Relation of serum total cholesterol and other factors to risk of cerebral infarction in Japanese men with hypercholesterolemia

Changes in the Gut Microbiota are Associated with Hypertension, Hyperlipidemia, and Type 2 Diabetes Mellitus in Japanese Subjects

The human gut microbiota is involved in host health and disease development. Therefore, lifestyle-related diseases such as hypertension (HT), hyperlipidemia (HL), and type 2 diabetes mellitus (T2D) may alter the composition of gut microbiota. Here, we investigated gut microbiota changes related to these diseases and their coexistence. This study involved 239 Japanese subjects, including healthy controls (HC). The fecal microbiota was analyzed through the isolation of bacterial genomic DNA obtained from fecal samples. Although there were no significant differences in the microbial structure between groups, there was a significant difference in the α-diversity between HC and the patients in whom two diseases coexisted. Moreover, Actinobacteria levels were significantly increased, whereas Bacteroidetes levels were significantly decreased in all disease groups. At the genus level, Bifidobacterium levels were significantly increased in the HL and T2D groups, as were those of Collinsella in all disease groups. In contrast, Alistipes levels were significantly lower in the HL group. Furthermore, metabolic enzyme families were significantly increased in all disease groups. Interestingly, the structure and function of the gut microbiota showed similar profiles in all the studied diseases. In conclusion, several changes in the structure of the gut microbiota are associated with T2D, HT, and HL in Japanese subjects.

Low density lipoprotein cholesterol values and outcome of stroke patients: influence of previous aspirin therapy

Background: The link between low-density lipoprotein cholesterol (LDL-C) and stroke risk remains controversial and few studies have evaluated the effect of LDL-C after stroke survival.Aims: We assessed the hypothesis proposing the effect of LDL-C on the outcome of stroke patients under the influence of previous Aspirin Therapy.Methods: Associations between LDL-C and outcomes. The effect of LDL cholesterol on stoke outcome was evaluated using Kaplan-Meier methodology, log-rank test, Cox proportional hazard models and Bootstrap Analysis.Results: In a cohort of 342 cases, we observed that among stroke patients with no record of previous aspirin therapy LDL-C levels within recommended range (nLDL-C) are associated to a poor overall survival on (p < 0.001, log-rank test) leading to a 4-fold increased mortality risk in both timeframes of 12 (HR 4.45, 95% CI 1.55-12.71; p = 0.004) or 24 months (HR 4.13, 95%CI 1.62-10.50;p = 0.003) after the first event of stroke. Moreover, modelling the risk of a second event after the first stroke in the timeframe of 24 months demonstrated a predictive capacity for nLDL-C plasmatic levels (HR 3.94, 95%CI 1.55-10.05; p = 0.004) confirmed by Bootstrap analysis (p = 0.003; 1000 replications). In a further step, the inclusion of LDL-C in simulating models equations to predict the risk of a second event in the timeframe of 12 months increased nearly 20% the predictive ability (c-index from 0.763 to 0.956).Conclusion: A worse outcome was seen in stroke patients with normal levels of LDLC, but this finding was restricted to patients not under previous aspirin therapy.

Serum cholesterol positively associated with oxidative DNA damage: a propensity score-matched analysis

Oxidative DNA damage pathogenically links to some major diseases. This study aimed to comprehensively assess the association between serum total cholesterol (TC) and oxidative DNA damage based on propensity score matching (PSM) method. A total of 407 participants chronically exposed to arsenic via drinking water from China were enrolled. Oxidative DNA damage was determined with urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG). Serum TC was classified into favourable TC (FTC, TC <5.18 mmol/L) and unfavourable TC (NFTC, TC ≥5.18 mmol/L) categories. Multivariable generalised linear regression model was applied to examine the association. Of 407 participants, 125 pairs with FTC and NFTC subjects were matched using PSM. Urinary 8-OHdG/creatinine levels in NFTC were significantly higher than those in FTC category (p = .002). As compared to the counterparts, additional adjusted log-transformed 8-OHdG/creatinine increase was observed in NFTC for unmatched (β = 0.12, p = .052) and matched (β = 0.17, p < .001) participants, respectively. We also detected obviously increased log-transformed urinary 8-OHdG/creatinine with per interquartile range raise of serum TC either in unmatched (β = 0.10, p = .007) or matched (β = 0.16, p = .003) subjects. In conclusion, serum TC was independently associated with oxidative DNA damage. Our findings provided new insights on the health promotion of lipids relevant to the early warning of diseases due to oxidative DNA damage.

Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis

BACKGROUND

Whether light-to-moderate alcohol consumption is protective against stroke, and whether any association differs by stroke type, is controversial. We conducted a meta-analysis to summarize the evidence from prospective studies on alcohol drinking and stroke types.

METHODS

Studies were identified by searching PubMed to September 1, 2016, and reference lists of retrieved articles. Additional data from 73,587 Swedish adults in two prospective studies were included. Study-specific results were combined in a random-effects model.

RESULTS

The meta-analysis included 27 prospective studies with data on ischemic stroke (25 studies), intracerebral hemorrhage (11 studies), and/or subarachnoid hemorrhage (11 studies). Light and moderate alcohol consumption was associated with a lower risk of ischemic stroke, whereas high and heavy drinking was associated with an increased risk; the overall RRs were 0.90 (95 % CI, 0.85-0.95) for less than 1 drink/day, 0.92 (95 % CI, 0.87-0.97) for 1-2 drinks/day, 1.08 (95 % CI, 1.01-1.15) for more than 2-4 drinks/day, and 1.14 (95 % CI, 1.02-1.28) for more than 4 drinks/day. Light and moderate alcohol drinking was not associated with any hemorrhagic stroke subtype. High alcohol consumption (>2-4 drinks/day) was associated with a non-significant increased risk of both hemorrhagic stroke subtypes, and the relative risk for heavy drinking (>4 drinks/day) were 1.67 (95 % CI, 1.25-2.23) for intracerebral hemorrhage and 1.82 (95 % CI, 1.18-2.82) for subarachnoid hemorrhage.

CONCLUSION

Light and moderate alcohol consumption was inversely associated only with ischemic stroke, whereas heavy drinking was associated with increased risk of all stroke types with a stronger association for hemorrhagic strokes.

Relationship between lumbar spinal stenosis and lifestyle-related disorders: a cross-sectional multicenter observational study

STUDY DESIGN

A cross-sectional multicenter observational study.

OBJECTIVE

To identify associations between lumbar spinal stenosis (LSS) and lifestyle-related diseases.

SUMMARY OF BACKGROUND DATA

Impaired blood flow as a result of arteriosclerosis facilitates degenerative changes in the spine. However, associations between LSS and lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) remain unclear.

METHODS

Participants comprised 526 patients diagnosed with LSS using the clinical diagnostic support tool and magnetic resonance imaging at 64 facilities. Data on 1218 males and 1636 females in the general population were selected from the 2006 National Health and Nutrition Survey as control data. We investigated the prevalence of lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) and levels of hemoglobin A1c, total cholesterol, and high-density lipoprotein cholesterol. LSS and control groups were divided into 4 subgroups by age (nonelderly, <70 yr old; elderly, ≥ 70 yr) and sex. Statistical analyses were performed to compare patients with LSS and the control group using the χ test or Fisher exact text. Values of P < 0.05 were considered statistically significant.

RESULTS

Among nonelderly patients, proportions of patients with hypertension and diabetes mellitus were higher in patients with LSS than in controls (P < 0.01 each). The proportion of patients with hemoglobin A1c was 6.1% or greater and higher for female patients with LSS than for female controls (P < 0.05). No significant difference in the proportion of patients with dyslipidemia was apparent between the LSS and control groups.

CONCLUSION

After adjusting for age and sex, this study revealed a close association between diabetes and hypertension in 50- to 69-year-old patients with LSS. Physicians should consider the possibility of concomitant hypertension or diabetes mellitus when examining 50- to 69-year-old patients with LSS.

Statin therapy in stroke prevention: a meta-analysis involving 121,000 patients

PURPOSE

More than 120,000 patients now have taken part in randomized trials evaluating statin therapy for stroke prevention. We aimed to conduct a comprehensive review of all randomized trials and determine the therapeutic potential of statins for all strokes.

METHODS

We searched 10 electronic databases (from inception to December 2006). We additionally contacted study authors and authors of previous reviews. We extracted data on study characteristics and outcomes related to all-cause mortality, all-stroke incidence, specific type of strokes, and cholesterol changes. We pooled data using a random-effects model and conducted meta-regression.

RESULTS

We included 42 trials assessing statin therapy for all-stroke prevention (n=121,285), resulting in a pooled relative risk (RR) of 0.84 (95% confidence interval [CI], 0.79-0.91). The pooled RR of statin therapy for all-cause mortality (n=116,080) was 0.88 (95% CI, 0.83-0.93). Each unit increase in low-density lipoprotein (LDL) resulted in a 0.3% increased RR of death (P=.02). Seventeen trials evaluated statins on cardiovascular death (n=57,599, RR 0.81, 95% CI, 0.74-0.90), and 11 evaluated nonhemorrhagic cerebrovascular events (n=58,604, RR 0.81, 95% CI, 0.69-0.94). Eleven trials reported hemorrhagic stroke incidence (total n=54,334, RR 0.94, 95% CI, 0.68-1.30) and 21 trials reported on fatal strokes (total n=82,278, RR 0.99, 95% CI, 0.80-1.21). Only one trial reported on statin therapy for secondary prevention.

CONCLUSIONS

Statin therapy provides high levels of protection for all-cause mortality and nonhemorrhagic strokes. This overview reinforces the need to consider prolonged statin treatment in patients at high risk of major vascular events, but caution remains for patients at risk of bleeds.

Plasma thrombomodulin, fibrinogen, and activity of tissue factor as risk factors for acute cerebral infarction

Several studies have indicated association between hematologic markers and increased risks of cerebrovascular disease, but few reports referred to their roles together. We studied plasma levels of 16 hematologic markers in 50 cases diagnosed as acute cerebral infarction (ACI) and 54 hospital control subjects. Plasma levels of thrombomodulin, fibrinogen, and activity of tissue factor (aTF) were significantly higher in cases than in control subjects (P < .001, P < .01, and P < .05, respectively). Multivariate logistic regression analysis showed that hypertension and high plasma levels of thrombomodulin, fibrinogen, and aTF were significantly associated with presence of ACI (odds ratio [OR], 143.74, P < .001; OR, 2.05, P < .05; OR, 2.09, P < .05; OR, 1.02, P < .05, respectively). Our findings indicate that hypertension and elevation of plasma thrombomodulin, fibrinogen, and aTF are independent risk factors for ACI.

Sex Difference in the Distribution of Atherosclerotic Risk Factors and Their Association With Peripheral Arterial Disease in Taiwanese Type 2 Diabetic Patients

BACKGROUND

There appear to be sex differences in the risk factors for peripheral arterial disease (PAD) in type 2 diabetic patients, but studies in Taiwanese patients have not been conducted.

METHODS AND RESULTS

A total of 610 (268 men, 342 women) Taiwanese patients aged 63.3+/-10.8 years were evaluated. PAD was diagnosed by an ankle - brachial index <0.9. Risk factors included age, sex, body mass index (BMI), waist circumference (WC), smoking, menopause, diabetes duration, hypertension, insulin therapy, systolic and diastolic blood pressures, fasting glucose, total cholesterol (TC), triglyceride (TG), high- (HDL-C) and low-density lipoprotein-cholesterol (LDL-C), apolipoproteins A1 (ApoA1) and B (ApoB) and uric acid (UA). When compared with the men, the women were significantly older and had longer duration, smaller WC, higher levels of systolic blood pressure, TC, TG, HDL-C, LDL-C, ApoA1 and ApoB, lower levels of UA, fewer smokers and more insulin users. Stepwise logistic regression showed age, BMI (inverse association) and systolic blood pressure as independent risk factors for men [respective odds ratios (OR): 1.080 (1.024-1.139), 0.832 (0.713-0.971) and 1.028 (1.005-1.051)]; and for women they were age, UA and insulin therapy [respective OR: 1.113 (1.056-1.173), 1.340 (1.101-1.630) and 4.173 (1.974-8.824).

CONCLUSIONS

PAD risk factors differ significantly between the sexes.

Prevalence of low HDL-cholesterol levels and associated factors among Koreans

BACKGROUND

Low levels of high-density lipoprotein cholesterol (HDL-C), as well as high levels of low-densi-ty lipoprotein cholesterol, play a crucial role in the development of cardiovascular disease, which has shown a remarkable increase in Korea.

METHOD AND RESULTS

Data were obtained from the 1998 Korean National Health and Nutrition Examination Survey, which was a cross-sectional national health survey. The total study population amounted to 7,300 individuals (3,283 men, 4,617 women), aged 18 years and older. The prevalence of low HDL-C levels, as proposed by National Cholesterol Education Program Adult Treatment Panel III or International Diabetes Federation, was 23.8% in men and 47.5% in women. After adjusting for independent variables, there was a greater risk of low HDL-C with an increased body mass index, abdominal obesity, cigarette smoking, and decreased alcohol consumption. Physically inactive lifestyle in men and low fat intake in women were identified as factors associated with low HDL-C level.

CONCLUSIONS

The prevalence of low HDL-C levels is relatively high among Koreans, which may have important implications for public health. Identified associated factors should be considered for reducing the risk of low HDL-C levels in Koreans.

Pravastatin Decreases Blood Pressure in Hypertensive and Hypercholesterolemic Patients Receiving Antihypertensive Treatment

BACKGROUND

Previous studies have suggested that the lipid-lowering agents, statins, may help reduce blood pressure (BP). The goal of the present study was to characterize the effect of pravastatin on BP in hypercholesterolemic and hypertensive patients already receiving antihypertensive drugs.

METHODS AND RESULTS

Eighty-two patients with hypercholesterolemia were retrospectively studied before and after 3 months of treatment with pravastatin. Forty-four patients had hypertension (HT group) and were receiving antihypertensive treatment, while the remaining 38 patients were normotensive (NT group). Patients in the HT group were further subdivided into those with uncontrolled or controlled BP. Pravastatin treatment significantly reduced systolic BP (SBP) in the HT group (134+/-16 to 130+/-13 mmHg, p<0.005) but not in the NT group (124+/-10 to 123+/-9 mmHg, p=0.52), despite the fact that treatment significantly reduced low-density lipoprotein cholesterol in both groups (HT group 178+/-27 to 132+/-17 mg/dl, p<0.0001; NT group 169+/-27 to 125+/-21 mg/dl, p<0.0001). Further, pravastatin significantly decreased SBP in the uncontrolled BP group (148+/-7 to 138+/-12 mmHg, p<0.005) but not in the controlled BP group (122+/-10 to 123+/-9 mmHg, p=0.72).

CONCLUSION

Concomitant use of statins and antihypertensive drugs could result in improved BP control in hypertensive patients with hypercholesterolemia.

Pharmacoeconomic Analysis of Cilostazol for the Secondary Prevention of Cerebral Infarction

BACKGROUND

The antiplatelet agent, cilostazol, is known to reduce the risk of subsequent cerebral infarction. However, the cost effectiveness of such treatment in comparison to aspirin has not been studied.

METHODS AND RESULTS

A Markov model was developed to calculate the health outcomes and associated costs for 65-year-old patients with cerebral infarction who were treated with 200 mg/day cilostazol or 81 mg/day aspirin. Cilostazol was more effective, but also more expensive than aspirin. Cilostazol would extend quality-adjusted life years (QALY) by 0.64, while increasing life-time costs by approximately Yen 1.1 million. The incremental cost-effectiveness ratio of cilostazol in comparison with aspirin was estimated to be Yen 1.8 million per QALY.

CONCLUSIONS

The use of cilostazol to prevent recurrence of cerebral infarction appears to be cost effective.

Large-scale cohort study on the relationship between serum lipid concentrations and risk of cerebrovascular disease under low-dose simvastatin in Japanese patients with hypercholesterolemia: sub-analysis of the Japan Lipid Intervention Trial (J-LIT)

BACKGROUND

The Japan Lipid Intervention Trial was a nationwide cohort study of 52,421 hypercholesterolemic patients treated with open-labeled simvastatin for 6 years under standard clinical practices. Cerebrovascular disease (CVD) is one of the leading causes of death in Japan, but the effect of hypercholesterolemia on CVD has not been well established in Japanese patients. This study aimed to determine the relationship between the risk of CVD and serum lipid concentrations during treatment in Japan.

METHODS AND RESULTS

Patients were treated with 5-10 mg/day of simvastatin and all, including those who discontinued simvastatin for any reason, had their lipid concentrations and incidence of CVD monitored for 6 years. Data of 41,088 patients were analyzed in this study, excluding those who had a history of coronary heart disease or CVD. The risk of cerebral infarction was higher in patients whose mean total cholesterol concentrations during treatment were > or = 240 mg/dl, low-density lipoprotein cholesterol concentrations > or = 160 mg/dl, triglycerides > or = 150 mg/dl and high-density lipoprotein cholesterol concentrations <40 mg/dl. There was no obvious correlation between cerebral hemorrhage and serum lipid concentrations.

CONCLUSION

Improvement of serum lipid concentrations is important for reducing the incidence of cerebral infarction.

Biphasic Effect of HMG-CoA Reductase Inhibitor, Pitavastatin, on Vascular Endothelial Cells and Angiogenesis

BACKGROUND

HMG-CoA reductase inhibitors (statins) have pleiotropic effects beyond their cholesterol-lowering effect. However, consensus on the effect of statins on endothelial cells and angiogenesis has not yet been reached.

METHODS AND RESULTS

The effects of pitavastatin on the migration, proliferation and viability of human epidermal microvessel endothelial cells (HMVECs) were examined using scratch assay, chemotaxis chamber, bromodeoxyuridine incorporation, trypan blue dye exclusion test, and nuclear DNA staining. Pitavastatin enhanced the migration, proliferation and viability of HMVECs at a low concentration (0.01 micromol/L) but inhibited them at high concentration (1 micromol/L). The inhibitory effect on cell viability by high concentration of pitavastatin was recovered by geranylgeranyl pyrophosphate, but the effect on migration and proliferation was not. The cell activating effect of a low concentration of pitavastatin was reversed by both farnesyl pyrophosphate and geranylgeranyl pyrophosphate. A quail chorioallantoic membrane assay showed that high concentration (1 micromol/L) of pitavastatin reduced fibroblast growth factor-2-induced angiogenesis, whereas low concentration (0.3 micromol/L) tended to increase angiogenesis.

CONCLUSION

Pitavastatin has a biphasic effect on HMVECs and on angiogenesis through at least 2 different pathways that include the mevalonate pathway.