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A Review of Novel Cardiac Biomarkers in Acute or Chronic Cardiovascular Diseases: The Role of Soluble ST2 (sST2), Lipoprotein-Associated Phospholipase A2 (Lp-PLA2), Myeloperoxidase (MPO), and Procalcitonin (PCT). DISEASE MARKERS 2021; 2021:6258865. [PMID: 34422136 PMCID: PMC8371622 DOI: 10.1155/2021/6258865] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 01/15/2023]
Abstract
While the received traditional predictors are still the mainstay in the diagnosis and prognosis of CVD events, increasing studies have focused on exploring the ancillary effect of biomarkers for the aspiring of precision. Under which circumstances, soluble ST2 (sST2), lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and procalcitonin (PCT) have recently emerged as promising markers in the field of both acute and chronic cardiovascular diseases. Existent clinical studies have demonstrated the significant associations between these markers with various CVD outcomes, which further verified the potentiality of markers in helping risk stratification and diagnostic and therapeutic work-up of patients. The current review article is aimed at illuminating the applicability of these four novels and often neglected cardiac biomarkers in common clinical scenarios, including acute myocardial infarction, acute heart failure, and chronic heart failure, especially in the emergency department. By thorough classification, combination, and discussion of biomarkers with clinical and instrumental evaluation, we hope the current study can provide insights into biomarkers and draw more attention to their importance.
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Distribution of Paraoxonase-1 (PON-1) and Lipoprotein Phospholipase A2 (Lp-PLA2) across Lipoprotein Subclasses in Subjects with Type 2 Diabetes. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:1752940. [PMID: 30524650 PMCID: PMC6247389 DOI: 10.1155/2018/1752940] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/15/2018] [Indexed: 12/11/2022]
Abstract
Paraoxonase-1 (PON1) and lipoprotein phospholipase A2 (Lp-PLA2) may exert an important protective role by preventing the oxidative transformation of high- and low-density lipoproteins (HDL and LDL, respectively). The activity of both enzymes is influenced by lipidome and proteome of the lipoprotein carriers. T2DM typically presents significant changes in the molecular composition of the lipoprotein subclasses. Thus, it becomes relevant to understand the interaction of PON1 and Lp-PLA2 with the subspecies of HDL, LDL, and other lipoproteins in T2DM. Serum levels of PON1-arylesterase and PON1-lactonase and Lp-PLA2 activities and lipoprotein subclasses were measured in 202 nondiabetic subjects (controls) and 92 T2DM outpatients. Arylesterase, but not lactonase or Lp-PLA2 activities, was inversely associated with TD2M after adjusting for potential confounding factors such as age, sex, smoking, body mass index, hypertension, and lipoprotein subclasses (odds ratio = 3.389, 95% confidence interval 1.069–14.756). Marked difference between controls and T2DM subjects emerged from the analyses of the associations of the three enzyme activities and lipoprotein subclasses. Arylesterase was independently related with large HDL-C and small intermediate-density lipoprotein cholesterol (IDL-C) in controls while, along with lactonase, it was related with small low-density lipoprotein cholesterol LDL-C, all IDL-C subspecies, and very low-density lipoprotein cholesterol (VLDL-C) in T2DM (p < 0.05 for all). Concerning Lp-PLA2, there were significant relationships with small LDL-C, large IDL-C, and VLDL-C only among T2DM subjects. Our study showed that T2DM subjects have lower levels of PON1-arylesterase compared to controls and that T2DM occurrence may coincide with a shift of PON1 and Lp-PLA2 towards the more proatherogenic lipoprotein subclasses. The possibility of a link between the two observed phenomena requires further investigations.
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Schliefsteiner C, Hirschmugl B, Kopp S, Curcic S, Bernhart EM, Marsche G, Lang U, Desoye G, Wadsack C. Maternal Gestational Diabetes Mellitus increases placental and foetal lipoprotein-associated Phospholipase A2 which might exert protective functions against oxidative stress. Sci Rep 2017; 7:12628. [PMID: 28974763 PMCID: PMC5626711 DOI: 10.1038/s41598-017-13051-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022] Open
Abstract
Increased Lipoprotein associated phospholipase A2 (LpPLA2) has been associated with inflammatory pathologies, including Type 2 Diabetes. Studies on LpPLA2 and Gestational Diabetes Mellitus (GDM) are rare, and have focused mostly on maternal outcome. In the present study, we investigated whether LpPLA2 activity on foetal lipoproteins is altered by maternal GDM and/or obesity (a major risk factor for GDM), thereby contributing to changes in lipoprotein functionality. We identified HDL as the major carrier of LpPLA2 activity in the foetus, which is in contrast to adults. We observed marked expression of LpPLA2 in placental macrophages (Hofbauer cells; HBCs) and found that LpPLA2 activity in these cells was increased by insulin, leptin, and pro-inflammatory cytokines. These regulators were also increased in plasma of children born from GDM pregnancies. Our results suggest that insulin, leptin, and pro-inflammatory cytokines are positive regulators of LpPLA2 activity in the foeto-placental unit. Of particular interest, functional assays using a specific LpPLA2 inhibitor suggest that high-density lipoprotein (HDL)-associated LpPLA2 exerts anti-oxidative, athero-protective functions on placental endothelium and foetus. Our results therefore raise the possibility that foetal HDL-associated LpPLA2 might act as an anti-inflammatory enzyme improving vascular barrier function.
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Affiliation(s)
| | - Birgit Hirschmugl
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Susanne Kopp
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Sanja Curcic
- Department of Clinical and Experimental Pharmacology, Medical University of Graz, Graz, Austria
| | - Eva Maria Bernhart
- Institute of Molecular Biology and Biochemistry, Medical University of Graz, Graz, Austria
| | - Gunther Marsche
- Department of Clinical and Experimental Pharmacology, Medical University of Graz, Graz, Austria
| | - Uwe Lang
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Christian Wadsack
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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Garg S, Madhu SV, Suneja S. Lipoprotein associated phospholipase A2 activity & its correlation with oxidized LDL & glycaemic status in early stages of type-2 diabetes mellitus. Indian J Med Res 2016; 141:107-14. [PMID: 25857502 PMCID: PMC4405925 DOI: 10.4103/0971-5916.154512] [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] [Indexed: 11/12/2022] Open
Abstract
Background & objectives: Lipoprotein associated phospholipase A2 (Lp-PLA2) is an important risk predictor of coronary artery disease (CAD). This study was aimed to evaluate Lp-PLA2 activity and oxidized low density lipoprotein (oxLDL) in newly diagnosed patients of type 2 diabetes mellitus and to determine the correlation of Lp-PLA2 activity with oxLDL and plasma glucose levels. Methods: Blood samples were collected in patients with newly diagnosed type 2 diabetes (n=40) before any treatment was started and healthy controls (n=40). These were processed for estimating plasma glucose: fasting and post prandial, ox LDL, and Lp-PLA2 activity. The parameters in the two groups were compared. Correlation between different parameters was calculated by Pearson correlation analysis in both groups. Results: Lp-PLA2 activity (24.48 ± 4.91 vs 18.63 ± 5.29 nmol/min/ml, P<0.001) and oxLDL levels (52.46 ± 40.19 vs 33.26 ± 12.54 μmol/l, P<0.01) were significantly higher in patients as compared to those in controls. Lp-PLA2 activity correlated positively with oxLDL in both controls (r=0.414, P<0.01), as well in patients (r=0.542, P<0.01). A positive correlation between Lp-PLA2 activity and fasting plasma glucose levels was observed only in patients (r=0.348, P<0.05). Interpretation & conclusions: Result of this study implies that higher risk of CAD in patients with diabetes may be due to increase in Lp-PLA2 activity during the early course of the disease. A positive correlation between enzyme activity and fasting plasma glucose indicates an association between hyperglycaemia and increased activity of Lp-PLA2. This may explain a higher occurrence of CAD in patients with diabetes. A positive correlation between oxLDL and Lp-PLA2 activity suggests that Lp-PLA2 activity may be affected by oxLDL also.
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Affiliation(s)
- Seema Garg
- Department of Biochemistr, University College of Medical Sciences & Guru Teg Bahadur Hospital, (University of Delhi), Delhi, India
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Gruppen EG, Connelly MA, Dullaart RPF. Higher circulating GlycA, a pro-inflammatory glycoprotein biomarker, relates to lipoprotein-associated phospholipase A2 mass in nondiabetic subjects but not in diabetic or metabolic syndrome subjects. J Clin Lipidol 2015; 10:512-8. [PMID: 27206938 DOI: 10.1016/j.jacl.2015.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/06/2015] [Accepted: 11/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a cardiovascular risk marker, which is in part complexed to low-density lipoproteins, where it exerts pro-inflammatory properties. GlycA is a pro-inflammatory proton nuclear magnetic resonance spectroscopy biomarker whose signal originates from a subset of N-acetylglucosamine residues on the most abundant glycosylated acute-phase proteins. OBJECTIVE We compared plasma GlycA and Lp-PLA2 mass between subjects without type 2 diabetes mellitus (T2DM) or the metabolic syndrome (MetS) and subjects with T2DM and/or MetS. We also tested the relationship of GlycA with Lp-PLA2 in each group. METHODS Plasma GlycA, Lp-PLA2 mass, high-sensitivity C-reactivity protein (hsCRP) and lipids were measured in 40 subjects with neither T2DM nor MetS (group 1) and in 58 subjects with T2DM and/or MetS (group 2). RESULTS GlycA and hsCRP were higher (P < .01 for each), whereas Lp-PLA2 was lower in group 2 vs group 1 (P < .001). GlycA was positively related to hsCRP in each group (P < .001). In contrast, GlycA was correlated positively with Lp-PLA2 in group 1 (r = 0.384, P = .015), but not in group 2 (r = 0.045; P = .74; interaction term for difference: P = .059). Although Lp-PLA2 was correlated positively with non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol in each group (P ≤ .02), its inverse relationship with high-density lipoprotein cholesterol in group 1 (r = -0.381, P = .013) was absent in group 2 (r = -0.101, P = .42). CONCLUSIONS A pro-inflammatory glycoprotein biomarker, GlycA, is higher in subjects with either T2DM, MetS, or both. The normally present positive relationship of GlycA with Lp-PLA2 is blunted in subjects with T2DM and/or MetS.
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Affiliation(s)
- Eke G Gruppen
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | - Robin P F Dullaart
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Maiolino G, Bisogni V, Rossitto G, Rossi GP. Lipoprotein-associated phospholipase A2 prognostic role in atherosclerotic complications. World J Cardiol 2015; 7:609-620. [PMID: 26516415 PMCID: PMC4620072 DOI: 10.4330/wjc.v7.i10.609] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/11/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Atherosclerosis manifests itself clinically at advanced stages when plaques undergo hemorrhage and/or rupture with superimposed thrombosis, thus abruptly stopping blood supply. Identification of markers of plaque destabilization at a pre-clinical stage is, therefore, a major goal of cardiovascular research. Promising results along this line were provided by studies investigating the lipoprotein-associated phospholipase A2 (Lp-PLA2), a member of phospholipase A2 proteins family that plays a key role in the metabolism of pro-inflammatory phospholipids, as oxidized low-density lipoproteins, and in the generation of pro-atherogenic metabolites, including lysophosphatidylcholine and oxidized free fatty acids. We herein review the experimental and clinical studies supporting use of Lp-PLA2 activity for predicting cardiovascular events. To his end we considered not only Lp-PLA2 activity and mass, but also Lp-PLA2 gene variations and their association with incident coronary artery disease, stroke, and cardiovascular mortality. Based on these evidences the major scientific societies have included in their guidelines the measurement of Lp-PLA2 activity among the biomarkers that are useful in risk stratification of adult asymptomatic patients at intermediate cardiovascular risk. The results of two recently published major clinical trials with the Lp-PLA2 inhibitor darapladib, which seem to challenge the pathogenic role of Lp-PLA2, will also be discussed.
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Julve J, Pardina E, Pérez-Cuéllar M, Ferrer R, Rossell J, Baena-Fustegueras JA, Fort JM, Lecube A, Blanco-Vaca F, Sánchez-Quesada JL, Peinado-Onsurbe J. Bariatric surgery in morbidly obese patients improves the atherogenic qualitative properties of the plasma lipoproteins. Atherosclerosis 2014; 234:200-5. [PMID: 24674904 DOI: 10.1016/j.atherosclerosis.2014.02.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of weight loss induced in morbidly obese subjects by Roux-en-Y gastric bypass bariatric surgery on the atherogenic features of their plasma lipoproteins. METHODS Twenty-one morbidly obese subjects undergoing bariatric surgery were followed up for up to 1 year after surgery. Plasma and lipoproteins were assayed for chemical composition and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity. Lipoprotein size was assessed by non-denaturing polyacrylamide gradient gel electrophoresis, and oxidised LDL by ELISA. Liver samples were assayed for mRNA abundance of oxidative markers. RESULTS Lipid profile analysis revealed a reduction in the plasma concentrations of cholesterol and triglycerides, which were mainly associated with a significant reduction in the plasma concentration of circulating apoB-containing lipoproteins rather than with changes in their relative chemical composition. All patients displayed a pattern A phenotype of LDL subfractions and a relative increase in the antiatherogenic plasma HDL-2 subfraction (>2-fold; P < 0.001). The switch towards predominantly larger HDL particles was due to an increase in their relative cholesteryl ester content. Excess weight loss also led to a significant decrease in the plasma concentration of oxidised LDL (∼-25%; P < 0.01) and in the total Lp-PLA2 activity. Interestingly, the decrease in plasma Lp-PLA2 was mainly attributed to a decrease in the apoB-containing lipoprotein-bound Lp-PLA2. CONCLUSION Our data indicate that the weight loss induced by bariatric surgery ameliorates the atherogenicity of plasma lipoproteins by reducing the apoB-containing Lp-PLA2 activity and oxidised LDL, as well as increasing the HDL-2 subfraction.
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Affiliation(s)
- Josep Julve
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Barcelona, Spain; Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Pardina
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Pérez-Cuéllar
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Roser Ferrer
- Departament de Bioquímica i Unitat de Cirurgia, Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joana Rossell
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | | | - José Manuel Fort
- Departament de Bioquímica i Unitat de Cirurgia, Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Albert Lecube
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida, Spain; Unitat de Recerca en Diabetes i Metabolisme, Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Barcelona, Spain; Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Blanco-Vaca
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Barcelona, Spain; Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Luis Sánchez-Quesada
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
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Hirschler V. Is lipoprotein-associated phospholipase A₂ correlated with cardiovascular risk in European women? Indian J Med Res 2013; 138:832-3. [PMID: 24521623 PMCID: PMC3978969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- V. Hirschler
- Nutrition & Diabetes Department Hospital Durand, Buenos Aires, Argentina
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Kones R. Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes. Vasc Health Risk Manag 2013; 9:617-70. [PMID: 24174878 PMCID: PMC3808150 DOI: 10.2147/vhrm.s37119] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Residual risk, the ongoing appreciable risk of major cardiovascular events (MCVE) in statin-treated patients who have achieved evidence-based lipid goals, remains a concern among cardiologists. Factors that contribute to this continuing risk are atherogenic non-low-density lipoprotein (LDL) particles and atherogenic processes unrelated to LDL cholesterol, including other risk factors, the inherent properties of statin drugs, and patient characteristics, ie, genetics and behaviors. In addition, providers, health care systems, the community, public policies, and the environment play a role. Major statin studies suggest an average 28% reduction in LDL cholesterol and a 31% reduction in relative risk, leaving a residual risk of about 69%. Incomplete reductions in risk, and failure to improve conditions that create risk, may result in ongoing progression of atherosclerosis, with new and recurring lesions in original and distant culprit sites, remodeling, arrhythmias, rehospitalizations, invasive procedures, and terminal disability. As a result, identification of additional agents to reduce residual risk, particularly administered together with statin drugs, has been an ongoing quest. The current model of atherosclerosis involves many steps during which disease may progress independently of guideline-defined elevations in LDL cholesterol. Differences in genetic responsiveness to statin therapy, differences in ability of the endothelium to regenerate and repair, and differences in susceptibility to nonlipid risk factors, such as tobacco smoking, hypertension, and molecular changes associated with obesity and diabetes, may all create residual risk. A large number of inflammatory and metabolic processes may also provide eventual therapeutic targets to lower residual risk. Classically, epidemiologic and other evidence suggested that raising high-density lipoprotein (HDL) cholesterol would be cardioprotective. When LDL cholesterol is aggressively lowered to targets, low HDL cholesterol levels are still inversely related to MCVE. The efflux capacity, or ability to relocate cholesterol out of macrophages, is believed to be a major antiatherogenic mechanism responsible for reduction in MCVE mediated in part by healthy HDL. HDL cholesterol is a complex molecule with antioxidative, anti-inflammatory, anti-thrombotic, antiplatelet, and vasodilatory properties, among which is protection of LDL from oxidation. HDL-associated paraoxonase-1 has a major effect on endothelial function. Further, HDL promotes endothelial repair and progenitor cell health, and supports production of nitric oxide. HDL from patients with cardiovascular disease, diabetes, and autoimmune disease may fail to protect or even become proinflammatory or pro-oxidant. Mendelian randomization and other clinical studies in which raising HDL cholesterol has not been beneficial suggest that high plasma levels do not necessarily reduce cardiovascular risk. These data, coupled with extensive preclinical information about the functional heterogeneity of HDL, challenge the "HDL hypothesis", ie, raising HDL cholesterol per se will reduce MCVE. After the equivocal AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides: Impact on Global Health Outcomes) study and withdrawal of two major cholesteryl ester transfer protein compounds, one for off-target adverse effects and the other for lack of efficacy, development continues for two other agents, ie, anacetrapib and evacetrapib, both of which lower LDL cholesterol substantially. The negative but controversial HPS2-THRIVE (the Heart Protection Study 2-Treatment of HDL to Reduce the Incidence of Vascular Events) trial casts further doubt on the HDL cholesterol hypothesis. The growing impression that HDL functionality, rather than abundance, is clinically important is supported by experimental evidence highlighting the conditional pleiotropic actions of HDL. Non-HDL cholesterol reflects the cholesterol in all atherogenic particles containing apolipoprotein B, and has outperformed LDL cholesterol as a lipid marker of cardiovascular risk and future mortality. In addition to including a measure of residual risk, the advantages of using non-HDL cholesterol as a primary lipid target are now compelling. Reinterpretation of data from the Treating to New Targets study suggests that better control of smoking, body weight, hypertension, and diabetes will help lower residual risk. Although much improved, control of risk factors other than LDL cholesterol currently remains inadequate due to shortfalls in compliance with guidelines and poor patient adherence. More efficient and greater use of proven simple therapies, such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, combined with statin therapy, may be more fruitful in improving outcomes than using other complex therapies. Comprehensive, intensive, multimechanistic, global, and national programs using primordial, primary, and secondary prevention to lower the total level of cardiovascular risk are necessary.
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Affiliation(s)
- Richard Kones
- Cardiometabolic Research Institute, Houston, TX, USA
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Abete P, Adlbrecht C, Assimakopoulos SF, Côté N, Dullaart RP, Evsyukova HV, Fang TC, Goswami N, Hinghofer-Szalkay H, Ho YL, Hoebaus C, Hülsmann M, Indridason OS, Kholová I, Lin YH, Maniscalco M, Mathieu P, Mizukami H, Ndrepepa G, Roessler A, Sánchez-Ramón S, Santamaria F, Schernthaner GH, Scopa CD, Sharp KM, Skuladottir GV, Steichen O, Stenvinkel P, Tejera-Alhambra M, Testa G, Visseren FL, Westerink J, Witasp A, Yagihashi S, Ylä-Herttuala S. Research update for articles published in EJCI in 2011. Eur J Clin Invest 2013. [DOI: 10.1111/eci.12131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Pasquale Abete
- Dipartimento di Scienze Mediche Traslazionali; Università degli Studi di Napoli “Federico II”; Naples Italy
| | - Christopher Adlbrecht
- Division of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | | | - Nancy Côté
- Department of Surgery; Laboratoire d'Études Moléculaires des Valvulopathies (LEMV); Institut Universitaire de Cardiologie et de Pneumologie de Québec/Research Center; Laval University; Québec Canada
| | - Robin P.F. Dullaart
- Department of Endocrinology; University of Groningen and University Medical Centre Groningen; Groningen The Netherlands
| | - Helen V. Evsyukova
- Department of Hospital Therapy; Medical Faculty; St Petersburg State University; St. Petersburg Russia
| | - Te-Chao Fang
- Division of Nephrology; Department of Internal Medicine; Buddhist Tzu Chi General Hospital; Hualien Taiwan
| | - Nandu Goswami
- Institute of Physiology; Medical University of Graz; Austria
| | | | - Yi-Lwun Ho
- Department of Internal Medicine; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Clemens Hoebaus
- Department of Medicine II; Angiology, Medical University and General Hospital of Vienna; Vienna Austria
| | - Martin Hülsmann
- Division of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | - Olafur S. Indridason
- Internal Medicine Services; Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - Ivana Kholová
- Pathology; Fimlab Laboratories; Tampere University Hospital; Tampere Finland
| | - Yen-Hung Lin
- Department of Internal Medicine; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Mauro Maniscalco
- Section of Respiratory Diseases; Hospital “S. Maria della Pietà”; Casoria Naples Italy
| | - Patrick Mathieu
- Department of Surgery; Laboratoire d'Études Moléculaires des Valvulopathies (LEMV); Institut Universitaire de Cardiologie et de Pneumologie de Québec/Research Center; Laval University; Québec Canada
| | - Hiroki Mizukami
- Department of Pathology and Molecular Medicine; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Gjin Ndrepepa
- Herz- und Kreislauferkrankungen; Deutsches Herzzentrum München; Technische Universität; Munich Germany
| | | | | | - Francesca Santamaria
- Department of Translational Medical Sciences; Federico II University; Naples Italy
| | | | | | | | - Gudrun V. Skuladottir
- Department of Physiology; Faculty of Medicine; School of Health Sciences; University of Iceland; Reykjavik Iceland
| | - Olivier Steichen
- Internal Medicine Department; Assistance Publique-Hôpitaux de Paris; Tenon Hospital; Paris France
- Faculty of Medicine; Université Pierre et Marie Curie-Paris 6; Paris France
| | - Peter Stenvinkel
- Divisions of Renal Medicine and Baxter Novum; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Marta Tejera-Alhambra
- Laboratory of Neuroimmunology; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | - Gianluca Testa
- Dipartimento di Medicina e Scienze della Salute; Università del Molise; Campobasso Italy
| | - Frank L.J. Visseren
- Department of Vascular Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine; University Medical Center Utrecht; Utrecht The Netherlands
| | - Anna Witasp
- Divisions of Renal Medicine and Baxter Novum; Department of Clinical Science; Intervention and Technology; Karolinska Institutet; Stockholm Sweden
| | - Soroku Yagihashi
- Department of Pathology and Molecular Medicine; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Seppo Ylä-Herttuala
- A.I.Virtanen Institute for Molecular Sciences; University of Eastern Finland; Kuopio Finland
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Sánchez-Quesada JL, Vinagre I, De Juan-Franco E, Sánchez-Hernández J, Bonet-Marques R, Blanco-Vaca F, Ordóñez-Llanos J, Pérez A. Impact of the LDL subfraction phenotype on Lp-PLA2 distribution, LDL modification and HDL composition in type 2 diabetes. Cardiovasc Diabetol 2013; 12:112. [PMID: 23915379 PMCID: PMC3750253 DOI: 10.1186/1475-2840-12-112] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/03/2013] [Indexed: 01/18/2023] Open
Abstract
Background Qualitative alterations of lipoproteins underlie the high incidence of atherosclerosis in diabetes. The objective of this study was to assess the impact of low-density lipoprotein (LDL) subfraction phenotype on the qualitative characteristics of LDL and high-density lipoprotein (HDL) in patients with type 2 diabetes. Methods One hundred twenty two patients with type 2 diabetes in poor glycemic control and 54 healthy subjects were included in the study. Patients were classified according to their LDL subfraction phenotype. Seventy-seven patients presented phenotype A whereas 45 had phenotype B. All control subjects showed phenotype A. Several forms of modified LDL, HDL composition and the activity and distribution of lipoprotein-associated phospholipase A2 (Lp-PLA2) were analyzed. Results Oxidized LDL, glycated LDL and electronegative LDL were increased in both groups of patients compared with the control group. Patients with phenotype B had increased oxidized LDL and glycated LDL concentration than patients with phenotype A. HDL composition was abnormal in patients with diabetes, being these abnormalities more marked in patients with phenotype B. Total Lp-PLA2 activity was higher in phenotype B than in phenotype A or in control subjects. The distribution of Lp-PLA2 between HDL and apoB-containing lipoproteins differed in patients with phenotype A and phenotype B, with higher activity associated to apoB-containing lipoproteins in the latter. Conclusions The presence of LDL subfraction phenotype B is associated with increased oxidized LDL, glycated LDL and Lp-PLA2 activity associated to apoB-containing lipoproteins, as well as with abnormal HDL composition.
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Affiliation(s)
- Jose Luis Sánchez-Quesada
- Biomedical Research Institute IIB Sant Pau, Cardiovascular Biochemistry Group, C/ Antoni Maria Claret, 167, 08025 Barcelona, Spain.
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Koska J, Saremi A, Bahn G, Yamashita S, Reaven PD. The effect of intensive glucose lowering on lipoprotein particle profiles and inflammatory markers in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care 2013; 36:2408-14. [PMID: 23536583 PMCID: PMC3714508 DOI: 10.2337/dc12-2082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Intensive glucose-lowering therapy (INT) did not reduce macrovascular events in the recent randomized trials, possibly because it did not improve or worsen other traditional or novel cardiovascular risk factors. RESEARCH DESIGN AND METHODS Standard plasma lipids, cholesterol content of lipoprotein subfractions, and plasma inflammatory and prothrombotic markers were determined in a subgroup of the Veterans Affairs Diabetes Trial (VADT) participants (n = 266) at baseline and after 9 months of INT or standard therapy. RESULTS INT lowered glycated hemoglobin (by a median of 2% vs. a median of 0.7% by standard treatment; P < 0.0001); increased BMI (4 vs. 1%; P < 0.001), total HDL (9 vs. 4%; P < 0.05), HDL2 (14 vs. 0%; P = 0.009), LDL2 (36 vs. 1%; P < 0.0001), and plasma adiponectin (130 vs. 80%; P < 0.01); and reduced triglycerides (-13 vs. -4%; P = 0.02) and small, dense LDL4 (-39 vs. -13%; P < 0.001), but had no effect on levels of plasma apolipoproteins B-100 and B-48, C-reactive protein, interleukin-6, lipoprotein-associated phospholipase A2, myeloperoxidase, fibrinogen, and plasminogen activator inhibitor 1. Incident macrovascular events were associated with baseline interleukin-6 (hazard ratio per each quartile increase 1.33 [95% CI 1.06-1.66]), total LDL (1.25 [1.01-1.55]), apolipoprotein B-100 (1.29 [1.01-1.65]), and fibrinogen (1.26 [1.01-1.57]) but not changes in any cardiovascular risk factors at 9 months. CONCLUSIONS INT was associated with improved adiponectin, lipid levels, and a favorable shift in LDL and HDL subfractions after 9 months. These data suggest that the failure of INT to lower cardiovascular outcomes occurred despite generally favorable changes in standard and novel risk factors early in the study.
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Affiliation(s)
- Juraj Koska
- Department of Medicine, Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA.
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Lipoprotein-associated phospholipase A2 activity predicts cardiovascular events in high risk coronary artery disease patients. PLoS One 2012; 7:e48171. [PMID: 23118945 PMCID: PMC3485195 DOI: 10.1371/journal.pone.0048171] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 09/21/2012] [Indexed: 01/03/2023] Open
Abstract
Objective Lipoprotein-associated phospholipase A2 (Lp-PLA2) is deemed to play a role in atherosclerosis and plaque destabilization as demonstrated in animal models and in prospective clinical studies. However, most of the literature is either focused on high-risk, apparently healthy patients, or is based on cross sectional studies. Therefore, we tested the hypothesis that serum Lp-PLA2 mass and activity are useful for predicting cardiovascular (CV) events over the coronary atherosclerotic burden and conventional risk factors in high-risk coronary artery disease patients. Methods and Results In a prospective cohort study of 712 Caucasian patients, who underwent coronary angiography and measurement of both Lp-PLA2 mass and activity at baseline, we determined incident CV events at follow-up after splitting the patients into a high and a low Lp-PLA2 mass and activity groups based on ROC analysis and Youden index. Kaplan-Meier and propensity score matching analysis were used to compare CV event-free survival between groups. Follow-up data were obtained in 75% of the cohort after a median of 7.2 years (range 1–12.7 years) during which 129 (25.5%) CV events were observed. The high Lp-PLA2 activity patients showed worse CV event-free survival (66.7% vs. 79.5%, p = 0.023) and acute coronary syndrome-free survival (75.4% vs. 85.6%, p = 0.04) than those in low Lp-PLA2 group. Conclusions A high Lp-PLA2 activity implies a worse CV prognosis at long term follow up in high-risk Caucasian patients referred for coronary angiography.
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