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Hamid H, Bagheri M, Benzing T, Krishnan S, Kianoush S, Ichikawa K, Ghanem AK, Javier D, Iskander B, Aldana-Bitar J, Budoff MJ. Effect of tirzepatide on the progression of coronary atherosclerosis using MDCT: Rationale and design of the Tirzepatide treatment on coronary atherosclerosis progression: The (T-PLAQUE) randomized-controlled trial design: tirzepatide and plaque. Am Heart J 2024:S0002-8703(24)00218-7. [PMID: 39187147 DOI: 10.1016/j.ahj.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Tirzepatide is a novel once-week dual GIP/GLP-1 RA agonist approved for T2DM and its role to reduce cardiovascular events remains to be elucidated. The goal of this trial is to assess how tirzepatide affects the progression of atherosclerotic plaque as determined by multidetector computed tomography angiography (MDCTA). METHODS This trial is a double blind, randomized, prospective, placebo-controlled multi-center phase IV trial. Participant eligible for the study will be adults with T2DM between 40 and 80 years of age who have HbA1c ≥7.0% to ≤10.5% and at least 20% stenosis in major epicardial vessel on CCTA. Baseline examination will include the results of their demographics, lab tests, coronary calcium, as well as coronary plaque volume/composition. Following randomization, tirzepatide or placebo will be given at a weekly dose of 2.5 mg, and a fixed dose-escalation strategy will be followed. Patients will undergo quarterly visits for safety assessments and labs, and follow up with repeat CCTA at 1 year. DISCUSSION This study evaluates the anti-atherogenic potential of tirzepatide, providing a mechanism of potential CV benefit. This is crucial to our understanding of T2DM treatment and CVD since plaque progression portends worse outcomes in these populations. MDCTA is a noninvasive method that assesses the volume, composition, and degree of coronary vessel stenosis. CONCLUSION This study will be the first study to assess the effects of tirzepatide on atherosclerotic plaque progression measured by MDCTA in participants with T2DM.
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Affiliation(s)
- Hossein Hamid
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Marziyeh Bagheri
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Travis Benzing
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Srikanth Krishnan
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Sina Kianoush
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Keishi Ichikawa
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Ahmed K Ghanem
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Denise Javier
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Beshoy Iskander
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Jairo Aldana-Bitar
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA
| | - Matthew J Budoff
- Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA.
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Howden N, Branch K, Douglas P, Gray M, Budoff M, Dewey M, Newby DE, Nicholls SJ, Blankstein R, Fathieh S, Grieve SM, Figtree GA. Computed tomographic angiography measures of coronary plaque in clinical trials: opportunities and considerations to accelerate drug translation. Front Cardiovasc Med 2024; 11:1359500. [PMID: 38500753 PMCID: PMC10945423 DOI: 10.3389/fcvm.2024.1359500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
Atherosclerotic coronary artery disease (CAD) is the causal pathological process driving most major adverse cardiovascular events (MACE) worldwide. The complex development of atherosclerosis manifests as intimal plaque which occurs in the presence or absence of traditional risk factors. There are numerous effective medications for modifying CAD but new pharmacologic therapies require increasingly large and expensive cardiovascular outcome trials to assess their potential impact on MACE and to obtain regulatory approval. For many disease areas, nearly a half of drugs are approved by the U.S. Food & Drug Administration based on beneficial effects on surrogate endpoints. For cardiovascular disease, only low-density lipoprotein cholesterol and blood pressure are approved as surrogates for cardiovascular disease. Valid surrogates of CAD are urgently needed to facilitate robust evaluation of novel, beneficial treatments and inspire investment. Fortunately, advances in non-invasive imaging offer new opportunity for accelerating CAD drug development. Coronary computed tomography angiography (CCTA) is the most advanced candidate, with the ability to measure accurately and reproducibly characterize the underlying causal disease itself. Indeed, favourable changes in plaque burden have been shown to be associated with improved outcomes, and CCTA may have a unique role as an effective surrogate endpoint for therapies that are designed to improve CAD outcomes. CCTA also has the potential to de-risk clinical endpoint-based trials both financially and by enrichment of participants at higher likelihood of MACE. Furthermore, total non-calcified, and high-risk plaque volume, and their change over time, provide a causally linked measure of coronary artery disease which is inextricably linked to MACE, and represents a robust surrogate imaging biomarker with potential to be endorsed by regulatory authorities. Global consensus on specific imaging endpoints and protocols for optimal clinical trial design is essential as we work towards a rigorous, sustainable and staged pathway for new CAD therapies.
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Affiliation(s)
- N. Howden
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Cardiology, Gosford Hospital, Gosford, NSW, Australia
| | - K. Branch
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | - P. Douglas
- Duke Department of Medicine, The Duke University Medical Center, Durham, NC, United States
| | - M. Gray
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - M. Budoff
- Department of Cardiology, Lundquist Institute, Torrance, CA, United States
| | - M. Dewey
- Department of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Campus Mitte, Charitéplatz 1, Berlin, Germany
| | - D. E. Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - S. J. Nicholls
- Victorian Heart Institute, Monash University, Melbourne, VIC, Australia
| | - R. Blankstein
- Departments of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - S. Fathieh
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - S. M. Grieve
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - G. A. Figtree
- Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Lu M, Pan J, Hu Y, Ding L, Li Y, Cui X, Zhang M, Zhang Z, Li C. Advances in the study of vascular related protective effect of garlic (Allium sativum) extract and compounds. J Nutr Biochem 2024; 124:109531. [PMID: 37984733 DOI: 10.1016/j.jnutbio.2023.109531] [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: 09/10/2023] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023]
Abstract
Garlic (Allium sativum) is a functional food containing multiple bioactive compounds that find widespread applications in culinary and medicinal practices. It consists of multiple chemical components, including allicin and alliin. This article offers a comprehensive review of the protective effects of garlic extracts and their active constituents on the vascular system. In vitro and in vivo experiments have shown that garlic extracts and their active ingredients possess various bioactive properties. These substances demonstrate beneficial effects on blood vessels by demonstrating anti-inflammatory and antioxidant activities, inhibiting lipid accumulation and migration, preventing lipid peroxidation, promoting angiogenesis, reducing platelet aggregation, enhancing endothelial function, and inhibiting endothelial cell apoptosis. In clinical studies, garlic and its extracts have demonstrated their efficacy in managing vascular system diseases, including atherosclerosis, diabetes, and high cholesterol levels. In summary, these studies highlight the potential therapeutic roles and underlying mechanisms of garlic and its constituents in managing conditions like diabetes, atherosclerosis, ischemic diseases, and other vascular disorders.
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Affiliation(s)
- Mengkai Lu
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jinyuan Pan
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuanlong Hu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Liang Ding
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuan Li
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xinhai Cui
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Muxin Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhiyuan Zhang
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chao Li
- Innovation Research Institute of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
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Chaurasia PK, Bharati SL, Singh S. Garlic against Heart-related Ailments: Chemistry, Pharmacology, and Future Perspective. Mini Rev Med Chem 2024; 24:521-530. [PMID: 37605421 DOI: 10.2174/1389557523666230821102512] [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: 02/22/2023] [Revised: 06/15/2023] [Accepted: 07/07/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Allium sativum L. (Garlic) is a well-recognized plant of great nutraceutical value with pharmacological evidences. It is full of dietary as well as pharmaceutical properties and has been used in traditional medications for a long time. It is known for good antioxidant, antifungal, antibacterial, anti-diabetic, anti-inflammatory, anticancer, and antiviral effects, along with other therapeutic roles in cardiovascular diseases, anti-atherosclerotic, antihypertensive, anti-thrombotic, blood pressure, bone and skin related problems etc. Objective: Considering the potential of garlic in the treatment of cardiovascular/heart-related diseases, the main objective of this study was to prepare a subject-centric mini-review focusing on its chemistry and pharmacology in heart-related issues. METHODS In order to prepare this mini-review article, an extensive online literature search was performed to find out the most recent studies related to this topic. These studies were briefly reviewed, assessed, and discussed to explore the possible capability of garlic for the cure of cardiovascular problems. RESULT Several experiments on mice models, rat models as well as on humans show the effective role of various forms of garlic in cardiovascular or heart-related ailments. After reviewing the available publications on garlic in heart-related issues, authors found that garlic and its sulfur (S)-based organic constituents may have advantageous applications in the treatment of cardiovascular diseases.
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Affiliation(s)
- Pankaj Kumar Chaurasia
- P.G. Department of Chemistry, Chemical, Biological and Environmental Laboratory, L.S. College, B.R. Ambedkar Bihar University, Muzaffarpur, Bihar, 842001, India
| | - Shashi Lata Bharati
- Department of Chemistry, North Eastern Regional Institute of Science and Technology, Nirjuli, Itanagar, Arunachal Pradesh, 791109, India
| | - Sunita Singh
- Department of Chemistry, Navyug Kanya Mahavidyalaya, University of Lucknow, Lucknow, Uttar Pradesh 226004, India
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Murali S, Smith ER, Tiong MK, Tan S, Toussaint ND. Interventions to Attenuate Cardiovascular Calcification Progression: A Systematic Review of Randomized Clinical Trials. J Am Heart Assoc 2023; 12:e031676. [PMID: 38014685 PMCID: PMC10727339 DOI: 10.1161/jaha.123.031676] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Cardiovascular calcification, characterized by deposition of calcium phosphate in the arterial wall and heart valves, is associated with cardiovascular morbidity and mortality and is commonly seen in aging, diabetes, and chronic kidney disease. Whether evidence-based interventions could significantly attenuate cardiovascular calcification progression remains uncertain. METHODS AND RESULTS We conducted a systematic review of randomized controlled trials involving interventions, compared with placebo, another comparator, or standard of care, to attenuate cardiovascular calcification. Included clinical trials involved participants without chronic kidney disease, and the outcome was cardiovascular calcification measured using radiological methods. Quality of evidence was determined by the Cochrane risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations assessment. Forty-nine randomized controlled trials involving 9901 participants (median participants 104, median duration 12 months) were eligible for inclusion. Trials involving aged garlic extract (n=6 studies) consistently showed attenuation of cardiovascular calcification. Trials involving 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (n=14), other lipid-lowering agents (n=2), hormone replacement therapies (n=3), vitamin K (n=5), lifestyle measures (n=4), and omega-3 fatty acids (n=2) consistently showed no attenuation of cardiovascular calcification with these therapies. Trials involving antiresorptive (n=2), antihypertensive (n=2), antithrombotic (n=4), and hypoglycemic agents (n=3) showed mixed results. Singleton studies involving salsalate, folate with vitamin B6 and 12, and dalcetrapib showed no attenuation of cardiovascular calcification. Overall, Cochrane risk of bias was moderate, and the Grading of Recommendations, Assessment, Development, and Evaluations assessment for a majority of analyses was moderate certainty of evidence. CONCLUSIONS Currently, there are insufficient or conflicting data for interventions evaluated in clinical trials for mitigation of cardiovascular calcification. Therapy involving aged garlic extract appears most promising, but evaluable studies were small and of short duration.
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Affiliation(s)
- Shashank Murali
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Edward R. Smith
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medicine (RMH)University of MelbourneParkvilleVictoriaAustralia
| | - Mark K. Tiong
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medicine (RMH)University of MelbourneParkvilleVictoriaAustralia
| | - Sven‐Jean Tan
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medicine (RMH)University of MelbourneParkvilleVictoriaAustralia
| | - Nigel D. Toussaint
- Department of NephrologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of Medicine (RMH)University of MelbourneParkvilleVictoriaAustralia
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Gavilán J, Mardones C, Oyarce G, Triviño S, Espinoza-Rubilar N, Ramírez-Molina O, Pérez C, Becerra J, Varas P, Duran-Arcos R, Muñoz-Montesino C, Moraga-Cid G, Yévenes GE, Fuentealba J. Elephant Black Garlic's Beneficial Properties for Hippocampal Neuronal Network, Chemical Characterization and Biological Evaluation. Foods 2023; 12:3968. [PMID: 37959086 PMCID: PMC10650549 DOI: 10.3390/foods12213968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
Garlic has been used for decades as an important food and additionally for its beneficial properties in terms of nutrition and ancestral therapeutics. In this work, we compare the properties of fresh (WG) and aged (BG) extract obtained from elephant garlic, harvested on Chiloe Island, Chile. BG was prepared from WG with a 20-day aging process under controlled temperature and humidity conditions. We observed that in BG, compounds such as diallyl disulfide decrease, and compounds of interest such as 5-hydroxymethylfurfural (69%), diallyl sulfide (17%), 3H-1,2-Dithiole (22%) and 4-Methyl-1,2,3-trithiolane (16%) were shown to be increased. Using 2,2-diphenyl-1-picrylhydrazyl (DPPH, BG: 51 ± 5.7%, WG: 12 ± 2.6%) and 2,20-azino-bis-(3-ethylbenzothiazoline-6 sulfonate) diammonium salt (ABTS, BG: 69.4 ± 2.3%, WG: 21 ± 3.9%) assays, we observed that BG possesses significantly higher antioxidant activity than WG and increased cell viability in hippocampal slices (41 ± 9%). The effects of WG and BG were shown to improve the neuronal function through an increased in intracellular calcium transients (189 ± 4%). In parallel, BG induced an increase in synaptic vesicle protein 2 (SV-2; 75 ± 12%) and brain-derived neurotrophic factor (BDNF; 32 ± 12%) levels. Thus, our study provides the initial scientific bases to foster the use of BG from Chiloe Island as a functional food containing a mixture of bioactive compounds that may contribute to brain health and well-being.
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Affiliation(s)
- Javiera Gavilán
- Departmento de Fisiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (J.G.); (N.E.-R.); (O.R.-M.); (R.D.-A.); (C.M.-M.); (G.M.-C.)
| | - Claudia Mardones
- Facultad de Farmacia, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile;
| | - Gabriela Oyarce
- Laboratorio de Quimica de Productos Naturales, Facultas de Ciencias Naturales y Oceanograficas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (G.O.); (S.T.); (C.P.); (J.B.)
| | - Sergio Triviño
- Laboratorio de Quimica de Productos Naturales, Facultas de Ciencias Naturales y Oceanograficas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (G.O.); (S.T.); (C.P.); (J.B.)
| | - Nicole Espinoza-Rubilar
- Departmento de Fisiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (J.G.); (N.E.-R.); (O.R.-M.); (R.D.-A.); (C.M.-M.); (G.M.-C.)
| | - Oscar Ramírez-Molina
- Departmento de Fisiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (J.G.); (N.E.-R.); (O.R.-M.); (R.D.-A.); (C.M.-M.); (G.M.-C.)
| | - Claudia Pérez
- Laboratorio de Quimica de Productos Naturales, Facultas de Ciencias Naturales y Oceanograficas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (G.O.); (S.T.); (C.P.); (J.B.)
| | - José Becerra
- Laboratorio de Quimica de Productos Naturales, Facultas de Ciencias Naturales y Oceanograficas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (G.O.); (S.T.); (C.P.); (J.B.)
| | | | - Robinson Duran-Arcos
- Departmento de Fisiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (J.G.); (N.E.-R.); (O.R.-M.); (R.D.-A.); (C.M.-M.); (G.M.-C.)
| | - Carola Muñoz-Montesino
- Departmento de Fisiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (J.G.); (N.E.-R.); (O.R.-M.); (R.D.-A.); (C.M.-M.); (G.M.-C.)
| | - Gustavo Moraga-Cid
- Departmento de Fisiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (J.G.); (N.E.-R.); (O.R.-M.); (R.D.-A.); (C.M.-M.); (G.M.-C.)
| | - Gonzalo E. Yévenes
- MinusPain, Facultad de Ciencias Biológicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile
| | - Jorge Fuentealba
- Departmento de Fisiologia, Facultad de Ciencias Biologicas, Universidad de Concepcion, Concepción P.O. Box 160-C, Chile; (J.G.); (N.E.-R.); (O.R.-M.); (R.D.-A.); (C.M.-M.); (G.M.-C.)
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Nna VU, McGrowder D, Nwokocha C. Nutraceutical management of metabolic syndrome as a palliative and a therapeutic to coronavirus disease (COVID) crisis. Arch Physiol Biochem 2023; 129:1123-1142. [PMID: 33770443 DOI: 10.1080/13813455.2021.1903041] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 03/09/2021] [Indexed: 12/19/2022]
Abstract
The global market for medicinal plants and herbs is on the increase due to their desirability, efficacy, and less adverse effects as complementary and alternative medications to the orthodox pharmaceuticals, perhaps due to their natural components and qualities. Metabolic syndromes are managed with changes in diet, exercise, lifestyle modifications and the use of pharmacological agents. Plants are now known to have potent antioxidant and cholinergic activities which are relevant to the management of several metabolic syndromes, which are unfortunately, co-morbidity factors in the coronavirus disease crisis. This review will focus on the biological activities of some plant products used as complementary and alternative medicines in the management of metabolic syndromes, and on their reported antiviral, antithrombotic, angiotensin-converting enzyme inhibitory properties, which are integral to their usage in the management of viral infections and may give an avenue for prophylactic and therapeutics especially in the absence of vaccines/formulated antiviral therapies.
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Affiliation(s)
- Victor Udo Nna
- Department of Physiology, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Donovan McGrowder
- Department of Pathology, The University of the West Indies, Mona, Jamaica
| | - Chukwuemeka Nwokocha
- Department of Basic Medical Sciences (Physiology Section), The University of the West Indies, Mona, Jamaica
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García-García J, Gracián C, Baños A, Guillamón E, Gálvez J, Rodriguez-Nogales A, Fonollá J. Beneficial Effects of Daily Consumption of Garlic and Onion Extract Concentrate on Infectious Respiratory Diseases in Elderly Resident Volunteers. Nutrients 2023; 15:nu15102308. [PMID: 37242191 DOI: 10.3390/nu15102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/17/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Aging is a biological process with high susceptibility to several infections. This risk increases in older patients in residential care facilities (RCF). Thus, there is a clear demand for developing preventive interventions with new therapeutic compounds that combine efficacy and safety. This could be the case of compounds derived from plants of the genus Allium spp. The purpose of this study was to evaluate the impact of a combination of a garlic and onion extract concentrate standardized in organosulfur compounds derived from propiin on the incidence of respiratory tract infections in elderly patients of RCF. Sixty-five volunteers were selected at random to receive a placebo or a single daily dose of the extract for thirty-six weeks. Different clinical visits were performed to evaluate the main respiratory diseases with an infectious origin, as well as the associated symptoms and their duration. The extract showed a clinical safety profile and significantly reduced the incidence of respiratory infections. Moreover, the treatment decreased the number and duration of the associated symptoms compared with the placebo group. For the first time, we demonstrated the protective effect of Alliaceae extract in respiratory infectious diseases in elderly healthy volunteers, which could be used prophylactically against the most common infectious respiratory diseases.
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Affiliation(s)
- Jorge García-García
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
| | - Carlos Gracián
- Nursing Home "Residencia de Mayores Claret", 18011 Granada, Spain
| | | | | | - Julio Gálvez
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), 18012 Granada, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBER-EHD), 28029 Madrid, Spain
| | - Alba Rodriguez-Nogales
- Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), 18012 Granada, Spain
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Cheung B, Sikand G, Dineen EH, Malik S, Barseghian El-Farra A. Lipid-Lowering Nutraceuticals for an Integrative Approach to Dyslipidemia. J Clin Med 2023; 12:jcm12103414. [PMID: 37240523 DOI: 10.3390/jcm12103414] [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: 12/31/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 05/28/2023] Open
Abstract
Dyslipidemia is a treatable risk factor for atherosclerotic cardiovascular disease that can be addressed through lifestyle changes and/or lipid-lowering therapies. Adherence to statins can be a clinical challenge in some patients due to statin-associated muscle symptoms and other side effects. There is a growing interest in integrative cardiology and nutraceuticals in the management of dyslipidemia, as some patients desire or are actively seeking a more natural approach. These agents have been used in patients with and without established atherosclerotic cardiovascular disease. We provide an updated review of the evidence on many new and emerging nutraceuticals. We describe the mechanism of action, lipid-lowering effects, and side effects of many nutraceuticals, including red yeast rice, bergamot and others.
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Affiliation(s)
- Brian Cheung
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Geeta Sikand
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Elizabeth H Dineen
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Shaista Malik
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
| | - Ailin Barseghian El-Farra
- Susan Samueli Integrative Health Institute, 856 Health Sciences Road, Irvine, CA 92617, USA
- Division of Cardiology, University of California, Irvine, CA 92521, USA
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NAUREEN ZAKIRA, BONETTI GABRIELE, MEDORI MARIACHIARA, AQUILANTI BARBARA, VELLUTI VALERIA, MATERA GIUSEPPINA, IACONELLI AMERIGO, BERTELLI MATTEO. Foods of the Mediterranean diet: garlic and Mediterranean legumes. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E12-E20. [PMID: 36479501 PMCID: PMC9710409 DOI: 10.15167/2421-4248/jpmh2022.63.2s3.2741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Mediterranean diet is a dietary regime derived from the one followed by the ancient civilizations of the Mediterranean region. It is characterized by many healthy constituents, among which are cereals, legumes, fruits, vegetables, olives, and white meat. Many studies suggest that this dietary regime is the key to obtaining a healthy and long life, like that of the Mediterranean peoples. Despite its popularity among health professionals, this diet is still confined to a certain geographical area of the world. Due to globalization and the modern busy lifestyle, this cultural diet is losing ground even in its home region, with more and more people embracing the so-called Western diet. An awareness of health benefits of the individual components of the Mediterranean diet will therefore draw attention from all over the world to this healthy and affordable dietary pattern, which can not only improve the overall health, but also reduce the risk of developing chronic and infectious diseases. In this regard, garlic and Mediterranean legumes present a huge repertoire of phytochemicals having both nutritive and nutraceutical properties, which therefore should be included in our daily dietary routines in moderate proportions. This narrative review aims at summarizing the principal components and health benefits of the Mediterranean diet, in particular of garlic and legumes.
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Affiliation(s)
| | | | - MARIA CHIARA MEDORI
- MAGI’S LAB, Rovereto (TN), Italy
- Correspondence: Maria Chiara Medori, MAGI’S LAB, Rovereto (TN), 38068, Italy. E-mail:
| | - BARBARA AQUILANTI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - VALERIA VELLUTI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - GIUSEPPINA MATERA
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - AMERIGO IACONELLI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - MATTEO BERTELLI
- MAGI EUREGIO, Bolzano, Italy
- MAGI’S LAB, Rovereto (TN), Italy
- MAGISNAT, Peachtree Corners (GA), USA
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11
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Li M, Yun W, Wang G, Li A, Gao J, He Q. Roles and mechanisms of garlic and its extracts on atherosclerosis: A review. Front Pharmacol 2022; 13:954938. [PMID: 36263122 PMCID: PMC9574545 DOI: 10.3389/fphar.2022.954938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
The prevention and treatment of cardiovascular diseases (CVDs) have achieved initial results, but the number of CVDs patients will increase rapidly in the next 10 years. Atherosclerosis (AS) is a significant risk factor for CVDs. The impact of lifestyle and daily diet varies considerably between different countries and continents and has been shown to affect the development of various diseases such as diabetes and CVDs. Primary and secondary prevention using alternative supplements and methods to avoid or reduce the use of traditional pharmacological drugs have also become popular. One of the reasons for this is that pharmacological drugs with lipid-lowering, and blood pressure-lowering effects cause many side effects that may negatively impact the quality of life. Patients are now emphasizing reliance on lifestyle changes to reduce cardiovascular risks. Garlic is a medicinal and edible plant that has been used for a long time. In order to reveal garlic application in the prevention and treatment of AS, reviewing the latest domestic and international studies through searching databases. The result shows that the antiatherogenic role of garlic is eximious. And the mechanisms are mainly related to hypolipidemic, antioxidant, antithrombotic, inhibiting angiogenesis, protecting endothelial cells, anti-inflammatory, anti-apoptotic, inhibiting vascular smooth muscle proliferation, and regulating gut microbiota. The main signaling pathways involve AMPK/TLRs, Keap1/Nrf2, PI3K/AKT, PPARγ/LXRα, GEF-H1/RhoA/Rac, etc. The antiatherogenic actions and molecular mechanism of garlic were reviewed in this study to obtain a robust evidence basis for the clinical application and mechanistic study and provide a theoretical basis for further utilization of garlic.
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Affiliation(s)
- Min Li
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wingyan Yun
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Clinical Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Guibin Wang
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Anqi Li
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Clinical Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Gao
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Clinical Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qingyong He
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Qingyong He,
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Imaizumi VM, Laurindo LF, Manzan B, Guiguer EL, Oshiiwa M, Otoboni AMMB, Araujo AC, Tofano RJ, Barbalho SM. Garlic: A systematic review of the effects on cardiovascular diseases. Crit Rev Food Sci Nutr 2022; 63:6797-6819. [PMID: 35193446 DOI: 10.1080/10408398.2022.2043821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Allium sativum (garlic) certainly is one of the oldest horticultural crops in the world and presents bioactive compounds that are related to the garlic's effects on human health. Several authors have shown beneficial effects on diabetes, hypertension, dyslipidemia, obesity, and cardiovascular diseases (CVD), which are among the most relevant causes of mortality in the world. The aim of this systematic review was to evaluate the effects of garlic in the risk factors of CVD and evaluate its economic importance. MEDLINE-PubMed, COCHRANE, EMBASE, and Google Scholar databases were searched. The included studies showed that the use of garlic can reduce blood pressure, waist circumference, body mass index, LDL-c, non-HDL-c, total cholesterol, triglycerides, and inflammatory markers. It also can increase the levels of HDL-c and can improve cardiovascular parameters such as coronary artery calcium, microcirculation, epicardial and periaortic adipose tissue, post occlusive reactive hyperemia, low attenuation plaque, carotid intima-media thickness; and carotid intima-media thickness. Due to these reasons, garlic can be considered in the prevention and treatment of CVD risk factors.
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Affiliation(s)
- Vitor Massami Imaizumi
- Department of Nutrition, School of Food and Technology of Marilia (FATEC), Marilia, São Paulo, Brazil
| | - Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, Marília, São Paulo, Brazil
| | - Barbara Manzan
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, Marília, São Paulo, Brazil
| | - Elen Landgraf Guiguer
- Department of Nutrition, School of Food and Technology of Marilia (FATEC), Marilia, São Paulo, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation - UNIMAR, Marília, São Paulo, Brazil
| | - Marie Oshiiwa
- Department of Nutrition, School of Food and Technology of Marilia (FATEC), Marilia, São Paulo, Brazil
| | | | - Adriano Cressoni Araujo
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation - UNIMAR, Marília, São Paulo, Brazil
| | - Ricardo Jose Tofano
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation - UNIMAR, Marília, São Paulo, Brazil
| | - Sandra Maria Barbalho
- Department of Nutrition, School of Food and Technology of Marilia (FATEC), Marilia, São Paulo, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Avenida Higino Muzzi Filho, Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation - UNIMAR, Marília, São Paulo, Brazil
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Nakanishi R, Osawa K, Kurata A, Miyoshi T. Role of coronary computed tomography angiography (CTA) post the ISCHEMIA trial: Precision prevention based on coronary CTA-derived coronary atherosclerosis. J Cardiol 2021; 79:572-580. [PMID: 34974937 DOI: 10.1016/j.jjcc.2021.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/10/2021] [Indexed: 12/28/2022]
Abstract
The International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial has been recently published and suggested the importance of the selection of patients at high risk for future cardiovascular disease events and the enhancing optimal medical therapy. In the ISCHEMIA trial, coronary computed tomography angiography (CTA) was performed in most of the patients to exclude high-risk patients and those without obstructive coronary artery disease (CAD) who should not be randomized. Coronary CTA has been widely used as a non-invasive diagnostic modality to assess patients with suspected CAD. Currently, the international guidelines allow use of coronary CTA as a class I recommendation for patients with chest pain. Besides, in the numerous multicenter trials, the emerging role of coronary CTA has proven that it could soon become the standard for monitoring CAD and identifying patients at high risk of future cardiovascular events. In this review article, we summarize the current evidence on coronary CTA and the potential role of coronary CTA after the ISCHEMIA trial for patients with CAD. Risk assessment using detailed CAD data obtained non-invasively and prevention of future cardiovascular events through improved medical care will become increasingly essential for the precision treatment and prevention of CAD in patients.
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Affiliation(s)
- Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
| | - Kazuhiro Osawa
- Department of General Internal Medicine 3, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Akira Kurata
- Department of Cardiology, Shikoku Cancer Center, Ehime, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Miki S, Suzuki JI, Takashima M, Ishida M, Kokubo H, Yoshizumi M. S-1-Propenylcysteine promotes IL-10-induced M2c macrophage polarization through prolonged activation of IL-10R/STAT3 signaling. Sci Rep 2021; 11:22469. [PMID: 34789834 PMCID: PMC8599840 DOI: 10.1038/s41598-021-01866-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Atherosclerosis is a chronic inflammatory disease that may lead to the development of serious cardiovascular diseases. Aged garlic extract (AGE) has been reported to ameliorate atherosclerosis, although its mode of action remains unclear. We found that AGE increased the mRNA or protein levels of arginase1 (Arg1), interleukin-10 (IL-10), CD206 and hypoxia-inducible factor 2α (HIF2α) and decreased that of CD68, HIF1α and inducible nitric oxide synthase in the aorta and spleen of apolipoprotein E knockout mice. We also found that S-1-propenylcysteine (S1PC), a characteristic sulfur compound in AGE, increased the level of IL-10-induced Arg1 mRNA and the extent of M2c-like macrophage polarization in vitro. In addition, S1PC increased the population of M2c-like macrophages, resulting in suppressed the population of M1-like macrophages and decreased lipopolysaccharide-induced production of pro-inflammatory cytokines. These effects were accompanied by prolonged phosphorylation of the IL-10 receptor α (IL-10Rα) and signal transducer and activator of transcription 3 (STAT3) that inhibited the interaction between IL-10Rα and Src homology-2-containing inositol 5'-phosphatase 1 (SHIP1). In addition, administration of S1PC elevated the M2c/M1 macrophage ratio in senescence-accelerated mice. These findings suggest that S1PC may help improve atherosclerosis due to its anti-inflammatory effect to promote IL-10-induced M2c macrophage polarization.
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Affiliation(s)
- Satomi Miki
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan.
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., 1624 Shimokotachi, Koda-cho, Akitakata-shi, Hiroshima, 739-1195, Japan.
| | - Jun-Ichiro Suzuki
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., 1624 Shimokotachi, Koda-cho, Akitakata-shi, Hiroshima, 739-1195, Japan
| | - Miyuki Takashima
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., 1624 Shimokotachi, Koda-cho, Akitakata-shi, Hiroshima, 739-1195, Japan
| | - Mari Ishida
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Hiroki Kokubo
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan
| | - Masao Yoshizumi
- Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima, 734-8551, Japan.
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Chao CJ, Lakshmanan S, Ceponiene I, Luo Y, Nakanishi R, Nezarat N, Kanisawa M, Budoff MJ. New carotid plaque, but not the progression of intima-media thickness, predicts the progression of high-risk coronary plaque. Coron Artery Dis 2021; 32:554-560. [PMID: 33417340 DOI: 10.1097/mca.0000000000001001] [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: 11/26/2022]
Abstract
BACKGROUND Carotid intima-media thickness (CIMT) is regarded as a controversial risk marker for cardiovascular disease (CVD). We aimed to evaluate the role of CIMT and carotid plaque progression as predictors for the progression of coronary plaque and compositions. METHODS In the Garlic 4 study, asymptomatic patients with intermediate CVD risk (Framingham risk score 6-20%) were recruited for a serial carotid ultrasound, and coronary artery calcium score (CAC)/coronary computed tomography angiography (CCTA) studies for subclinical atherosclerosis at a baseline and 1 year. The association between progression of quantitatively measured coronary plaque compositions and the progression of CIMT/carotid plaque was analyzed. A P value <0.05 is considered as statistically significant. RESULTS Forty-seven consecutive patients were included. The mean age was 58.5 ± 6.6 years, and 69.1 % were male. New carotid plaque appeared in 34.0 % (n = 16) of participants, and 55.3 % (n = 26) of subjects had coronary plaque progression. In multilinear regression analysis, adjusted by age, gender, and statin use, the development of new carotid plaque was significantly associated with an increase in noncalcified coronary plaque [β (SE) 2.0 (0.9); P = 0.025] and necrotic core plaque (1.7 (0.6); P = 0.009). In contrast, CIMT progression was not associated with the progression of coronary plaque, or coronary artery calcium (CAC) (P = NS). CONCLUSION Compared to CIMT, carotid plaque is a better indicator of coronary plaque progression. The appearance of a new carotid plaque is associated with significant progression of necrotic core and noncalcified plaque, which are high-risk coronary plaque components.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona
- Lundquist Institute, California, USA
| | | | - Indre Ceponiene
- Lundquist Institute, California, USA
- Department of Cardiology, Lithuanian University of Health Sciences, Lithuania
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Budoff MJ, Bhatt DL, Kinninger A, Lakshmanan S, Muhlestein JB, Le VT, May HT, Shaikh K, Shekar C, Roy SK, Tayek J, Nelson JR. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J 2021; 41:3925-3932. [PMID: 32860032 PMCID: PMC7654934 DOI: 10.1093/eurheartj/ehaa652] [Citation(s) in RCA: 254] [Impact Index Per Article: 84.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/10/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023] Open
Abstract
Aims Despite the effects of statins in reducing cardiovascular events and slowing progression of coronary atherosclerosis, significant cardiovascular (CV) risk remains. Icosapent ethyl (IPE), a highly purified eicosapentaenoic acid ethyl ester, added to a statin was shown to reduce initial CV events by 25% and total CV events by 32% in the REDUCE-IT trial, with the mechanisms of benefit not yet fully explained. The EVAPORATE trial sought to determine whether IPE 4 g/day, as an adjunct to diet and statin therapy, would result in a greater change from baseline in plaque volume, measured by serial multidetector computed tomography (MDCT), than placebo in statin-treated patients. Methods and results A total of 80 patients were enrolled in this randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis as documented by MDCT (one or more angiographic stenoses with ≥20% narrowing), be on statin therapy, and have persistently elevated triglyceride (TG) levels. Patients underwent an interim scan at 9 months and a final scan at 18 months with coronary computed tomographic angiography. The pre-specified primary endpoint was change in low-attenuation plaque (LAP) volume at 18 months between IPE and placebo groups. Baseline demographics, vitals, and laboratory results were not significantly different between the IPE and placebo groups; the median TG level was 259.1 ± 78.1 mg/dL. There was a significant reduction in the primary endpoint as IPE reduced LAP plaque volume by 17%, while in the placebo group LAP plaque volume more than doubled (+109%) (P = 0.0061). There were significant differences in rates of progression between IPE and placebo at study end involving other plaque volumes including fibrous, and fibrofatty (FF) plaque volumes which regressed in the IPE group and progressed in the placebo group (P < 0.01 for all). When further adjusted for age, sex, diabetes status, hypertension, and baseline TG, plaque volume changes between groups remained significantly different, P < 0.01. Only dense calcium did not show a significant difference between groups in multivariable modelling (P = 0.053). Conclusions Icosapent ethyl demonstrated significant regression of LAP volume on MDCT compared with placebo over 18 months. EVAPORATE provides important mechanistic data on plaque characteristics that may have relevance to the REDUCE-IT results and clinical use of IPE.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Suvasini Lakshmanan
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Joseph B Muhlestein
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Viet T Le
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA.,Department of Medicine, Rocky Mountain University of Health Profession, Provo, UT, USA
| | - Heidi T May
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Kashif Shaikh
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Chandana Shekar
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - Sion K Roy
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - John Tayek
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA
| | - John R Nelson
- California Cardiovascular Institute, Fresno, CA, USA
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Taron J, Lee S, Aluru J, Hoffmann U, Lu MT. A review of serial coronary computed tomography angiography (CTA) to assess plaque progression and therapeutic effect of anti-atherosclerotic drugs. Int J Cardiovasc Imaging 2020; 36:2305-2317. [PMID: 32076919 PMCID: PMC7434668 DOI: 10.1007/s10554-020-01793-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/10/2020] [Indexed: 12/15/2022]
Abstract
Change in coronary artery plaque on serial catheter intravascular ultrasound (IVUS) is an established technique to monitor the therapeutic effect of drugs on coronary atherosclerosis. Recent advances in coronary computed tomography angiography (CTA) now allow for non-invasive assessment of change in coronary plaque. Because coronary CTA is noninvasive, it enables clinical trials with lower-risk populations, higher retention rates, and lower costs. This review presents an overview of serial coronary CTA as a noninvasive imaging technique to gauge the therapeutic effect of anti-atherosclerotic therapies. Furthermore, it reviews the increasing use of serial CTA as an imaging endpoint in completed and ongoing clinical trials.
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Affiliation(s)
- Jana Taron
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA.
- Department for Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
| | - Saeyun Lee
- Division of Rheumatology/Immunology/Pulmonology, Emory University School of Medicine, Atlanta, USA
| | - John Aluru
- Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Udo Hoffmann
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Michael T Lu
- Department of Radiology, Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA
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García-García FJ, Monistrol-Mula A, Cardellach F, Garrabou G. Nutrition, Bioenergetics, and Metabolic Syndrome. Nutrients 2020; 12:E2785. [PMID: 32933003 PMCID: PMC7551996 DOI: 10.3390/nu12092785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
According to the World Health Organization (WHO), the global nutrition report shows that whilst part of the world's population starves, the other part suffers from obesity and associated complications. A balanced diet counterparts these extreme conditions with the proper proportion, composition, quantity, and presence of macronutrients, micronutrients, and bioactive compounds. However, little is known on the way these components exert any influence on our health. These nutrients aiming to feed our bodies, our tissues, and our cells, first need to reach mitochondria, where they are decomposed into CO2 and H2O to obtain energy. Mitochondria are the powerhouse of the cell and mainly responsible for nutrients metabolism, but they are also the main source of oxidative stress and cell death by apoptosis. Unappropriated nutrients may support mitochondrial to become the Trojan horse in the cell. This review aims to provide an approach to the role that some nutrients exert on mitochondria as a major contributor to high prevalent Western conditions including metabolic syndrome (MetS), a constellation of pathologic conditions which promotes type II diabetes and cardiovascular risk. Clinical and experimental data extracted from in vitro animal and cell models further demonstrated in patients, support the idea that a balanced diet, in a healthy lifestyle context, promotes proper bioenergetic and mitochondrial function, becoming the best medicine to prevent the onset and progression of MetS. Any advance in the prevention and management of these prevalent complications help to face these challenging global health problems, by ameliorating the quality of life of patients and reducing the associated sociosanitary burden.
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Affiliation(s)
- Francesc Josep García-García
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Anna Monistrol-Mula
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Francesc Cardellach
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
| | - Glòria Garrabou
- Muscle Research and Mitochondrial Function Laboratory, CELLEX-IDIBAPS, Internal Medicine Department, Faculty of Medicine, University of Barcelona, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (F.J.G.-G.); (A.M.-M.); (F.C.)
- CIBERER—Centre for Biomedical Research Network in Rare Diseases, 28029 Madrid, Spain
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Naveed M, Majeed F, Taleb A, Zubair HM, Shumzaid M, Farooq MA, Baig MMFA, Abbas M, Saeed M, Changxing L. A Review of Medicinal Plants in Cardiovascular Disorders: Benefits and Risks. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:259-286. [PMID: 32345058 DOI: 10.1142/s0192415x20500147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Many cultivated and wild plants are used for the management of various diseases, specifically renal and hepatic diseases and those of the immune and cardiovascular systems. In China, medicinal plants from ancient to modern history have been used in patients with angina pectoris, congestive heart failure (CHF), systolic hypertension, arrhythmia, and venous insufficiency for centuries. The latest increase in the fame of natural products and alternative medicine has revived interest in conventional remedies that have been consumed in the management of CVD. The cardio-protective properties of the various herbs are possibly due to their anti-oxidative, antihypercholesterolemic, anti-ischemic activities, and inhibition of platelet aggregation that reduce the risk of CVD. Ethno-pharmacological and biological properties of these plants are explored, based upon published scientific literature. Although a majority of medicinal plants having a biological mechanism that linked with CVD management, to date, published literature pertaining to their promising scientific properties are still poorly understood. Compared with synthetic medicines, alternative medicines do not need scientific studies before their formal approval from the government sector and due to this purpose; their safety, as well as efficacy, still remain elusive. Taken together, we addressed all accessible evidence on alternative medicines commonly consumed in CVD management. Our comprehensive analysis of the scientific literature indicated that many TCMs are available and valuable herbal medication would be the best alternative for the management of CVD as a complementary therapy. Furthermore, practitioners should always discuss possible benefits-risks of alternative medicines with patients so that they are aware of the consumption of alternative medications.
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Affiliation(s)
- Muhammad Naveed
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Fatima Majeed
- Department of Nutrition and Food Hygiene, School of Public Health, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Abdoh Taleb
- Department of Clinical Pharmacology, School of Pharmacy, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Hafiz Muhammad Zubair
- Department of Pharmacology, School of Basic Medical Sciences, Nanjing Medical University, Jiangsu Province, Nanjing 211166, P. R. China
| | - Muhammad Shumzaid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Punjab Province, Lahore 54770, Pakistan
| | - Muhammad Asim Farooq
- Department of Pharmacy, School of Pharmacy, China Pharmaceutical University, Jiangsu Province, Nanjing 211198, P. R. China
| | - Mirza Muhammad Faran Ashraf Baig
- State Key Laboratory of Analytical Chemistry for Life Sciences, School of Chemistry and Chemical Engineering, Nanjing University, Jiangsu Province, Nanjing 210093, P. R. China
| | - Muhammad Abbas
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Jiangsu Province, Nanjing 210093, P. R. China
| | - Muhammad Saeed
- Faculty of Animal Production and Technology, The Cholistan University of Veterinary and Animal Sciences, Bahawalpur 6300, Pakistan
| | - Li Changxing
- Department of Human Anatomy, Medical College of Qinghai University, Xining 810000, Qinghai Province, P. R. China
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Ushijima M, Kunimura K, Suzuki JI. S -1-Propenylcysteine, a sulfur compound in aged garlic extract, alleviates cold-induced reduction in peripheral blood flow in rat via activation of the AMPK/eNOS/NO pathway. Exp Ther Med 2020; 20:2815-2821. [PMID: 32765777 PMCID: PMC7401927 DOI: 10.3892/etm.2020.8969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022] Open
Abstract
Aged garlic extract (AGE) has been shown to improve peripheral circulatory disturbances in both clinical trials and experimental animal models. To investigate the effect of S-1-propenylcysteine (S1PC), a characteristic sulfur compound in AGE, on cold-induced reduction in tail blood flow of rat, Wistar rats were individually placed in a restraint cage and given the treatment with cold water (15˚C) after the oral administration of AGE or its constituents S1PC, S-allylcysteine (SAC) and S-allylmercaptocysteine (SAMC). After the cold-treatment the tail blood flow of rats was measured at the indicated times. The pretreatment with AGE (2 g/kg BW) and S1PC (6.5 mg/kg BW) significantly alleviated the reduction of rat tail blood flow induced by cold treatment. The effect of S1PC was dose-dependent and maximal at the dose of 6.5 mg/kg BW, whereas SAC and SAMC were ineffective. To gain insight into the mechanism of S1PC action, the concentration of nitrogen oxide metabolites (NOx) in the plasma and the levels of phosphorylated endothelial nitric oxide synthase (eNOS) and 5'-AMP-activated protein kinase (AMPK) in the aorta were measured. The pretreatment with S1PC significantly increased the plasma concentration of NOx as well as the level of phosphorylated form of AMPK and eNOS in the aorta after cold-treatment. The present findings suggest that S1PC is a major constituent responsible for the effect of AGE to alleviate the cold-induced reduction of peripheral blood flow in rat by acting on the AMPK/eNOS/NO pathway in the aorta.
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Affiliation(s)
- Mitsuyasu Ushijima
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Hiroshima 739-1195, Japan
| | - Kayo Kunimura
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Hiroshima 739-1195, Japan
| | - Jun-Ichiro Suzuki
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Hiroshima 739-1195, Japan
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21
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Potential Health Benefit of Garlic Based on Human Intervention Studies: A Brief Overview. Antioxidants (Basel) 2020; 9:antiox9070619. [PMID: 32679751 PMCID: PMC7402177 DOI: 10.3390/antiox9070619] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Garlic is a polyphenolic and organosulfur enriched nutraceutical spice consumed since ancient times. Garlic and its secondary metabolites have shown excellent health-promoting and disease-preventing effects on many human common diseases, such as cancer, cardiovascular and metabolic disorders, blood pressure, and diabetes, through its antioxidant, anti-inflammatory, and lipid-lowering properties, as demonstrated in several in vitro, in vivo, and clinical studies. The present review aims to provide a comprehensive overview on the consumption of garlic, garlic preparation, garlic extract, and garlic extract-derived bioactive constituents on oxidative stress, inflammation, cancer, cardiovascular and metabolic disorders, skin, bone, and other common diseases. Among the 83 human interventional trials considered, the consumption of garlic has been reported to modulate multiple biomarkers of different diseases; in addition, its combination with drugs or other food matrices has been shown to be safe and to prolong their therapeutic effects. The rapid metabolism and poor bioavailability that have limited the therapeutic use of garlic in the last years are also discussed.
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Budoff MJ, Muhlestein JB, Bhatt DL, Le Pa VT, May HT, Shaikh K, Shekar C, Kinninger A, Lakshmanan S, Roy SK, Tayek J, Nelson JR. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: a prospective, placebo-controlled randomized trial (EVAPORATE): interim results. Cardiovasc Res 2020; 117:1070-1077. [PMID: 32609331 DOI: 10.1093/cvr/cvaa184] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/30/2022] Open
Abstract
AIMS Though statin therapy is known to slow coronary atherosclerosis progression and reduce cardiovascular (CV) events, significant CV risk still remains. In the REDUCE-IT study, icosapent ethyl (IPE) added to statin therapy reduced initial CV events by 25% and total CV events by 30%, but its effects on coronary atherosclerosis progression have not yet been fully investigated. Therefore, this study is to determine whether IPE 4 g/day will result in a greater change from baseline in plaque volume measured by serial multidetector computed tomography than placebo in statin-treated patients. METHODS AND RESULTS EVAPORATE is a randomized, double-blind, placebo-controlled trial. Patients had to have coronary atherosclerosis by coronary computed tomographic angiography (CCTA) (≥1 angiographic stenoses with ≥20% narrowing), on stable statin therapy with low-density lipoprotein cholesterol levels 40-115 mg/dL, and persistently high triglyceride levels (135-499 mg/dL). Patients underwent an interim scan at 9 months and were followed for an additional 9 months with CCTA at 0, 9, and 18 months. Here, we present the protocol-specified interim efficacy results. A total of 80 patients were enrolled, with 67 completing the 9-month visit and having interpretable CCTA at baseline and at 9 months (age = 57 ± 6 years, male = 36, 63%). At the 9-month interim analysis, there was no significant change in low attenuation plaque (LAP) between active and placebo groups (74% vs. 94%, P = 0.469). However, there was slowing of total non-calcified plaque (sum of LAP, fibrofatty, and fibrous plaque) (35% vs. 43%, P = 0.010), total plaque (non-calcified + calcified plaque) (15% vs. 26%, P = 0.0004), fibrous plaque (17% vs. 40%, P = 0.011), and calcified plaque (-1% vs. 9%, P = 0.001), after adjustment by baseline plaque, age, sex, diabetes, baseline triglyceride levels, and statin use. CONCLUSION EVAPORATE is the first study using CCTA to evaluate the effects of IPE as an adjunct to statin therapy on atherosclerotic plaque characteristics in a high-risk CV population with persistently high triglyceride levels. It provides important mechanistic data in regards to the reduction in CV events in the REDUCE-IT clinical trial. CLINICALTRIALS. GOVIDENTIFIER NCT029226027.
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Affiliation(s)
- Matthew J Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, CDCRC, Torrance, CA 90502, USA
| | - Joseph B Muhlestein
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Deepak L Bhatt
- Department of Internal Medicine, Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Viet T Le Pa
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Rocky Mountain University of Health Profession, Provo, UT, USA
| | - Heidi T May
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Kashif Shaikh
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, CDCRC, Torrance, CA 90502, USA
| | - Chandana Shekar
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, CDCRC, Torrance, CA 90502, USA
| | - April Kinninger
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, CDCRC, Torrance, CA 90502, USA
| | - Suvasini Lakshmanan
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, CDCRC, Torrance, CA 90502, USA
| | - Sion K Roy
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, CDCRC, Torrance, CA 90502, USA
| | - John Tayek
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W Carson Street, CDCRC, Torrance, CA 90502, USA
| | - John R Nelson
- Department of Internal Medicine, California Cardiovascular Institute, Fresno, CA, USA
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23
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Lakshmanan S, Shekar C, Kinninger A, Dahal S, Onuegbu A, Cai AN, Hamal S, Birudaraju D, Cherukuri L, Flores F, Dailing C, Roy SK, Bhatt DL, Nelson JR, Budoff MJ. Association of high-density lipoprotein levels with baseline coronary plaque volumes by coronary CTA in the EVAPORATE trial. Atherosclerosis 2020; 305:34-41. [PMID: 32615321 DOI: 10.1016/j.atherosclerosis.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/24/2020] [Accepted: 05/20/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Dyslipidemia with elevated triglycerides (TGL) and low high-density lipoprotein cholesterol (HDL-C) predicts residual cardiovascular risk, despite goal LDL-C levels and optimal statin therapy. Coronary plaque characterization by CCTA can provide mechanistic understanding of coronary artery disease and associated prognosis. The role of HDL-C in the pathogenesis of atherosclerosis is not well understood in statin-treated patients with elevated TGL. We sought to examine the association of HDL-C levels with baseline coronary plaque volumes, namely total plaque (TP) and total non-calcified plaque (TNCP) volumes by CCTA in participants enrolled in the EVAPORATE trial. METHODS We analyzed 80 participants who were enrolled in the trial. Linear regression analysis as a univariate and multivariate model adjusted for significant cardiovascular risk factors was performed to evaluate independent association of HDL-C and baseline coronary plaque volumes. In an exploratory analysis, stratified by sex, we compared the association of serum HDL-C levels with baseline coronary plaque volumes in males and females. RESULTS Mean (SD) age of participants (n = 80) was 57.1 (8.6) years and 43% were male. Median (Inter Quartile Range/IQR) log-TNCP volume was 83.0 (0.1-7.3) mm3 and median (IQR) log-TP volume was 144.8 (0.1-7.1) mm3. After adjustment for relevant clinical covariates including age, gender, BMI, hypertension, diabetes, past smoking and baseline TGL levels, increasing levels of HDL-C remain independently associated with lower baseline log-TNCP volumes (β: 0.043 ± 0.021, p = 0.042) and baseline log-TP volumes (β: 0.046 ± 0.022, p = 0.035) on CCTA. On stratifying by sex in a multivariable regression analysis, HDL-C levels were inversely associated with baseline log-TNCP volumes (β: 0.066 ± 0.026, p = 0.018) and log-TP volumes (β: 0.077 ± 0.025, p = 0.004) in females, but not in males (log-TNCP volumes β: 0.038 ± 0.034, p = 0.282) and log-TP volumes (β: -0.033 ± 0.036, p = 0.364). CONCLUSIONS In a cohort of statin treated patients with known atherosclerosis and residually elevated TGL, there was a significant inverse relationship between HDL-C levels and baseline coronary plaque, TP and TNCP volumes on CCTA. Our findings provide more detailed mechanistic evidence regarding the protective role of HDL-C in coronary atherosclerosis in a high-risk cohort. Further investigation to evaluate the interaction of HDL-C levels and coronary plaque volumes on differential CVD risk in statin-treated patients with elevated TGL levels is warranted.
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Affiliation(s)
- Suvasini Lakshmanan
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | | | - April Kinninger
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suraj Dahal
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Afiachukwu Onuegbu
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Andrew N Cai
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sajad Hamal
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Divya Birudaraju
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Lavanya Cherukuri
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ferdinand Flores
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Christopher Dailing
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sion K Roy
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John R Nelson
- Department of Cardiology, California Cardiovascular Institute, Fresno, CA, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, Torrance, CA, USA.
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24
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Hamal S, Cherukuri L, Shaikh K, Kinninger A, Doshi J, Birudaraju D, Budoff MJ. Effect of semaglutide on coronary atherosclerosis progression in patients with type II diabetes: rationale and design of the semaglutide treatment on coronary progression trial. Coron Artery Dis 2020; 31:306-314. [PMID: 32271261 DOI: 10.1097/mca.0000000000000830] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cardiovascular morbidity and mortality are a major burden in patients with type 2 diabetic mellitus. In a landmark study, semaglutide (an injectable glucagon like peptide-1 receptor agonist) has been shown to significantly reduce cardiovascular events, however, the mechanism of benefit is still unknown. The primary hypothesis of our current study is to assess the effect of semaglutide to reduce progression of noncalcified coronary atherosclerotic plaque volume as measured by serial coronary CTA as compared to placebo in persons with diabetes over 1 year. METHODS One hundred forty patients will be enrolled after signing informed consent and followed up for 12 months and with a phone call 30 days after medical discontinuation. All the participants will undergo coronary artery calcium scoring and coronary computed tomography angiography at our center at baseline and 12 months. Eligible participants will be randomly assigned to semaglutide 2 mg/1.5 ml (1.34 mg/ml) prefilled pen for subcutaneous (SC) injection or placebo 1.5 ml, pen-injector for SC injection in a 1:1 fashion as add-on to their standard of care. RESULTS As of July 2019, the study was approximately 30% enrolled with an estimated enrollment completion by first quarter of 2020 and end of study by first quarter 2021. Thirty patients were enrolled as of 23 July 2019. Preliminary data of demographics and clinical characteristics were summarized. CONCLUSION Our current study will provide important imaging-derived data that may add relevance to the clinically derived outcomes from liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results and semaglutide and cardiovascular outcomes in patients with type 2 diabetic mellitus 6 trials.
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Affiliation(s)
- Sajad Hamal
- Department of Cardiology, Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, California, USA
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25
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Comprehensive plaque assessment with serial coronary CT angiography: translation to bedside. Int J Cardiovasc Imaging 2020; 36:2335-2346. [DOI: 10.1007/s10554-020-01849-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 12/24/2022]
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26
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Lakshmanan S, Shekar C, Kinninger A, Dahal S, Onuegbu A, Cai AN, Hamal S, Birudaraju D, Roy SK, Nelson JR, Budoff MJ, Bhatt DL. Comparison of mineral oil and non-mineral oil placebo on coronary plaque progression by coronary computed tomography angiography. Cardiovasc Res 2020; 116:479-482. [PMID: 31825484 PMCID: PMC7031703 DOI: 10.1093/cvr/cvz329] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Suvasini Lakshmanan
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Chandana Shekar
- Department of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - April Kinninger
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Suraj Dahal
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Afiachukwu Onuegbu
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Andrew N Cai
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Sajad Hamal
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Divya Birudaraju
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Sion K Roy
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - John R Nelson
- Department of Cardiology, California Cardiovascular Institute, Fresno, CA, USA
| | - Matthew J Budoff
- Department of Cardiology, Lundquist Institute for Biomedical Innovation and Research at Harbor UCLA Medical Center, 1124 West Carson Street Torrance, CA 90502, USA
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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The preventive and therapeutic application of garlic and other plant ingredients in the treatment of periodontal diseases. Exp Ther Med 2020; 19:1507-1510. [PMID: 32010331 PMCID: PMC6966117 DOI: 10.3892/etm.2019.8382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
Since ancient times, pharmacologically active ingredients derived from natural sources, including plants and microbials have been used in the treatment of a wide array of diseases, such as atherosclerosis, diabetes mellitus and cancers. Herbal extracts and polyphenols are produced from herbs that contain a variety of ingredients, most of which exhibit anti-inflammatory, anti-oxidative and anti-microbial actions. Gingivitis is triggered by the infection of the periodontal tissues with periodontal disease-causing pathogens present in the dental biofilm. This is accompanied by weak inflammatory immune reactions in the gingiva. In periodontitis, prolonged and excessive inflammation results in the destruction of gingival connective tissue and in the resorption of alveolar bone, leading to tooth loss. There are a number of clinical reports showing the effectiveness of both herbal extracts and polyphenols on periodontal diseases when applied as a mouthwash or dentifrice into the oral cavity. However, to date, at least to the best of our knowledge, there is no clinical report available on the therapeutic effects of garlic or its extract on periodontal diseases, apart from a recent study, which reported that the intake of aged garlic extract (AGE) containing various pharmacologically active sulfur compounds, alleviated the symptoms of gingivitis clinically. The finding suggests that AGE may be a promising candidate for use in the treatment of periodontal diseases, although additional clinical trials are warranted to confirm this. In addition, further studies are required for the clarification of the basic molecular mechanisms through which AGE attenuates gingivitis. In this review, we summarize the beneficial effects of several natural compounds on periodontal disease and describe the possible applications of garlic ingredients in detail.
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Shaikh K, Kinninger A, Cherukuri L, Birudaraju D, Nakanishi R, Almeida S, Jayawardena E, Shekar C, Flores F, Hamal S, Sheikh MS, Johanis A, Cu B, Budoff MJ. Aged garlic extract reduces low attenuation plaque in coronary arteries of patients with diabetes: A randomized, double-blind, placebo-controlled study. Exp Ther Med 2020; 19:1457-1461. [PMID: 32010322 PMCID: PMC6966158 DOI: 10.3892/etm.2019.8371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/21/2019] [Indexed: 01/28/2023] Open
Abstract
Several previous studies have demonstrated that aged garlic extract (AGE) inhibits the progression of coronary artery calcification and non-calcified plaque (NCP) in the general population. However, its effects on plaque progression in patients with diabetes have not yet been investigated, at least to the best of our knowledge. This study investigated whether AGE reduces the coronary plaque volume measured by cardiac computed tomography angiography (CCTA) in patients with diabetes mellitus (DM). A total of 80 participants with DM with a median age of 57 years were prospectively assigned to consume 2,400 mg AGE/day (after completion, 37 participants) or placebo (after completion, 29 participants) orally. Both groups underwent CCTA at baseline and follow-up 365 days apart. In total, 66 participants completed the study. Coronary plaque volume, including total plaque (TP), dense calcium (DC), fibrous, fibro-fatty and low-attenuation plaque (LAP) volumes were measured based upon pre-defined intensity cut-off values using semi-automated software (QAngio CT). Changes in various plaque types were normalized to the total coronary artery length. The non-parametric Wilcoxon rank-sum test was performed to examine the differences in plaque formation between the 2 groups. No significant differences were found in the baseline characteristics between the AGE and placebo groups. Compared with the placebo group, the AGE group exhibited a statistically significant regression in normalized LAP [median and standard deviation (SD) -0.2 (18.8) vs. 2.5 (69.3), P=0.0415]. No differences were observed in TP, fibrous, or fibrofatty plaque volumes between the AGE and placebo group. On the whole, this study indicated that the %LAP change in the AGE group was significantly greater than that in the placebo group in patients with diabetes. However, further studies are warranted to evaluate whether AGE has the ability to stabilize vulnerable plaque and decrease adverse cardiovascular events.
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Affiliation(s)
- Kashif Shaikh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - April Kinninger
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Lavanya Cherukuri
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Divya Birudaraju
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Rine Nakanishi
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Shone Almeida
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Eranthi Jayawardena
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Chandana Shekar
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Ferdinand Flores
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Sajad Hamal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Mohammed Salman Sheikh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Amit Johanis
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Benedict Cu
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
| | - Matthew J. Budoff
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA 90502, USA
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Quesada I, de Paola M, Torres-Palazzolo C, Camargo A, Ferder L, Manucha W, Castro C. Effect of Garlic’s Active Constituents in Inflammation, Obesity and Cardiovascular Disease. Curr Hypertens Rep 2020; 22:6. [DOI: 10.1007/s11906-019-1009-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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30
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Song H, Cui J, Mossine VV, Greenlief CM, Fritsche K, Sun GY, Gu Z. Bioactive components from garlic on brain resiliency against neuroinflammation and neurodegeneration. Exp Ther Med 2019; 19:1554-1559. [PMID: 32010338 PMCID: PMC6966118 DOI: 10.3892/etm.2019.8389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/05/2019] [Indexed: 01/05/2023] Open
Abstract
Garlic (Allium sativum) has been widely used for culinary and medicinal purposes. Aged garlic extract (AGE) and sulfur-containing compounds, including S-allylcysteine (SAC) are well documented botanical active components of garlic. AGE is prepared by the prolonged extraction of fresh garlic with aqueous ethanol and is considered a nutritional supplement with potential to promote human health. SAC is a water-soluble organosulfur compound and the most abundant component of AGE. Studies have demonstrated that both AGE and SAC can exert neuroprotective effects against neuroinflammation and neurodegeneration. Another bioactive component in AGE is N-α-(1-deoxy-D-fructos-1-yl)-L-arginine (FruArg) although less is known about the metabolic activity of this compound. The main aim of this review was to provide an undated overview of the neuroprotective perspectives of these active garlic components (AGE, SAC and FruArg). Of interest, our studies and those of others indicate that both AGE and FruArg are involved in the regulation of gene transcription and protein expression. AGE has been shown to reverse 67% of the transcriptome alteration induced by endotoxins-lipopolysaccharide (LPS), and FruArg has been shown to account for the protective effects by reversing 55% of genes altered in a cell-based neuroinflammation paradigm stimulated by LPS in murine BV-2 microglial cells. AGE and FruArg can alleviate neuroinflammatory responses through a variety of signaling pathways, such as Toll-like receptor and interleukin (IL)-6 signaling, as well as by upregulating the nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated oxidative stress pathways known to promote microglial resiliency against neuroinflammation and neurodegeneration. The capability of FruArg to pass through the blood-brain barrier further supports its potential as a therapeutic compound. In summary, these experimental results provide new insight into the understanding of the neuroprotective effects of garlic components in promoting brain resiliency for health benefits.
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Affiliation(s)
- Hailong Song
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Jiankun Cui
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA.,Truman VA Hospital Research Service, Columbia, MO 65201, USA
| | - Valeri V Mossine
- Department of Biochemistry, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | | | - Kevin Fritsche
- Division of Animal Sciences, University of Missouri, Columbia, MO 65211, USA
| | - Grace Y Sun
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA.,Department of Biochemistry, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Zezong Gu
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO 65212, USA.,Truman VA Hospital Research Service, Columbia, MO 65201, USA
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Miki S, Suzuki JI, Kunimura K, Morihara N. Mechanisms underlying the attenuation of chronic inflammatory diseases by aged garlic extract: Involvement of the activation of AMP-activated protein kinase. Exp Ther Med 2019; 19:1462-1467. [PMID: 32010323 PMCID: PMC6966139 DOI: 10.3892/etm.2019.8372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
AMP-activated protein kinase (AMPK) is an ubiquitously expressed serine/threonine kinase and an important regulator of energy metabolism. The decreased activity of AMPK induced by low-grade chronic inflammation has been implicated in several diseases, including type 2 diabetes and atherosclerosis. However, the activation of AMPK by natural and synthetic products can ameliorate these diseases through the inhibition of inflammation. For example, aged garlic extract (AGE) has been shown to enhance the phosphorylation of Thr172 of the α-subunit of AMPK in several tissues of disease model animals. In addition, AGE has been reported to suppress the progression of atherosclerotic plaque formation in an animal model of atherosclerosis. Moreover, AGE has been found to decrease the level of plasma glycated albumin and to improve hyperglycemia in an animal model of type 2 diabetes. These inhibitory effects of AGE are induced by the suppression of the inflammatory response. In the present review, we discuss the mechanisms through which AGE activates AMPK, as well as the mechanisms through which the activation of AMPK by AGE modulates the inflammatory response in disease models.
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Affiliation(s)
- Satomi Miki
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Akitakata-shi, Hiroshima 739-1195, Japan
| | - Jun-Ichiro Suzuki
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Akitakata-shi, Hiroshima 739-1195, Japan
| | - Kayo Kunimura
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Akitakata-shi, Hiroshima 739-1195, Japan
| | - Naoaki Morihara
- Central Research Institute, Wakunaga Pharmaceutical Co., Ltd., Akitakata-shi, Hiroshima 739-1195, Japan.,Research and Development, Wakunaga of America Co., Ltd., Mission Viejo, CA 92691, USA
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Dahal S, Budoff MJ. Implications of serial coronary computed tomography angiography in the evaluation of coronary plaque progression. Curr Opin Lipidol 2019; 30:446-451. [PMID: 31592788 DOI: 10.1097/mol.0000000000000645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The purpose is to review the use of coronary computed tomography (CT) angiography to assess coronary plaque burden/progression and to discuss about recent clinical trials that have utilized this imaging modality to study the effect of new pharmacotherapies on plaque burden/progression. RECENT FINDINGS There are numerous clinical trials that have utilized coronary CT angiography to demonstrate the potential benefits of statins, apixaban, rivaroxaban, aged garlic extract, biologic agents, and omega-3 fatty acids to reduce coronary plaque progression. Coronary CT angiography can identify high-risk plaques and can also quantify total plaque burden, both of which are independent risk factors to predict major adverse cardiac events. SUMMARY Coronary heart disease remains one of the leading cause of mortality in the world. Utilizing coronary CT angiography, it is possible to identify rupture-prone plaques and also to quantify the total plaque burden. New pharmacotherapies that have the potential to reduce plaque progression have been used in clinical trials and these trials have utilized coronary CT angiography to track coronary atheroma progression. In future, we will see frequent utilization of coronary CT angiography to track coronary atheroma.
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Affiliation(s)
- Suraj Dahal
- Department of Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, CDCRC, Torrance, California, USA
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Tajbakhsh A, Kovanen PT, Rezaee M, Banach M, Sahebkar A. Ca 2+ Flux: Searching for a Role in Efferocytosis of Apoptotic Cells in Atherosclerosis. J Clin Med 2019; 8:jcm8122047. [PMID: 31766552 PMCID: PMC6947386 DOI: 10.3390/jcm8122047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
In atherosclerosis, macrophages in the arterial wall ingest plasma lipoprotein-derived lipids and become lipid-filled foam cells with a limited lifespan. Thus, efficient removal of apoptotic foam cells by efferocytic macrophages is vital to preventing the dying foam cells from forming a large necrotic lipid core, which, otherwise, would render the atherosclerotic plaque vulnerable to rupture and would cause clinical complications. Ca2+ plays a role in macrophage migration, survival, and foam cell generation. Importantly, in efferocytic macrophages, Ca2+ induces actin polymerization, thereby promoting the formation of a phagocytic cup necessary for efferocytosis. Moreover, in the efferocytic macrophages, Ca2+ enhances the secretion of anti-inflammatory cytokines. Various Ca2+ antagonists have been seminal for the demonstration of the role of Ca2+ in the multiple steps of efferocytosis by macrophages. Moreover, in vitro and in vivo experiments and clinical investigations have revealed the capability of Ca2+ antagonists in attenuating the development of atherosclerotic plaques by interfering with the deposition of lipids in macrophages and by reducing plaque calcification. However, the regulation of cellular Ca2+ fluxes in the processes of efferocytic clearance of apoptotic foam cells and in the extracellular calcification in atherosclerosis remains unknown. Here, we attempted to unravel the molecular links between Ca2+ and efferocytosis in atherosclerosis and to evaluate cellular Ca2+ fluxes as potential treatment targets in atherosclerotic cardiovascular diseases.
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Affiliation(s)
- Amir Tajbakhsh
- Halal Research Center of IRI, FDA, Tehran, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahdi Rezaee
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948, Iran
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI), 93-338 Lodz, Poland
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948, Iran
- Correspondence: or ; Tel.: +98-51-1800-2288; Fax: +98-51-1800-2287
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Abstract
BACKGROUND Historically, garlic containing compounds have been used on wounds to improve healing and ward off infection. Researchers have tested many of these ancient ointments, discovering that garlic is a common ingredient in those that are effective. OBJECTIVE To determine the efficacy of topical garlic on surgical wounds compared with Vaseline by analysis of visual analog scales and digital photograph analysis. MATERIALS AND METHODS Seventeen patients with 2 skin excisions applied a 30% garlic ointment to one surgical wound and Vaseline to the other surgical wound twice daily. They were followed up at 2 weeks and 4 weeks post-op. Digital photographs were taken of the sites, and wound visual analog scales were filled out by the patient and the physician. RESULTS Patients and the onsite physician stated the garlic site healed better in 59% and 65% of the wounds, respectively, at 2 weeks. At 4 weeks, the patients and the onsite physician stated the garlic site healed better in 76% and 88% of wounds, respectively. Digital photograph analysis revealed less erythema at the garlic sites (p-value = .02). CONCLUSION Surgical wounds treated with 30% garlic ointment healed with more cosmetically appealing scars than the Vaseline-treated sites.
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Nakanishi R, Motoyama S, Leipsic J, Budoff MJ. How accurate is atherosclerosis imaging by coronary computed tomography angiography? J Cardiovasc Comput Tomogr 2019; 13:254-260. [DOI: 10.1016/j.jcct.2019.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/11/2019] [Accepted: 06/10/2019] [Indexed: 02/01/2023]
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Vlachojannis C, Schoenenberger AW, Erne P, Chrubasik‐Hausmann S. Preliminary evidence of the clinical effectiveness of odourless garlic. Phytother Res 2019; 33:2179-2191. [DOI: 10.1002/ptr.6409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/24/2022]
Affiliation(s)
| | - Andreas W. Schoenenberger
- Department of GeriatricsInselspital, Bern University Hospital, and University of Bern Bern Switzerland
| | - Paul Erne
- Department of BiomedicineUniversita della Svizzera Lugano Switzerland
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Darooghegi Mofrad M, Milajerdi A, Koohdani F, Surkan PJ, Azadbakht L. Garlic Supplementation Reduces Circulating C-reactive Protein, Tumor Necrosis Factor, and Interleukin-6 in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Nutr 2019; 149:605-618. [PMID: 30949665 DOI: 10.1093/jn/nxy310] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/04/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Conflicting findings on the effects of garlic supplementation on inflammatory biomarkers have been observed in randomized clinical trials (RCTs). OBJECTIVES The aim of this study was to summarize study results regarding the effects of garlic supplementation on serum inflammatory biomarkers in adults. METHODS We searched Scopus, PubMed, Google Scholar and Cochrane library databases for relevant papers published until April 2018, using keywords such as "garlic" and "inflammatory biomarker." We included RCTs that 1) were conducted in adults, 2) examined the effects of garlic supplementation on inflammatory biomarkers compared to a control group, and 3) reported sufficient data on inflammatory biomarkers. Results were reported as weighted mean differences (WMD) with 95% CI using random effects models. Cochrane's Q and I-squared (I2) tests were used to determine heterogeneity among studies. Funnel plots and Egger's regression test were used to assess publication bias. RESULTS Sixteen RCTs were included. Garlic doses ranged from 12 to 3600 mg/d, and intervention duration ranged from 2 to 52 wk. Garlic administration significantly reduced serum C-reactive protein (CRP) (n = 13) (WMD: -0.61 mg/L, 95% CI: -1.12, -0.11, P = 0.018, I2 = 76.9%), IL-6 (n = 5) (WMD: -0.73 ng/L, 95% CI: -1.06, -0.40, P < 0.001, I2 = 0%), and TNF (n = 7) (WMD: -0.26 ng/L, 95% CI: -0.41, -0.12, P < 0.001, I2 = 0.0%), compared to controls. However, the effect of garlic supplementation on serum adiponectin (n = 3) (WMD: 0.18 µg/L, 95% CI: -0.21, 0.57, P = 0.35, I2 = 60.7%) and leptin (n = 2) (WMD: -1.25 µg/L, 95% CI: -2.64, 0.14, P = 0.07, I2 = 0.0%) concentrations were not significant. CONCLUSION In this meta-analysis of RCTs, we found that garlic supplementation reduced serum concentrations of CRP, TNF, IL-6, but did not affect serum adiponectin and leptin in adults. More RCTs are needed to test the effects of garlic supplementation on inflammation.
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Affiliation(s)
- Manije Darooghegi Mofrad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran, IR.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, IR
| | - Alireza Milajerdi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran, IR
| | - Fariba Koohdani
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran, IR.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IR
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran, IR.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IR.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR
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Yamato O, Tsuneyoshi T, Ushijima M, Jikihara H, Yabuki A. Safety and efficacy of aged garlic extract in dogs: upregulation of the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway and Nrf2-regulated phase II antioxidant enzymes. BMC Vet Res 2018; 14:373. [PMID: 30497454 PMCID: PMC6267818 DOI: 10.1186/s12917-018-1699-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022] Open
Abstract
Background Plants of Allium spp., including garlic (A. sativum) and onions (A. cepa), are known to be oxidatively toxic to canine erythrocytes resulting in Heinz body hemolytic anemia in dogs. In humans, these plants have been used as medicinal agents for multiple diseases since ancient times. Especially, fresh garlic extracted over a prolonged period produces less irritative and odorless aged garlic extract (AGE), containing unique and beneficial organosulfur compounds that can help prevent many kinds of diseases. In this study, the safety and efficacy of long-term oral administration of AGE is evaluated in dogs. The objectives are to confirm the safe dosage for long-term use and beneficial functions of AGE for dogs and to plan and design a canine health supplement or a preventive agent for multiple diseases based on the data of this study. Results Beagles were orally administered AGE (45 or 90 mg/kg body weight once a day) or an equivalent amount of water as control for 12 weeks. In AGE-treated groups, at 12 weeks post-administration at a dose of 90 mg/kg, there were no observable changes in the clinical signs, complete blood count, and serum biochemical parameters. Heinz bodies and eccentrocytes, the markers of oxidative damage in erythrocytes, did not appear in blood smear examination. In order to further evaluate the beneficial effects of AGE on health of dogs, the expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) gene (NFE2L2) and Nrf2-regulated phase II antioxidant enzyme genes (NQO1, GCLM, HMOX1, and SOD2) were determined in whole blood between pre- and post-AGE administration. The expression of NFE2L2 gene was significantly upregulated in the AGE-treated groups [45 (p < 0.05) and 90 mg/kg (p < 0.01), 8 weeks] as compared to in the control group. Among the Nrf2-regulated enzymes examined, the expressions of NQO1 [45 (p < 0.05) and 90 mg/kg (p < 0.01), 8 weeks] and GCLM [45 (p < 0.05) and 90 mg/kg (p < 0.01), 12 weeks] genes were significantly upregulated. Conclusion The long-term oral administration of AGE at a dose of 90 mg/kg/day for 12 weeks did not show any adverse effects in dogs. Furthermore, the administration of AGE upregulated the gene expressions of canine Nrf2 and Nrf2-regulated phase II antioxidant enzymes. These results suggest that AGE might safely contribute to the health of dogs provided that the appropriate dosage is used. Electronic supplementary material The online version of this article (10.1186/s12917-018-1699-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Osamu Yamato
- Laboratory of Clinical Pathology, Department of Veterinary Medicine, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Kohrimoto, Kagoshima, 890-0065, Japan.
| | - Tadamitsu Tsuneyoshi
- Central Research Institute, Wakunaga Pharmaceutical Co. Ltd., 1624 Shimokotachi, Koda-cho, Akitakata-shi, Hiroshima, 739-1195, Japan
| | - Mitsuyasu Ushijima
- Central Research Institute, Wakunaga Pharmaceutical Co. Ltd., 1624 Shimokotachi, Koda-cho, Akitakata-shi, Hiroshima, 739-1195, Japan
| | - Hiroshi Jikihara
- Research Administration Department, Wakunaga Pharmaceutical Co. Ltd., 1624 Shimokotachi, Koda-cho, Akitakata-shi, Hiroshima, 739-1195, Japan
| | - Akira Yabuki
- Laboratory of Clinical Pathology, Department of Veterinary Medicine, Joint Faculty of Veterinary Medicine, Kagoshima University, 1-21-24 Kohrimoto, Kagoshima, 890-0065, Japan
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Abstract
INTRODUCTION Coronary artery calcification (CAC) is reflective of atherosclerotic disease and incrementally predictive of future cardiovascular events (CVE), independent of traditional risk factors. Extra coronary calcium such as aortic valve calcification, which can be identified and quantified by computed tomography (CT) imaging, has shown to predict future CVE in both asymptomatic and symptomatic (i.e. stable angina and acute coronary syndrome [ACS]) settings. It has hence been a vital tool in studies involving new therapies for cardiovascular disease. Areas covered: In this review, promising therapies on the horizon are reviewed, along with the role of cardiac CT and coronary calcification in these studies. A Medline search for peer-reviewed publications using keywords related to coronary calcium score, aortic valve calcium, and therapies targeting the same was carried out. Expert commentary: CT scanning provides a distinct means of detecting and quantifying coronary plaque as well as valvular calcification with excellent reproducibility. Based on voluminous data available, the absence of coronary calcium serves as a factor to de-risk patients for cardiovascular risk stratification and management algorithms. Newer therapies have shown to lower progression of coronary calcification, thus being beneficial in slowing progression of atherosclerotic disease. As British Epidemiologist Geoffrey Rose states, the best predictor of a life-threatening disease is the early manifestation of that disease. As CAC represents the early manifestation of atherosclerosis, it is the best-known stratifier of risk today, and its clinical use will continue to rise.
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Affiliation(s)
- Chandana Shekar
- a Department of Cardiology , Los Angeles Biomedical Research Institute at Harbor-UCLA , Los Angeles , CA , USA
| | - Matthew Budoff
- a Department of Cardiology , Los Angeles Biomedical Research Institute at Harbor-UCLA , Los Angeles , CA , USA
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Bianconi V, Mannarino MR, Sahebkar A, Cosentino T, Pirro M. Cholesterol-Lowering Nutraceuticals Affecting Vascular Function and Cardiovascular Disease Risk. Curr Cardiol Rep 2018; 20:53. [PMID: 29802549 DOI: 10.1007/s11886-018-0994-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an update on the effects of the dietary supplementation with cholesterol-lowering nutraceuticals and nutraceutical combinations affecting vascular function and CV risk in clinical interventional studies. RECENT FINDINGS Current evidence supports the mild-to-moderate cholesterol-lowering efficacy of red yeast rice, berberine, plant sterols, fibers, and some nutraceutical combinations whereas data on the individual cholesterol-lowering action of other nutraceuticals are either less striking or even inconclusive. There is also promising evidence on the vascular protective effects of some of the aforementioned nutraceuticals. However, except for red yeast rice, clinical interventional studies have not investigated their impact on CV outcomes. Evidence of both cholesterol-lowering and vascular protection is a prerogative of few single nutraceuticals and nutraceutical combinations, which may support their clinical use; however, caution on their uncontrolled adoption is necessary as they are freely available on the market and, therefore, subject to potential misuse.
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Affiliation(s)
- Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
- Hospital "Santa Maria della Misericordia", Piazzale Menghini, 1, 06129, Perugia, Italy
| | - Massimo Raffaele Mannarino
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
- Hospital "Santa Maria della Misericordia", Piazzale Menghini, 1, 06129, Perugia, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Teresa Cosentino
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
- Hospital "Santa Maria della Misericordia", Piazzale Menghini, 1, 06129, Perugia, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy.
- Hospital "Santa Maria della Misericordia", Piazzale Menghini, 1, 06129, Perugia, Italy.
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Budoff M, Brent Muhlestein J, Le VT, May HT, Roy S, Nelson JR. Effect of Vascepa (icosapent ethyl) on progression of coronary atherosclerosis in patients with elevated triglycerides (200-499 mg/dL) on statin therapy: Rationale and design of the EVAPORATE study. Clin Cardiol 2018; 41:13-19. [PMID: 29365351 PMCID: PMC5838559 DOI: 10.1002/clc.22856] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Despite reducing progression and promoting regression of coronary atherosclerosis, statin therapy does not fully address residual cardiovascular (CV) risk. High‐purity eicosapentaenoic acid (EPA) added to a statin has been shown to reduce CV events and induce regression of coronary atherosclerosis in imaging studies; however, data are from Japanese populations without high triglyceride (TG) levels and baseline EPA serum levels greater than those in North American populations. Icosapent ethyl is a high‐purity prescription EPA ethyl ester approved at 4 g/d as an adjunct to diet to reduce TG levels in adults with TG levels >499 mg/dL. The objective of the randomized, double‐blind, placebo‐controlled EVAPORATE study is to evaluate the effects of icosapent ethyl 4 g/d on atherosclerotic plaque in a North American population of statin‐treated patients with coronary atherosclerosis, TG levels of 200 to 499 mg/dL, and low‐density lipoprotein cholesterol levels of 40 to 115 mg/dL. The primary endpoint is change in low‐attenuation plaque volume measured by multidetector computed tomography angiography. Secondary endpoints include incident plaque rates; quantitative changes in different plaque types and morphology; changes in markers of inflammation, lipids, and lipoproteins; and the relationship between these changes and plaque burden and/or plaque vulnerability. Approximately 80 patients will be followed for 9 to 18 months. The clinical implications of icosapent ethyl 4 g/d treatment added to statin therapy on CV endpoints are being evaluated in the large CV outcomes study REDUCE‐IT. EVAPORATE will provide important imaging‐derived data that may add relevance to the clinically derived outcomes from REDUCE‐IT.
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Affiliation(s)
- Matthew Budoff
- Department of Internal Medicine, Los Angeles Biomedical Research Institute, Torrance, California
| | - J Brent Muhlestein
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City
| | - Viet T Le
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Heidi T May
- Department of Internal Medicine, Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
| | - Sion Roy
- Department of Internal Medicine, Los Angeles Biomedical Research Institute, Torrance, California
| | - John R Nelson
- Department of Cardiology, California Cardiovascular Institute, Fresno, California
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Kesarwani M, Nakanishi R, Choi TY, Shavelle DM, Budoff MJ. Evaluation of Plaque Morphology by 64-Slice Coronary Computed Tomographic Angiography Compared to Intravascular Ultrasound in Nonocclusive Segments of Coronary Arteries. Acad Radiol 2017; 24:968-974. [PMID: 28359681 DOI: 10.1016/j.acra.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/02/2016] [Accepted: 03/04/2017] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES Although intravascular ultrasound (IVUS) is the current gold standard for plaque characterization, noninvasive coronary computed tomographic angiography (CCTA) requires further evaluation. The ability to detect plaque morphology by CCTA remains unclear. The purpose of this study was to evaluate the diagnostic accuracy of CCTA for plaque detection and morphology. MATERIALS AND METHODS Thirty-one patients underwent cardiac catheterization with IVUS and CCTA. The presence of plaque was evaluated by both modalities in nonocclusive segments (<50% stenosis) of the left anterior descending artery, left circumflex artery, and right coronary artery. Plaque morphology was classified as (1) normal, (2) soft or fibrous, (3) fibrocalcific, or (4) calcific. Results by IVUS and CCTA were compared blindly on a segment-to-segment basis with subgroup analysis based on CCTA tube voltage. RESULTS Among the 31 patients (mean age 56.2 ± 8.6 years, 27% female), 152 segments were analyzed. Of these segments, 42% were in the left anterior descending artery, 32% were in the left circumflex artery, and 26% were in the right coronary artery. Plaque morphology by IVUS identified 103 segments as fibrous (68%), 31 as fibrocalcific (20%), and 6 as calcific (4.0%); 12 segments were normal (8.0%). To evaluate for the presence of plaque, CCTA had an overall sensitivity and specificity of 99% and 75%, respectively. In patients who underwent CCTA with a tube voltage of 100 kV, both sensitivity and specificity were 100%. The sensitivity and specificity of CCTA to identify plaque as calcified (fibrocalcific or calcific) vs noncalcified (soft or fibrous) were 87% and 96%, respectively. Overall, the accuracy of CCTA to detect the presence of plaque was 97%; the accuracy to detect plaque calcification was 94%. CONCLUSIONS CCTA offers excellent sensitivity and accuracy for plaque detection and morphology characterization in nonocclusive coronary segments. In addition, diagnostic accuracy is preserved with a reduced tube voltage protocol.
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Budoff MJ, Ellenberg SS, Lewis CE, Mohler ER, Wenger NK, Bhasin S, Barrett-Connor E, Swerdloff RS, Stephens-Shields A, Cauley JA, Crandall JP, Cunningham GR, Ensrud KE, Gill TM, Matsumoto AM, Molitch ME, Nakanishi R, Nezarat N, Matsumoto S, Hou X, Basaria S, Diem SJ, Wang C, Cifelli D, Snyder PJ. Testosterone Treatment and Coronary Artery Plaque Volume in Older Men With Low Testosterone. JAMA 2017; 317:708-716. [PMID: 28241355 PMCID: PMC5465430 DOI: 10.1001/jama.2016.21043] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Recent studies have yielded conflicting results as to whether testosterone treatment increases cardiovascular risk. OBJECTIVE To test the hypothesis that testosterone treatment of older men with low testosterone slows progression of noncalcified coronary artery plaque volume. DESIGN, SETTING, AND PARTICIPANTS Double-blinded, placebo-controlled trial at 9 academic medical centers in the United States. The participants were 170 of 788 men aged 65 years or older with an average of 2 serum testosterone levels lower than 275 ng/dL (82 men assigned to placebo, 88 to testosterone) and symptoms suggestive of hypogonadism who were enrolled in the Testosterone Trials between June 24, 2010, and June 9, 2014. INTERVENTION Testosterone gel, with the dose adjusted to maintain the testosterone level in the normal range for young men, or placebo gel for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was noncalcified coronary artery plaque volume, as determined by coronary computed tomographic angiography. Secondary outcomes included total coronary artery plaque volume and coronary artery calcium score (range of 0 to >400 Agatston units, with higher values indicating more severe atherosclerosis). RESULTS Of 170 men who were enrolled, 138 (73 receiving testosterone treatment and 65 receiving placebo) completed the study and were available for the primary analysis. Among the 138 men, the mean (SD) age was 71.2 (5.7) years, and 81% were white. At baseline, 70 men (50.7%) had a coronary artery calcification score higher than 300 Agatston units, reflecting severe atherosclerosis. For the primary outcome, testosterone treatment compared with placebo was associated with a significantly greater increase in noncalcified plaque volume from baseline to 12 months (from median values of 204 mm3 to 232 mm3 vs 317 mm3 to 325 mm3, respectively; estimated difference, 41 mm3; 95% CI, 14 to 67 mm3; P = .003). For the secondary outcomes, the median total plaque volume increased from baseline to 12 months from 272 mm3 to 318 mm3 in the testosterone group vs from 499 mm3 to 541 mm3 in the placebo group (estimated difference, 47 mm3; 95% CI, 13 to 80 mm3; P = .006), and the median coronary artery calcification score changed from 255 to 244 Agatston units in the testosterone group vs 494 to 503 Agatston units in the placebo group (estimated difference, -27 Agatston units; 95% CI, -80 to 26 Agatston units). No major adverse cardiovascular events occurred in either group. CONCLUSIONS AND RELEVANCE Among older men with symptomatic hypogonadism, treatment with testosterone gel for 1 year compared with placebo was associated with a significantly greater increase in coronary artery noncalcified plaque volume, as measured by coronary computed tomographic angiography. Larger studies are needed to understand the clinical implications of this finding. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00799617.
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Affiliation(s)
- Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Susan S Ellenberg
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham
| | - Emile R Mohler
- Section of Vascular Medicine, Division of Cardiovascular Disease, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory Heart and Vascular Center, Emory University School of Medicine, Atlanta, Georgia
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, La Jolla
| | - Ronald S Swerdloff
- Division of Endocrinology, Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, California
| | - Alisa Stephens-Shields
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jill P Crandall
- Division of Endocrinology, Albert Einstein College of Medicine, Bronx, New York11Division of Geriatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Glenn R Cunningham
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Baylor College of Medicine and Baylor St. Luke's Medical Center, Houston, Texas13Department of Molecular and Cell Biology, Baylor College of Medicine and Baylor St. Luke's Medical Center, Houston, Texas
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis15Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Thomas M Gill
- Division of Geriatric Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Alvin M Matsumoto
- Geriatric Research, Education, and Clinical Center, VA Puget Sound Health System, University of Washington School of Medicine, Seattle18Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle
| | - Mark E Molitch
- Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rine Nakanishi
- Division of Cardiology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Negin Nezarat
- Division of Cardiology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Suguru Matsumoto
- Division of Cardiology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
| | - Xiaoling Hou
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan J Diem
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis
| | - Christina Wang
- Division of Endocrinology, Los Angeles Biomedical Research Institute, Harbor-UCLA, Torrance, California
| | - Denise Cifelli
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Peter J Snyder
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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An update on the assessment and management of metabolic syndrome, a growing medical emergency in paediatric populations. Pharmacol Res 2017; 119:99-117. [PMID: 28111263 DOI: 10.1016/j.phrs.2017.01.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 01/19/2023]
Abstract
In the last decades the increasing rate of obesity in children and adolescents worldwide has led to the onset in paediatric age of metabolic syndrome, a disease commonly associated to adulthood. Central obesity, dyslipidaemia, hyperglycaemia, and hypertension are typical features of metabolic syndrome that seem to hesitate often in type 2 diabetes, cardiovascular disease, non-alcoholic fatty liver disease, and many other clinical conditions. Thus preventing and curing metabolic syndrome in paediatric patients is becoming an urgent need for public health. While diagnostic criteria and therapy of metabolic syndrome in adults are very well defined, there is no consensus on the definition of metabolic syndrome in children and adolescents as well as on healing approaches. The aim of this review is to describe the recent advances on the pathogenesis and clinical outcomes of paediatric metabolic syndrome. We then detail the therapeutic strategies (i.e. dietary regimens, physical exercise, nutraceuticals, and medications) employed to manage the disease. Finally, we analyse the safety profile of the drugs used in children and adolescents by performing a retrospective review of paediatric adverse reactions reported in the FDA's Adverse Event Reporting System database.
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Matsumoto S, Ibrahim R, Grégoire JC, L'Allier PL, Pressacco J, Tardif JC, Budoff MJ. Effect of treatment with 5-lipoxygenase inhibitor VIA-2291 (atreleuton) on coronary plaque progression: a serial CT angiography study. Clin Cardiol 2016; 40:210-215. [PMID: 27883201 DOI: 10.1002/clc.22646] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/20/2016] [Accepted: 10/26/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Inflammation has a key role in the process of atherosclerosis. Production of leukotrienes by 5-lipoxygenase has been linked to atherosclerotic plaques and cardiovascular events. HYPOTHESIS In this study, a selective 5-LO inhibitor will slow plaque progression using serial cardiac computed tomographic angiography (CCTA). METHODS Patients with recent acute coronary syndrome (ACS) were prospectively assigned to one of 3 VIA-2291 doses (25 mg, 50 mg, 100 mg) or placebo by oral administration. All groups underwent CCTA at baseline and at 6 months' follow-up. Plaque types such as low-attenuation plaque (LAP), fibro-fatty tissue (FF), fibro-calcified plaque (FC), and dense calcium plaque (DC) were measured based upon predefined density threshold, and changes from baseline CCTA were analyzed. RESULTS The final analysis included 54 patients (age, 56 ± 9 years; 85.1% male) with CCTA at baseline and 24 weeks. Evaluating on treatment VIA-2291 (all 3 doses, n = 37) demonstrated significant reductions in plaque progression compared with placebo (n = 17). VIA-2291 significantly reduced LAP (5.9 ± 20.7 mm3 vs -9.7 ± 33.3 mm3 ), FF (11.1 mm3 ± 13.3 mm3 vs -0.9 ± 2.7 mm3 ), and FC (-0.1 ± 6.22 mm3 vs -14.3 ± 6.2 mm3 ; all P < 0.05) and retarded the progression of DC (3.9 ± 3.2 mm3 vs 0.2 ± 0.4 mm3 ) compared with placebo. CONCLUSIONS VIA-2291 resulted in slowed plaque progression compared with placebo across different plaque subtypes in patients with recent ACS (http://ClinicalTrials.gov NCT00358826).
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Affiliation(s)
- Suguru Matsumoto
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
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Morihara N, Hino A. Aged garlic extract suppresses platelet aggregation by changing the functional property of platelets. J Nat Med 2016; 71:249-256. [PMID: 27766480 DOI: 10.1007/s11418-016-1055-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Abstract
Aged garlic extract (AGE), a garlic preparation rich in water-soluble cysteinyl moieties, has been reported to have multiple beneficial effects on cardiovascular disease including inhibition of platelet aggregation. However, the mode of AGE action on platelets has not been clear. In this study, we examined the effect of AGE on the functional property of platelet by administering AGE to rats and evaluating the platelet aggregation in response to collagen in vitro. We found that AGE treatment significantly reduced the ability of platelet to aggregate and this effect of AGE was manifested on the 14 day, but not 7 day of treatment. In addition, AGE treatment produced platelets that responded to collagen by significantly increasing the amount of both the extracellular ATP and the extra- and intracellular TXB2. AGE treatment also dose-dependently suppressed the phosphorylation of collagen-induced ERK, p38 and JNK. However, AGE administration did not affect the bleeding time. These findings suggest that AGE treatment results in suppression of platelet aggregation by changing the functional property of platelets to respond to collagen.
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Affiliation(s)
- Naoaki Morihara
- Drug Discovery Laboratory, Wakunaga Pharmaceutical Co. Ltd., 1624 Shimokotachi, Kodacho, Akitakata, Hiroshima, 739-1195, Japan.
| | - Atsuko Hino
- Healthcare Research and Development Division, Wakunaga Pharmaceutical Co. Ltd., 1624 Shimokotachi, Kodacho, Akitakata, Hiroshima, 739-1195, Japan
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