary outcomes were 30-day and 1-year mortality identified by linkage to national death registry for date and cause of death. Receiver operating characteristic (ROC) curve analysis and multivariate Cox proportional hazard models were used to examine the association of lipid profiles on admission with mortality. Results: Among the 18,268 admitted stroke patients, 3,746 IS and 465 HS patients were eligible for analysis. In IS, total cholesterol (TC) <163.5 mg/dL, triglyceride (TG) <94.5 mg/dL, low-density lipoprotein (LDL) <100 mg/dL, non-high-density lipoprotein cholesterol (non-HDL-C) <130.5 mg/dL, and TC/HDL ratio <4.06 had significantly higher risk for 30-day/1-year mortality with hazard ratio (HR) of 2.05/1.37, 1.65/1.31, 1.68/1.38, 1.80/1.41, and 1.58/1.38, respectively, compared with high TC, TG, LDL, non-HDL-C, and TC/HDL ratio (p < 0.01 in all cases). In HS, lipid profiles were not associated with mortality, except HDL for 30-day mortality (p = 0.025) and high uric acid (UA) concentrations for 30-day and 1-year mortality (p = 0.002 and 0.012, respectively). High fasting glucose and high National Institute of Health Stroke Scale (NIHSS) score at admission were associated with higher 30-day and 1-year mortality in both IS and HS and low blood pressure only in IS (p < 0.05). Synergic effects on mortality were found when low lipids were incorporated with high fasting glucose, low blood pressure, and high NIHSS score in IS (p < 0.05). Conclusions: Lipid paradox showing low acute-phase lipid levels with high mortality could be seen in statin-naïve acute IS but not in HS. The mortality in IS was increased when low lipids were incorporated with high fasting glucose, low blood pressure, and high NIHSS score.
Collapse
Affiliation(s)
- Kai-Hung Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Craig S Anderson
- Neurological and Mental Health Division, The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia.,Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | |
Collapse
|
29
|
Spigoni V, Aldigeri R, Antonini M, Micheli MM, Fantuzzi F, Fratter A, Pellizzato M, Derlindati E, Zavaroni I, Bonadonna RC, Dei Cas A. Effects of a New Nutraceutical Formulation (Berberine, Red Yeast Rice and Chitosan) on Non-HDL Cholesterol Levels in Individuals with Dyslipidemia: Results from a Randomized, Double Blind, Placebo-Controlled Study. Int J Mol Sci 2017; 18:ijms18071498. [PMID: 28704936 PMCID: PMC5535988 DOI: 10.3390/ijms18071498] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 06/29/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022] Open
Abstract
Increased non high-density lipoprotein (HDL)/low-density lipoprotein (LDL) cholesterol levels are independent risk factors for cardiovascular (CV) mortality with no documented threshold. A new combination of nutraceuticals (berberine 200 mg, monacolin K 3 mg, chitosan 10 mg and coenzyme Q 10 mg) with additive lipid-lowering properties has become available. The aim of the study is to test the efficacy of the nutraceutical formulation (one daily) in lowering non-HDL cholesterol vs. placebo at 12 weeks in individuals with non-HDL-cholesterol levels ≥160 mg/dL. 39 subjects (age 52 ± 11 years; 54% females; body mass index 27 ± 4 kg/m2) were randomized (3:1) in a double blind phase II placebo-controlled study. At baseline, 4 and 12 weeks main clinical/biohumoral parameters, pro-inflammatory cytokines, (gut)-hormones, proprotein convertase subtilisin/kexin type 9 (PCSK9) levels and endothelial progenitor cell (EPC) number were assessed. Baseline characteristics were comparable in the two groups. The intervention significantly decreased non-HDL cholesterol (−30 ± 20 mg/dL; p = 0.012), LDL cholesterol (−31 ± 18 mg/dL, p = 0.011) and apolipoprotein (Apo) B (−14 ± 12 mg/dL, p = 0.030) levels compared to the placebo. Pro-inflammatory, hormonal, PCSK9 and EPC levels remained stable throughout the study in both groups. The intervention was well tolerated. Three adverse events occurred: Epstein Barr virus infection, duodenitis and asymptomatic but significant increase in creatine phosphokinase (following intense physical exercise) which required hospitalization. The tested nutraceutical formulation may represent a possible therapeutic strategy in dyslipidemic individuals in primary prevention.
Collapse
Affiliation(s)
- Valentina Spigoni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
| | - Raffaella Aldigeri
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
| | - Monica Antonini
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy.
| | - Maria Maddalena Micheli
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy.
| | - Federica Fantuzzi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
| | - Andrea Fratter
- Nutraceutical Research and Innovation Technology, Labomar Research, Istrana, 31036 Treviso, Italy.
| | - Marzia Pellizzato
- Nutraceutical Formulation, Labomar Research, Istrana, 31036 Treviso, Italy.
| | - Eleonora Derlindati
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
| | - Ivana Zavaroni
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy.
| | - Riccardo C Bonadonna
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy.
| | - Alessandra Dei Cas
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, 43126 Parma, Italy.
| |
Collapse
|