Estimated sdLDL-C for predicting high-risk coronary plaque features in psoriasis: a prospective observational study

HDL-associated vitamin D binding protein levels are inversely associated with necrotic plaque burden in psoriasis

Background and aims

Vitamin D binding protein (DBP) serves a dual function as a vitamin D carrier and actin scavenger. Free DBP is present in high concentrations in serum, while a smaller pool is bound to lipoproteins like HDL and VLDL. The role of DBP's interaction with lipoproteins remains unclear. Given that HDL has been proposed to have both atheroprotective and anti-inflammatory properties, we sought to compare whether HDL-associated DBP and/or total serum DBP could serve as useful biomarkers for assessing disease severity in psoriasis and cardiovascular disease.

Methods

Psoriasis (PSO) patients (N = 83), which were part of a prospective, observational cohort and non-psoriasis (non-PSO) subjects (n = 35) underwent blood collection for HDL purification by liquid chromatography and CCTA scans to assess coronary plaque burden. Serum and HDL-bound DBP levels were measured by ELISA.

Results

The psoriasis cohort was middle-aged (mean ± IQR: 50 (38-59), predominantly male (n = 55, 66 %) and had moderate-to-severe skin disease [psoriasis area severity index score, PASI score, med (IQR): 9.6 (6-18.3)]. Consistent with our previous reports, PSO patients had significantly higher Framingham Risk Score (FRS), high sensitivity C-reactive protein (hs-CRP), Body Mass Index (BMI), insulin resistance (HOMA-IR) and total coronary plaque burden, driven by the rupture-prone non-calcified necrotic core. However, while the concentration of serum DBP (S-DBP) between PSO and non-PSO was unchanged (PSO: 177.80 (125.77-250.99) vs non-PSO: 177.74 (104.32-254.04), the concentration of DBP associated with HDL (HDL-DBP) was decreased in psoriatics (PSO μg/ml: 1.38 (0.64-2.75) vs non-PSO: 1.72 (1.18-3.90). Although both S-DBP and HDL-DBP levels showed inverse correlations with a measure of skin disease severity (PASI) (S-DBP, Rho = -0.022 vs HDL-DBP, Rho = -113), only HDL-DBP exhibited an inverse relationship with necrotic plaque burden [Rho -0.226, p = 0.085 vs S-DBP (0.041, p = 0.76)]. This relationship was strengthened after adjusting for traditional cardiovascular risk factors such as age and sex (β = -0.237, p = 0.045), FRS (β = -0.295, p = 0.033) and including biological treatment and HDL-cholesterol (β = -0.213, p = 0.048).

Conclusions

In conclusion, we found HDL-DBP levels may better capture the severity of psoriatic disease and association with cardiovascular risk factors than S-DBP.

Estimated small dense low-density lipoprotein-cholesterol and the risk of kidney and cardiovascular outcomes in diabetic kidney disease

AIMS

This study aimed to investigate the correlations between estimated small dense low-density lipoprotein-cholesterol (esd-LDL-c) and the development of end-stage kidney disease (ESKD), cardiovascular mortality, and all-cause mortality in individuals with diabetic kidney disease (DKD) or diabetes mellitus (DM) concomitant chronic kidney disease (CKD).

METHODS

We analyzed the data from a biopsy-proven DKD cohort conducted at West China Hospital of Sichuan University between 2009 and 2021 (the DKD cohort) and participants with DM and CKD in the National Health and Nutrition Examination Survey (NHANES) 2011-2014 (the NHANES DM-CKD cohort). Cox regression analysis was also used to estimate associations between esd-LDL-c and the incidence of ESKD, cardiovascular mortality, and all-cause mortality.

RESULTS

There were 175 ESKD events among 338 participants in the DKD cohort. Patients were divided into three groups based on esd-LDL-c tertiles (T1 < 33.7 mg/dL, T2 ≥ 33.7 mg/dL to <45.9 mg/dL, T3 ≥ 45.9 mg/dL). The highest tertile of esd-LDL-c was associated with ESKD (adjusted HR 2.016, 95% CI 1.144-3.554, p = .015). Furthermore, there were 99 deaths (39 cardiovascular) among 293 participants in the NHANES DM-CKD cohort. Participants were classified into three groups in line with the tertile values of esd-LDL-c in the DKD cohort. The highest tertile of esd-LDL-c was associated with cardiovascular mortality (adjusted HR 3.95, 95% CI 1.3-12, p = .016) and all-cause mortality (adjusted HR 2.37, 95% CI 1.06-5.32, p = .036).

CONCLUSIONS

Higher esd-LDL-c was associated with increased risk of ESKD in people with biopsy-proven DKD, and higher cardiovascular and all-cause mortality risk among those with DM-CKD.

Radical Oxygen Species, Oxidized Low-Density Lipoproteins, and Lectin-like Oxidized Low-Density Lipoprotein Receptor 1: A Vicious Circle in Atherosclerotic Process

Atherosclerosis is a complex condition that involves the accumulation of lipids and subsequent plaque formation in the arterial intima. There are various stimuli, cellular receptors, and pathways involved in this process, but oxidative modifications of low-density lipoprotein (ox-LDL) are particularly important in the onset and progression of atherosclerosis. Ox-LDLs promote foam-cell formation, activate proinflammatory pathways, and induce smooth-muscle-cell migration, apoptosis, and cell death. One of the major receptors for ox-LDL is LOX-1, which is upregulated in several cardiovascular diseases, including atherosclerosis. LOX-1 activation in endothelial cells promotes endothelial dysfunction and induces pro-atherogenic signaling, leading to plaque formation. The binding of ox-LDLs to LOX-1 increases the generation of reactive oxygen species (ROS), which can induce LOX-1 expression and oxidize LDLs, contributing to ox-LDL generation and further upregulating LOX-1 expression. This creates a vicious circle that is amplified in pathological conditions characterized by high plasma levels of LDLs. Although LOX-1 has harmful effects, the clinical significance of inhibiting this protein remains unclear. Further studies both in vitro and in vivo are needed to determine whether LOX-1 inhibition could be a potential therapeutic target to counteract the atherosclerotic process.

New Advances in Rapid Pretreatment for Small Dense LDL Cholesterol Measurement Using Shear Horizontal Surface Acoustic Wave (SH-SAW) Technology

Atherosclerosis is an inflammatory disease of the arteries associated with alterations in lipid and other metabolism and is a major cause of cardiovascular disease (CVD). LDL consists of several subclasses with different sizes, densities, and physicochemical compositions. Small dense LDL (sd-LDL) is a subclass of LDL. There is growing evidence that sd-LDL-C is associated with CVD risk, metabolic dysregulation, and several pathophysiological processes. In this study, we present a straightforward membrane device filtration method that can be performed with simple laboratory methods to directly determine sd-LDL in serum without the need for specialized equipment. The method consists of three steps: first, the precipitation of lipoproteins with magnesium harpin; second, the collection of effluent from a 100 nm filter; and third, the quantification of sd-LDL-ApoB in the effluent with an SH-SAW biosensor. There was a good correlation between ApoB values obtained using the centrifugation (y = 1.0411x + 12.96, r = 0.82, n = 20) and filtration (y = 1.0633x + 15.13, r = 0.88, n = 20) methods and commercially available sd-LDL-C assay values. In addition to the filtrate method, there was also a close correlation between sd-LDL-C and ELISA assay values (y = 1.0483x - 4489, r = 0.88, n = 20). The filtration treatment method also showed a high correlation with LDL subfractions and NMR spectra ApoB measurements (y = 2.4846x + 4.637, r = 0.89, n = 20). The presence of sd-LDL-ApoB in the effluent was also confirmed by ELISA assay. These results suggest that this filtration method is a simple and promising pretreatment for use with the SH-SAW biosensor as a rapid in vitro diagnostic (IVD) method for predicting sd-LDL concentrations. Overall, we propose a very sensitive and specific SH-SAW biosensor with the ApoB antibody in its sensitive region to monitor sd-LDL levels by employing a simple delay-time phase shifted SH-SAW device. In conclusion, based on the demonstration of our study, the SH-SAW biosensor could be a strong candidate for the future measurement of sd-LDL.

Prospective evaluation of cardiovascular risk and mortality in patients with psoriasis: An American population-based study

The association between psoriasis and cardiovascular disease (CVD) has long been discussed and continually refined. However, there is currently a lack of prospective studies on the cardiovascular risk attributed to psoriasis in the United States general population. Representative adult participants were selected from the National Health and Nutrition Examination Survey (NHANES). Risks of cardiovascular symptoms and diseases prevalence were evaluated between participants with and without psoriasis. The hazards for all-cause mortality and CVD mortality were stratified by psoriasis status. Mediation analysis was then conducted to identify potential mediators between psoriasis and cardiac death. Overall, 19 741 participants were included in the current study, 542 (2.7%) had psoriasis and 19 199 (97.3%) did not have psoriasis. After adjusting for known CVD risk factors, odds for hypertension (OR = 1.37, 95% CI: 1.13-1.66, p = 0.001), hypercholesterolemia (OR = 1.37, 95% CI: 1.13-1.64, p < 0.001) and angina pectoris (OR = 1.74, 95% CI: 1.11-2.60, p = 0.011) were higher in psoriasis patients. Compared with participants without psoriasis, moderate/severe but not mild patients showed significantly higher CVD mortality (HR = 2.55, 95% CI: 1.27-5.15, p = 0.009). This result was supported by subgroup analyses. Mediation analysis further suggested that the direct effect of moderate/severe psoriasis on CVD mortality accounted for 81.4% (65.8%-97.1%). Besides, the indirect effect might derive from disturbance of serum albumin, urea nitrogen and uric acid. Moderate-to-severe psoriasis is an independent risk factor for cardiovascular disease, making it necessary to regularly conduct cardiovascular disease-related examinations for patients with higher severity of psoriasis in clinical settings.

Comparative predictive efficacy of atherogenic indices on metabolic syndrome in patients with schizophrenia

BACKGROUND

Schizophrenia patients endure high risks of metabolic syndrome and related cardiovascular mortality. Evidence on comparing detective power among atherogenic indices of the metabolic syndrome in schizophrenia patients with antipsychotics treatment is still lacking.

METHOD

We recruited 128 schizophrenia patients and collected blood samples to determine plasma levels of fasting glucose, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol. Five components of metabolic syndrome were assessed. Atherogenic indices, such as atherogenic index of plasma (AIP), atherogenic coefficient (AC), Castelli's risk index-I (CRI-I) and Castelli's risk index-II (CRI-II), were calculated. The area under the receiver operating characteristics curve (AUC) and regression analysis were adopted to compare the detective power of each atherogenic index for metabolic syndrome. The optimal cutoff points using maximization of Youden's index and the positive likelihood ratios were calculated.

RESULTS

51 (39.8 %) had metabolic syndrome. AIP (0.2 ± 0.2 vs. 0.6 ± 0.2), AC (2.5 ± 0.9 vs. 3.4 ± 0.9), CRI-I (3.5 ± 0.9 vs. 4.4 ± 0.9,) and CRI-II (2.1 ± 0.7 vs. 2.6 ± 0.7) were higher in the group with metabolic syndrome (all p < 0.001). AIP had the highest AUC (0.845, 95 % CI: 0.770, 0.920). The optimal cut-off point of AIP to predict metabolic syndrome was 0.4 with the corresponding sensitivity 83.7 %, specificity 80.3 %, and positive likelihood ratio 4.2. Regression analysis revealed that only AIP significantly correlated with the metabolic syndrome (p < 0.001).

CONCLUSION

Among atherogenic indices, only AIP has superior discrimination for detecting metabolic syndrome in schizophrenia with antipsychotics treatment.

Novel Biomarkers for Atherosclerotic Disease: Advances in Cardiovascular Risk Assessment

Atherosclerosis is a significant health concern with a growing incidence worldwide. It is directly linked to an increased cardiovascular risk and to major adverse cardiovascular events, such as acute coronary syndromes. In this review, we try to assess the potential diagnostic role of biomarkers in the early identification of patients susceptible to the development of atherosclerosis and other adverse cardiovascular events. We have collected publications concerning already established parameters, such as low-density lipoprotein cholesterol (LDL-C), as well as newer markers, e.g., apolipoprotein B (apoB) and the ratio between apoB and apoA. Additionally, given the inflammatory nature of the development of atherosclerosis, high-sensitivity c-reactive protein (hs-CRP) or interleukin-6 (IL-6) are also discussed. Additionally, newer publications on other emerging components linked to atherosclerosis were considered in the context of patient evaluation. Apart from the already in-use markers (e.g., LDL-C), emerging research highlights the potential of newer molecules in optimizing the diagnosis of atherosclerotic disease in earlier stages. After further studies, they might be fully implemented in the screening protocols.