Hypertriglyceridemia and Cardiovascular Diseases: Revisited

Adaptive immunity and atherosclerosis: aging at its crossroads

Adaptive immunity plays a profound role in atherosclerosis pathogenesis by regulating antigen-specific responses, inflammatory signaling and antibody production. However, as we age, our immune system undergoes a gradual functional decline, a phenomenon termed "immunosenescence". This decline is characterized by a reduction in proliferative naïve B- and T cells, decreased B- and T cell receptor repertoire and a pro-inflammatory senescence associated secretory profile. Furthermore, aging affects germinal center responses and deteriorates secondary lymphoid organ function and structure, leading to impaired T-B cell dynamics and increased autoantibody production. In this review, we will dissect the impact of aging on adaptive immunity and the role played by age-associated B- and T cells in atherosclerosis pathogenesis, emphasizing the need for interventions that target age-related immune dysfunction to reduce cardiovascular disease risk.

Targeting Lipoprotein(a): Can RNA Therapeutics Provide the Next Step in the Prevention of Cardiovascular Disease?

Numerous genetic and epidemiologic studies have demonstrated an association between elevated levels of lipoprotein(a) (Lp[a]) and cardiovascular disease. As a result, lowering Lp(a) levels is widely recognized as a promising strategy for reducing the risk of new-onset coronary heart disease, stroke, and heart failure. Lp(a) consists of a low-density lipoprotein-like particle with covalently linked apolipoprotein A (apo[a]) and apolipoprotein B-100, which explains its pro-thrombotic, pro-inflammatory, and pro-atherogenic properties. Lp(a) serum concentrations are genetically determined by the apo(a) isoform, with shorter isoforms having a higher rate of particle synthesis. To date, there are no approved pharmacological therapies that effectively reduce Lp(a) levels. Promising treatment approaches targeting apo(a) expression include RNA-based drugs such as pelacarsen, olpasiran, SLN360, and lepodisiran, which are currently in clinical trials. In this comprehensive review, we provide a detailed overview of RNA-based therapeutic approaches and discuss the recent advances and challenges of RNA therapeutics specifically designed to reduce Lp(a) levels and thus the risk of cardiovascular disease.

Atherogenic Index of Plasma Predicts Obstructive Coronary Artery Disease in Patients with Stable Angina Pectoris

AIMS

Chronic coronary syndrome is associated with several risk factors, such as dyslipidemia and hypertension. The atherogenic index of plasma (AIP) has been demonstrated to be a biochemical risk factor for coronary artery disease (CAD). This study aimed to determine whether the AIP is an effective parameter for estimating obstructive CAD.

METHODS AND RESULTS

A total of 345 patients (with a mean age of 62.2 ± 10.3; 63% male) who underwent coronary angiography were included in this study. Obstructive CAD is defined as having one or more vessels with a stenosis level of ≥50%. Depending on the presence of obstructive CAD, all patients were divided into two groups. The mean AIP value was found to be 0.538 ± 0.26 in the study group. The AIP values were significantly higher in the obstructive coronary artery group (AIP; 0.49 ± 0.26 vs. 0.58 ± 0.27, p = 0.002). According to a univariable analysis, AIP values were significantly associated with obstructive coronary artery disease [OR: 3.74 (CI 95% 1.62-8.64), p = 0.020]. The AIP was further adjusted for confounding risk factors in three multivariable analysis models and, all three models showed a significant association. According to an ROC analysis, 0.49 is the cut-off value for AIP, and a value above 0.49 indicates 50% coronary artpery stenosis.

CONCLUSIONS

The AIP may be used in the assessment of cardiovascular risk for patients with stable angina pectoris, and it may also be used to estimate obstructive CAD.

Which Biomarker(s) Augment the Diagnostic Value of the Positive Exercise Electrocardiography Test: Systemic Inflammatory Index, Plasma Atherogenic Index, or Monocyte/HDL-C Ratio?

The exercise electrocardiography test (EET) is still used before coronary angiography in the diagnosis of chronic coronary syndromes. This study aimed to demonstrate the value of the combination of a positive EET with the systemic inflammatory index (SII), the plasma atherogenic index (PAI), and the monocyte/HDL-C ratio (MHR) in the determination of obstructive coronary artery disease (CAD). This single-center, retrospective study included 540 patients who underwent coronary angiography after ETT. The patients were separated into Group 1, comprising 434 patients with normal coronary arteries and non-obstructive CAD, and Group 2, including 106 with obstructive CAD. In Group 2, the patients were separated into SYNTAX ≤ 22 or ≥23. Glucose, low-density lipoprotein, white blood cells, and MHR were determined to be significantly higher in Group 2 (p < 0.05). According to the multivariate logistic regression analysis, age, gender, diabetes mellitus, and low-density lipoprotein were determined to be independent predictors of CAD. In the ROC curve analysis, a cut-off value of 12 for the MHR in the determination of obstructive CAD had a sensitivity of 60.4% and a specificity of 53.0%. The main result of this study was that a high MHR is an indicator of obstructive CAD in patients with positive EET and suspected CAD.

Sour Tamarind Is More Antihypertensive than the Sweeter One, as Evidenced by In Vivo Biochemical Indexes, Ligand-Protein Interactions, Multitarget Interactions, and Molecular Dynamic Simulation

This research investigated the antihypertensive effects of tamarind products and compared their potentials based on an animal model's data verified by molecular docking, multitarget interactions, and dynamic simulation assays. GC-MS-characterized tamarind products were administered to cholesterol-induced hypertensive albino rat models. The two-week-intervened animals were dissected to collect their serum and organs and respectively subjected to analyses of their hypertension-linked markers and tissue architectures. The lead biometabolites of tamarinds interacted with eight target receptors in the molecular docking and dynamic simulation studies and with multitarget in the network pharmacological analyses. The results show that the serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), C-reactive protein (CRP), troponin I, and lipid profiles were maximally reinstated by the phenolic-enriched ripened sour tamarind extract compared to the sweet one, but the seed extracts had a smaller influence. Among the tamarind's biometabolites, ϒ-sitosterol was found to be the best ligand to interact with the guanylate cyclase receptor, displaying the best drug-likeliness with the highest binding energy, -9.3 Kcal. A multitargeted interaction-based degree algorithm and a phylogenetic tree of pathways showed that the NR3C1, REN, PPARG, and CYP11B1 hub genes were consistently modulated by ϒ-sitosterol to reduce hypertension and related risk factors. The dynamic simulation study showed that the P-RMSD values of ϒ-sitosterol-guanylate cyclase were stable between 75.00 and 100.00 ns at the binding pocket. The findings demonstrate that ripened sour tamarind extract may be a prospective antihypertensive nutraceutical or supplement target affirmed through advanced preclinical and clinical studies.

Atherogenic index of plasma and coronary artery disease: A systematic review

Various studies suggest that the atherogenic index of plasma (AIP) is associated with the risk of coronary artery disease (CAD) in different clinical scenarios. This review aimed to synthesize evidence of the association between AIP values and CAD. A literature search was carried out on four databases, namely, PubMed, Scopus, Web of Science, and Ovid-Medline. A handsearch was performed on preprint repositories (MedRxiv and Research Square). The effect measurements were expressed as odds ratios (OR) with their corresponding 95% confidence intervals (CI). For the quantitative synthesis, we employed a random-effects model. We analyzed 14 articles (with 40,902 participants) from seven different countries. The quantitative analysis revealed that an increase in one unit of AIP was associated with higher odds of developing CAD (OR 2.11; 95% CI 1.65-2.69; P < 0.001; I ² = 98%). We conducted subgroup analyses of Chinese (OR 1.89; 95% CI 1.40-2.56; P < 0.001) and non-Chinese studies (OR 2.51; 95% CI 1.42-4.42; P < 0.001). The sensitivity analysis by risk of bias continued to demonstrate an association, and the heterogeneity remained unchanged (OR 1.75; 95% CI 1.33-2.31; P < 0.001; I ² = 98%). Higher AIP values were associated with higher odds of developing CAD.

Relation Between New York Heart Association Functional Class and Remnant Cholesterol, and Non-high Density Lipoprotein Cholesterol in Coronary Heart Disease Patients With Type 2 Diabetes Mellitus

Remnant cholesterol (RC) and non-high-density lipoprotein cholesterol (non-HDL-C) are associated with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). However, the association between RC, non-HDL-C, and CHD patients with T2DM has not been comprehensively investigated. We analyzed the association between RC, non-HDL-C, and cardiac function in CHD patients with T2DM. Of the 22 022 CHD patients from six hospitals in Tianjin, 5373 (24.4%) patients with T2DM had higher levels of RC and non-HDL-C (P < .001) than those without T2DM. Among CHD patients with T2DM, RC and non-HDL-C were positively associated with New York Heart Association (NYHA) class Ⅱ [RC: odds ratio (OR), 1.74; 95% confidence interval (CI), 1.50-2.01; P < .01; non-HDL-C: OR, 1.23; 95% CI, 1.15-1.31; P < .01]. After adjusting for confounding factors, this association remained (RC: OR, 1.22; 95% CI, 1.03-1.45; P < .05; non-HDL-C: OR, 1.09; 95% CI, 1.02-1.17; P < .05). These findings provide evidence of an independent positive association between RC, non-HDL-C, and NYHA functional classes. More research is warranted to confirm these findings and determine the mechanisms involved.

Relationship between Hyperlipidemia, Cardiovascular Disease and Stroke: A Systematic Review

BACKGROUND

Globally, dyslipidemia has been shown to be an independent predictor of many cardiovascular and cerebrovascular events, which led to recent advocacy towards dyslipidemia prevention and control as a key risk factor and its prognostic significance to reduce the burden of stroke and myocardial infarction (MI).

AIMS

This study aimed to evaluate hyperlipidemia as a risk factor connected with stroke and CVD. Moreover, having identified this risk factor, the study evaluates how hyperlipidemia has been examined earlier and what can be done in the future.

METHODS

All prospective studies concerning hyperlipidemia as risk factors for stroke and CVD were identified by a search of PubMed/MEDLINE and EMBASE databases with keywords hyperlipidemia, risk factors, stroke, and cardiovascular disease.

RESULTS

The constant positive association between the incidence of coronary heart disease and cholesterol concentration of LDL is apparent in observational studies in different populations. Thus, the reduction of LDL cholesterol in those populations, particularly with regard to initial cholesterol concentrations, can reduce the risk of vascular diseases. However, the impact of using lipid-lowering drugs, such as statins, has been demonstrated in several studies as an important factor in decreasing the mortality and morbidity rates of patients with stroke and CVD.

CONCLUSION

After reviewing all the research mentioned in this review, most studies confirmed that hyperlipidemia is a risk factor for stroke and correlated in patients with CVD.

Prospective Analysis of Lipid Variations in Hyperthyroid Subjects from Lahore, Pakistan

Perturbations in the actions of T3 and T4 influence the normal metabolic pathways. Responsiveness of lipid biomarkers like LDL-C, HDL-C, TC, TG, Apo-A, and Apo-B after rehabilitation of thyroid profile attaining euthyroid state was determined. A total of 179 age-matched subjects of both genders were recruited for this research. Sixty healthy controls, thirty-four subclinical, fifty overt hyperthyroid, and thirty-five follow-up subjects having 3 months of Carbimazole therapy were enrolled. Biochemical analysis was performed by chemistry analyzer, RIA, and ELISA. One-way ANOVA was applied for the statistical analysis, while significance (P < 0.05) of means was compared by the Student-Newman-Keuls (SNK) test. Pronounced reduction (P < 0.001) of cholesterol in overt as compared to control and subclinical was noticed, whereas marked improvement (P < 0.001) was evidenced in follow-up. Prominent elevation (P < 0.05) of TG in follow-up was evidenced as compared to control. Overt presented marked reduction of HDL-C as compared to subclinical and control (P < 0.01 and P < 0.001), respectively. Pronounced elevation (P < 0.001) of HDL-C was evidenced after treatment. Overt presented reduction of LDL-C as compared to subclinical and control (P < 0.01 and P < 0.05, respectively). The follow-up group demonstrated considerable (P < 0.001) improvement of LDL-C after treatment and elevation (P < 0.05) as compared to control. Overt presented reduction of Apo-B as compared to subclinical and control (P < 0.05 and P < 0.001, respectively). Improvement (P < 0.05) of Apo-B was evidenced in follow-up. Reduction (P < 0.05) of Apo-A in overt as compared to control and elevation (P < 0.05) in follow-up as compared to overt was evidenced. Conclusively, improvement after treatment was evidenced in lipid profile.

Consumption of Sourdough Breads Improves Postprandial Glucose Response and Produces Sourdough-Specific Effects on Biochemical and Inflammatory Parameters and Mineral Absorption

To evaluate responses to different sourdough breads, six groups of rats were fed a conventional refined wheat bread with no sourdough content (C_WhB); a leavened spelt bread baked with Rebola sourdough (Re_SpB); a durum wheat bread with Rebola sourdough (Re_DuB); or a multigrain bread leavened with Rebola (Re_MGB), Carla (Ca_MGB), or San Francisco sourdough (SF_MGB). Compared to C_WhB-fed rats, Re_SpB-, Re_DuB-, and Re_MGB-fed animals showed lower postprandial blood glucose levels, whereas SF_MGB-fed rats displayed a decreased postprandial blood insulin response and glucose and insulin products. The 3 week intake of Ca_MGB decreased blood triacylglycerols and the relative apparent absorption (RAA) of Fe²⁺, Cu²⁺, and Zn²⁺, whereas Re_MGB-fed animals showed lower serum levels of the MCP-1 inflammatory marker and decreased the Fe RAA. The 3 week consumption of the multigrain bread produced sourdough-specific effects. Thus, Re_MGB-fed animals displayed higher insulin concentrations than Ca_MGB- and SF_MGB-fed rats and decreased blood MCP-1 levels compared to those of Ca_MGB-fed animals. In addition, Ca_MGB-fed rats showed lower serum triacylglycerol concentrations than those of Re_MGB- and SF_MGB-fed animals, whereas SF_MGB-fed rats displayed higher RAA values of Ca²⁺, Cu²⁺, Fe²⁺, Mg²⁺, and Zn²⁺ than their Re_MGB and Ca_MGB counterparts. These sourdough-specific effects could be related to changes in the contents of sugars and organic acids, acidity, microbial composition, and proteolytic activity among sourdoughs. Hence, the consumption of sourdough breads improved postprandial blood glucose and insulin responses and produced sourdough-specific effects on RAA and serum insulin and triacylglycerol and MCP-1 levels in rats, showing that SF_MGB has the most promising beneficial effects.

Genome-Wide Identification of Rare and Common Variants Driving Triglyceride Levels in a Nevada Population

Clinical conditions correlated with elevated triglyceride levels are well-known: coronary heart disease, hypertension, and diabetes. Underlying genetic and phenotypic mechanisms are not fully understood, partially due to lack of coordinated genotypic-phenotypic data. Here we use a subset of the Healthy Nevada Project, a population of 9,183 sequenced participants with longitudinal electronic health records to examine consequences of altered triglyceride levels. Specifically, Healthy Nevada Project participants sequenced by the Helix Exome+ platform were cross-referenced to their electronic medical records to identify: (1) rare and common single-variant genome-wide associations; (2) gene-based associations using a Sequence Kernel Association Test; (3) phenome-wide associations with triglyceride levels; and (4) pleiotropic variants linked to triglyceride levels. The study identified 549 significant single-variant associations (p < 8.75 × 10-9), many in chromosome 11's triglyceride hotspot: ZPR1, BUD13, APOC3, APOA5. A well-known protective loss-of-function variant in APOC3 (R19X) was associated with a 51% decrease in triglyceride levels in the cohort. Sixteen gene-based triglyceride associations were identified; six of these genes surprisingly did not include a single variant with significant associations. Results at the variant and gene level were validated with the UK Biobank. The combination of a single-variant genome-wide association, a gene-based association method, and phenome wide-association studies identified rare and common variants, genes, and phenotypes associated with elevated triglyceride levels, some of which may have been overlooked with standard approaches.

Short-Term Efficacy (at 12 Weeks) and Long-Term Safety (up to 52 Weeks) of Omega-3 Free Fatty Acids (AZD0585) for the Treatment of Japanese Patients With Dyslipidemia - A Randomized, Double-Blind, Placebo-Controlled, Phase III Study

BACKGROUND

This study is the first to evaluate the short-term efficacy and long-term safety of AZD0585, a mixture of omega-3 free fatty acids, in Japanese patients with dyslipidemia.Methods and Results:In this randomized double-blind placebo-controlled Phase III study, 383 patients were randomized to 2 g AZD0585, 4 g AZD0585, or placebo once daily for 52 weeks. Eligible patients had low-density lipoprotein cholesterol (LDL-C) levels controlled regardless of statin use, and triglyceride levels between 150 and 499 mg/dL. The least-squares (LS) mean percentage changes in triglyceride concentrations from baseline to the 12-week endpoint (mean of measurements at Weeks 10 and 12) in the 2 and 4 g AZD0585 and placebo groups were -15.57%, -21.75%, and 11.15% respectively (P<0.0001 for both AZD0585 doses vs. placebo). No clinically significant changes from baseline to the 12-week endpoint in total cholesterol, LDL-C, and LDL-C/apolipoprotein (Apo) B were found with AZD0585. High-density lipoprotein cholesterol (HDL-C) was slightly increased and very low-density lipoprotein cholesterol, non-HDL-C, ApoC-II, and ApoC-III were decreased with AZD0585 compared with placebo at the 12-week endpoint. Lipid profiles up to Week 52 were consistent with those up to the 12-week endpoint. No clinically important safety concerns were raised.

CONCLUSIONS

AZD0585 significantly decreased serum triglyceride levels compared with placebo at the 12-week endpoint and was generally safe and well tolerated in Japanese patients with dyslipidemia.

Lipoprotein(a) and Cardiovascular Diseases - Revisited

Two decades ago, it was recognized that lipoprotein(a) (Lp(a)) concentrations were elevated in patients with cardiovascular disease (CVD). However, the importance of Lp(a) was not strongly established due to a lack of both Lp(a)-lowering therapy and evidence that reducing Lp(a) levels improves CVD risk. Recent advances in clinical and genetic research have revealed the crucial role of Lp(a) in the pathogenesis of CVD. Mendelian randomization studies have shown that Lp(a) concentrations are causal for different CVDs, including coronary artery disease, calcified aortic valve disease, stroke, and heart failure, despite optimal low-density lipoprotein cholesterol (LDL-C) management. Lp(a) consists of apolipoprotein (apo) B100 covalently bound to apoA. Thus, Lp(a) has atherothrombotic traits of both apoB (from LDL) and apoA (thrombo-inflammatory aspects). Although conventional pharmacological therapies, such as statin, niacin, and cholesteryl ester transfer protein, have failed to significantly reduce Lp(a) levels, emerging new therapeutic strategies using proprotein convertase subtilisin-kexin type 9 inhibitors or antisesnse oligonucleotide technology have shown promising results in effectively lowering Lp(a). In this review we discuss the revisited important role of L(a) and strategies to overcome residual risk in the statin era.

Effect of fenugreek supplementation on blood lipids and body weight: A systematic review and meta-analysis of randomized controlled trials

ETHNOPHARMACOLOGICAL RELEVANCE

Fenugreek is a traditional herbal medicine that has been used for centuries to treat hyperglycemia, muscle spasms, gastritis, constipation, edema, and other metabolic disorders. Recently, lipid-lowering effects of fenugreek have been identified.

AIM OF THE STUDY

The aim of this systematic review and meta-analysis was to determine and clarify the impact of fenugreek supplementation on anthropometric indices and serum lipid levels.

MATERIALS AND METHODS

We searched PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar from inception to June 2019 using relevant keywords. All randomized controlled trials (RCTs) investigating the effects of fenugreek on anthropometric indices and plasma lipids in adults were included. A random-effects model was used for quantitative data synthesis. A sensitivity analysis was conducted using the leave-one-out method.

RESULTS

A meta-analysis of 12 RCTs (14 arms) with 560 participants suggested a significant decrease in plasma concentrations of total cholesterol (WMD = -9.371 mg/dL; 95% CI: -15.419, -3.323, p = 0.002), triglycerides (WMD = -13.776 mg/dL; 95% CI: -26.636, -0.916, p = 0.036), and low density lipoprotein cholesterol (WMD = -6.590 mg/Dl; 95% CI: -13.042, -0.137, p = 0.045), as well as an increase in plasma high density lipoprotein cholesterol (WMD = 3.501 mg/dL; 95% CI: 1.309, 5.692, p = 0.002), while body weight (WMD = 0.223 kg; 95% CI: -0.509, 0.955, p = 0.551) and body mass index (WMD = 0.091 kg/m2; 95% CI: -0.244, 0.426, p = 0.596) were not altered.

CONCLUSION

Fenugreek supplementation improved lipid parameters in adults. However, to confirm these results, more studies, particularly among hyperlipidemic patients, are needed.

Design and rationale of a randomized control trial testing the effectiveness of combined therapy with STAtin plus FENOfibrate and statin alone in non-diabetic, combined dyslipidemia patients with non-intervened intermediate coronary artery disease - STAFENO study

Background

Despite the chronicled success of low-density lipoprotein cholesterol (LDLc)-lowering statin therapy, substantial residual cardiovascular (CV) disease risk remains a problem worldwide, highlighting the need to for combination therapies targeting non-LDLc factors, such as with fenofibrate.

Methods/design

The STAFENO trial is a prospective, randomized, open-label, multi-center trial to compare the effect of statin plus fenofibrate with statin alone on the reduction and stabilization of plaque in non-diabetic, combined dyslipidemia patients with non-intervened, intermediate coronary artery disease (CAD) using virtual histology-intravascular ultrasound at 12 months. A total of 106 eligible patients are planned to be randomized to receive either a combination therapy (rosuvastatin 10 mg plus fenofibrate 160 mg/day) or monotherapy (rosuvastatin 10 mg/day) for 12 months. The primary endpoint of this study is the percentage change in the necrotic core volume. Secondary endpoints include changes in tissue characteristics and 1-year major CV events, including all-cause mortality, CV mortality, nonfatal myocardial infarction, stroke, and revascularization of the intervened and non-intervened lesions.

Discussion

The STAFENO trial will address whether combination treatment of statin and fenofibrate has an additive beneficial effect compared to statin alone on the reduction and stabilization of plaque and CV events in non-diabetic, combined dyslipidemia patients with non-intervened intermediate CAD.

Trial registration

ClinicalTrials.gov, NCT02232360. Registered 9 February 2014.

https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0004ULE&selectaction=Edit&uid=U00023SZ&ts=2&cx=juppd2

Genome-phenome explorer (GePhEx): a tool for the visualization and interpretation of phenotypic relationships supported by genetic evidence

MOTIVATION

Association studies based on SNP arrays and Next Generation Sequencing technologies have enabled the discovery of thousands of genetic loci related to human diseases. Nevertheless, their biological interpretation is still elusive, and their medical applications limited. Recently, various tools have been developed to help bridging the gap between genomes and phenomes. To our knowledge, however none of these tools allows users to retrieve the phenotype-wide list of genetic variants that may be linked to a given disease or to visually explore the joint genetic architecture of different pathologies.

RESULTS

We present the Genome-Phenome Explorer (GePhEx), a web-tool easing the visual exploration of phenotypic relationships supported by genetic evidences. GePhEx is primarily based on the thorough analysis of linkage disequilibrium between disease-associated variants and also considers relationships based on genes, pathways or drug-targets, leveraging on publicly available variant-disease associations to detect potential relationships between diseases. We demonstrate that GePhEx does retrieve well-known relationships as well as novel ones, and that, thus, it might help shedding light on the patho-physiological mechanisms underlying complex diseases. To this end, we investigate the potential relationship between schizophrenia and lung cancer, first detected using GePhEx and provide further evidence supporting a functional link between them.

AVAILABILITY AND IMPLEMENTATION

GePhEx is available at: https://gephex.ega-archive.org/.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Identification of hypertriglyceridemia based on bone density, body fat mass, and anthropometry in a Korean population

BACKGROUND

Hypertriglyceridemia is strongly associated with the risks of cardiovascular disease, coronary heart disease, and metabolic syndrome. The relationship between hypertriglyceridemia or high triglyceride levels and bone mineral density remains controversial. Furthermore, to date, no study has simultaneously examined the association among hypertriglyceridemia, bone area, bone mineral content, bone mineral density, body fat mass, and anthropometrics. The present study aimed to evaluate the association among hypertriglyceridemia, anthropometrics and various bone density and body fat composition variables to identify the best indicator of hypertriglyceridemia in a Korean population.

METHODS

The data were obtained from the fifth Korea National Health and Nutrition Examination Survey. In total, 3918 subjects aged 20-80 years participated in this study. In the variable analysis of the waist circumference (WC), trunk fat mass (Trk-Ft), body mass index, etc., a binary logistic regression analysis was performed to examine the significance of the differences between the normal group and hypertriglyceridemia groups.

RESULTS

In both men and women, the WC showed the strongest association with hypertriglyceridemia in the crude analysis (odds ratio (OR) = 1.738 [confidence interval = 1.529-1.976] and OR = 2.075 [1.797-2.397]), but the Trk-Ft was the most strongly associated with the disease after adjusting for age and body mass index (adjusted OR = 1.565 [1.262-1.941] and adjusted OR = 1.730 [1.291-2.319]). In particular, the Pelvis area (Plv-A) was the most significant among the bone variables in women (adjusted OR = 0.641 [0.515-0.796]). In the predictive power analysis, the best indicator of hypertriglyceridemia was WC in women (the area under the receiver operating characteristic curve (AUC) = 0.718 [0.685-0.751]) and Trk-Ft in men (AUC = 0.672 [0.643-0.702]). The WC was also the most predictive among the anthropometric variables in men (AUC = 0.670 [0.641-0.700]). The strength of the association and predictive power was stronger in women than in men.

CONCLUSIONS

The WC in women and Trk-Ft in men exhibited the best predictive power for hypertriglyceridemia. Our findings support the use of basic information for the identification of hypertriglyceridemia or high triglyceride levels in initial health screening efforts.

Almond oil for patients with hyperlipidemia: A randomized open-label controlled clinical trial

BACKGROUND

Cardiovascular diseases currently account for nearly half of non-communicable diseases. It was shown that enjoying a handful of nuts every day can significantly reduce the risk of developing heart diseases as they contain a variety of nutrients and other bioactive substances contributing to lowering the risk of heart diseases and controlling the cholesterol. The aim of this study was to determine the effect of almond oil on the lipid profile of patients with hyperlipidemia.

METHODS

Ninety-seven patients were divided into the intervention (n = 49) and control (n = 48) groups. The intervention group received 10 ml of almond oil two times daily for 30 days. There was no intervention for the control group. The serum lipoproteins were measured before and after the study.

RESULTS

The total cholesterol and LDL levels decreased significantly in the intervention group (treatment difference = -16.12 ± 26.16, P = 0.009; treatment difference = -20.88 ± 18.4, p < 0.001 respectively). But regular almond oil consumption did not significantly affect the triglyceride and HDL in this sample of hyperlipidemic patients.

CONCLUSION

Consumption of almond could reduce the total cholesterol and LDL in dyslipidemic patients.

Best Treatment Strategies With Statins to Maximize the Cardiometabolic Benefits

Statins are important for preventing adverse cardiovascular events in patients with both high and low risk of vascular disease, by reducing the levels of low-density lipoprotein cholesterol (LDL-C). However, statins dose-dependently increase adverse effects and increase the risk of type 2 diabetes. Previously, it was hypothesized this was caused by to off-target effects, but recent studies demonstrate it is caused by on-target effects. Nonetheless, the American guidelines recommend the use of high-intensity statin therapy, and extend its use to most people at risk of vascular diseases, particularly older people. In contrast, European, Korean, and Japanese committees have expressed concerns about the potential adverse effects of using high-intensity statins for lifelong periods in a large fraction of the population. Patients who have achieved LDL-C levels below currently recommended targets may still experience cardiovascular events, resulting from residual risk. Ezetimibe, PCSK9 inhibitors, inclisiran, and ANGPTL3 antisense oligonucleotides are promising alternative non-statin drugs. Of interest, cross-talk between hypercholesterolemia and the renin-angiotensin-system exists at multiple levels of insulin resistance and endothelial dysfunction. There are still unanswered questions on how to maximize the cardiometabolic benefits of statins in patients. We will discuss the results of randomized clinical trials, meta-analysis, and recent clinicopharmacogenetic studies, and propose practical guidelines to maximize the cardiometabolic benefits while reducing adverse effects and overcoming residual risk.

Combining Potent Statin Therapy with Other Drugs to Optimize Simultaneous Cardiovascular and Metabolic Benefits while Minimizing Adverse Events

Hypercholesterolemia and hypertension are among the most important risk factors for cardiovascular (CV) disease. They are also important contributors to metabolic diseases including diabetes that further increase CV risk. Updated guidelines emphasize targeted reduction of overall CV risks but do not explicitly incorporate potential adverse metabolic outcomes that also influence CV health. Hypercholesterolemia and hypertension have synergistic deleterious effects on interrelated insulin resistance and endothelial dysfunction. Dysregulation of the renin-angiotensin system is an important pathophysiological mechanism linking insulin resistance and endothelial dysfunction to atherogenesis. Statins are the reference standard treatment to prevent CV disease in patients with hypercholesterolemia. Statins work best for secondary CV prevention. Unfortunately, most statin therapies dose-dependently cause insulin resistance, increase new onset diabetes risk and exacerbate existing type 2 diabetes mellitus. Pravastatin is often too weak to achieve target low-density lipoprotein cholesterol levels despite having beneficial metabolic actions. Renin-angiotensin system inhibitors improve both endothelial dysfunction and insulin resistance in addition to controlling blood pressure. In this regard, combined statin-based and renin-angiotensin system (RAS) inhibitor therapies demonstrate additive/synergistic beneficial effects on endothelial dysfunction, insulin resistance, and other metabolic parameters in addition to lowering both cholesterol levels and blood pressure. This combined therapy simultaneously reduces CV events when compared to either drug type used as monotherapy. This is mediated by both separate and interrelated mechanisms. Therefore, statin-based therapy combined with RAS inhibitors is important for developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity. This combined therapy can help prevent or treat CV disease while minimizing adverse metabolic consequences.

Effect of Fenofibrate Medication on Renal Function

BACKGROUND

Fibrates are widely used to treat hypertriglyceridemia, a risk factor for arteriosclerosis, but these compounds have been associated with renal dysfunction. This study aimed to investigate the effects of fibrates on renal function in relatively healthy adult subjects with no cardiovascular diseases.

METHODS

This retrospective study included 558 outpatients who were prescribed 160 mg fenofibrate (fenofibrate group) or 10 mg atorvastatin (control group) between August 2007 and October 2015. The groups were randomly matched using propensity scores at a 1:1 ratio. Serum creatinine levels and estimated glomerular filtration rates before and after treatment were compared between the two groups.

RESULTS

Patients in the fenofibrate group showed greater changes in serum creatinine levels than those in the control group (9.73%±9.83% versus -0.89%±7.37%, P<0.001). Furthermore, 55.1% of patients in the fenofibrate group, but only 6.1% of those in the control group, exhibited a serum creatinine level increase ≥0.1 mg/dL (P<0.001). The fenofibrate group showed significantly greater declines in the estimated glomerular filtration rate than the control group (-10.1%±9.48% versus 1.42%±9.42%, P<0.001). Moreover, 34.7% of the fenofibrate group, but only 4.1% of the control group, exhibited an estimated glomerular filtration rate decrease ≥10 mL/min·1.73 m² (P<0.001).

CONCLUSION

Fenofibrate treatment resulted in increased serum creatinine levels and reduced estimated glomerular filtration rates in a primary care setting. Therefore, regular renal function monitoring should be considered essential during fibrate administration.

Atherogenic index of plasma may be strong predictor of subclinical atherosclerosis in patients with Behçet disease

OBJECTIVES

Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. The purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients.

PATIENTS AND METHODS

A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated.

RESULTS

cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (β = 0.232, p = 0.018). In the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients.

CONCLUSION

Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.

A 1H-NMR based metabolomics study of the intervention effect of mangiferin on hyperlipidemia hamsters induced by a high-fat diet

Mangiferin ameliorated hyperlipidemia by intervening in some major metabolic pathways.

Structural design approaches for creating fat droplet and starch granule mimetics

This article focuses on hydrogel-based strategies for creating reduced calorie foods with desirable physicochemical, sensory, and nutritional properties.

Triglycerides Revisited to the Serial

This review discusses the role of triglycerides (TGs) in the normal cardiovascular system as well as in the development and clinical manifestation of cardiovascular diseases. Regulation of TGs at the enzymatic and genetic level, in addition to their possible relevance as preclinical and clinical biomarkers, is discussed, culminating with a description of available and emerging treatments. Due to the high complexity of the subject and the vast amount of material in the literature, the objective of this review was not to exhaust the subject, but rather to compile the information to facilitate and improve the understanding of those interested in this topic. The main publications on the topic were sought out, especially those from the last 5 years. The data in the literature still give reason to believe that there is room for doubt regarding the use of TG as disease biomarkers; however, there is increasing evidence for the role of hypertriglyceridemia on the atherosclerotic inflammatory process, cardiovascular outcomes, and mortality.

Effect of fenugreek on hyperglycaemia and hyperlipidemia in diabetes and prediabetes: A meta-analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Fenugreek is a widely used herb for the treatment of diabetes mellitus (DM) but the effects in randomized controlled trials (RCTs) were controversial. Therefore, a meta-analysis was conducted to estimate the overall effects of fenugreek on hyperglycaemia and hyperlipidemia in diabetes and prediabetes.

MATERIALS AND METHODS

PubMed, EMBASE, web of science, Chinese Biomedical Literature database (CBM), the Cochrane library, China Doctor Dissertations Full-text Database (CDFD), Wan Fang medical database, China Proceedings of Conference Full-text Database (CPCD), China national knowledge internet (CNKI) and China Master's Theses Full-text Database (CMFD) were searched to find the available literatures. RCTs with regard to the efficacy and safety of fenugreek on prediabetes or DM were included. The data of fasting blood glucose (FBG), postprandial 2h blood glucose (2hBG), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c) and high density lipoprotein cholesterol (HDL-c) were extracted to appraise the net change with fixed or randomized effect model.

RESULTS

A total of 10 articles (12 studies) were included in the analysis. Pooled results showed fenugreek significantly decreased the levels of FBG (MD -0.84mmol/L; 95% CI -1.38 to -0.31; p=0.002), 2hBG (MD -1.30mmol/L; 95% CI -1.78 to -0.83; p<0.0001), HbA1c (MD -1.16; 95% CI -1.23 to -1.09; p<0.00001) and TC (MD -0.30mmol/L; 95% CI-0.56 to -0.03; p=0.03). In spite of the reductive trends in the TG or LDL-c levels and incremental trends of HDL-c, these results were not statistically significant or need further verification for fenugreek in the treatment of DM and prediabetes. Some studies were of low quality. No liver and kidney toxicity were found in all included studies, and the main side effects were gastrointestinal discomfort.

CONCLUSIONS

The results suggest fenugreek has the hypoglycaemic and TC-lowering efficacy; however, the effects on TG, LDL-c and HDL-c need further confirmations.

Atherogenic index of plasma may be strong predictor of subclinical atherosclerosis in patients with Behçet disease

OBJECTIVES

Behcet's disease (BD) is a systemic vasculitis characterized by cardiovascular complications. Early diagnosis of these complications can reduce morbidity and mortality. Carotid artery intima-media thickness (cIMT) and the logarithmic value of triglyceride to high density lipoprotein ratio (atherogenic index of plasma, AIP) are good markers of atherosclerosis. The purpose of this study was to investigate whether AIP is a predictive marker of subclinical atherosclerosis in BD patients.

PATIENTS AND METHODS

A total of 84 BD patients (60 male, 24 female) and 84 healthy control individuals (58 male, 26 female) were included in this study. cIMT measurements were made, and AIP values were calculated.

RESULTS

cIMT (p < 0.001) and AIP (p < 0.001) values of the BD patients were higher than those of the control group. A strong independent relationship was found between the AIP value and cIMT (β = 0.232, p = 0.018). In the subgroup analysis, the cIMT and AIP values of male BD patients were higher than those of female BD patients.

CONCLUSION

Increased AIP and cIMT values can be a good marker for subclinical atherosclerosis in BD patients, especially in male BD patients.

Vascular and metabolic effects of omega-3 fatty acids combined with fenofibrate in patients with hypertriglyceridemia

BACKGROUND

Effects of omega-3 fatty acids (n-3 FA) combined with fenofibrate are not yet investigated, compared with fenofibrate.

METHODS

This was a randomized, single-blind, placebo-controlled, parallel study. Age, sex, and body mass index were matched among groups. All patients were recommended to maintain a low fat diet. Fifty patients with hypertriglyceridemia in each group were given placebo, n-3 FA 2g+fenofibrate 160mg (combination), or fenofibrate 160mg, respectively daily for 2months.

RESULTS

Placebo, combination, and fenofibrate significantly decreased triglycerides by 7%, 41% and 30%, respectively and triglycerides/HDL cholesterol ratio by 11%, 45% and 32%, respectively relative to baseline measurements (all P<0.05 by paired t-test). When compared with placebo and fenofibrate, these with combination were significant (P<0.001 by ANOVA). When compared with placebo, both combination and fenofibrate significantly decreased apolipoprotein B and non-HDL cholesterol and improved flow-mediated dilation and reduced CRP and fibrinogen (all P<0.05 by ANOVA), however, there were no significant differences between combination and fenofibrate. When compared with placebo, both combination and fenofibrate significantly reduced insulin and glucose (both P<0.05 by ANOVA), and improved insulin sensitivity (P=0.005 by ANOVA). However, there were no significant differences between combination and fenofibrate.

CONCLUSIONS

When compared with fenofibrate, combination significantly decreased triglycerides and triglycerides/HDL cholesterol ratio. Otherwise, combination and fenofibrate significantly reduced apolipoprotein B and non-HDL cholesterol and improved flow-mediated dilation and reduced CRP and fibrinogen to a similar extent. Also, combination and fenofibrate significantly improved insulin sensitivity to a similar extent by reducing insulin and glucose in patients with hypertriglyceridemia.