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Wang Z, Barinas-Mitchell E, Brooks MM, Crawford SL, Leis AM, Derby CA, Thurston RC, Hedderson MM, Janssen I, Jackson EA, McConnell DS, El Khoudary SR. HDL-C criterion of the metabolic syndrome and future diabetes and atherosclerosis in midlife women: The SWAN Study. Am J Prev Cardiol 2024; 19:100687. [PMID: 39070021 PMCID: PMC11279330 DOI: 10.1016/j.ajpc.2024.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/21/2024] [Accepted: 06/12/2024] [Indexed: 07/30/2024] Open
Abstract
Objective High-density lipoprotein cholesterol (HDL-C) is one of 5 components [high blood pressure, glucose, triglycerides, waist circumference, low HDL-C], 3 of which, needed to diagnose metabolic syndrome (MetS). Evolving research shows that higher HDL-C is not necessarily cardioprotective in midlife women, supporting a need to re-evaluate HDL-C's contribution to risks related to MetS. We tested whether risk of future diabetes and higher carotid intima-media thickness (cIMT) differ by HDL-C status in midlife women diagnosed with MetS based on the other 4 components. Methods Midlife women were classified into 3 groups 1) no MetS, 2) MetS with HDL-C ≥ 50 mg/dL (MetS hiHDL), and 3) MetS with HDL-C < 50 mg/dL (MetS loHDL). cIMT was measured 13.8 ± 0.6 years post baseline. Incident diabetes was assessed yearly. Results Among 2773 women (1350 (48 %) of them had cIMT), 2383 (86 %) had no MetS, 117 (4 %) had MetS hiHDL, 273 (10 %) had MetS loHDL. Compared with no MetS, both MetS- hiHDL and loHDL groups had higher cIMT and diabetes risk. Risk of having high cIMT did not differ between MetS loHDL vs. hiHDL groups. Adjusting for levels of MetS criteria other than HDL-C at baseline explained the associations of each of the two MetS groups with cIMT. Conversely, after adjustment, associations of MetS hiHDL and MetS loHDL with incident diabetes persisted. Conclusions In midlife women, HDL-C status matters for predicting risk of incident diabetes but not higher cIMT beyond other MetS components.
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Affiliation(s)
- Ziyuan Wang
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh PA, USA
| | - Emma Barinas-Mitchell
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh PA, USA
| | - Maria M. Brooks
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh PA, USA
| | - Sybil L. Crawford
- Tan Chingfen Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Aleda M. Leis
- Department of Epidemiology, The University of Michigan, Ann Arbor, MI, USA
| | - Carol A. Derby
- Departments of Neurology, and of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rebecca C. Thurston
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA
| | - Imke Janssen
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Elizabeth A. Jackson
- Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Samar R. El Khoudary
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh PA, USA
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Lee J, Gilliland TC, Dron J, Koyama S, Nakao T, Lannery K, Wong M, Peloso GM, Hornsby WE, Natarajan P. Integrative Metabolomics Differentiate Coronary Artery Disease, Peripheral Artery Disease, and Venous Thromboembolism Risks. Arterioscler Thromb Vasc Biol 2024; 44:2108-2117. [PMID: 39051123 PMCID: PMC11335080 DOI: 10.1161/atvbaha.124.321282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Arterial and venous cardiovascular conditions, such as coronary artery disease (CAD), peripheral artery disease (PAD), and venous thromboembolism (VTE), are genetically correlated. Interrogating underlying mechanisms may shed light on disease mechanisms. In this study, we aimed to identify (1) epidemiological and (2) causal, genetic relationships between metabolites and CAD, PAD, and VTE. METHODS We used metabolomic data from 95 402 individuals in the UK Biobank, excluding individuals with prevalent cardiovascular disease. Cox proportional-hazards models estimated the associations of 249 metabolites with incident disease. Bidirectional 2-sample Mendelian randomization (MR) estimated the causal effects between metabolites and outcomes using genome-wide association summary statistics for metabolites (n=118 466 from the UK Biobank), CAD (n=184 305 from CARDIoGRAMplusC4D 2015), PAD (n=243 060 from the Million Veterans Project), and VTE (n=650 119 from the Million Veterans Project). Multivariable MR was performed in subsequent analyses. RESULTS We found that 196, 115, and 74 metabolites were associated (P<0.001) with CAD, PAD, and VTE, respectively. Further interrogation of these metabolites with MR revealed 94, 34, and 9 metabolites with potentially causal effects on CAD, PAD, and VTE, respectively. There were 21 metabolites common to CAD and PAD and 4 common to PAD and VTE. Many putatively causal metabolites included lipoprotein traits with heterogeneity across different sizes and lipid subfractions. Small VLDL (very-low-density lipoprotein) particles increased the risk for CAD while large VLDL particles decreased the risk for VTE. We identified opposing directions of CAD and PAD effects for cholesterol and triglyceride concentrations within HDLs (high-density lipoproteins). Subsequent sensitivity analyses including multivariable MR revealed several metabolites with robust, potentially causal effects of VLDL particles on CAD. CONCLUSIONS While common vascular conditions are associated with overlapping metabolomic profiles, MR prioritized the role of specific lipoprotein species for potential pharmacological targets to maximize benefits in both arterial and venous beds.
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Affiliation(s)
- Jiwoo Lee
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (J.L., T.C.G., J.D., S.K., T.N., W.E.H., P.N.)
| | - Thomas C. Gilliland
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (J.L., T.C.G., J.D., S.K., T.N., W.E.H., P.N.)
| | - Jacqueline Dron
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (J.L., T.C.G., J.D., S.K., T.N., W.E.H., P.N.)
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.L., T.C.G., J.D., T.N., K.L., M.W., W.E.H., P.N.)
| | - Satoshi Koyama
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (J.L., T.C.G., J.D., S.K., T.N., W.E.H., P.N.)
| | - Tetsushi Nakao
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.L., T.C.G., J.D., T.N., K.L., M.W., W.E.H., P.N.)
| | - Kim Lannery
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.L., T.C.G., J.D., T.N., K.L., M.W., W.E.H., P.N.)
| | - Megan Wong
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.L., T.C.G., J.D., T.N., K.L., M.W., W.E.H., P.N.)
| | - Gina M. Peloso
- Department of Biostatistics, Boston University School of Public Health, MA (G.M.P.)
| | - Whitney E. Hornsby
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (J.L., T.C.G., J.D., S.K., T.N., W.E.H., P.N.)
| | - Pradeep Natarajan
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA (J.L., T.C.G., J.D., S.K., T.N., W.E.H., P.N.)
- Department of Medicine, Harvard Medical School, Boston, MA (P.N.)
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Wong CL, Hung LY, Siu WKC, Tam VHK, Mak CM. A novel splicing variant in ABCA1 in the first reported Hong Kong Chinese patient with high-density lipoprotein deficiency. Endocrinol Diabetes Metab Case Rep 2024; 2024:23-0102. [PMID: 39096933 PMCID: PMC11301564 DOI: 10.1530/edm-23-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 07/10/2024] [Indexed: 08/05/2024] Open
Abstract
Summary Low high-density lipoprotein cholesterol (HDL-C) is a risk factor for cardiovascular disease. Very low HDL-C levels (less than 20 mg/dL), however, were uncommonly seen and can be due to genetic defects involving the metabolic pathway of high-density lipoprotein (HDL). We encountered a 50-year-old Chinese man who was only noticed to have extremely low HDL-C levels after surviving recurrent episodes of myocardial infarction. Further workup revealed the undetectable level of apolipoprotein A-I, the absence of HDL on gel electrophoresis, and a novel heterozygous splicing variant in the ABCA1 gene, which was predicted to be pathogenic by in silico analysis. To the best of our knowledge, this is the first reported Hong Kong Chinese with ABCA1 deficiency and probable Tangier disease. The association of ABCA1 deficiency/Tangier disease and accelerated atherosclerosis is discussed. Learning points Clinicians should be aware of the differential diagnoses of very low HDL-C, which could be divided into genetic and acquired causes. Genetic low HDL syndromes include apoA-I deficiency, Tangier disease, and familial LCAT deficiency, each of which has characteristic clinical features and can be differentiated from the other further by apoA-I measurement, lipoprotein analysis, and genetic testing. Patients with ABCA1 deficiency and Tangier disease are at risk of premature coronary artery disease and should be aggressively screened and treated for cardiovascular risk factors and established cardiovascular diseases. Revascularization strategy and indications for coronary artery bypass grafting in patients with Tangier disease and coronary artery disease follow that as for patients without Tangier disease.
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Affiliation(s)
- Cheuk Lik Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Hong Kong
| | - Ling Yin Hung
- Department of Pathology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - Wai Kwan Carol Siu
- Department of Pathology, Princess Margaret Hospital, Laichikok, Hong Kong
| | - Vicki Ho Kee Tam
- Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Hong Kong
| | - Chloe Miu Mak
- Department of Pathology, Princess Margaret Hospital, Laichikok, Hong Kong
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Zhang H, Xu Y, Xu Y. The association of the platelet/high-density lipoprotein cholesterol ratio with self-reported stroke and cardiovascular mortality: a population-based observational study. Lipids Health Dis 2024; 23:121. [PMID: 38659020 PMCID: PMC11040779 DOI: 10.1186/s12944-024-02115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Previous studies have shown that the relationship between high-density lipoprotein cholesterol (HDL-C) and stroke is controversial, and the association between the platelet/high-density lipoprotein cholesterol ratio (PHR), a novel marker for inflammation and hypercoagulability states, and stroke has not been established. METHODS This study presents an analysis of cross-sectional data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Stroke history, HDL-C levels, and platelet counts were obtained during cross-sectional surveys. The PHR was calculated as the ratio of the number of platelets to HDL-C concentration. Weighted logistic regression was used to assess the associations of HDL-C and the PHR with stroke. Nonlinearity of this relationship was determined through restricted cubic splines (RCSs) and two-piecewise linear regression for identifying inflection points. Furthermore, Cox regression was utilized to prospectively analyze the associations of the PHR and HDL-C concentration with cardiovascular disease (CVD) mortality in stroke survivors. RESULTS A total of 27,301 eligible participants were included in the study; mean age, 47.28 years and 50.57% were female, among whom 1,040 had a history of stroke. After full adjustment, the odds ratio (OR) of stroke associated with a per standard deviation (SD) increase in the PHR was estimated at 1.13 (95% confidence interval (CI): 1.03 - 1.24, P = 0.01), and the OR of stroke associated with a per SD increase in HDL-C was 0.95 (95% CI: 0.86-1.05, P = 0.30). The RCS indicated a nonlinear relationship for both variables (PPHR = 0.018 and PHDL-C = 0.003), and further piecewise linear regression identified inflection points at PHR = 223.684 and HDL-C = 1.4 mmol/L. Segmental regression indicated that in the PHR ≥ 223.684 segment, the estimated OR of stroke associated with a per-SD increase in the PHR was 1.20 (95% CI: 1.09 - 1.31, P < 0.001), while the association of stroke with HDL-C was not significant before or after the inflection point (P > 0.05). Furthermore, Cox regression and RCS showed that a per-SD increase in the PHR was linearly associated with a greater risk of CVD mortality among stroke survivors (HR: 1.14, 95% CI: 1.06 - 1.22, P < 0.001; nonlinear, P = 0.956), while HDL-C was not significantly associated with CVD mortality. CONCLUSION The association between the PHR and stroke incidence exhibited a significant threshold effect, with an inflection point at 223.684. A PHR exceeding 223.684 was positively associated with stroke, while the association between HDL-C and stroke was not significant. Additionally, the PHR was positively and linearly associated with CVD mortality among stroke survivors.
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Affiliation(s)
- Huifeng Zhang
- Department of Cardiovascular, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, No. 24, Jinghua Road, Jianxi District, Luoyang City, Henan Province, China.
| | - Ying Xu
- Department of Hematology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yaying Xu
- Department of Endocrinology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Baluku JB, Nalwanga R, Kazibwe A, Olum R, Nuwagira E, Mugenyi N, Mulindwa F, Bongomin F. Association between biomarkers of inflammation and dyslipidemia in drug resistant tuberculosis in Uganda. Lipids Health Dis 2024; 23:65. [PMID: 38429714 PMCID: PMC10905847 DOI: 10.1186/s12944-024-02063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Active tuberculosis (TB) significantly increases the risk of cardiovascular disease, but the underlying mechanisms remain unclear. This study aimed to investigate the association between inflammation biomarkers and dyslipidemia in patients with drug-resistant TB (DR-TB). METHODS This was a secondary analysis of data from a cross-sectional multi-center study in Uganda conducted 2021. Participants underwent anthropometric measurements and laboratory tests included a lipid profile, full haemogram and serology for HIV infection. Dyslipidemia was defined as total cholesterol > 5.0 mmol/l and/or low-density lipoprotein cholesterol > 4.14 mmol/l, and/or triglycerides (TG) ≥ 1.7 mmol/l, and/or high density lipoprotein cholesterol (HDL-c) < 1.03 mmol/l for men and < 1.29 mmol/l for women. Biomarkers of inflammation were leukocyte, neutrophil, lymphocyte, monocyte, and platelet counts, as well as neutrophil/lymphocyte (NLR), platelet/lymphocyte, and lymphocyte/monocyte (LMR) ratios, mean corpuscular volume (MCV), and the systemic immune inflammation index (SII) (neutrophil × platelet/lymphocyte). Modified Poisson Regression analysis was used for determining the association of the biomarkers and dyslipidemia. RESULTS Of 171 participants, 118 (69.0%) were co-infected with HIV. The prevalence of dyslipidemia was 70.2% (120/171) with low HDL-c (40.4%, 69/171) and hypertriglyceridemia (22.5%, 38/169) being the most common components. Patients with dyslipidemia had significantly higher lymphocyte (P = 0.008), monocyte (P < 0.001), and platelet counts (P = 0.014) in addition to a lower MCV (P < 0.001) than those without dyslipidemia. Further, patients with dyslipidemia had lower leucocyte (P < 0.001) and neutrophil (P = 0.001) counts, NLR (P = 0.008), LMR (P = 0.006), and SII (P = 0.049). The MCV was inversely associated with low HDL-C (adjusted prevalence ratio (aPR) = 0.97, 95% CI 0.94-0.99, P = 0.023) but was positively associated with hypertriglyceridemia (aPR = 1.04, 95% CI 1.00-1.08, P = 0.052). CONCLUSIONS Individuals with dyslipidemia exhibited elevated lymphocyte, monocyte, and platelet counts compared to those without. However, only MCV demonstrated an independent association with specific components of dyslipidemia. There is need for further scientific inquiry into the potential impact of dyslipidemia on red cell morphology and a pro-thrombotic state among patients with TB.
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Affiliation(s)
- Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | | | | | - Ronald Olum
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edwin Nuwagira
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nathan Mugenyi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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6
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Dunne S, Gibney ER, McGillicuddy FC, Feeney EL. The effects of saturated fat intake from dairy on CVD markers: the role of food matrices. Proc Nutr Soc 2024:1-9. [PMID: 38316603 DOI: 10.1017/s0029665124000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
CVD is the leading cause of death worldwide, and is commonly associated with modifiable risk factors. Most studies to date examining link between food intake and risk of CVD, have focused on modulation of plasma cholesterol concentrations (total cholesterol (TC), LDL-C). However, recent studies suggest LDL particle size is a more sensitive risk marker for CVD with smaller, dense LDL particles reported as more atherogenic than larger, more buoyant LDL. Although dietary guidelines recommend SFA intake of < 10 % of total energy, this does not consider food source, with recent evidence suggesting differing, sometimes beneficial, lipid responses following consumption of SFA from dairy compared to other food sources. This may be from differences in the physical food matrices, the nutrient content of the foods, and/or how these components interact with each other, described as a 'dairy matrix effect'. Dietary fat not only raises LDL-C, but also HDL cholesterol (HDL-C), associated with reduced CVD risk. HDL particles are complex emulsions of lipids, proteins and microRNAs that exhibit atheroprotective properties. In addition, HDL particles exhibit a very heterogeneous proteomic composition, dependent on a person's disease state - with a more pro-inflammatory proteome evident in patients with established CVD. This review will discuss the evidence to date on the importance of the food matrix in modulating response to dietary SFA and impact on CVD risk factors. A focus on potential biomarker properties of lipoprotein particles beyond cholesterol and current use of such biomarkers in human nutrition research will be considered.
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Affiliation(s)
- Simone Dunne
- Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
- UCD Institute for Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Eileen R Gibney
- Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
- UCD Institute for Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Fiona C McGillicuddy
- UCD Diabetes Complications Research Centre, University College Dublin, Dublin 4, Republic of Ireland
| | - Emma L Feeney
- Food for Health Ireland, University College Dublin, Dublin 4, Republic of Ireland
- UCD Institute for Food and Health, University College Dublin, Dublin 4, Republic of Ireland
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7
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Lippman D, Stump M, Veazey E, Guimarães ST, Rosenfeld R, Kelly JH, Ornish D, Katz DL. Foundations of Lifestyle Medicine and its Evolution. Mayo Clin Proc Innov Qual Outcomes 2024; 8:97-111. [PMID: 38304165 PMCID: PMC10831813 DOI: 10.1016/j.mayocpiqo.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Lifestyle Medicine (LM) is a rapidly growing discipline that focuses on the role of lifestyle factors in preventing, managing, and reversing chronic disease. At this point in the field's evolution, there is strong evidence that the 6 pillars of LM-a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections-are central in the creation and maintenance of health. Previous publications, many of them randomized controlled studies and meta-analyses, have solidified the evidence base for the use of the 6 pillars within the field of LM. As data emerged, so did its governing body, the American College of Lifestyle Medicine (ACLM), and with it a rich history began to unfold. Several articles have been written on the early history of the ACLM and the growth of the field; however, this review article explores the history and foundation of LM, aiming to provide a comprehensive understanding of its relevance and impact on health care. It underscores landmark studies that have defined the field and provides a road map detailing national and global barriers and areas of potential future growth.
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Affiliation(s)
| | - Mariah Stump
- Warren Alpert Medical School, Brown University, Providence, RI
| | - Erica Veazey
- St. Mark’s Family Medicine Residency, Salt Lake City, UT
| | | | - Richard Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - John H. Kelly
- American College of Lifestyle Medicine, Chesterfield, MO
| | - Dean Ornish
- Preventive Medicine Research Institute, University of California, San Francisco, CA
| | - David L. Katz
- American College of Lifestyle Medicine, Chesterfield, MO
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8
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Perswani P, Ismail SM, Mumtaz H, Uddin N, Asfand M, Khalil ABB, Ijlal A, Khan SE, Usman M, Younas H, Rai A. Rethinking HDL-C: An In-Depth Narrative Review of Its Role in Cardiovascular Health. Curr Probl Cardiol 2024; 49:102152. [PMID: 37852560 DOI: 10.1016/j.cpcardiol.2023.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
The interplay between HDL-C and LDL levels are closely intertwined with the cardiovascular system. High-Density Lipoprotein Cholesterol (HDL-C) is a well-known biomarker traditionally being interpreted as higher the HDL-C levels, minimal the risk of adverse cardiovascular disease (CVD) outcomes. However, recent research has unveiled a more complex relationship between HDL-C levels and cardiovascular outcomes, including genetic influences and potential risks associated with extremely high HDL-C levels. Intriguingly, extremely high HDL-C levels have been linked to unexpected cardiovascular risks. Up To date research suggests that individuals with genetically linked ultra-high HDL-C levels may depict an increased susceptibility to CVD, challenging the conventional realm that higher HDL-C is always beneficial. The mechanisms underlying this mystery are not fully understood but may involve HDL particle functionality and composition. In a nutshell, the relationship between HDL-C levels and cardiovascular outcomes is multifactorial. While low HDL-C remains a recognized risk factor for CVD, the genetic determinants of HDL-C levels add complexity to this association. Furthermore, extremely high HDL-C levels may not exhibit the expected protective benefits and may even pose unprecedented cardiovascular risks. A comprehensive understanding of these dynamics is essential for advancing our knowledge of CVD risk assessment and developing targeted therapeutic interventions. Further studies are needed to unravel the intricacies of HDL-C's role in cardiovascular health and disease.
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Affiliation(s)
| | | | - Hassan Mumtaz
- Care Coordinator: Association for Social Development, Islamabad, Pakistan; International Practitioner: Faculty of Public Health UK.
| | - Naseer Uddin
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | | | | | - Aisha Ijlal
- South City Institute of physical therapy and rehabilitation, Karachi.
| | - Shaheer Ellahi Khan
- Associate Professor of Public Health: Health services Academy, Islamabad, Pakistan; Adjunct Professor: Dala Lana School Of Public Health, University of Toronto, Canada.
| | | | - Hadia Younas
- Services institute of medical Sciences, Lahore, Pakistan.
| | - Anushree Rai
- Govt. Chhattisgarh institute of Medical sciences, Bilaspur, Chhattisgarh, India.
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9
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Razavi AC, Jain V, Grandhi GR, Patel P, Karagiannis A, Patel N, Dhindsa DS, Liu C, Desai SR, Almuwaqqat Z, Sun YV, Vaccarino V, Quyyumi AA, Sperling LS, Mehta A. Does Elevated High-Density Lipoprotein Cholesterol Protect Against Cardiovascular Disease? J Clin Endocrinol Metab 2024; 109:321-332. [PMID: 37437107 PMCID: PMC11032254 DOI: 10.1210/clinem/dgad406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/15/2023] [Accepted: 07/07/2023] [Indexed: 07/14/2023]
Abstract
High-density lipoprotein (HDL) contributes to reverse cholesterol transport, which is 1 of the main explanations for the described inverse association between HDL-cholesterol (HDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk. However, efforts to therapeutically raise HDL-C levels with niacin, fibrates, or cholesteryl ester transfer protein inhibitors have not demonstrated a reduction in ASCVD events when compared with placebo among individuals treated with statins. Furthermore, mendelian randomization studies suggest that HDL-C is unlikely to be a direct biologic variable impacting ASCVD risk. More recently, observations from well-conducted epidemiologic studies have indicated a nonlinear U-shaped relationship between HDL-C and subclinical atherosclerosis, and that very high HDL-C (≥80 mg/dL in men, ≥100 mg/dL in women) is paradoxically associated with higher all-cause and ASCVD-related mortality. These observations suggest that HDL-C is not a universal protective factor for atherosclerosis. Thus, there are several opportunities for reframing the contribution of HDL-C to ASCVD risk and related clinical calculators. Here, we examine our growing understanding of HDL-C and its role in ASCVD risk assessment, treatment, and prevention. We discuss the biological functions of HDL-C and its normative values in relation to demographics and lifestyle markers. We then summarize original studies that observed a protective association between HDL-C and ASCVD risk and more recent evidence indicating an elevated ASCVD risk at very high HDL-C levels. Through this process, we advance the discussion regarding the future role of HDL-C in ASCVD risk assessment and identify knowledge gaps pertaining to the precise role of HDL-C in atherosclerosis and clinical ASCVD.
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Affiliation(s)
- Alexander C Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Vardhmaan Jain
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Gowtham R Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Parth Patel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Angelos Karagiannis
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nidhi Patel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Devinder S Dhindsa
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Chang Liu
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Shivang R Desai
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Zakaria Almuwaqqat
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Yan V Sun
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA 30322, USA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Anurag Mehta
- Virginia Commonwealth University Health Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
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10
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Chehab O, Akl E, Abdollahi A, Zeitoun R, Ambale-Venkatesh B, Wu C, Tracy R, Blumenthal RS, Post WS, Lima JAC, Rodriguez A. Higher HDL cholesterol levels are associated with increased markers of interstitial myocardial fibrosis in the MultiEthnic Study of Atherosclerosis (MESA). Sci Rep 2023; 13:20115. [PMID: 37978334 PMCID: PMC10656454 DOI: 10.1038/s41598-023-46811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease (CVD) outcomes. Yet, there is no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association between HDL-C levels with interstitial myocardial fibrosis (IMF) and myocardial scar measured by CMR T1-mapping and late-gadolinium enhancement (LGE), respectively. There were 1863 participants (mean age of 69 years) who had both serum HDL-C measurements and underwent CMR. Analysis was done among those with available indices of interstitial fibrosis (extracellular volume fraction [ECV]; N = 1172 and native-T1; N = 1863) and replacement fibrosis by LGE (N = 1172). HDL-C was analyzed as both logarithmically-transformed and categorized into < 40 (low),40-59 (normal), and ≥ 60mg/dL (high). Multivariable linear and logistic regression models were constructed to assess the associations of HDL-C with CMR-obtained measures of IMF, ECV% and native-T1 time, and myocardial scar, respectively. In the fully adjusted model, each 1-SD increment of log HDL-C was associated with a 1% increment in ECV% (p = 0.01) and an 18-ms increment in native-T1 (p < 0.001). When stratified by HDL-C categories, those with high HDL-C (≥ 60mg/dL) had significantly higher ECV (β = 0.5%, p = 0.01) and native-T1 (β = 7 ms, p = 0.01) compared with those with normal HDL-C levels. Those with low HDL-C were not associated with IMF. Results remained unchanged after excluding individuals with a history of myocardial infarction. Neither increasing levels of HDL-C nor any HDL-C category was associated with the prevalence of myocardial scar. Increasing levels of HDL-C were associated with increased markers of IMF, with those with high levels of HDL-C being linked to subclinical fibrosis in a community-based setting.
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Affiliation(s)
- Omar Chehab
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Elie Akl
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ashkan Abdollahi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ralph Zeitoun
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Colin Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Russell Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Annabelle Rodriguez
- Center for Vascular Biology, University of Connecticut Health, Farmington, CT, USA.
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Gora AH, Rehman S, Dias J, Fernandes JMO, Olsvik PA, Sørensen M, Kiron V. Microbial oil, alone or paired with β-glucans, can control hypercholesterolemia in a zebrafish model. Biochim Biophys Acta Mol Cell Biol Lipids 2023; 1868:159383. [PMID: 37657755 DOI: 10.1016/j.bbalip.2023.159383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/12/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
Dyslipidemia is often associated with unhealthy dietary habits, and many mammalian studies have explored the mode of action of certain bioactive compounds such as β-glucans and n-3 PUFAs to understand their potential to normalize the lipid metabolism. There are only a few investigations that adopted omic approaches to unveil their combined effect on hypercholesterolemia. Zebrafish (Danio rerio) was used as a model organism to reveal the efficacy of Schizochytrium oil and β-glucans (from Euglena gracilis and Phaeodactylum tricornutum) against cholesterol-rich diet induced dyslipidemia. One of the folowing four diets was fed to a particular group of fish: a control high-cholesterol diet, a Schizochytrium oil diet or one of the two diets containing the oil and β-glucan. The plasma HDL, expression of hepatic genes linked to, among others, ferric ion binding and plasma phosphatidylcholines were higher and plasma cholesterol esters and triacylglycerols were lower in the microbial oil-fed fish compared to the fish fed high cholesterol diet. While the fish fed a mix of microbial oil and Euglena β-glucan had lower plasma triacylglycerols and expression of hepatic genes linked to PPAR signaling pathway and enriched biosynthesis of plasma unsaturated fatty acids, the fish fed microbial oil-Phaeodactylum β-glucan combination had lower abundance of triacylglycerols rich in saturated and mono-unsaturated fatty acids and cholesterol esters in the plasma.
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Affiliation(s)
- Adnan H Gora
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Saima Rehman
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | | | | | - Pål A Olsvik
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Mette Sørensen
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway
| | - Viswanath Kiron
- Faculty of Biosciences and Aquaculture, Nord University, Bodø, Norway.
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Ayati A, Akbari K, Shafiee A, Zoroufian A, Jalali A, Samimi S, Pashang M, Hosseini K, Bagheri J, Masoudkabir F. Time-varying effect of postoperative cholesterol profile on long-term outcomes of isolated coronary artery bypass graft surgery. Lipids Health Dis 2023; 22:163. [PMID: 37789387 PMCID: PMC10546688 DOI: 10.1186/s12944-023-01927-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Controlling cholesterol levels is one of the primary goals of preventing atherosclerotic plaque progression in patients undergoing coronary artery bypass graft (CABG) surgery. This study aimed to investigate the impact of serum cholesterol profile at multiple time points following isolated CABG surgery on long-term patient outcomes. METHOD This retrospective cohort study was conducted on the admission and follow-up data of isolated CABG patients from the Tehran Heart Center registry between 2009 and 2016. The association of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and their ratio as an atherogenic index with major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality were evaluated using time-varying survival analysis methods. RESULT A total of 18657 patients were included in this analysis. After adjusting for known confounding factors, no significant difference in all-cause mortality and MACCE was observed at different LDL levels. The incidence of acute coronary syndrome (ACS) in patients with LDL > 100 mg/dl and LDL < 50 mg/dl was significantly higher than in the control group (P-value = 0.004 and 0.04, respectively). The incidence of cerebrovascular accidents (CVA) at LDL > 100 mg/dl was also significantly higher compared to the control group (P -value = 0.033). Lower HDL levels were significantly associated with a higher MACCE (P -value < 0.001), all-cause mortality (P -value < 0.001), ACS (P -value = 0.00), and CVA (P -value = 0.014). The atherogenic index was also directly related to MACCE and all its components (all P-values < 0.001). CONCLUSION LDL/HDL ratio is suggested as a better marker for secondary prevention goals compared to LDL alone in patients undergoing CABG surgery.
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Affiliation(s)
- Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Akbari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Samimi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Pashang
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
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13
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Chehab O, Akl E, Abdollahi A, Zeitoun R, Ambale-Venkatesh B, Wu C, Tracy R, Blumenthal R, Post W, Lima J, Rodriguez A. Higher HDL Cholesterol Levels Are Associated with Increased Markers of Interstitial Myocardial Fibrosis: Insights from The Multi-Ethnic Study of Atherosclerosis. RESEARCH SQUARE 2023:rs.3.rs-3299344. [PMID: 37790448 PMCID: PMC10543254 DOI: 10.21203/rs.3.rs-3299344/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Emerging research indicates that high HDL-C levels might not be cardioprotective, potentially worsening cardiovascular disease(CVD)outcomes. Yet, there's no data on HDL-C's association with other CVD risk factors like myocardial fibrosis, a key aspect of cardiac remodeling predicting negative outcomes. We therefore aimed to study the association between HDL-C levels with interstitial myocardial fibrosis (IMF) and myocardial scar measured by CMR T1-mapping and late-gadolinium enhancement(LGE), respectively. Methods There were 1,863 participants (mean age of 69-years) who had both serum HDL-C measurements and underwent CMR. Analysis was done among those with available indices of interstitial fibrosis (extracellular volume fraction[ECV];N=1,172 and native-T1;N=1,863) and replacement fibrosis by LGE(N=1,172). HDL-C was analyzed as both logarithmically-transformed and categorized into <40 (low), 40-59 (normal), and ≥60mg/dL (high). Multivariable linear and logistic regression models were constructed to assess the associations of HDL-C with CMR-obtained measures of IMF, ECV% and native-T1 time, and myocardial scar, respectively. Results In the fully adjusted model, each 1-SD increment of log HDL-C was associated with a 1% increment in ECV%(p=0.01) and an 18-ms increment in native-T1(p<0.001). When stratified by HDL-C categories, those with high HDL-C(≥60mg/dL) had significantly higher ECV(β=0.5%,p=0.01) and native-T1(β =7ms,p=0.01) compared with those with normal HDL-C levels. Those with low HDL-C were not associated with IMF. Results remained unchanged after excluding individuals with a history of myocardial infarction. Neither increasing levels of HDL-C nor any HDL-C category was associated with the prevalence of myocardial scar. Conclusions Increasing levels of HDL-C were associated with increased markers of IMF, with those with high levels of HDL-C being linked to subclinical fibrosis in a community-based setting.
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Affiliation(s)
| | | | | | | | | | - Colin Wu
- National Heart Lung and Blood Institute
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14
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Rungraung N, Muangpracha N, Trachootham D. Twelve-Week Safety and Potential Lipid Control Efficacy of Coffee Cherry Pulp Juice Concentrate in Healthy Volunteers. Nutrients 2023; 15:nu15071602. [PMID: 37049443 PMCID: PMC10097379 DOI: 10.3390/nu15071602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Coffee cherry pulp, a major waste product from coffee manufacturing, contains polyphenols with antioxidant activity. However, its clinical safety and health benefits are unclear. This randomized, double-blinded, placebo-controlled trial evaluated the safety and potential efficacy of coffee cherry pulp juice concentrate. A total of 61 participants were randomly divided into a study group (n = 30), receiving the juice, and a control group (n = 31), receiving a placebo drink of 14 g twice daily for 12 weeks. Adverse symptoms, changes in body weight, hematological and biochemical parameters, vital signs, and heart function were evaluated using subject diaries, interviews, blood and urine tests, and electrocardiograms. The results showed no intervention-related adverse events. Body weight, liver, renal function, complete blood counts, blood glucose, urinalysis, and electrocardiograms were not significantly altered throughout the study. Consuming the juice for at least 8 weeks significantly decreased cholesterol and LDL levels. The glucose levels were maintained significantly better than those of the placebo group. The findings suggest that continuously consuming 28 g/day of coffee pulp juice concentrate for 12 weeks is safe in healthy volunteers. Future studies could employ a dose of ≤28 g/day to investigate the efficacy of this novel food, especially for preventing dyslipidemia and diabetes.
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15
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Mendoza MF, Lavie CJ. Clinical associations between exercise and lipoproteins. Curr Opin Lipidol 2022; 33:364-373. [PMID: 36305382 DOI: 10.1097/mol.0000000000000848] [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] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW One of the major concerns in global health is the deteriorating control of dyslipidemia (DLD), which is a very strong modifiable risk factor for untoward cardiovascular disease (CVD) outcomes. It serves as a foundation for atherosclerotic lesions that can be destabilized by co-inflammatory processes leading to distal clot migration and other related CVD events. There are many misconceptions regarding the management of DLD. Many health sectors advocate for weight loss without a clear-cut target to achieve better CVD outcomes. There is growing evidence that exercise training compliance regardless of weight change is a more reliable indicator of favorable outcomes. This review is intended to understand the relationship between exercise training, lipoprotein readings, and with CVD and all-cause morbidity and mortality. RECENT FINDINGS Aerobic exercise training (aET) and resistance exercise training (rET) increase cardiorespiratory fitness (CRF) and muscular strength (MusS), respectively. Regardless of weight loss, aET and rET are both known to independently reduce mortality possibly partly through improvement of lipid profiles. Of the two modes of exercise, rET has propensity for enhanced compliance because of its significant lipid and mortality-attenuating effect even with just brief exercise sessions. However, there are several studies showing that participation in both modes of exercise causes more pronounced improvements in DLD and CVD-related mortality compared with either mode of exercise training alone. In addition, Lipoprotein-a [Lp(a)] has been increasingly acknowledged to be atherogenic because of its LDL core. The close proximity of Lp(a) with macrophages triggers the development of atheromas, plaque formation, and growth. This causes a cascade of inflammatory processes that increase the development of ischemic CVD and calcific aortic valve stenosis. Although exercise training is known to reduce plasma LDL-C levels, it has no direct effect on Lp(a) levels as the latter lipoprotein is not influenced by motion nor exercise. Reviews of multiple studies lead us to infer that exercise training may potentially have an indirect impact on Lp(a) attenuation because of the ability of exercise training to inhibit Proprotein Convertase Subtisilin/Kexin type-9 (PCSK-9), as some studies using pharmacologic therapy with PCSK-9 inhibitors were able to show a concomitant decrease in Lp(a) levels. SUMMARY It is clear that normal-to-overweight populations who are highly active have better CVD outcomes and lipid profiles than their sedentary counterparts, and those who were underweight and unfit fared much worse. This allows us to take a more precise approach in the management of DLD rather than plainly focusing on gross weight in patients. Exercise training certainly has beneficial impact on longevity owing to its advantageous effect on lipoprotein levels and particle size. As such, reputable health societies, such as the ESC, ACC, and AHA have prescribed the ideal exercise training regimen, which have noticeable similarities. Increasing the use of wearable devices may help improve our ability to prescribe, quantify, and precisely track physical activity in our continuing efforts to combat increasing morbidity related to unhealthy lifestyles and inactivity.
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Affiliation(s)
- Michael F Mendoza
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine
- The Gayle and Tom Benson Cancer Center, New Orleans, Louisiana, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine
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16
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Abstract
Cardiovascular diseases (CVD) remain the leading cause of death globally, and further efforts are being undertaken to understand and modify CVD risk factors, such as dyslipidemia (DLD), hypertension, and diabetes. The sedentary lifestyle of most individuals today contributes to the prevalence of these conditions. Uncontrolled dyslipidemia serves as a fertile ground for atherosclerotic plaque formation, while lipoproteins (Lp) act as cofactors for inflammatory processes that cause plaque destabilization leading to subsequent CVD events. As such, many health experts and institutions continue to emphasize the importance of cardiorespiratory fitness (CRF) and muscular strength (MusS) with the intent to reduce atherogenic lipoproteins and proprotein convertase subtilisin kexin type 9 (PCSK-9) expression. Concordantly, the two modes of exercise training (ET), such as aerobic ET (aET) and resistance ET (rET) have both demonstrated to improve CRF and MusS, respectively. Although both modes of ET were shown to independently reduce mortality, participation in both forms resulted in a more pronounced improvement in cholesterol levels and CVD-related mortality. Though reduction of adiposity is not a pre-requisite to achieve better control of DLD through increased CRF and MusS, the beneficial effects of physical activity on the inflammatory processes linked to atherosclerosis are almost always associated with a simultaneous decrease in overall adiposity. It is therefore essential to promote both aET and rET, including weight loss in order to attenuate the risks stemming from atherosclerosis and its proinflammatory components.
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17
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Nelson AJ, Sniderman AD, Ditmarsch M, Dicklin MR, Nicholls SJ, Davidson MH, Kastelein JJP. Cholesteryl Ester Transfer Protein Inhibition Reduces Major Adverse Cardiovascular Events by Lowering Apolipoprotein B Levels. Int J Mol Sci 2022; 23:ijms23169417. [PMID: 36012684 PMCID: PMC9409323 DOI: 10.3390/ijms23169417] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Cholesteryl ester transfer protein (CETP) facilitates the exchange of cholesteryl esters and triglycerides (TG) between high-density lipoprotein (HDL) particles and TG-rich, apolipoprotein (apo) B-containing particles. Initially, these compounds were developed to raise plasma HDL cholesterol (HDL-C) levels, a mechanism that was previously thought to lower the risk of atherosclerotic cardiovascular disease (ASCVD). More recently, the focus changed and the use of pharmacologic CETP inhibitors to reduce low-density lipoprotein cholesterol (LDL-C), non-HDL-C and apoB concentrations became supported by several lines of evidence from animal models, observational investigations, randomized controlled trials and Mendelian randomization studies. Furthermore, a cardiovascular outcome trial of anacetrapib demonstrated that CETP inhibition significantly reduced the risk of major coronary events in patients with ASCVD in a manner directly proportional to the substantial reduction in LDL-C and apoB. These data have dramatically shifted the attention on CETP away from raising HDL-C instead to lowering apoB-containing lipoproteins, which is relevant since the newest CETP inhibitor, obicetrapib, reduces LDL-C by up to 51% and apoB by up to 30% when taken in combination with a high-intensity statin. An ongoing cardiovascular outcome trial of obicetrapib in patients with ASCVD is expected to provide further evidence of the ability of CETP inhibitors to reduce major adverse cardiovascular events by lowering apoB. The purpose of the present review is to provide an up-to-date understanding of CETP inhibition and its relationship to ASCVD risk reduction.
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Affiliation(s)
- Adam J. Nelson
- Victorian Heart Institute, Monash University, Clayton, VIC 3800, Australia
| | - Allan D. Sniderman
- Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, Department of Medicine, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | | | | | | | | | - John J. P. Kastelein
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Correspondence:
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Li H, Qian F, Zuo Y, Yuan J, Chen S, Wu S, Wang A. U-Shaped Relationship of High-Density Lipoprotein Cholesterol and Incidence of Total, Ischemic and Hemorrhagic Stroke: A Prospective Cohort Study. Stroke 2022; 53:1624-1632. [PMID: 35086360 DOI: 10.1161/strokeaha.121.034393] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to investigate the association between serially measured HDL-C (high-density lipoprotein cholesterol) levels and stroke risk in a prospective cohort study. METHODS We included 96 258 individuals (79.6% men, mean age 51.5 years) without a history of stroke, myocardial infarction, or cancer at baseline from the Kailuan Study, with repeated measurements of HDL-C in 2006, 2008, 2010, 2012, 2014, and 2016. Cumulatively, averaged HDL-C concentrations were calculated using all available HDL-C measurements before incidence stroke or end of follow-up (December 31, 2017). Incident stroke cases were confirmed by review of medical records and further subclassified into ischemic or hemorrhagic stroke. Cox proportional hazards regression and restricted cubic splines were used to examine these associations. RESULTS During a median follow-up of 10.7 years, 5012 incident stroke cases occurred. Restricted cubic splines analysis suggested a U-shaped association between concentrations of cumulatively averaged HDL-C and risk of stroke (Pnonlinearity <0.001), with the nadir of risk at 1.29 mmol/L. After adjustment for cardiovascular risk factors, individuals with cumulatively averaged HDL-C ≤1.06 mmol/L or ≥2.05 mmol/L had hazard ratios for total stroke of 1.31 (95% CI, 1.15-1.49) and 1.85 (1.63-2.09) compared with those with HDL-C of 1.26 to 1.39 mmol/L. Corresponding hazard ratios were 1.29 (1.11-1.48) and 1.84 (1.60-2.11) for ischemic stroke and 1.54 (1.12-2.12) and 2.29 (1.73-3.04) for hemorrhagic stroke, respectively. CONCLUSIONS Both low and high cumulatively averaged HDL-C were associated with an increased risk of ischemic and hemorrhagic strokes.
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Affiliation(s)
- Haibin Li
- Department of Cardiac Surgery, Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, China (H.L.).,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, China (H.L.).,Beijing Laboratory for Cardiovascular Precision Medicine, China (H.L.)
| | - Frank Qian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (F.Q.)
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China (Y.Z.)
| | - Jinhuan Yuan
- Department of Epidemiology and Health Statistics, School of Public Health (J.Y.), North China University of Science and Technology, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital (S.C., S.W.), North China University of Science and Technology, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital (S.C., S.W.), North China University of Science and Technology, Tangshan, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases (A.W.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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19
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Nøkleby K, Berg TJ, Mdala I, Buhl ES, Claudi T, Cooper JG, Løvaas KF, Sandberg S, Jenum AK. High adherence to recommended diabetes follow-up procedures by general practitioners is associated with lower estimated cardiovascular risk. Diabet Med 2021; 38:e14586. [PMID: 33876447 DOI: 10.1111/dme.14586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/26/2021] [Accepted: 04/15/2021] [Indexed: 01/10/2023]
Abstract
AIMS To explore whether the general practitioners' (GPs') performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes. METHODS A cross-sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP's average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10-year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables. RESULTS The mean total and modifiable estimated 10-year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest-performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17-2.60) and 1.78 (1.14-2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest-performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27-2.46) times higher than that for patients with a GP in the highest quintile. CONCLUSIONS We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.
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Affiliation(s)
- Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tore J Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Ibrahimu Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Esben S Buhl
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tor Claudi
- Department of Medicine, Nordland Hospital, Bodø, Norway
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Karianne F Løvaas
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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20
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Wei Y, Huang Y, Yang W, Huang Q, Chen Y, Zeng K, Chen J, Chen J. The significances and clinical implications of cholesterol components in human breast cancer. Sci Prog 2021; 104:368504211028395. [PMID: 34510991 PMCID: PMC10450717 DOI: 10.1177/00368504211028395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Breast cancer is one the most common malignancies and leading cause of cancer-related mortality in women. Recent studies suggested that hypercholesterolemia may be the potential modifiable risk factors for breast cancer. Cholesterol was well-known for its strong association with cardiovascular disease for long. Moreover, solid evidence has been provided by different studies to illustrate the correlation between lipid and incidence in multiple cancers. Although the conclusion remains controversial or sometimes contrary, which may be due to the multifactorial nature of the disease and the disparity of ethnic population, it is critical to elucidate the relationship between specific cholesterol components in certain population and the exact underlying mechanism of the lipid-associated signaling pathway in breast cancer. The implications of dysregulated lipoproteins as therapeutic targets or options for breast cancer provide novel strategies for us in combating with this malignant disease, which may be achieved by manipulating lipid levels with pharmacological compounds.
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Affiliation(s)
- Yanghui Wei
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yao Huang
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Weiqin Yang
- School of Biomedical Sciences, The Chinese, University of Hong Kong, Hong Kong, China
| | - Qingnan Huang
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Yong Chen
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Kai Zeng
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Juan Chen
- Department of Medicine & Rehabilitation, Tung Wah Eastern Hospital, Hong Kong, China
| | - Jiawei Chen
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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21
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Mayne TJ, Nordyke RJ, Schold JD, Weir MR, Mohan S. Defining a minimal clinically meaningful difference in 12-month estimated glomerular filtration rate for clinical trials in deceased donor kidney transplantation. Clin Transplant 2021; 35:e14326. [PMID: 33896052 PMCID: PMC8365649 DOI: 10.1111/ctr.14326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A Minimal Clinically Meaningful Difference (MCMD) has not been defined for Estimated glomerular filtration rate (eGFR). Our goal was to define the MCMD for eGFR anchored to kidney graft failure. METHODS A systematic review of studies with 12-month eGFR and subsequent renal graft failure was conducted. For observational studies, we calculated hazard ratio (HR) differences between adjacent eGFR intervals weighted by population distribution. Interventional trials yielded therapeutically induced changes in eGFR and failure risk. OPTN data analysis divided 12-month eGFR into bands for Cox regressions comparing adjacent eGFR bands with a death-censored graft survival outcome. RESULTS Observational studies indicated that lower eGFR was associated with increased death-censored graft failure risk; each 5 ml/min/1.73 m2 12-month eGFR band associated with a weighted incremental HR = 1.12 to 1.23. Clinical trial data found a 5 ml/min/1.73 m2 difference was associated with incremental HR = 1.16 to 1.35. OPTN analyses showed weighted mean HRs across 10, 7, and 5 ml/min/1.73 m2 bands of 1.47, 1.30, and 1.19. CONCLUSIONS A 5 ml/min/1.73 m2 difference in 12-month eGFR was consistently associated with ~20% increase in death-censored graft failure risk. The magnitude of effect has been interpreted as clinically meaningful in other disease states and should be considered the MCMD in renal transplantation clinical trials.
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Affiliation(s)
| | | | - Jesse D. Schold
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | - Matthew R. Weir
- Division of NephrologyDepartment of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Sumit Mohan
- Department of MedicineDivision of NephrologyVagelos College of Physicians & Surgeons and Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
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22
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Ahmed N, Farooq J, Siddiqi HS, Meo SA, Kulsoom B, Laghari AH, Jamshed H, Pasha F. Impact of Intermittent Fasting on Lipid Profile-A Quasi-Randomized Clinical Trial. Front Nutr 2021; 7:596787. [PMID: 33598473 PMCID: PMC7882512 DOI: 10.3389/fnut.2020.596787] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Sub-optimal HDL is a prognostic marker of cardiovascular disease. South Asia has a high prevalence of sub-optimal HDL compared to other parts of the world. Intermittent fasting (IF) is a type of energy restriction which may improve serum HDL and other lipids thereby reducing the risk of cardiovascular diseases. Objective: The aim of the study was to evaluate the effect of IF on lipid profile and HDL-cholesterol in a sample of South Asian adults. Methods: A 6-week quasi-experimental (non-randomized) clinical trial was conducted on participants with low HDL (< 40 mg/dl for men and < 50 mg/dl for women). Participants of the control group were recommended not to change their diet. The intervention group was recommended to fast for ~12 h during day time, three times per week for 6 weeks. Pulse rate, blood pressure, body weight, waist circumference, serum lipid profile, and blood glucose levels were measured at baseline and after 6 weeks. Result: A total of 40 participants were enrolled in the study (N = 20 in each group), while 35 (20 control and 15 intervention) completed the trial and were included in data analysis of the study. Body measurements, including body weight, BMI and waist circumference, showed significant interaction effects (p's < 0.001), indicating that there were larger reductions in the IF group than in the control group. Significant interaction effects were also observed for total (p = 0.033), HDL (p = 0.0001), and LDL cholesterol (p = 0.010) with larger improvements in the IF group. Conclusion: This study suggests that intermittent fasting may protect cardiovascular health by improving the lipid profile and raising the sub-optimal HDL. Intermittent fasting may be adopted as a lifestyle intervention for the prevention, management and treatment of cardiovascular disorders. Clinical Trial Registration: NCT03805776, registered on January 16, 2019, https://clinicaltrials.gov/ct2/show/NCT03805776
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Affiliation(s)
- Naseer Ahmed
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Javeria Farooq
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Hasan Salman Siddiqi
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Sultan Ayoub Meo
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bibi Kulsoom
- Postgraduate Programme-Training and Monitoring, Bahria University Medical and Dental College, Karachi, Pakistan
| | - Abid H Laghari
- Department of Medicine, Section of Cardiology, Aga Khan University, Karachi, Pakistan
| | - Humaira Jamshed
- Integrated Sciences and Mathematics, Dhanani School of Science and Engineering, Habib University, Karachi, Pakistan
| | - Farooq Pasha
- Economics, Boston College, Chestnut Hill, MA, United States
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23
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Patel PN, Giugliano RP. Low-density lipoprotein cholesterol lowering therapy for the secondary prevention of atherosclerotic cardiovascular disease. Glob Cardiol Sci Pract 2020; 2020:e202039. [PMID: 33598499 PMCID: PMC7868100 DOI: 10.21542/gcsp.2020.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent and a major contributor to morbidity and mortality worldwide. Elevated blood cholesterol is a key driver of risk for atherosclerotic events, and patients with established ASCVD comprise a specific high-risk population in which low-density lipoprotein cholesterol (LDL-C) lowering therapy is strongly endorsed by multiple guidelines. An increasing number of medications across several pharmacologic classes are available today in clinical practice. Therefore, guidance on the appropriate use of these interventions is necessary for cost-effective solutions to managing residual atherothrombotic risk. In this review we summarize the key evidence supporting LDL-C lowering as described in the most recent 2018 multi-society Blood Cholesterol Guidelines, and provide a framework for optimizing LDL-C lowering therapy in secondary prevention populations.
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Affiliation(s)
- Parth N Patel
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert P Giugliano
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
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24
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O'Malley PG, Arnold MJ, Kelley C, Spacek L, Buelt A, Natarajan S, Donahue MP, Vagichev E, Ballard-Hernandez J, Logan A, Thomas L, Ritter J, Neubauer BE, Downs JR. Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med 2020; 173:822-829. [PMID: 32956597 DOI: 10.7326/m20-4648] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
DESCRIPTION In June 2020, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) released a joint update of their clinical practice guideline for managing dyslipidemia to reduce cardiovascular disease risk in adults. This synopsis describes the major recommendations. METHODS On 6 August to 9 August 2019, the VA/DoD Evidence-Based Practice Work Group (EBPWG) convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature (English-language publications from 1 December 2013 to 16 May 2019), and developed 27 recommendations and a simple 1-page algorithm. The recommendations were graded by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. RECOMMENDATIONS This synopsis summarizes key features of the guideline in 7 crucial areas: targeting of statin dose (not low-density lipoprotein cholesterol goals), additional tests for risk prediction, primary and secondary prevention, laboratory testing, physical activity, and nutrition.
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Affiliation(s)
- Patrick G O'Malley
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - Michael J Arnold
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - Cathy Kelley
- U.S. Department of Veterans Affairs Pharmacy Benefits Management Services, Scottsdale, Arizona (C.K.)
| | - Lance Spacek
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas (L.S., J.R.D.)
| | - Andrew Buelt
- Bay Pines VA Healthcare System, Bay Pines, Florida (A.B.)
| | - Sundar Natarajan
- New York University School of Medicine and VA New York Harbor Healthcare System, New York, New York (S.N.)
| | - Mark P Donahue
- Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina (M.P.D.)
| | - Elena Vagichev
- Walter Reed National Military Medical Center, Bethesda, Maryland (E.V., L.T.)
| | | | - Amanda Logan
- Cincinnati VA Medical Center, Cincinnati, Ohio (A.L.)
| | - Lauren Thomas
- Walter Reed National Military Medical Center, Bethesda, Maryland (E.V., L.T.)
| | - Joan Ritter
- Walter Reed Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland (J.R.)
| | - Brian E Neubauer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
| | - John R Downs
- South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas (L.S., J.R.D.)
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25
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Chaudhuri A. Frontiers in Lipid Lowering Therapy: To Statins and Beyond. Eur J Vasc Endovasc Surg 2020; 60:798-799. [PMID: 33004279 DOI: 10.1016/j.ejvs.2020.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/17/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK. https://twitter.com/vascularis
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26
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Kim DH, Lee JE, Kim YG, Lee Y, Seo DW, Lee KH, Lee JH, Kim WS, Kim YH, Oh JS. High-Throughput Algorithm for Discovering New Drug Indications by Utilizing Large-Scale Electronic Medical Record Data. Clin Pharmacol Ther 2020; 108:1299-1307. [PMID: 32621536 DOI: 10.1002/cpt.1980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022]
Abstract
Drug repositioning is an effective way to mitigate the production problem in the pharmaceutical industry. Electronic medical record (EMR) databases harbor a large amount of data on drug prescriptions and laboratory test results and may thus be useful for finding new indications for existing drugs. Here, we present a novel high-throughput data-driven algorithm that identifies and prioritizes drug candidates that show significant effects on specific clinical indicators by utilizing large-scale EMR data. We chose four laboratory tests as clinical indicators: hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) cholesterol, triglycerides (TGs), and high-density lipoprotein (HDL) cholesterol. From a 5-year EMR database, we generated datasets consisting of paired data with averaged measurement values during on and off each drug in each patient, adjusted for co-administered drug effects at each timepoint, and applied one sample t-test with the Bonferroni correction for statistical analysis. Among 1,774 drugs, 45 were associated with increases in HDL cholesterol, and 41, 146, and 65 were associated with reductions in HbA1c, LDL cholesterol, and TGs, respectively. We compared the list of candidate drugs with that of drugs indicated for relevant clinical conditions and found that the algorithm had high values for both sensitivity (range 0.95-1.00) and negative predictive value (range 0.95-1.00). Our algorithm was able to rediscover well-known drugs that are used for diabetes and dyslipidemia while revealing potential candidates without current indications but have shown promising results in the literature. Our algorithm may facilitate the repositioning of drugs with proven safety profiles.
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Affiliation(s)
- Do-Hoon Kim
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung-Eun Lee
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong-Woo Seo
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kye Hwa Lee
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Ho Lee
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Sung Kim
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Hak Kim
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea.,Health Innovation Big Data Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea.,Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, Seoul, Republic of Korea.,Health Innovation Big Data Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea
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27
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Rogers J, Baker M. Understanding the most commonly billed diagnoses in primary care: Hyperlipidemia. Nurse Pract 2020; 45:42-48. [PMID: 32701880 DOI: 10.1097/01.npr.0000681792.32984.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This installment in the series on the most commonly billed diagnoses in primary care focuses on hyperlipidemia. This article discusses the pathophysiologic processes of hyperlipidemia as well as how the clinical manifestations and treatments are linked to the pathogenesis of disease.
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28
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Rosada A, Kassner U, Weidemann F, König M, Buchmann N, Steinhagen-Thiessen E, Spira D. Hyperlipidemias in elderly patients: results from the Berlin Aging Study II (BASEII), a cross-sectional study. Lipids Health Dis 2020; 19:92. [PMID: 32410691 PMCID: PMC7227351 DOI: 10.1186/s12944-020-01277-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/05/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hyperlipidemias are common and the last decades have seen substantially growing evidence of their causative role in the development of atherosclerosis and subsequent cardiovascular diseases. Since hyperlipidemias usually do not cause direct clinical symptoms, they often remain undiagnosed until a serious cardiovascular event occurs. Especially for LDL-hypercholesteremia, there are well-established treatment options available to prevent the occurrence of atherosclerosis. However, there is a lack of knowledge regarding the proper treatment of elderly patients. The goal of this study was to assess the prevalence of hyperlipidemia in a group of young and a group of elderly community-dwelling participants and to determine to what extent treatment of hyperlipidemia should be initiated or required. METHODS Crossectional data from a total of 2151 subjects (1657 in the elderly group, mean age 69, and 494 in the young group (control group), mean age 29) of the Berlin Aging Study II (BASE-II) were available. Medical history was assessed and recorded by trained physicians and prevalence of lipid disorders was determined with laboratory tests, including a lipid-profile. RESULTS A large proportion of subjects (39%) were unaware of an existing lipid disorder. The prevalence of hyperlipidemia was more frequent in the elderly group (76%) compared to the young group (41%). Hypercholesterolemia was the most common diagnosed disorder (64%), followed by hyperlipoproteinemia(a) (18%), hypertriglyceridemia (7%) and combined hyperlipoproteinaemia (5%). Only a minority of this cohort was treated with lipid-lowering medication (17%) and of those treatment targets according to ESC guidelines were reached only in 16.5 %. CONCLUSIONS Hyperlipidemias appear underdiagnosed and undertreated. As the prevalence of these disorders increases with age and with regard to their role as a major modifiable risk factor for cardiovascular disease it seems to be advisable to aim for more consistent and sustainable screening and treatment of these common disorders. TRIAL REGISTRATION BASE-II registered with the clinical trial registry Deutsches Register Klinischer Studien (DRKS00009277).
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Affiliation(s)
- Adrian Rosada
- Department of Geriatrics, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Ursula Kassner
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Weidemann
- Faculty of Mathematics, Informatics and Statistics, Ludwig-Maximilians-University, Munich, Germany
| | - Maximilian König
- Department of Geriatrics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Buchmann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Spira
- Department of Endocrinology and Metabolic Diseases (including Lipid Metabolism), Charité Universitätsmedizin Berlin, Berlin, Germany
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29
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Jomard A, Osto E. High Density Lipoproteins: Metabolism, Function, and Therapeutic Potential. Front Cardiovasc Med 2020; 7:39. [PMID: 32296714 PMCID: PMC7136892 DOI: 10.3389/fcvm.2020.00039] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/28/2020] [Indexed: 12/16/2022] Open
Abstract
High Density Lipoproteins (HDLs) have long been considered as “good cholesterol,” beneficial to the whole body and, in particular, to cardio-vascular health. However, HDLs are complex particles that undergoes dynamic remodeling through interactions with various enzymes and tissues throughout their life cycle, making the complete understanding of its functions and roles more complicated than initially expected. In this review, we explore the novel understanding of HDLs' behavior in health and disease as a multifaceted class of lipoprotein, with different size subclasses, molecular composition, receptor interactions, and functionality. Further, we report on emergent HDL-based therapeutics tested in small and larger scale clinical trials and their mixed successes.
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Affiliation(s)
- Anne Jomard
- Laboratory of Translational Nutrition Biology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland.,Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland
| | - Elena Osto
- Laboratory of Translational Nutrition Biology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland.,Institute of Clinical Chemistry, University Hospital Zurich, Zurich, Switzerland.,Department of Cardiology, Heart Center, University Hospital Zurich, Zurich, Switzerland
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30
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Adorni MP, Zimetti F, Cangiano B, Vezzoli V, Bernini F, Caruso D, Corsini A, Sirtori CR, Cariboni A, Bonomi M, Ruscica M. High-Density Lipoprotein Function Is Reduced in Patients Affected by Genetic or Idiopathic Hypogonadism. J Clin Endocrinol Metab 2019; 104:3097-3107. [PMID: 30835274 DOI: 10.1210/jc.2018-02027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/26/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Low testosterone levels are associated with an increased incidence of cardiovascular (CV) events, but the underlying biochemical mechanisms are not fully understood. The clinical condition of hypogonadism offers a unique model to unravel the possible role of lipoprotein-associated abnormalities in CV risk. In particular, the assessment of the functional capacities of high-density lipoproteins (HDLs) may provide insights besides traditional risk factors. DESIGN To determine whether reduced testosterone levels correlate with lipoprotein function, HDL cholesterol (HDL-C) efflux capacity (CEC) and serum cholesterol loading capacity (CLC). PARTICIPANTS Genetic and idiopathic hypogonadal patients (n = 20) and control subjects (n = 17). RESULTS Primary and secondary hypogonadal patients presented with lower HDL ATP-binding cassette transporter A1 (ABCA1)-, ATP-binding cassette transporter G1 (ABCG1)-, and aqueous diffusion-mediated CEC (-19.6%, -40.9%, and -12.9%, respectively), with a 16.2% decrement of total CEC. In the whole series, positive correlations between testosterone levels and both total HDL CEC (r2 = 0.359, P = 0.0001) and ABCG1 HDL CEC (r2 = 0.367, P = 0.0001) were observed. Conversely, serum CLC was markedly raised (+43%) in hypogonadals, increased, to a higher extent, in primary vs secondary hypogonadism (18.45 ± 2.78 vs 15.15 ± 2.10 µg cholesterol/mg protein) and inversely correlated with testosterone levels (r2 = 0.270, P = 0.001). HDL-C concentrations did not correlate with either testosterone levels, HDL CEC (total, ABCG1, and ABCA1) or serum CLC. CONCLUSIONS In hypogonadal patients, proatherogenic lipoprotein-associated changes are associated with lower cholesterol efflux and increased influx, thus offering an explanation for a potentially increased CV risk.
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Affiliation(s)
| | | | - Biagio Cangiano
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Laboratory of Endocrine and Metabolic Research and Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Milan, Italy
| | - Valeria Vezzoli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Laboratory of Endocrine and Metabolic Research and Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Milan, Italy
| | - Franco Bernini
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Donatella Caruso
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
- Multimedica Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Italy
| | - Cesare R Sirtori
- Centro Dislipidemie, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Anna Cariboni
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marco Bonomi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Laboratory of Endocrine and Metabolic Research and Division of Endocrine and Metabolic Diseases, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Auxologico Italiano, Milan, Italy
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
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31
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Vaccination against atherosclerosis. Curr Opin Immunol 2019; 59:15-24. [PMID: 30928800 DOI: 10.1016/j.coi.2019.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/11/2019] [Accepted: 02/22/2019] [Indexed: 12/30/2022]
Abstract
Atherosclerosis is a chronic inflammatory disease that causes most heart attacks and strokes, making it the biggest killer in the world. Although cholesterol-lowering drugs have dramatically reduced these major adverse cardiovascular events, there remains a high residual risk called inflammatory risk. Atherosclerosis has an autoimmune component that can be manipulated by immunologic approaches including vaccination. Vaccination is attractive, because it is antigen-specific, does not impair host defense, and provides long-term protection. Several candidate antigens for atherosclerosis vaccine development have been identified and have been shown to reduce atherosclerosis in animal models. In this review, we focus on two different types of atherosclerosis vaccines: antibody-inducing and regulatory T cell-inducing.
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32
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Clifton PM. Diet, exercise and weight loss and dyslipidaemia. Pathology 2018; 51:222-226. [PMID: 30528924 DOI: 10.1016/j.pathol.2018.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/06/2023]
Abstract
There is a large amount of controversy relating dietary fat intake and coronary artery disease. It has been strongly suggested that saturated fat is not harmful and that polyunsaturated fat is either not beneficial or even harmful. Given that dietary lipids and fibre can influence serum lipids which are strongly linked to the risk of coronary artery disease I have reviewed recent evidence linking diet and serum lipids to confirm a diet-heart disease link. Over 84 studies have been included in a recent meta-analysis and meta-regression which examined the effects of changes in fat type on lipid levels. An absolute 1% reduction in saturated fat or trans fat intake as a percentage of energy with replacement by n-6 polyunsaturated fat would lead to a reduction in low density lipoprotein (LDL) cholesterol of 0.05 mmol/L. In most Western countries the difference in intake between the highest quintile and the lowest quintile of saturated fat is about 7%, so moving from the highest to the lowest quintile should lower LDL cholesterol by 0.35 mmol/L or about 10%. This change should lower cardiovascular disease rates by at least 10%. Replacing this amount of saturated fat with carbohydrate of average quality would lower LDL cholesterol by 0.21 mmol/L and increase fasting triglyceride by 0.17 mmol/L. This combination of effects would have a neutral effect on cardiovascular disease rates. However, replacement of trans fat appears to reduce disease rates and total mortality. Substituting low glycaemic index carbohydrates for high glycaemic index carbohydrates will lower triglyceride by 15-25% and reduce cardiovascular risk. Large doses of fish oil will lower triglyceride with a mean lowering of 0.45 mmol/L for a 3.5 g/day amount. Large doses of soluble fibre (3.5-7.0 g/day) lower LDL cholesterol by 0.2-0.35 mmol/L with Konjac glucomannan being the most effective per gram. Plant sterols or stanols lower LDL cholesterol by about 10% for a 2 g/day dose, while exercise and weight loss lower cardiovascular risk predominantly by lowering fasting triglyceride. In conclusion, diet lowers LDL cholesterol and triglyceride and dietary changes should be ultimately linked to a reduced risk of heart disease.
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Affiliation(s)
- Peter M Clifton
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
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Generoso G, Bensenor IM, Santos IS, Santos RD, Goulart AC, Jones SR, Kulkarni KR, Blaha MJ, Toth PP, Lotufo PA, Bittencourt MS. Diabetes alters the association between high-density lipoprotein subfractions and carotid intima-media thickness: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Diab Vasc Dis Res 2018; 15:541-547. [PMID: 30024274 DOI: 10.1177/1479164118788080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION High-density lipoprotein cholesterol comprises a group of heterogeneous subfractions that might have differential effects on atherosclerosis. Moreover, prior investigations suggest that the presence of diabetes (T2D) modifies the impact of some subfractions on atherosclerosis. In this study, we aimed to evaluate the association between high-density lipoprotein cholesterol subfractions and carotid intima-media thickness in the baseline assessment of the Brazilian Longitudinal Study of Adult Health participants from the São Paulo investigation centre. METHODS We evaluated 3930 individuals between 35 and 74 years without previous cardiovascular disease not using lipid-lowering drugs. High-density lipoprotein cholesterol subfractions (HDL2-C and HDL3-C) were measured by vertical ultracentrifugation (vertical auto profile). The relationship between each high-density lipoprotein cholesterol subfraction and carotid intima-media thickness was analysed by multiple linear regression models. RESULTS Total high-density lipoprotein cholesterol, as well as HDL2-C and HDL3-C, was negatively associated with carotid intima-media thickness after adjustment for demographic data (all p < 0.001) and traditional risk factors (all p < 0.05). When stratified by T2D status, the HDL2-C/HDL3-C ratio showed a negative association with carotid intima-media thickness in participants with T2D ( p = 0.032), even after fully controlling for confounding variables, including total high-density lipoprotein cholesterol. CONCLUSION HDL2-C, HDL3-C and HDL2/HDL3-C ratio are inversely associated with carotid intima-media thickness after adjustment for traditional risk factors. Association of the HDL2-C/HDL3-C ratio is modified by the presence of diabetes, being more pronounced in diabetic individuals.
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Affiliation(s)
- Giuliano Generoso
- 1 Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabela M Bensenor
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Departamento de Clinica Medica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Itamar S Santos
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Departamento de Clinica Medica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Raul D Santos
- 1 Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alessandra C Goulart
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven R Jones
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | | | - Michael J Blaha
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
| | - Peter P Toth
- 4 The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA
- 6 Preventive Cardiology, CGH Medical Center, Sterling, IL, USA
| | - Paulo A Lotufo
- 2 Center for Clinical and Epidemiological Research, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Departamento de Clinica Medica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcio Sommer Bittencourt
- 1 Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Estrada-Luna D, Ortiz-Rodriguez MA, Medina-Briseño L, Carreón-Torres E, Izquierdo-Vega JA, Sharma A, Cancino-Díaz JC, Pérez-Méndez O, Belefant-Miller H, Betanzos-Cabrera G. Current Therapies Focused on High-Density Lipoproteins Associated with Cardiovascular Disease. Molecules 2018; 23:molecules23112730. [PMID: 30360466 PMCID: PMC6278283 DOI: 10.3390/molecules23112730] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/20/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
High-density lipoproteins (HDL) comprise a heterogeneous family of lipoprotein particles divided into subclasses that are determined by density, size and surface charge as well as protein composition. Epidemiological studies have suggested an inverse correlation between High-density lipoprotein-cholesterol (HDL-C) levels and the risk of cardiovascular diseases and atherosclerosis. HDLs promote reverse cholesterol transport (RCT) and have several atheroprotective functions such as anti-inflammation, anti-thrombosis, and anti-oxidation. HDLs are considered to be atheroprotective because they are associated in serum with paraoxonases (PONs) which protect HDL from oxidation. Polyphenol consumption reduces the risk of chronic diseases in humans. Polyphenols increase the binding of HDL to PON1, increasing the catalytic activity of PON1. This review summarizes the evidence currently available regarding pharmacological and alternative treatments aimed at improving the functionality of HDL-C. Information on the effectiveness of the treatments has contributed to the understanding of the molecular mechanisms that regulate plasma levels of HDL-C, thereby promoting the development of more effective treatment of cardiovascular diseases. For that purpose, Scopus and Medline databases were searched to identify the publications investigating the impact of current therapies focused on high-density lipoproteins.
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Affiliation(s)
- Diego Estrada-Luna
- Instituto Nacional de Cardiología "Ignacio Chávez" Juan Badiano No. 1, Belisario Domínguez Sección 16, 14080 Tlalpan, Mexico City, Mexico.
| | - María Araceli Ortiz-Rodriguez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, UAEM, Calle Río Iztaccihuatl S/N, Vista Hermosa, 62350 Cuernavaca, Morelos, Mexico.
| | - Lizett Medina-Briseño
- Universidad de la Sierra Sur, UNSIS, Miahuatlán de Porfirio Díaz, 70800 Oaxaca, Mexico.
| | - Elizabeth Carreón-Torres
- Instituto Nacional de Cardiología "Ignacio Chávez" Juan Badiano No. 1, Belisario Domínguez Sección 16, 14080 Tlalpan, Mexico City, Mexico.
| | - Jeannett Alejandra Izquierdo-Vega
- Área Académica de Medicina, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Carretera Actopan-Tilcuautla, Ex-Hacienda La Concepción S/N, San Agustín Tlaxiaca, 42160 Hidalgo, Mexico.
| | - Ashutosh Sharma
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Queretaro, Epigmenio Gonzalez 500, 76130 Queretaro, Mexico.
| | - Juan Carlos Cancino-Díaz
- Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional, 11340 Ciudad de México, Mexico.
| | - Oscar Pérez-Méndez
- Instituto Nacional de Cardiología "Ignacio Chávez" Juan Badiano No. 1, Belisario Domínguez Sección 16, 14080 Tlalpan, Mexico City, Mexico.
| | | | - Gabriel Betanzos-Cabrera
- Área Académica de Medicina, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Carretera Actopan-Tilcuautla, Ex-Hacienda La Concepción S/N, San Agustín Tlaxiaca, 42160 Hidalgo, Mexico.
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Husni ME, Wilson Tang WH, Lucke M, Chandrasekharan UM, Brennan DM, Hazen SL. Correlation of High-Density Lipoprotein-Associated Paraoxonase 1 Activity With Systemic Inflammation, Disease Activity, and Cardiovascular Risk Factors in Psoriatic Disease. Arthritis Rheumatol 2018; 70:1240-1250. [PMID: 29569857 DOI: 10.1002/art.40499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/13/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the activity of high-density lipoprotein (HDL)-associated paraoxonase 1 (PON1) in patients with psoriasis (PsO) and patients with psoriatic arthritis (PsA), and to evaluate the association of PON1 activity with the extent of disease activity and severity of the cardiovascular disease (CVD) burden in these patients. METHODS Serum levels of paraoxonase and arylesterase activity (both measures of PON1 function in humans) were measured in patients with PsA (n = 198, 51.0% male) and patients with PsO (n = 145, 50.3% male) who were enrolled in a longitudinal psoriatic disease biorepository. Data on PsA disease activity (using the Disease Activity Score in 28 joints [DAS28], Clinical Disease Activity Index, and painful/swollen joint counts), preexistent CVD and CVD risk factors (including diabetes, dyslipidemia, hypertension, and smoking), Framingham Risk Scores for CVD, quality of life measures, and laboratory test findings (erythrocyte sedimentation rate, C-reactive protein level, and lipid profiles) were recorded. RESULTS Serum arylesterase activities were significantly lower in patients with PsO and patients with PsA (mean ± SD 111.1 ± 25.5 μmoles/minute/ml and 124.4 ± 33.4 μmoles/minute/ml, respectively) compared to healthy controls (144.3 ± 33.4 μmoles/minute/ml) (each P < 0.001 versus healthy controls). Serum arylesterase activity decreased in parallel with increasing levels of disease activity (DAS28 scores, P = 0.012), older age (P = 0.013), higher body mass index (P = 0.042), greater incidence of metabolic syndrome (P = 0.004) and hypertension (P = 0.014), and worsening Framingham Risk Scores (P = 0.001). However, no correlation was seen between serum arylesterase activity and the extent of disease activity or CVD burden in patients with PsO. Serum paraoxonase activity trended lower both in patients with PsO and in patients with PsA (each P = 0.073 versus healthy controls). However, no association was seen between serum paraoxonase activity and the extent of disease activity or CVD burden in either of the patient cohorts. CONCLUSION PON1 activity is decreased in psoriatic diseases. In the PsA cohort, decreases in arylesterase activity correlated with increasing severity of joint disease and CVD burden. Arylesterase activity, as compared to paraoxonase activity, appeared to serve as a more sensitive predictor of preexisting CV risk factors in the PsA cohort. However, this correlation was not observed in the PsO population.
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Zhang X, Price NL, Fernández-Hernando C. Non-coding RNAs in lipid metabolism. Vascul Pharmacol 2018; 114:93-102. [PMID: 29929012 DOI: 10.1016/j.vph.2018.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/01/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
Cardiovascular disease (CVD), the leading cause of death and morbidity in the Western world, begins with lipid accumulation in the arterial wall, which is the initial step in atherogenesis. Alterations in lipid metabolism result in increased risk of cardiometabolic disorders, and treatment of lipid disorders remains the most common strategy aimed at reducing the incidence of CVD. Work done over the past decade has identified numerous classes of non-coding RNA molecules including microRNAs (miRNAs) and long-non-coding RNAs (lncRNAs) as critical regulators of gene expression involved in lipid metabolism and CVD, mostly acting at post-transcriptional level. A number of miRNAs, including miR-33, miR-122 and miR-148a, have been demonstrated to play important role in controlling the risk of CVD through regulation of cholesterol homeostasis and lipoprotein metabolism. lncRNAs are recently emerging as important regulators of lipid and lipoprotein metabolism. However, much additional work will be required to fully understand the impact of lncRNAs on CVD and lipid metabolism, due to the high abundance of lncRNAs and the poor-genetic conservation between species. This article reviews the role of miRNAs and lncRNAs in lipid and lipoprotein metabolism and their potential implications for the treatment of CVD.
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Affiliation(s)
- Xinbo Zhang
- Vascular Biology and Therapeutics Program, Integrative Cell Signaling and Neurobiology of Metabolism Program, Department of Comparative Medicine, Department of Pathology, Yale University School of Medicine, 10 Amistad St., New Haven, CT 06510. USA
| | - Nathan L Price
- Vascular Biology and Therapeutics Program, Integrative Cell Signaling and Neurobiology of Metabolism Program, Department of Comparative Medicine, Department of Pathology, Yale University School of Medicine, 10 Amistad St., New Haven, CT 06510. USA
| | - Carlos Fernández-Hernando
- Vascular Biology and Therapeutics Program, Integrative Cell Signaling and Neurobiology of Metabolism Program, Department of Comparative Medicine, Department of Pathology, Yale University School of Medicine, 10 Amistad St., New Haven, CT 06510. USA.
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Pol T, Held C, Westerbergh J, Lindbäck J, Alexander JH, Alings M, Erol C, Goto S, Halvorsen S, Huber K, Hanna M, Lopes RD, Ruzyllo W, Granger CB, Hijazi Z. Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial. J Am Heart Assoc 2018; 7:e007444. [PMID: 29419390 PMCID: PMC5850246 DOI: 10.1161/jaha.117.007444] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 12/04/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Dyslipidemia is a major risk factor for cardiovascular events. The prognostic importance of lipoproteins in patients with atrial fibrillation is not well understood. We aimed to explore the association between apolipoprotein A1 (ApoA1) and B (ApoB) and cardiovascular events in patients with atrial fibrillation receiving oral anticoagulation. METHODS AND RESULTS Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, ApoA1 and ApoB plasma levels were measured at baseline in 14 884 atrial fibrillation patients. Median length of follow-up was 1.9 years. Relationships between continuous levels of ApoA1 and ApoB and clinical outcomes were evaluated using Cox models adjusted for cardiovascular risk factors, medication including statins, and cardiovascular biomarkers. A composite ischemic outcome (ischemic stroke, systemic embolism, myocardial infarction, and cardiovascular death) was used as the primary end point. Median (25th, 75th) ApoA1 and ApoB levels were 1.10 (0.93, 1.30) and 0.70 g/L (0.55, 0.85), respectively. In adjusted analyses, higher levels of ApoA1 were independently associated with a lower risk of the composite ischemic outcome (hazard ratio, 0.81; P<0.0001). Similar results were observed for the individual components of the composite outcome. ApoB was not significantly associated with the composite ischemic outcome (P=0.8240). Neither apolipoprotein was significantly associated with major bleeding. There was no interaction between lipoproteins and randomized treatment for the primary outcome (both P values ≥0.2448). CONCLUSIONS In patients with atrial fibrillation on oral anticoagulation, higher levels of ApoA1 were independently associated with lower risk of ischemic cardiovascular outcomes. Investigating therapies targeting dyslipidemia may thus be useful to improve cardiovascular outcomes in patients with atrial fibrillation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984.
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Affiliation(s)
- Tymon Pol
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Johan Westerbergh
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Johan Lindbäck
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Marco Alings
- Working Group on Cardiovascular Research the Netherlands, Utrecht, The Netherlands
| | - Cetin Erol
- Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Shinya Goto
- Department of Medicine, School of Medicine, Tokai University, Isehara, Japan
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Norway
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenshopital, Vienna, Austria
- Medical School, Sigmund Freud University, Vienna, Austria
| | | | - Renato D Lopes
- Duke Clinical Research Institute, Duke Health, Durham, NC
| | | | | | - Ziad Hijazi
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Affiliation(s)
- Byung Jin Kim
- Division of Cardiology, Department of Internal Medicine, Diabetes & Vascular Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kjellmo CA, Karlsson H, Nestvold TK, Ljunggren S, Cederbrant K, Marcusson-Ståhl M, Mathisen M, Lappegård KT, Hovland A. Bariatric surgery improves lipoprotein profile in morbidly obese patients by reducing LDL cholesterol, apoB, and SAA/PON1 ratio, increasing HDL cholesterol, but has no effect on cholesterol efflux capacity. J Clin Lipidol 2018; 12:193-202. [DOI: 10.1016/j.jacl.2017.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/24/2017] [Accepted: 10/11/2017] [Indexed: 11/27/2022]
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Qi Y, Liu J, Wang W, Wang M, Zhao F, Sun J, Liu J, Zhao D. Apolipoprotein E-containing high-density lipoprotein (HDL) modifies the impact of cholesterol-overloaded HDL on incident coronary heart disease risk: A community-based cohort study. J Clin Lipidol 2017; 12:89-98.e2. [PMID: 29217413 DOI: 10.1016/j.jacl.2017.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Experimental studies have shown that cholesterol-overloaded high-density lipoprotein (HDL) can promote the formation of apolipoprotein E (APOE)-containing HDL, a process correcting the atherogenic function of cholesterol-overloaded HDL. OBJECTIVE The objective of the study was to explore whether APOE-containing HDL can attenuate the defective impact of cholesterol-overloaded HDL on the development of coronary heart disease (CHD) in humans. METHODS We measured APOE-HDL cholesterol (APOE-HDLC), HDL cholesterol (HDLC), and HDL particle number in 1112 participants aged 45 to 74 years at baseline in a community-based cohort study. Cholesterol molecules per HDL particle (HDL-C/P ratio) were calculated as the ratio of HDLC to HDL particle number. The ratio of APOE-HDLC to total HDLC (APOE-HDLC/HDLC ratio) was calculated to assess the relative proportion of APOE-HDLC in total HDLC. RESULTS The HDL-C/P ratio was strongly correlated with APOE-HDLC (partial-r: 0.615). Participants with cholesterol-overloaded HDL (indicated by the highest level of the HDL-C/P ratio) had a high APOE-HDLC/HDLC ratio. Baseline cholesterol-overloaded HDL significantly increased the 10-year risk of incident CHD (hazard ratio = 2.42; 95% confidence interval = 1.06-8.32), but this was attenuated by an increased APOE-HDLC/HDLC ratio. Participants with high HDL-C/P ratio and APOE-HDLC/HDLC ratio had a 42% lower risk, whereas those with a high HDL-C/P ratio and low APOE-HDLC/HDLC ratio had a 2.54-fold higher risk, than those with low HDL-C/P ratio and APOE-HDLC/HDLC ratio after multiple adjustments. CONCLUSION Cholesterol-overloaded HDLs are related with increased APOE-containing HDL species. APOE-containing HDL was found to attenuate the impact of cholesterol-overloaded HDL on increased incident CHD risk, suggesting that APOE-containing HDL may correct the dysfunction of cholesterol-overloaded HDL.
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Affiliation(s)
- Yue Qi
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fan Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jiayi Sun
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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Martini D, Rossi S, Biasini B, Zavaroni I, Bedogni G, Musci M, Pruneti C, Passeri G, Ventura M, Di Nuzzo S, Galli D, Mirandola P, Vitale M, Dei Cas A, Bonadonna RC, Del Rio D. Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the framework of protection against oxidative damage and cardiovascular health. Nutr Metab Cardiovasc Dis 2017; 27:473-503. [PMID: 28434807 DOI: 10.1016/j.numecd.2017.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The high number of negative opinions from the European Food Safety Authority (EFSA) to the requests for authorization of health claims is largely due to the design of human intervention studies, including the inappropriate choice of outcome variables (OVs) and of their methods of measurement (MMs). The present manuscript reports the results of an investigation aimed to collect, collate and critically analyse the information in relation to claimed effects, OVs and MMs, in the context of protection against oxidative damage and cardiovascular health compliant with Regulation 1924/2006. METHODS AND RESULTS Claimed effects, OVs and the related MMs were collected from EFSA Guidance documents and applications for authorization of health claims under Articles 13.5 and 14. The OVs and their MMs were evaluated only if the claimed effect was sufficiently defined and was considered beneficial by EFSA. The collection, collation and critical analysis of the relevant scientific literature consisted in the definition of the keywords, the PubMed search strategies and the creation of databases of references. The critical analysis of the OVs and their MMs was performed on the basis of the literature review and was aimed at defining the appropriateness of OVs and MMs in the context of the specific claimed effects. CONCLUSIONS The information provided in this document could serve to EFSA for the development of further guidance on the scientific requirements for health claims, as well as to the stakeholders for the proper design of human intervention studies aimed to substantiate such health claims.
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Affiliation(s)
- D Martini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - S Rossi
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - B Biasini
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy
| | - I Zavaroni
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | - M Musci
- Department of Food and Drug, University of Parma, Parma, Italy
| | - C Pruneti
- Department of Medicine and Surgery, Clinical Psychology Unit, University of Parma, Medical School Building, Parma, Italy
| | - G Passeri
- Department of Medicine and Surgery, Building Clinica Medica Generale, University of Parma, Parma, Italy
| | - M Ventura
- Department of Chemistry, Life Sciences and Environmental Sustainability, Laboratory of Probiogenomics, University of Parma, Parma, Italy
| | - S Di Nuzzo
- Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy
| | - D Galli
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - P Mirandola
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - M Vitale
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - A Dei Cas
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - R C Bonadonna
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - D Del Rio
- The Laboratory of Phytochemicals in Physiology, Department of Food and Drug, University of Parma, Parma, Italy.
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Association of Circulating IGFBP1 Level with the Severity of Coronary Artery Lesions in Patients with Unstable Angina. DISEASE MARKERS 2017; 2017:1917291. [PMID: 28316362 PMCID: PMC5338062 DOI: 10.1155/2017/1917291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/09/2017] [Accepted: 01/29/2017] [Indexed: 02/07/2023]
Abstract
Aims. Local IGFBP1 level was reported to affect the development of coronary artery plaque. This study investigated the association of circulating IGFBP1 level with the severity of coronary artery lesions in patients with unstable angina. Materials and Methods. In 112 consecutive patients with clinically diagnosed unstable angina, admitted from July 2014 to July 2015, we studied the correlations of circulating IGFBP1 and the severity of coronary artery disease (CAD). Results. All patients underwent scheduled coronary angiography, and 67 cases were diagnosed with critical and 45 with noncritical CAD. Of the 67 critical CAD patients, 41 (61.19%) presented with multivessel and 26 (38.81%) with single-vessel lesions. IGFBP1 levels were higher in patients with multivessel than those with single-vessel lesions. Moreover, the IGFBP1 level was positively correlated with the GRACE score. Among clinical variables, the IGFBP1 level was correlated with HDL-C. IGFBP1 alone (cutoff 20.86 ng/ml) demonstrated a sensitivity of 0.448 and specificity of 0.933 in predicting CAD. Combination of IGFBP1 and HDL-C had a sensitivity of 0.821 and specificity of 0.800 in predicting CAD. Conclusions. Circulating IGFBP1 level positively correlated with the severity of CAD. IGFBP1, when combined with HDL-C, might be useful in screening for high risk CAD patients.
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Sex differences in lipid profiles and treatment utilization among young adults with acute myocardial infarction: Results from the VIRGO study. Am Heart J 2017; 183:74-84. [PMID: 27979045 DOI: 10.1016/j.ahj.2016.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/12/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Young women with acute myocardial infarction (AMI) have higher mortality risk than similarly aged men. An adverse lipid profile is an important risk factor for cardiovascular outcomes after AMI, but little is known about whether young women with AMI have a higher-risk lipid pattern than men. We characterized sex differences in lipid profiles and treatment utilization among young adults with AMI. METHODS A total of 2,219 adults with AMI (1,494 women) aged 18-55 years were enrolled from 103 hospitals in the United States (2008-2012). Serum lipids and lipoprotein subclasses were measured 1 month after discharge. RESULTS More than 90% of adults were discharged on a statin, but less than half received a high-intensity dose and 12% stopped taking treatments by 1 month. For both men and women, the median of low-density lipoprotein (LDL) cholesterol was reduced to <100 mg/dL 1 month after discharge for AMI, but high-density lipoprotein (HDL) cholesterol remained <40 mg/dL. Multivariate regression analyses showed that young women had favorable lipoprotein profiles compared with men: women had higher HDL cholesterol and HDL large particle, but lower total cholesterol-to-HDL cholesterol ratio and LDL small particle. CONCLUSIONS Young women with AMI had slightly favorable lipid and lipoprotein profiles compared with men, suggesting that difference in lipid and lipoprotein may not be a major contributor to sex differences in outcomes after AMI. In both men and women, statin remained inadequately used, and low HDL cholesterol level was a major lipid abnormality.
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High-density Lipoprotein and Inflammation and Its Significance to Atherosclerosis. Am J Med Sci 2016; 352:408-415. [DOI: 10.1016/j.amjms.2016.06.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 06/06/2016] [Accepted: 06/24/2016] [Indexed: 01/09/2023]
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Ditah C, Otvos J, Nassar H, Shaham D, Sinnreich R, Kark JD. Small and medium sized HDL particles are protectively associated with coronary calcification in a cross-sectional population-based sample. Atherosclerosis 2016; 251:124-131. [DOI: 10.1016/j.atherosclerosis.2016.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 01/21/2023]
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Tragante V, Asselbergs FW, Swerdlow DI, Palmer TM, Moore JH, de Bakker PIW, Keating BJ, Holmes MV. Harnessing publicly available genetic data to prioritize lipid modifying therapeutic targets for prevention of coronary heart disease based on dysglycemic risk. Hum Genet 2016; 135:453-467. [PMID: 26946290 PMCID: PMC4835528 DOI: 10.1007/s00439-016-1647-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/07/2016] [Indexed: 01/14/2023]
Abstract
Therapeutic interventions that lower LDL-cholesterol effectively reduce the risk of coronary artery disease (CAD). However, statins, the most widely prescribed LDL-cholesterol lowering drugs, increase diabetes risk. We used genome-wide association study (GWAS) data in the public domain to investigate the relationship of LDL-C and diabetes and identify loci encoding potential drug targets for LDL-cholesterol modification without causing dysglycemia. We obtained summary-level GWAS data for LDL-C from GLGC, glycemic traits from MAGIC, diabetes from DIAGRAM and CAD from CARDIoGRAMplusC4D consortia. Mendelian randomization analyses identified a one standard deviation (SD) increase in LDL-C caused an increased risk of CAD (odds ratio [OR] 1.63 (95 % confidence interval [CI] 1.55, 1.71), which was not influenced by removing SNPs associated with diabetes. LDL-C/CAD-associated SNPs showed consistent effect directions (binomial P = 6.85 × 10−5). Conversely, a 1-SD increase in LDL-C was causally protective of diabetes (OR 0.86; 95 % CI 0.81, 0.91), however LDL-cholesterol/diabetes-associated SNPs did not show consistent effect directions (binomial P = 0.15). HMGCR, our positive control, associated with LDL-C, CAD and a glycemic composite (derived from GWAS meta-analysis of four glycemic traits and diabetes). In contrast, PCSK9, APOB, LPA, CETP, PLG, NPC1L1 and ALDH2 were identified as “druggable” loci that alter LDL-C and risk of CAD without displaying associations with dysglycemia. In conclusion, LDL-C increases the risk of CAD and the relationship is independent of any association of LDL-C with diabetes. Loci that encode targets of emerging LDL-C lowering drugs do not associate with dysglycemia, and this provides provisional evidence that new LDL-C lowering drugs (such as PCSK9 inhibitors) may not influence risk of diabetes.
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Affiliation(s)
- Vinicius Tragante
- Department of Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Heart and Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands. .,Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK. .,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.
| | - Daniel I Swerdlow
- Institute of Cardiovascular Science, University College London, 222 Euston Road, London, NW1 2DA, UK.,Department of Medicine, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Tom M Palmer
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Jason H Moore
- Department of Biostatistics and Epidemiology, Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, 19104-6021, USA
| | - Paul I W de Bakker
- Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brendan J Keating
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.,Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Michael V Holmes
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. .,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. .,Clinical Trials Services Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, Richard Doll Building, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, UK.
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Papageorgiou N, Zacharia E, Androulakis E, Briasoulis A, Charakida M, Tousoulis D. HDL as a prognostic biomarker for coronary atherosclerosis: the role of inflammation. Expert Opin Ther Targets 2016; 20:907-21. [PMID: 26854521 DOI: 10.1517/14728222.2016.1152264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Emerging evidence suggests that the role of high density lipoprotein (HDL) in the atherosclerotic process is not as clear as previously thought, since atheroprotective HDL becomes atherogenic in states of increased inflammatory processes. AREAS COVERED In this review we aim to elucidate the role of HDL as a prognostic biomarker and we discuss therapeutic approaches that aim to increase HDL and their possible clinical benefit. EXPERT OPINION Given the structural variability and biological complexity of the HDL particle, its role in the atherosclerotic process is far from clear. According to current evidence, the atheroprotective role of HDL turns atherogenic in states of increased inflammatory processes, while even minor alterations in systemic inflammation are likely to hinder the endothelial protective effects of HDL. In accordance, significant data have revealed that HDL-related drugs may be effective in reducing cardiovascular mortality; however they are not as encouraging or unanimous as expected. Possible future goals could be to quantify either HDL subclasses or functions in an attempt to reach safer conclusions as to the prognostic importance of HDL in coronary atherosclerosis. Having achieved that, a more targeted therapy that would aim to raise either HDL functionality or to remodel HDL structure would be more easily designed.
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Affiliation(s)
| | - Effimia Zacharia
- b 1st Department of Cardiology , Hippokration Hospital, University of Athens , Athens , Greece
| | | | - Alexandros Briasoulis
- d Division of Cardiology , Wayne State University/Detroit Medical Center , Detroit , MI , USA
| | - Marietta Charakida
- e Vascular Physiology Unit, Institute of Cardiovascular Science , University College London , London , UK
| | - Dimitris Tousoulis
- b 1st Department of Cardiology , Hippokration Hospital, University of Athens , Athens , Greece
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Page MM, Hooper AJ, Burnett JR. Anacetrapib for the treatment of dyslipidaemia: the last bastion of the cholesteryl ester transfer protein inhibitors? Expert Opin Pharmacother 2015; 17:275-81. [PMID: 26642232 DOI: 10.1517/14656566.2016.1129402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Inhibition of cholesteryl ester transfer protein (CETP) has emerged as a potential way to decrease cardiovascular risk by raising high density lipoprotein (HDL) cholesterol and lowering low density lipoprotein (LDL) cholesterol concentrations. However, high profile withdrawals of several CETP inhibitors have cast doubt over this hypothesis. Despite this concern, anacetrapib appears to be safe, well-tolerated and delivers a substantial increases in HDL cholesterol and reductions in LDL cholesterol as monotherapy and when combined with a statin. AREAS COVERED We discuss the role of CETP and HDL cholesterol as therapeutic targets, describe the pharmacokinetics and pharmacodynamics of anacetrapib, as well as report on the recent clinical trials. EXPERT OPINION The focus of CETP inhibition has shifted from HDL cholesterol-raising to LDL cholesterol-lowering. Although anacetrapib appears to be safe and is effective in altering lipid-related biochemical parameters of interest, its effect on cardiovascular outcomes remains unknown. Extrapolation of LDL cholesterol lowering to improved cardiovascular outcomes is not possible, because LDL and HDL functionality in the setting of anacetrapib treatment is unclear. The results of the phase III REVEAL randomised controlled trial will be critical for anacetrapib to establish a place in clinical care.
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Affiliation(s)
- Michael M Page
- a Department of Clinical Biochemistry, PathWest Laboratory Medicine WA , Royal Perth Hospital and Fiona Stanley Hospital Network , Perth , Australia
| | - Amanda J Hooper
- a Department of Clinical Biochemistry, PathWest Laboratory Medicine WA , Royal Perth Hospital and Fiona Stanley Hospital Network , Perth , Australia.,b School of Medicine & Pharmacology , University of Western Australia , Perth , Australia.,c School of Pathology & Laboratory Medicine , University of Western Australia , Perth , Australia
| | - John R Burnett
- a Department of Clinical Biochemistry, PathWest Laboratory Medicine WA , Royal Perth Hospital and Fiona Stanley Hospital Network , Perth , Australia.,b School of Medicine & Pharmacology , University of Western Australia , Perth , Australia
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Ascaso JF, Carmena R. Importancia de la dislipidemia en la enfermedad cardiovascular: un punto de vista. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2015; 27:301-8. [DOI: 10.1016/j.arteri.2015.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022]
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Taylor AE, Lu F, Carslake D, Hu Z, Qian Y, Liu S, Chen J, Shen H, Smith GD. Exploring causal associations of alcohol with cardiovascular and metabolic risk factors in a Chinese population using Mendelian randomization analysis. Sci Rep 2015; 5:14005. [PMID: 26364564 PMCID: PMC4568464 DOI: 10.1038/srep14005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/11/2015] [Indexed: 11/16/2022] Open
Abstract
Observational studies suggest that moderate alcohol consumption may be protective for cardiovascular disease, but results may be biased by confounding and reverse causality. Mendelian randomization, which uses genetic variants as proxies for exposures, can minimise these biases and therefore strengthen causal inference. Using a genetic variant in the ALDH2 gene associated with alcohol consumption, rs671, we performed a Mendelian randomization analysis in 1,712 diabetes cases and 2,076 controls from Nantong, China. Analyses were performed using linear and logistic regression, stratified by sex and diabetes status. The A allele of rs671 was strongly associated with reduced odds of being an alcohol drinker in all groups, but prevalence of alcohol consumption amongst females was very low. The A allele was associated with reduced systolic and diastolic blood pressure and decreased total and HDL cholesterol in males. The A allele was also associated with decreased triglyceride levels, but only robustly in diabetic males. There was no strong evidence for associations between rs671 and any outcomes in females. Our results suggest that associations of alcohol consumption with blood pressure and HDL-cholesterol are causal. Alcohol also appeared to have adverse effects on triglyceride levels, although this may be restricted to diabetics.
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Affiliation(s)
- Amy E Taylor
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology, University of Bristol, Bristol, BS8 1TU, UK
| | - Feng Lu
- Department of Epidemiology &Biostatistics at Nanjing Medical University School of Public Health, 818 East Tianyuan Rd, Nanjing 211166, P.R. China.,Department of Chronic Non-communicable Disease Control, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Rd, Hangzhou 310053, P.R. China
| | - David Carslake
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Zhibin Hu
- Department of Epidemiology &Biostatistics at Nanjing Medical University School of Public Health, 818 East Tianyuan Rd, Nanjing 211166, P.R. China
| | - Yun Qian
- Department of Epidemiology &Biostatistics at Nanjing Medical University School of Public Health, 818 East Tianyuan Rd, Nanjing 211166, P.R. China.,Department of Chronic Non-communicable Disease Control, Wuxi Center for Disease Control and Prevention, 499 Jincheng Rd, Wuxi 214023, P.R. China
| | - Sijun Liu
- Department of Epidemiology &Biostatistics at Nanjing Medical University School of Public Health, 818 East Tianyuan Rd, Nanjing 211166, P.R. China
| | - Jiaping Chen
- Department of Epidemiology &Biostatistics at Nanjing Medical University School of Public Health, 818 East Tianyuan Rd, Nanjing 211166, P.R. China
| | - Hongbing Shen
- Department of Epidemiology &Biostatistics at Nanjing Medical University School of Public Health, 818 East Tianyuan Rd, Nanjing 211166, P.R. China
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.,School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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