Atherosclerotic Coronary Artery Disease in Patients With Cardiometabolic Syndrome

Association between high-density lipoprotein cholesterol levels and major adverse cardiovascular events in patients who underwent coronary computed tomography angiography: FU-CCTA registry

It is unclear whether higher levels of serum high-density lipoprotein cholesterol (HDL-C) prevent major adverse cardiovascular events (MACE). We prospectively evaluated 501 patients who had undergone coronary computed tomography angiography at Fukuoka University Hospital and either were clinically suspected of having coronary artery disease (CAD) or had at least one cardiovascular risk factor with a follow-up of up to 5 years. The primary endpoint was MACE (cardiovascular death, ischemic stroke, acute myocardial infarction and coronary revascularization). The patients were divided into tertiles according to the HDL-C level: 47 mg/dl ≥ HDL-C level [n = 167, lower HDL-C level (L-HDL)], 58 mg/dl ≥ HDL-C level ≥ 48 mg/dl [n = 167, middle HDL-C level (M-HDL)] and HDL-C level ≥ 59 mg/dl [n = 167, higher HDL-C level (H-HDL)] groups. There were significant differences in %CAD among the L-HDL, M-HDL and H-HDL groups. Unexpectedly, there was no difference in %MACE between M-HDL and H-HDL, although %MACE in M-HDL was significantly lower than that in L-HDL (p < 0.05). By a multivariate logistic regression analysis, MACE in H-HDL-C was independently associated with diabetes mellitus (DM) (p = 0.03). A Kaplan-Meier curve according to the HDL subgroup indicated that M-HDL, not H-HDL, enjoyed the greatest freedom from MACE among the 3 groups (log-rank test p = 0.047). Finally, the results of a Cox regression model indicated that L-HDL and H-HDL had significantly higher risk of MACE than M-HDL. In conclusions, patients with middle HDL-C levels, not higher HDL-C levels, showed the greatest freedom from MACE. Patients with higher HDL-C levels need to be strictly managed for DM to prevent MACE.

Sex Difference in the Association Between Metabolic Syndrome and Obstructive Coronary Artery Disease: Analysis of Data from the KoRean wOmen'S chest pain rEgistry (KoROSE)

Background: The sex-related impact of metabolic syndrome (MetS) on obstructive coronary artery disease (OCAD) has not been well evaluated. Methods: A total of 1156 patients (62 years and 58% women) with chest pain undergoing invasive coronary angiography (CAG) were recruited from the database of the nation-wide chest pain registry. MetS was defined according to the criteria of the International Diabetes Federation. OCAD was defined as ≥50% stenosis of the left main coronary artery and/or ≥70% stenosis of any other coronary arteries. Results: Women were older than men (65 vs. 59 years, p < 0.001). OCAD (32.0% vs. 30.9%) and MetS (27.8% vs. 27.9%) prevalence rates were similar in both sexes (p > 0.05). The presence of MetS was associated with higher prevalence of OCAD in women (24.5% vs. 47.3%, p < 0.001), but not in men (31.0% vs. 34.3%, p = 0.487). The linear association between the number of components meeting MetS criteria and OCAD prevalence was significant in both sexes (p < 0.001 for each), but it was stronger in women than in men (Chi-square value: 81.9 vs. 14.8, p < 0.001). In a multivariable model, the presence of MetS was independently associated with OCAD in women even after controlling for potential confounders (odds ratio, 1.92; 95% confidence interval, 1.31-2.81; p = 0.001). Conclusions: In patients with chest pain undergoing invasive CAG, the association between the number of components meeting MetS criteria and OCAD prevalence was stronger in women than in men.

A Strict Target for Low-Density Lipoprotein Cholesterol May not Be Necessary for Secondary Prevention of Cardiovascular Disease in All Elderly Patients With Dyslipidemia

According to the Japan Atherosclerosis Society Guidelines for the Prevention of Atherosclerotic Cardiovascular Diseases 2017, standard statin therapy for hyper-low-density lipoprotein cholesterol cholesterolemia in elderly patients may be effective for the secondary prevention of coronary artery disease, as in non-elderly adults. On the other hand, high-intensity statin therapy may not be recommended in all elderly cardiovascular disease patients with dyslipidemia, and particularly in elderly patients aged ≥ 85 years. In any case, tailor-made medical care with use of statin is required that matches the background of each patient.

Trimethylamine N-Oxide in Relation to Cardiometabolic Health-Cause or Effect?

Trimethylamine-N-oxide (TMAO) is generated in a microbial-mammalian co-metabolic pathway mainly from the digestion of meat-containing food and dietary quaternary amines such as phosphatidylcholine, choline, betaine, or L-carnitine. Fish intake provides a direct significant source of TMAO. Human observational studies previously reported a positive relationship between plasma TMAO concentrations and cardiometabolic diseases. Discrepancies and inconsistencies of recent investigations and previous studies questioned the role of TMAO in these diseases. Several animal studies reported neutral or even beneficial effects of TMAO or its precursors in cardiovascular disease model systems, supporting the clinically proven beneficial effects of its precursor, L-carnitine, or a sea-food rich diet (naturally containing TMAO) on cardiometabolic health. In this review, we summarize recent preclinical and epidemiological evidence on the effects of TMAO, in order to shed some light on the role of TMAO in cardiometabolic diseases, particularly as related to the microbiome.

Anti-atherosclerotic effects of an improved apolipoprotein A-I mimetic peptide

BACKGROUND

Apolipoprotein (Apo)A-I is a major protein component of high-density lipoprotein (HDL) that causes cholesterol efflux from peripheral cells through ATP-binding cassette transporter A1 (ABCA1) and the generation of HDL. Furthermore, it has a possible protective function against atherosclerotic cardiovascular disease (ASCVD). We previously developed a novel ApoA-I mimetic peptide without phospholipids (Fukuoka University ApoA-I Mimetic Peptide, FAMP). According to our previous studies, FAMP had an anti-arteriosclerotic effect. Since the required dose and reaction time of conventional FAMP were relatively large and short, respectively, we newly developed an improved FAMP (i-FAMP).

METHODS AND RESULTS

We synthesized four candidate i-FAMPs, i-FAMP-D1, -D2, -D3 and -D4, and examined which i-FAMP has greater cholesterol efflux capacity than FAMP in A172 human glioblastoma cells transiently transfected with human ABCA1 cDNA. Only i-FAMP-D1 showed significantly greater cholesterol efflux capacity than conventional FAMP. i-FAMP-D1 formed stronger α-helical conformations than FAMP as assessed by circular dichroism spectra. Thus, we selected i-FAMP-D1 for further experiments. i-FAMP-D1 had a greater atheroprotective effect than FAMP in ApoE knockout mice. In addition, i-FAMP-D1 activated cholesterol efflux from macrophage to HDL more strongly than FAMP and increased cholesterol excretion from liver to feces.

CONCLUSION

These results suggest that i-FAMP-D1 has a stronger anti-atherosclerotic effect than conventional FAMP.

PREVALENCE AND CORRELATES OF DEPRESSION, ANXIETY, AND DISTRESS AMONG FILIPINOS FROM LOW-INCOME COMMUNITIES IN THE PHILIPPINES

INTRODUCTION

More than one billion people worldwide are affected by mental health disorders, making up 16% of the world's population. However, psychological morbidity has been understudied and disparately estimated among Filipinos living in low-income communities in the Philippines.

PURPOSE

The specific aims of this descriptive, cross-sectional study were to 1) describe depression, anxiety, distress, and quality of life in a large sample of Filipinos from low-income communities in the Philippines; and 2) determine the prevalence and correlates of depression, anxiety, and distress in this sample.

METHODS

A convenient sample of Filipinos (⩾ 18 years old) were recruited to participate in the study and asked to complete a general health survey. Only one person per household was eligible to participate in the study to avoid biases based on the prevalence of mental health disorders.

RESULTS

One thousand two hundred three participants, mean age, 49.5 ± 17.6 years, primarily women (64.6%) and married (58.4%) reported the following cardiometabolic disorders: overweight/obesity (29%), hypertension (43%), hyperlipidemia (21%), type 2 diabetes (14%), and current smoker (19%). The mean physical and mental quality of life was 46.2 ± 8.1 and 48.6 ± 7.7, respectively. Depression (21%), anxiety (39%) and distress (82%) were prevalent in the sample. Depression was associated with older age, higher distress and anxiety, and lower quality of life. Anxiety and distress were associated with younger age, female gender, higher depression, and lower quality of life.

CONCLUSION

Mental health disorders are prevalent in Filipinos from low-income communities. Findings provide empirical support for the provision of mental health services consistent with the World Health Organization's action plan in this understudied population. The high association between psychological morbidity and perceived physical and mental quality of life signifies the need to screen for depression in older adults and anxiety and distress in younger adults and women.