1
|
Zhang G, Zhang Q, Guan X, Liu M, Meng L, Han X, Li Y, Jiang G. Short-chain chlorinated paraffin (SCCP) exposure and type 2 diabetes risk: A population-based case-control study in East China. Sci Total Environ 2024; 908:168192. [PMID: 37924874 DOI: 10.1016/j.scitotenv.2023.168192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
Exposure to persistent organic pollutants may be associated to type 2 diabetes, but the studies on associations between short-chain chlorinated paraffin (SCCP) exposure and type 2 diabetes risk in humans are still scarce. Here, we conducted a case-control study involving 344 participants in Shandong Province, East China, to explore the effects of SCCPs on type 2 diabetes risk and their correlations with glycemic biomarker and serum lipid parameters. SCCPs were detected in all serum samples with a median concentration of 24 ng mL-1 in cases and 19 ng mL-1 in controls. Exposure to C10-CPs, C11-CPs, and ΣSCCPs were positively associated with the risk of type 2 diabetes after adjusting for confounders. The associations remained consistent in stratified analyses but stronger in male participants and obese individuals. In the control group, there were significant and positive correlations between SCCP exposure and levels of total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), total lipid, and non-high-density lipoprotein-cholesterol. Significant joint effects on SCCP exposure and lipid parameters were observed in females when analyzed by the quantile-based g-computation model, and C10-CPs showed the highest contribution. Mediation analysis showed that LDL-C had significant mediation effects on the associations between C10-CPs, C11-CPs, and ΣSCCPs exposure and risk of type 2 diabetes. Moreover, TC and high-density lipoprotein-cholesterol were mediators in the relationship between C11-CPs and type 2 diabetes. Taken together, our study revealed that human exposure to SCCPs may increase the risk of type 2 diabetes and disrupt lipid metabolism.
Collapse
Affiliation(s)
- Gaoxin Zhang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qinghua Zhang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China; School of Environment, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, Zhejiang 310024, China
| | - Xiaoling Guan
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong 250014, China
| | - Mei Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Lingling Meng
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong 250014, China.
| | - Xu Han
- Sinopec Research Institute of Petroleum Processing Co., Ltd., Beijing 100083, China
| | - Yingming Li
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Guibin Jiang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China; School of Environment, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Hangzhou, Zhejiang 310024, China
| |
Collapse
|
2
|
|
3
|
Higgins V, Garcia L, Gifford JL, Volodko N, Beriault DR, Parker ML, Estey MP, Proctor DT, Ismail OZ. Validating the NIH LDL-C equation for provincial implementation in Alberta. Clin Biochem 2023; 121-122:110678. [PMID: 37866698 DOI: 10.1016/j.clinbiochem.2023.110678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND LDL-C, a cardiovascular disease risk assessment biomarker, is commonly calculated using the Friedewald equation. The NIH equation overcomes several limitations of the Friedewald equation. Consistent with the Canadian Society of Clinical Chemists (CSCC) lipid reporting recommendations, we assessed the NIH LDL-C equation in Alberta prior to its provincial implementation. METHODS 1-year (01/01/2021-12/31/2021) of lipid results (n = 1,486,584 after data cleaning) were obtained from five analytical instrument groups used across Alberta. Analyses were performed on all data and after separating by age, analytical instrument group, and fasting status. The correlation between Friedewald- and NIH-calculated LDL-C and between Friedewald- and NIH-calculated LDL-C difference and each lipid parameter, was determined. The frequency of unreportable/inaccurate LDL-C results was compared between the two equations. The concordance between the two equations and with non-HDL-C was determined at LDL-C thresholds. Lastly, LDL-C calculated by Friedewald, NIH, and Martin-Hopkins equations was compared to density-gradient ultracentrifugation. RESULTS Friedewald- and NIH-calculated LDL-C exhibit the strongest correlation when triglycerides ≤ 4.52 mmol/L. The difference between Friedewald- and NIH-calculated LDL-C increases with decreasing LDL-C concentration. The NIH equation yields fewer inaccurate results (0.35 % vs. 22.0 %). The percent agreement between equations was > 96 % at all LDL-C thresholds, suggesting most patients will not require treatment changes. NIH-calculated LDL-C exhibited better agreement with non-HDL-C when triglycerides ≤ 9.04 mmol/L and better correlated with LDL-C measured by ultracentrifugation (r2 = 0.926 vs. 0.775 (Friedewald) and 0.863 (Martin-Hopkins)). Results were consistent across age, analytical instrument group, and fasting status. CONCLUSIONS Our findings demonstrate the benefits of implementing the NIH equation across Alberta.
Collapse
Affiliation(s)
- V Higgins
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
| | - L Garcia
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - J L Gifford
- DynaLIFE Medical Labs, Calgary, AB, Canada; Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - N Volodko
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - D R Beriault
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, St Michael's Hospital, Toronto, ON, Canada
| | - M L Parker
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - M P Estey
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - D T Proctor
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - O Z Ismail
- DynaLIFE Medical Labs, Edmonton, AB, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
4
|
Lowhalidanon K, Khunkaewla P. Development of Direct LDL Measurement by LDL Precipitation Combined with Sandwich ELISA Using In-House-Generated mAbs. Monoclon Antib Immunodiagn Immunother 2023; 42:132-139. [PMID: 37581494 DOI: 10.1089/mab.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
One of the major risk factors for the progression of cardiovascular diseases is a high blood level of low-density lipoprotein (LDL), so progression of the disease may be prevented by lowering the plasma LDL. Evaluation and monitoring of LDL concentrations are therefore necessary. Friedewald's equation is a calculation method that is currently used routinely to estimate plasma LDL concentrations in hospital laboratories. However, this method cannot be applied to samples with a high concentration of triglyceride (TG). To overcome this limitation, this study aimed to develop direct LDL measurements using in-house generated monoclonal antibodies against human LDL in combination with LDL precipitation using heparin-containing citrate buffer pH 5.04. The method was applied to measure the LDL concentration in 208 randomized samples from Suranaree University of Technology Hospital. The mean values obtained from the developed method and the hospital laboratory were 126.6 ± 43.1 mg/dL and 123.2 ± 42.3 mg/dL, respectively. Linear regression analysis showed a high correlation between these two methods (r = 0.8491, p < 0.0001). High concentrations of TG, total cholesterol, and HDL have no influence on the LDL values obtained by this method. In this study, we offer an alternative technique for the direct measurement of plasma LDL. Further development for more convenient and easy use can now be undertaken.
Collapse
Affiliation(s)
- Kanokwan Lowhalidanon
- Biochemistry-Electrochemistry Research Unit, School of Chemistry, Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, Thailand
- Institute of Research and Development, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Panida Khunkaewla
- Biochemistry-Electrochemistry Research Unit, School of Chemistry, Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| |
Collapse
|
5
|
Zhang S, Hu J, Xiao G, Chen S, Wang H. Urban particulate air pollution linked to dyslipidemia by modification innate immune cells. Chemosphere 2023; 319:138040. [PMID: 36739990 DOI: 10.1016/j.chemosphere.2023.138040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
Air particulate matter (PM) is an essential risk factor for lipid metabolism disorders. However, the underlying mechanism remains unclear. In this cross-sectional study, 216 healthcare workers were recruited to estimate the associations among the daily exposure dose (DED) of air PM, innate immune cells, and plasma lipid levels. All participants were divided into two groups according to the air particulate combined DED (DED-PMC). The peripheral white blood cell counts, lymphocyte counts, and monocyte counts and percentages were higher in the higher-exposure group (HEG) than in the lower-exposure group (LEG), whereas the percentage of natural-killer cells was lower in the HEG than in the LEG. The plasma concentrations of the total cholesterol, triglycerides, LDL-C, and apolipoprotein B were higher in the HEG than in the LEG, whereas the HDL-C and apolipoprotein A1 were lower in the HEG than in the LEG. A dose-effect analysis indicated that when the DED of the air PM increased, there were increased peripheral monocyte counts and percentages, a decreased NK cell percentage, elevated plasma concentrations of total cholesterol, triglycerides, LDL-C, and apolipoprotein B, and reduced plasma levels of HDL-C and apolipoprotein A1. In addition, the modification of the innate immune cells was accompanied by alterations in the plasma lipid levels in a dose-dependent manner. Mediation effect analysis suggested innate immune cells were the potential mediators for the associations among air PM exposure on abnormal lipid metabolism. These results indicated that chronic exposure to air PM may disturb lipid metabolism by altering the distribution of innate immune cells in the peripheral blood, ultimately advancing cardiovascular disease risk.
Collapse
Affiliation(s)
- Shaocheng Zhang
- Department of Clinical Laboratory Medicine, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Juan Hu
- Department of Clinical Laboratory Medicine, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Guangjun Xiao
- Department of Clinical Laboratory Medicine, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Shu Chen
- Department of Clinical Laboratory Medicine, Suining Central Hospital, Suining, 629000, Sichuan, China
| | - Huanhuan Wang
- School of Laboratory Medicine, Chengdu Medical College, Chengdu, 610500, Sichuan, China.
| |
Collapse
|
6
|
Scalsky RJ, Chen YJ, Desai K, O’Connell JR, Perry JA, Hong CC. Baseline cardiometabolic profiles and SARS-CoV-2 infection in the UK Biobank. PLoS One 2021; 16:e0248602. [PMID: 33793566 PMCID: PMC8016301 DOI: 10.1371/journal.pone.0248602] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background SARS-CoV-2 is a rapidly spreading coronavirus responsible for the Covid-19 pandemic, which is characterized by severe respiratory infection. Many factors have been identified as risk factors for SARS-CoV-2, with much early attention being paid to body mass index (BMI), which is a well-known cardiometabolic risk factor. Objective This study seeks to examine the impact of additional baseline cardiometabolic risk factors including high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), Apolipoprotein A-I (ApoA-I), Apolipoprotein B (ApoB), triglycerides, hemoglobin A1c (HbA1c) and diabetes on the odds of testing positive for SARS-CoV-2 in UK Biobank (UKB) study participants. Methods We examined the effect of BMI, lipid profiles, diabetes and alcohol intake on the odds of testing positive for SARS-Cov-2 among 9,005 UKB participants tested for SARS-CoV-2 from March 16 through July 14, 2020. Odds ratios and 95% confidence intervals were computed using logistic regression adjusted for age, sex and ancestry. Results Higher BMI, Type II diabetes and HbA1c were associated with increased SARS-CoV-2 odds (p < 0.05) while HDL-C and ApoA-I were associated with decreased odds (p < 0.001). Though the effect of BMI, Type II diabetes and HbA1c were eliminated when HDL-C was controlled, the effect of HDL-C remained significant when BMI was controlled for. LDL-C, ApoB and triglyceride levels were not found to be significantly associated with increased odds. Conclusion Elevated HDL-C and ApoA-I levels were associated with reduced odds of testing positive for SARS-CoV-2, while higher BMI, type II diabetes and HbA1c were associated with increased odds. The effects of BMI, type II diabetes and HbA1c levels were no longer significant after controlling for HDL-C, suggesting that these effects may be mediated in part through regulation of HDL-C levels. In summary, our study suggests that baseline HDL-C level may be useful for stratifying SARS-CoV-2 infection risk and corroborates the emerging picture that HDL-C may confer protection against sepsis in general and SARS-CoV-2 in particular.
Collapse
Affiliation(s)
- Ryan J. Scalsky
- Medical Scientist Training Program, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Yi-Ju Chen
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Karan Desai
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jeffery R. O’Connell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - James A. Perry
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (JAP); (CCH)
| | - Charles C. Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail: (JAP); (CCH)
| |
Collapse
|
7
|
Hoogeveen RC, Ballantyne CM. Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation. Clin Chem 2021; 67:143-153. [PMID: 33257928 PMCID: PMC7793228 DOI: 10.1093/clinchem/hvaa252] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current guidelines target low-density lipoprotein cholesterol (LDL-C) concentrations to reduce atherosclerotic cardiovascular disease (ASCVD) risk, and yet clinical trials demonstrate persistent residual ASCVD risk despite aggressive LDL-C lowering. CONTENT Non-LDL-C lipid parameters, most notably triglycerides, triglyceride-rich lipoproteins (TGRLs), and lipoprotein(a), and C-reactive protein as a measure of inflammation are increasingly recognized as associated with residual risk after LDL-C lowering. Eicosapentaenoic acid in statin-treated patients with high triglycerides reduced both triglycerides and ASCVD events. Reducing TGRLs is believed to have beneficial effects on inflammation and atherosclerosis. High lipoprotein(a) concentrations increase ASCVD risk even in individuals with LDL-C < 70 mg/dL. Although statins do not generally lower lipoprotein(a), proprotein convertase subtilisin/kexin type 9 inhibitors reduce lipoprotein(a) and cardiovascular outcomes, and newer approaches are in development. Persistent increases in C-reactive protein after intensive lipid therapy have been consistently associated with increased risk for ASCVD events. SUMMARY We review the evidence that biochemical assays to measure TGRLs, lipoprotein(a), and C-reactive protein are associated with residual risk in patients treated to low concentrations of LDL-C. Growing evidence supports a causal role for TGRLs, lipoprotein(a), and inflammation in ASCVD; novel therapies that target TGRLs, lipoprotein(a), and inflammation are in development to reduce residual ASCVD risk.
Collapse
Affiliation(s)
- Ron C Hoogeveen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| |
Collapse
|
8
|
Egbaria A, Saliba W, Zafrir B. Assessment of Low LDL Cholesterol in Patients Treated by PCSK9 Inhibition: Comparison of Martin/Hopkins and Friedewald Estimations. Cardiovasc Drugs Ther 2020; 35:787-792. [PMID: 33226544 DOI: 10.1007/s10557-020-07107-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Recent guidelines recommend further reduction of low-density lipoprotein cholesterol (LDL-C) in high-risk populations. The use of proprotein convertase subtilisin/kexin type-9 inhibitors (PCSK9i) enables many patients to achieve profound reduction in LDL-C. However, in patients with low cholesterol, the commonly used Friedewald equation tends to underestimate LDL-C, which may result in undertreatment. We aimed to compare Friedewald LDL-C estimation with the more novel Martin/Hopkins method in PCSK9i-treated patients achieving low LDL-C. METHODS We investigated high-risk patients treated by PCSK9i in whom Friedewald LDL-C levels were < 70 mg/dL and triglycerides ≤ 300 mg/dL. LDL-C was additionally assessed by the Martin/Hopkins method. The compatibility between estimations was evaluated using methods of concordance and reclassification between LDL-C categories (< 25, 25-40, 40-55, 55-70 mg/dL) and according to triglyceride strata. RESULTS Mean age was 65 ± 10 years. The correlation coefficient between LDL-C estimations was r = 0.898. Martin/Hopkins reclassified 269 of the 608 patients (44%) to a higher LDL-C category, with 14% of the patients reaching LDL-C > 70 mg/dL. Of the 390 patients achieving Friedewald LDL-C < 55 mg/dL, 113 (29%) were estimated to have LDL-C ≥ 55 mg/dL by the Martin/Hopkins equation. The magnitude of discordance between LDL-C estimates was more pronounced in hypertriglyceridemic patients in whom LDL-C reclassification from < 55 to ≥ 55 mg/dL was observed in 48%. CONCLUSIONS In real-world practice of high-risk patients achieving low LDL-C under PCSK9i, Martin/Hopkins algorithm displayed significant proportion of LDL-C upward discordance compared to the Friedewald equation, particularly observed in patients with elevated triglycerides, identifying patients that may need treatment intensification.
Collapse
Affiliation(s)
- Aya Egbaria
- Faculty of Medicine, Technion, Israel Institute of Medicine,, Haifa, Israel
| | - Walid Saliba
- Faculty of Medicine, Technion, Israel Institute of Medicine,, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Barak Zafrir
- Faculty of Medicine, Technion, Israel Institute of Medicine,, Haifa, Israel.
- Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel.
| |
Collapse
|
9
|
Liou L, Kaptoge S. Association of small, dense LDL-cholesterol concentration and lipoprotein particle characteristics with coronary heart disease: A systematic review and meta-analysis. PLoS One 2020; 15:e0241993. [PMID: 33166340 PMCID: PMC7652325 DOI: 10.1371/journal.pone.0241993] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/25/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to systematically collate and appraise the available evidence regarding the associations between small, dense low-density lipoprotein (sdLDL) and incident coronary heart disease (CHD), focusing on cholesterol concentration (sdLDL-C) and sdLDL particle characteristics (presence, density, and size). BACKGROUND Coronary heart disease (CHD) is the leading cause of death worldwide. Small, dense low-density lipoprotein (sdLDL) has been hypothesized to induce atherosclerosis and subsequent coronary heart disease (CHD). However, the etiological relevance of lipoprotein particle size (sdLDL) versus cholesterol content (sdLDL-C) remains unclear. METHODS PubMed, MEDLINE, Web of Science, and EMBASE were systematically searched for studies published before February 2020. CHD associations were based on quartile comparisons in eight studies of sdLDL-C and were based on binary categorization in fourteen studies of sdLDL particle size. Reported hazards ratios (HR) and odds ratios (OR) with 95% confidence interval (CI) were standardized and pooled using a random-effects meta-analysis model. RESULTS Data were collated from 21 studies with a total of 30,628 subjects and 5,693 incident CHD events. The average age was 67 years, and 53% were men. Higher sdLDL and sdLDL-C levels were both significantly associated with higher risk of CHD. The pooled estimate for the high vs. low categorization of sdLDL was 1.36 (95% CI: 1.21, 1.52) and 1.07 (95% CI: 1.01, 1.12) for comparing the top quartiles versus the bottom of sdLDL-C. Several studies suggested a dose response relationship. CONCLUSIONS The findings show a positive association between sdLDL or sdLDL-C levels and CHD, which is supported by an increasing body of genetic evidence in favor of its causality as an etiological risk factor. Thus, the results support sdLDL and sdLDL-C as a risk marker, but further research is required to establish sdLDL or sdLDL-C as a potential therapeutic marker for incident CHD risk reduction.
Collapse
Affiliation(s)
- Lathan Liou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
10
|
Abstract
INTRODUCTION Blood-based sample collection is a challenge, and dried blood spots (DBS) represent an attractive alternative. However, for DBSs to be an alternative to venous blood it is important that these samples are able to deliver comparable associations with clinical outcomes. To explore this we looked to see if lipid profile data could be used to predict the concentration of triglyceride, HDL, LDL and total cholesterol in DBSs using markers identified in plasma. OBJECTIVES To determine if DBSs can be used as an alternative to venous blood in both research and clinical settings, and to determine if machine learning could predict 'clinical lipid' concentration from lipid profile data. METHODS Lipid profiles were generated from plasma (n = 777) and DBS (n = 835) samples. Random forest was applied to identify and validate panels of lipid markers in plasma, which were translated into the DBS cohort to provide robust measures of the four 'clinical lipids'. RESULTS In plasma samples panels of lipid markers were identified that could predict the concentration of the 'clinical lipids' with correlations between estimated and measured triglyceride, HDL, LDL and total cholesterol of 0.920, 0.743, 0.580 and 0.424 respectively. When translated into DBS samples, correlations of 0.836, 0.591, 0.561 and 0.569 were achieved for triglyceride, HDL, LDL and total cholesterol. CONCLUSION DBSs represent an alternative to venous blood, however further work is required to improve the combined lipidomics and machine learning approach to develop it for use in health monitoring.
Collapse
Affiliation(s)
- Stuart G Snowden
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Level 4 Pathology, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Aniko Korosi
- Centre for Neuroscience, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne R de Rooij
- Department of Clinical Epidemiology, Amsterdam University Medical Centre, Biostatistics & Bio informaticslocation AMC, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert Koulman
- Core Metabolomics and Lipidomics Laboratory, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Level 4 Pathology, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
11
|
Al Salmi I, Hannawi S. Birthweight and Lipids in Adult Life: Population-Based Cross Sectional Study. Lipids 2020; 55:365-374. [PMID: 32372421 DOI: 10.1002/lipd.12242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/04/2020] [Accepted: 04/17/2020] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to examine the association of birthweight with lipid profile in the general adult population. Participants in the second-wave of a nationally representative cross sectional AusDiab-study were asked to complete a birthweight questionnaire. Fasting total cholesterol (TC), LDL-C, HDL-C, and triacylglycerol levels were modeled against birthweight. Four thousand five hundred and two people reported their birthweights, mean (SD) of 3.4(0.7) kg. Females with low birthweight-LBW had higher levels of TC, LDL-C, and triacylglycerols, but no difference in HDL-C, than those with normal-birthweight-NBW;≥2.5 kg. People with LBW showed a trend toward increased risk for high TC (≥5.5 mmol/L) compared to NBW. Among females with LBW, the risk for high LDL-C (≥3.5 mmol/L) was increased compared to those of NBW. The risk for low HDL-C (<0.9 mmol/L) was increased among males with LBW compared to those with NBW. Examination of the relationship on the continuum showed no differences except for high triacylglycerol levels among females with the lowest birthweight quintile compared to the higher birthweight quintile. However, the risk for various abnormalities by birthweight quintiles was similar to that when we used the traditional definition of LBW vs. NBW. Females and males with low birthweight differ in their risk for lipids abnormalities. Females had higher risk for high LDL-C, whereas males had high risk for low HDL-C (<0.9 mmol/L). In addition, females with low birthweight had the highest triacylglycerol levels. High LDL-C, low HDL-C, and high triacylglycerols are well-recognized risk factors for cardiovascular disease.
Collapse
Affiliation(s)
- Issa Al Salmi
- The Medicine Department, The Royal Hospital, 23 July Street, P O Box 1331, code 111, Muscat, Oman
| | - Suad Hannawi
- The Medicine Department, MOHAP, PO Box 6552, Dubai, UAE
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Homozygous familial hypercholesterolemia (HoFH) is a rare disorder associated with early atherosclerotic disease due to impairment of the LDL receptor (LDLR) pathway. Because of their molecular defect, current treatment options have limited success in bringing HoFH patient to LDL-C target and morbidity and mortality remain high. We review current and upcoming therapies directed at HoFH, including gene therapy. RECENT FINDINGS Recent real-world studies have confirmed the strength in lomitapide as a treatment adjunct to statins and other lipid-lowering therapies in HoFH patients. The approval of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor monoclonal antibodies has also been a welcome addition to the treatment armamentarium offering an additional average reduction in LDL-C levels of 24% when added to background lipid-lowering therapies in this population. Although achieving adequate LDL-C levels in this population is difficult, there are several therapies on the horizon that may help more patients reach goal. Evinacumab, a monoclonal antibody against ANGPTL3, has been shown to substantially reduce LDL-C of an average of 49%, independently of residual LDLR activity. RNA interference targeting PCSK9 and ANGPTL3 shows promise in clinical trials. Adeno-associated virus-mediated gene transfer and gene editing techniques are in early clinical and preclinical development. SUMMARY LDL-C lowering in HoFH patients remains very challenging. However, novel treatment options are emerging. Upcoming therapies directed at PCSK9 and ANPTL3 may offer additional LDL-C reduction, to help patients achieve adequate LDL-C levels. Gene therapy and gene editing techniques, if proven effective, may offer a unique opportunity to treat patients with a one-time treatment.
Collapse
Affiliation(s)
- Archna Bajaj
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
13
|
Menon V, Kumar A, Patel DR, St John J, Riesmeyer J, Weerakkody G, Ruotolo G, Wolski KE, McErlean E, Cremer PC, Nicholls SJ, Lincoff AM, Nissen SE. Effect of CETP inhibition with evacetrapib in patients with diabetes mellitus enrolled in the ACCELERATE trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e000943. [PMID: 32179516 PMCID: PMC7073792 DOI: 10.1136/bmjdrc-2019-000943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND High-density lipoprotein (HDL) levels are inversely associated with cardiovascular risk. Cholesteryl ester transfer protein inhibition with evacetrapib results in a marked increase in HDL and reduction in low-density lipoprotein (LDL) levels. We evaluated the impact of treatment with evacetrapib versus placebo in the subset of 8236 patients with diabetes mellitus (DM) enrolled in the Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition with Evacetrapib in Patients at a High Risk for Vascular Outcomes trial. METHODS AND RESULTS Time to first occurrence of any component of the primary composite endpoint of cardiovascular death, myocardial infarction, stroke, revascularization, and hospitalization for unstable angina was compared among patients with DM randomized to treatment with evacetrapib (n=4127) or placebo (n=4109) over a median of 26 months of follow-up. The mean baseline LDL at initiation was 80 mg/dL with a mean baseline HDL of 44 mg/dL. In patients with DM, evacetrapib resulted in a 131% mean increase in HDL levels and a 32% mean decrease in LDL at 3 months that was sustained during the course of the trial. At 6 months, hemoglobin A1c (HbA1c) levels were lower with evacetrapib than placebo (7.08% vs 7.15%, p=0.023). Composite event rates were higher in patients with DM than without DM (Kaplan-Meier estimates: 15.2% vs 10.6%, HR 1.46, 95% CI 1.30 to 1.64, p<0.001). In the DM group, event rates for the composite endpoint (14.5% evacetrapib vs 16% placebo, HR 0.95, 95% CI 0.85 to 1.07, p=0.38) and individual components of the composite were similar for both evacetrapib and placebo groups. No significant treatment interaction between treatment assignment and diabetes status was noted. CONCLUSION Despite a favorable increase in HDL, and decreases in LDL and HbA1c levels in patients with DM, we observed no benefits of treatment with evacetrapib on prespecified clinical outcomes in this high-risk population.
Collapse
Affiliation(s)
- Venu Menon
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anirudh Kumar
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Divyang R Patel
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Julie St John
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | - Kathy E Wolski
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ellen McErlean
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
| | - A Michael Lincoff
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Steven E Nissen
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW β-Quantification is considered the reference measurement procedure for low-density lipoprotein cholesterol (LDL-C). However, this technique is time-consuming and thus is inappropriate for routine clinical practice. Therefore, the Friedewald equation or homogeneous assays have been widely utilized. As several pitfalls exist with these two methods, a novel method for estimating LDL-C was developed by Martin et al. RECENT FINDINGS: Martin's method uses a strata-specific median for the triglycerides/very low-density lipoprotein cholesterol (VLDL-C) ratio on the basis of triglycerides and non-HDL-C concentrations. Recent studies show that Martin's method better correlates with β-quantification or homogeneous assays compared with the Friedewald equation, especially with values of triglycerides at least 150 mg/dl and/or LDL-CD less than 70 mg/dl. Such findings have also been demonstrated in other ethnic groups (Japanese and Korean) and disease populations, including diabetes and cardiovascular disease, in which the triglycerides/VLDL-C ratio can be affected. SUMMARY For the current therapeutic goal of LDL-C values below 70 mg/dl in high-risk patients, accurate assessment of LDL-C levels at very low levels is required. Martin's method could overcome pitfalls such as underestimation of the Friedewald equation at this level. Further evaluation of the triglycerides/VLDL-C ratio in participants with diverse ethnic backgrounds or clinical conditions would expand the implementation of this novel method.
Collapse
Affiliation(s)
- Soie Chung
- Department of Laboratory Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
15
|
Abstract
The aim of this study was to conduct a more comprehensive analysis of the association between psoriasis and abnormal lipid metabolism.The case-control study included 222 psoriatic patients and 445 non-psoriatic control patients matched for age and gender. Clinical parameters included age, gender, and body mass index (BMI). Serum lipid levels were recorded and included cholesterol (CHO), triglycerides (TG), low-density lipoprotein (LDL), high density lipoprotein (HDL), phospholipids (PLIP), free fatty acids (FFA), lipoprotein (a) [Lp(a)], and apolipoproteins (apoA1, apoB, and apoE). Statistical analysis was carried out through the IBM Statistical Package for the Social Studies version 23.0.Compared with controls, levels of BMI and the prevalence of obesity were significantly higher in psoriatic patients. The results revealed that when compared to controls, significant elevation of serum TG (P <.001) and Lp(a) (P = .022) was observed. Levels of HDL (P <.001) and apoA1 (P <.001) were significantly lower in psoriatic patients. There was no significant difference in CHO (P = .367), LDL (P = .400), apoB (P = .294), apoE (P = .05), PLIP (P = .931) and FFA (P = .554) between patients and controls. The levels of CHO, TG, PLIP, FFA, and apoE were positively correlated with BMI level.Dyslipidemia was more common in psoriatic patients, compared with non-psoriatic controls.
Collapse
Affiliation(s)
- Chaoyang Miao
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Jing Li
- The 306th Hospital of People's Liberation Army, Beijing, China
| | - Ying Li
- Peking University China-Japan Friendship School of Clinical Medicine
| | - Xiaoyan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine
- China-Japan Friendship Hospital
| |
Collapse
|
16
|
Trojnar M, Patro-Małysza J, Kimber-Trojnar Ż, Czuba M, Mosiewicz J, Leszczyńska-Gorzelak B. Vaspin in Serum and Urine of Post-Partum Women with Excessive Gestational Weight Gain. ACTA ACUST UNITED AC 2019; 55:medicina55030076. [PMID: 30909620 PMCID: PMC6473861 DOI: 10.3390/medicina55030076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 12/30/2022]
Abstract
Background and objectives: Data concerning vaspin in obstetric aspects are limited and conflicting. The aim of the study was to evaluate vaspin concentrations in the serum and urine of women with excessive gestational weight gain (EGWG) in the early post-partum period (i.e., 48 h after delivery), when placental function no longer influences the results. Materials and Methods: The study subjects were divided into two groups of 28 healthy controls and 38 mothers with EGWG. Maternal body composition and hydration status were evaluated by the bioelectrical impedance analysis (BIA) method. Concentrations of vaspin, fatty acid-binding protein 4 (FABP4), leptin, and ghrelin were determined via enzyme-linked immunosorbent assay (ELISA). Results: Serum vaspin levels were lower in the EGWG group, whereas no significant differences were noted between the groups, with regard to the urine vaspin concentrations. In both studied groups, the serum vaspin concentrations correlated positively with the urine FABP4 levels and negatively with gestational weight gain, body mass index gain in the period from pre-pregnancy to 48 h after delivery (ΔBMI), and fat tissue index (FTI). In the multiple linear regression models, the serum vaspin concentrations were positively dependent on the serum FABP4 levels, as well as negatively dependent on triglycerides, FTI, and ΔBMI. Conclusions: Our study revealed that the EGWG mothers were characterized by significantly lower serum vaspin concentrations in the early post-partum period compared with the subjects that had appropriate gestational weight gain. Our observation supports previous hypotheses that vaspin might be used as a marker of lipid metabolism in pregnancy and maternal adipose tissue. Considering the fact that FABP4 is widely referred to as a pro-inflammatory adipokine, further research on the protective role of vaspin seems crucial, especially in the context of its relationship to FABP4.
Collapse
Affiliation(s)
- Marcin Trojnar
- Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.
| | - Jolanta Patro-Małysza
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Żaneta Kimber-Trojnar
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Monika Czuba
- Chair and Department of Obstetrics and Perinatology, Medical University of Lublin, 20-090 Lublin, Poland.
| | - Jerzy Mosiewicz
- Chair and Department of Internal Medicine, Medical University of Lublin, 20-081 Lublin, Poland.
| | | |
Collapse
|
17
|
Nam JH, Shin J, Jang SI, Kim JH, Han KT, Lee JK, Lim YJ, Park EC. Associations between lipid profiles of adolescents and their mothers based on a nationwide health and nutrition survey in South Korea. BMJ Open 2019; 9:e024731. [PMID: 30898813 PMCID: PMC6475165 DOI: 10.1136/bmjopen-2018-024731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Dyslipidaemia is a metabolic disease influenced by environmental and genetic factors. Especially, family history related to genetic background is a strong risk factor of lipid abnormality. The aim of this study is to evaluate the association between the lipid profiles of adolescents and their mothers. DESIGN A cross-sectional study. SETTING The data were derived from the Korea National Health and Nutrition Examination Survey (IV-VI) between 2009 and 2015. PARTICIPANTS 2884 adolescents aged 12-18 years and their mothers were included. PRIMARY OUTCOME MEASURES Outcome variables were adolescents' lipid levels. Mothers' lipid levels were the interesting variables. The lipid profiles included total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). We identified partial correlation coefficients (r) between the lipids. Multiple linear regressions were performed to identify the amount of change in adolescents' lipid levels for each unit increase of their mothers' lipids. The regression models included various clinical characteristics and health behavioural factors of both adolescents and mothers. RESULTS The mean levels of adolescents' lipids were 156.6, 83.6, 50.4 and 89.4 mg/dL, respectively for TC, TG, HDL-C and LDL-C. Positive correlations between lipid levels of adolescents and mothers were observed for TC, TG, HDL-C and LDL-C (r, 95% CI: 0.271, 0.236 to 0.304; 0.204, 0.169 to 0.239; 0.289, 0.255 to 0.322; and 0.286, 0.252 to 0.319). The adolescent TC level was increased by 0.23 mg/dL for each unit increase of the mother's TC (SE, 0.02; p<0.001). The beta coefficients were 0.16 (SE, 0.01), 0.24 (SE, 0.02) and 0.24 (SE, 0.02), respectively, in each model of TG, HDL-C and LDL-C (all p<0.001). The linear relationships were significant regardless of sex and mother's characteristics. CONCLUSIONS Mothers' lipid levels are associated with adolescents' lipids; therefore, they can serve as a reference for the screening of adolescent's dyslipidaemia.
Collapse
Affiliation(s)
- Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea (the Republic of)
- Department of Medicine, Graduate School, Yonsei University, Seoul, Korea (the Republic of)
| | - Jaeyong Shin
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Sung-In Jang
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Ji Hyun Kim
- Department of Pediatrics, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea (the Republic of)
| | - Kyu-Tae Han
- Division of Cancer Management Policy, National Cancer Center, Goyang, Korea (the Republic of)
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea (the Republic of)
| | - Yun Jeong Lim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea (the Republic of)
| | - Eun-Cheol Park
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| |
Collapse
|
18
|
Kim YC, Byun S, Seok S, Guo G, Xu HE, Kemper B, Kemper JK. Small Heterodimer Partner and Fibroblast Growth Factor 19 Inhibit Expression of NPC1L1 in Mouse Intestine and Cholesterol Absorption. Gastroenterology 2019; 156:1052-1065. [PMID: 30521806 PMCID: PMC6409196 DOI: 10.1053/j.gastro.2018.11.061] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The nuclear receptor subfamily 0 group B member 2 (NR0B2, also called SHP) is expressed at high levels in the liver and intestine. Postprandial fibroblast growth factor 19 (human FGF19, mouse FGF15) signaling increases the transcriptional activity of SHP. We studied the functions of SHP and FGF19 in the intestines of mice, including their regulation of expression of the cholesterol transporter NPC1L1 )NPC1-like intracellular cholesterol transporter 1) and cholesterol absorption. METHODS We performed histologic and biochemical analyses of intestinal tissues from C57BL/6 and SHP-knockout mice and performed RNA-sequencing analyses to identify genes regulated by SHP. The effects of fasting and refeeding on intestinal expression of NPC1L1 were examined in C57BL/6, SHP-knockout, and FGF15-knockout mice. Mice were given FGF19 daily for 1 week; fractional cholesterol absorption, cholesterol and bile acid (BA) levels, and composition of BAs were measured. Intestinal organoids were generated from C57BL/6 and SHP-knockout mice, and cholesterol uptake was measured. Luciferase reporter assays were performed with HT29 cells. RESULTS We found that the genes that regulate lipid and ion transport in intestine, including NPC1L1, were up-regulated and that cholesterol absorption was increased in SHP-knockout mice compared with C57BL/6 mice. Expression of NPC1L1 was reduced in C57BL/6 mice after refeeding after fasting but not in SHP-knockout or FGF15-knockout mice. SHP-knockout mice had altered BA composition compared with C57BL/6 mice. FGF19 injection reduced expression of NPC1L1, decreased cholesterol absorption, and increased levels of hydrophilic BAs, including tauro-α- and -β-muricholic acids; these changes were not observed in SHP-knockout mice. SREBF2 (sterol regulatory element binding transcription factor 2), which regulates cholesterol, activated transcription of NPC1L1. FGF19 signaling led to phosphorylation of SHP, which inhibited SREBF2 activity. CONCLUSIONS Postprandial FGF19 and SHP inhibit SREBF2, which leads to repression of intestinal NPC1L1 expression and cholesterol absorption. Strategies to increase FGF19 signaling to activate SHP might be developed for treatment of hypercholesterolemia.
Collapse
Affiliation(s)
- Young-Chae Kim
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois.
| | - Sangwon Byun
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Sunmi Seok
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Grace Guo
- Department of Pharmacology and Toxicology, School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - H Eric Xu
- Laboratory of Structure Sciences, Van Andel Research Institute, Grand Rapids, Michigan
| | - Byron Kemper
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Jongsook Kim Kemper
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, Illinois.
| |
Collapse
|
19
|
Choi HD, Chae SM. Comparison of efficacy and safety of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13593. [PMID: 30558030 PMCID: PMC6320142 DOI: 10.1097/md.0000000000013593] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Dyslipidemia is a major risk factor for the development of cardiovascular disease. Both statins and omega-3 fatty acids demonstrate beneficial effects on lipid concentrations. The goal was to evaluate the safety and efficacy of combination therapy with statins and omega-3 fatty acids. METHODS We performed a systematic review and meta-analysis of published data to compare the safety and efficacy of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia. Six articles were assessed in the present meta-analysis (quantitative assessment) and qualitative assessment. RESULTS In terms of efficacy, the combination treatment afforded a significantly greater reduction in total cholesterol/high-density lipoprotein cholesterol than statin alone did [standard difference in means = -0.215; 95% confidence interval (CI) -0.359--0.071]. However, there was no significant difference in low-density lipoprotein (LDL) cholesterol between the 2 groups. Qualitative assessment of other lipid parameters was performed. Combination therapy with statins and omega-3 fatty acids was generally more effective on lipid concentration than statin monotherapy. In terms of safety, there were no significant differences in total adverse events between the 2 groups. Gastrointestinal adverse events were found to be significantly increased in patients receiving combination therapy using the fixed-effects model (relative risk = 0.547; 95% CI 0.368-0.812). CONCLUSIONS We suggest that combination therapy with statins and omega-3 fatty acids enhances lipid profile, except LDL cholesterol, compared with statin monotherapy. Nevertheless, statin and omega-3 fatty acid combination should be cautiously recommended, taking into account the clinical importance of LDL cholesterol and safety issues associated with their concomitant use.
Collapse
|
20
|
Ghasemi A, Asgari S, Hadaegh F, Kheirandish M, Azimzadeh I, Azizi F, Tohidi M. New modified Friedewald formulae for estimating low-density lipoprotein cholesterol according to triglyceride levels: extraction and validation. Endocrine 2018; 62:404-411. [PMID: 30043091 DOI: 10.1007/s12020-018-1685-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/11/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE The most commonly used method for estimating low-density lipoprotein cholesterol (LDLC) is Friedewald formula (FF). This study aims to extract and validate new modified Friedewald formulae for estimating LDLC according to triglyceride (TG) levels in Iranians. METHODS Total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), LDLC, and TG were measured in 5030 fasted subjects. The original FF was used for estimating LDLC. Data were divided into training and validation data sets. For extracting modified Friedewald formulae, linear regression was used with TG as independent and TC, HDLC, and directly measured LDLC (D-LDLC) as dependent variables, respectively. An overall modified formula was extracted for TG concentrations <400 mg/dL. The specific modified formulae were extracted for different TG categories. The performance of the modified formulae was assessed in the validation data set. RESULTS The overall derived formula for calculating LDLC was M-LDLC = TC-HDLC-TG/4. The coefficients of TG (specific TG terms) in modified formulae were 2.7, 3.7, 4.6, and 5 for TG <100, 100-200, 200-300, and 300-400 mg/dL, respectively. Compared to the original FF, applying a new modified formula with TG/4 to a validation data set provided a less mean difference (4.03 vs. 10.86 mg/dL), greater kappa coefficient (0.691 vs. 0.505), and better subject classification (80.8 vs. 67.1%). After applying modified formulae with specific TG terms, the difference between M-LDLC and D-LDLC decreased to 1.41 mg/dL. CONCLUSIONS Modified formulae were developed and validated for LDLC estimation that compared to the original FF, provided more accurate estimation of LDLC and better classification of subjects. These findings shall be useful for preventive, diagnostic, and therapeutic purposes.
Collapse
Affiliation(s)
- Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Kheirandish
- Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar-Abbas, Iran
| | - Iraj Azimzadeh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
21
|
Pandya A, Asch DA, Volpp KG, Sy S, Troxel AB, Zhu J, Weinstein MC, Rosenthal MB, Gaziano TA. Cost-effectiveness of Financial Incentives for Patients and Physicians to Manage Low-Density Lipoprotein Cholesterol Levels. JAMA Netw Open 2018; 1:e182008. [PMID: 30646152 PMCID: PMC6324619 DOI: 10.1001/jamanetworkopen.2018.2008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Financial incentives shared between physicians and patients were shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) levels in a randomized clinical trial, but it is not known whether these health benefits are worth the added incentive and utilization costs required to achieve them. OBJECTIVE To evaluate the long-term cost-effectiveness of financial incentives on LDL-C level control. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, a previously validated microsimulation computer model was parameterized using individual-level data from the randomized clinical trial on financial incentives, National Health and Nutrition Examination Surveys for model population inputs, and other published sources. The study was conducted from April 15, 2016, to March 29, 2018. INTERVENTIONS The following interventions were used: (1) usual care, (2) trial control strategy (increased cholesterol level monitoring and use of electronic pill bottles), (3) financial incentives for physicians, (4) financial incentives for patients, and (5) incentives shared between physicians and patients. MAIN OUTCOMES AND MEASURES Discounted costs (2017 US dollars), lifetime cardiovascular disease risk, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS The model population (n = 1 000 000 [30.7% women]) had similar mean (SD) age (61.5 [11.9] years) and LDL-C level (153.9 mg/dL) as the observed trial population (n = 1503 [42.7% women]; age, 62.0 [8.7] years; and LDL-C level, 160.6 mg/dL). Using base-case assumptions (including a 10-year waning period of LDL-C level reductions), the usual-care strategy was dominated (higher costs and lower QALYs) by all other strategies. Strategies for physician- or patient-only incentives were dominated by the shared-incentives strategy, which had an ICER of $60 000/QALY compared with the trial control strategy. In a sensitivity analysis regarding the duration of LDL-C level reductions, the shared-incentives strategy remained cost-effective (ICERs <$100 000/QALY and <$150 000/QALY) for scenarios with LDL-C level reductions lasting, with linear waning, at least 7 and 5 years, respectively. In the 1-way sensitivity analysis for the time horizon of the analysis, the ICER of the shared-incentives strategy exceeded $100 000/QALY at 11 years and $150 000/QALY at 8 years. In probabilistic sensitivity analysis, the shared-incentives intervention was cost-effective in 69% to 77% of iterations using cost-effectiveness thresholds of $100 000 to $150 000/QALY. Cost-effectiveness results were also sensitive to the duration of intervention costs. CONCLUSIONS AND RELEVANCE This study suggests that the financial incentives shared between patients and physicians for LDL-C level control meet conventional standards of cost-effectiveness, but these results appeared to be sensitive to assumptions about the durations of LDL-C level reductions and years of intervention costs included, as well as to the choice of time horizon.
Collapse
Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - David A. Asch
- Department of Information, Decisions and Operations, The Wharton School, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Stephen Sy
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Andrea B. Troxel
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Milton C. Weinstein
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Meredith B. Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas A. Gaziano
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
22
|
Ebell MH. Statins Effective for LDL 190 mg per dL or Higher, Regardless of Risk Level. Am Fam Physician 2018; 98:54-55. [PMID: 30215964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
23
|
Zhong Z, Liu J, Zhang Q, Zhong W, Li B, Li C, Liu Z, Yang M, Zhao P. Relationship Between Preoperative Low-Density Lipoprotein Cholesterol and Periprocedural Myocardial Injury in Patients Following Elective Percutaneous Coronary Intervention in Southern China. Med Sci Monit 2018; 24:4154-4161. [PMID: 29910459 PMCID: PMC6038720 DOI: 10.12659/msm.907400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/28/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Periprocedural myocardial injury (PMI) is known to be a predictor of postprocedural cardiovascular morbidity and mortality following a percutaneous coronary intervention (PCI). However, the correlation between low-density lipoprotein cholesterol and periprocedural myocardial injury in patients following elective PCI in southern China remains unclear. Therefore, we aimed to investigate the association of preoperative low-density lipoprotein cholesterol (LDL-C) levels with PMI in patients following elective PCI. MATERIAL AND METHODS This study included 1942 consecutive patients who received elective PCI. Cardiac troponin I (cTnI) was used to assess perioperative myocardial injury. The peak cTnI was measured within 24 h after PCI, and the correlation between the cTnI value and the preoperative LDL level was studied. RESULTS The data suggest that the PCI patients with preprocedural LDL-C <100 mg/dl were strongly and independently correlated with less risk of PMI. Univariate logistic regression indicated that patients with preprocedural LDL-C of 70~99 mg/dl were correlated with lower risk of postprocedural cTnI elevation above 3×ULN (odds ratio [OR]: 0.762; 95% [CI]: 0.603-0.965; P<0.024) up to 20×ULN (OR: 0.730; 95% CI: 0.576-0.924; P<0.000) compared to those with preprocedural LDL-C ≥100 mg/dl. Moreover, patients with preprocedural LDL-C of <70 mg/dl were more strongly correlated with lower risk of postprocedural cTnI elevation above 3×ULN (OR: 0.641; 95% CI: 0.436-0.936; P<0.021) up to 20×ULN (OR: 0.476; 95% CI: 0.316-0.717; P<0.000). CONCLUSIONS Our study demonstrated that PCI patients with lower preprocedural LDL-C were correlated with a lower risk of PMI in southern China.
Collapse
Affiliation(s)
- Zhixiong Zhong
- Center for Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Jing Liu
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
- Clinical Core Laboratory, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Qifeng Zhang
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Wei Zhong
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Bin Li
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Cunren Li
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Zhidong Liu
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Min Yang
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| | - Pingsen Zhao
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
- Clinical Core Laboratory, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, Guangdong, P.R. China
| |
Collapse
|
24
|
Julin B, Willers C, Leksell J, Lindgren P, Looström Muth K, Svensson AM, Lilja M, Dahlström T. Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden. Diabetes Metab Res Rev 2018; 34:e2984. [PMID: 29377503 DOI: 10.1002/dmrr.2984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/11/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Concurrent multifactorial treatment is needed to reduce consequent risks of diabetes, yet most studies investigating the relationship between sociodemographic factors and health outcomes have focused on only one risk factor at a time. Swedish health care is mainly tax-funded, thus providing an environment that should facilitate equal health outcomes in patients, independent of background, socioeconomic status, or health profile. This study aimed at investigating the association between several sociodemographic factors and diabetes-related health outcomes represented by HbA1c , systolic blood pressure, low-density lipoprotein cholesterol, predicted 5-year risk of cardiovascular disease, and statin use. METHODS This large retrospective registry study was based on patient-level data from individuals diagnosed with type 2 diabetes during 2010 to 2011 (n = 416,228) in any of 7 Swedish regions (~65% of the Swedish population). Health equity in diabetes care analysed through multivariate regression analyses on intermediary outcomes (HbA1c , systolic blood pressure, and low-density lipoprotein), predicted 5-year risk of cardiovascular disease and process (i.e., statin use) after 1-year follow-up, adjusting for several sociodemographic factors. RESULTS We observed differences in intermediary risk measures, predicted 5-year risk of cardiovascular disease, and process dependent on place of birth, sex, age, education, and social setting, despite Sweden's articulated vision of equal health care. CONCLUSIONS Diabetes patients' health was associated with sociodemographic prerequisites. Furthermore, in addition to demographics (age and sex) and disease history, educational level, marital status, and region of birth are important factors to consider when benchmarking health outcomes, e.g., average HbA1c level, and evaluating the level of health equity between organizational units or between different administrative regions.
Collapse
Affiliation(s)
| | - Carl Willers
- Ivbar Institute, Stockholm, Sweden
- Department for Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Janeth Leksell
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Lindgren
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- The Swedish Institute for Health Economics, Lund, Sweden
| | | | | | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education, and Development, Östersund, Umeå University, Umeå, Sweden
| | - Tobias Dahlström
- Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| |
Collapse
|
25
|
Kozlov SG, Khamchieva LS, Pogorelova OA, Tripoten' MI, Balakhonova TV. [Dynamics of asymptomatic atherosclerosis of carotid arteries depending on the achieved level of cholesterol in moderate-risk patients]. Angiol Sosud Khir 2018; 24:11-18. [PMID: 29924771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The study was aimed at assessing the dynamics of asymptomatic atherosclerosis of carotid arteries (CA) depending upon the achieved level of low-density lipoprotein cholesterol (LDLC) in patients with moderate total risk by the SCORE scale. We followed up a total of eighty-two 40-to-65-year-old patients with the LDLC level above 2.6 mmol/l, being at moderate total risk by the SCORE scale and having symptom-free atherosclerosis of the extracranial portion of brachiocephalic arteries (up to 50% narrowing of their lumen) as diagnosed by duplex scanning. The patients were randomly divided into two groups. Group One patients (n=41) received therapy with atorvastatin in order to achieve the LDLC level less than 1.8 mmol/l. Group Two patients (n=41) were treated in order to achieve the LDLC level below 2.6 mmol/l. At 12 months of follow up we compared the dynamics of carotid atherosclerosis (change in the number, total height, structure, echogenicity, as well as the state of the surface of atherosclerotic plaques, alteration of the thickness of the CA intima-media complex). Group Two patients were found to have an increase in the number and average sum of the heights of atherosclerotic plaques. An increase of the maximum thickness of the intima-media complex of the wall of the right and left CA was more pronounced as compared with that in Group One patients. Aggressive hypolipidemic therapy aimed at achieving the LDLC level below 1.8 mmol/l turned out to be more effective in slowing down the progression of asymptomatic carotid atherosclerosis in patients with moderate cardiovascular risk than therapy targeted at achieving the LDLC level below 2.6 mmol/l.
Collapse
Affiliation(s)
- S G Kozlov
- Department of Problems of Atherosclerosis, Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research and Production Complex under the Ministry of Health of the Russian Federation, Moscow, Russia
| | - L Sh Khamchieva
- Laboratory of Vascular Ultrasonography, Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research and Production Complex under the Ministry of Health of the Russian Federation, Moscow, Russia
| | - O A Pogorelova
- Laboratory of Vascular Ultrasonography, Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research and Production Complex under the Ministry of Health of the Russian Federation, Moscow, Russia
| | - M I Tripoten'
- Laboratory of Vascular Ultrasonography, Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research and Production Complex under the Ministry of Health of the Russian Federation, Moscow, Russia
| | - T V Balakhonova
- Laboratory of Vascular Ultrasonography, Institute of Clinical Cardiology named after A.L. Myasnikov, Russian Cardiological Research and Production Complex under the Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
26
|
Ngo-Metzger Q, Gottfredson R. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. Am Fam Physician 2017; 96:805-806. [PMID: 29431375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
| | | |
Collapse
|
27
|
Raal FJ, Hovingh GK, Blom D, Santos RD, Harada-Shiba M, Bruckert E, Couture P, Soran H, Watts GF, Kurtz C, Honarpour N, Tang L, Kasichayanula S, Wasserman SM, Stein EA. Long-term treatment with evolocumab added to conventional drug therapy, with or without apheresis, in patients with homozygous familial hypercholesterolaemia: an interim subset analysis of the open-label TAUSSIG study. Lancet Diabetes Endocrinol 2017; 5:280-290. [PMID: 28215937 DOI: 10.1016/s2213-8587(17)30044-x] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Homozygous familial hypercholesterolaemia is a genetic disorder characterised by substantially raised LDL cholesterol, reduced LDL receptor function, xanthomas, and cardiovascular disease before age 20 years. Conventional therapy is with statins, ezetimibe, and apheresis. We aimed to assess the long-term safety and efficacy of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab in a subset of patients with homozygous familial hypercholesterolaemia enrolled in an open-label, non-randomised phase 3 trial. METHODS In this interim subset analysis of the TAUSSIG study, which was undertaken at 35 sites in 17 countries, we included patients aged 12 years or older with homozygous familial hypercholesterolaemia who were on stable LDL cholesterol-lowering therapy for at least 4 weeks; all patients received evolocumab 420 mg subcutaneously monthly, or if on apheresis every 2 weeks. Dosing could be increased to every 2 weeks after 12 weeks in patients not on apheresis. The primary outcome of the TAUSSIG study was treatment-emergent adverse events; secondary outcomes were the effects of evolocumab on LDL cholesterol and other lipids. We analysed patients on an intention-to-treat basis, and all statistical comparisons were done post hoc in this interim analysis. The TAUSSIG study is registered with ClinicalTrials.gov, number NCT01624142, and is ongoing. FINDINGS 106 patients were included in this analysis, 34 receiving apheresis at study entry and 14 younger than 18 years. The first patient was enrolled on June 28, 2012, and the cutoff date for the analysis was Aug 13, 2015; mean follow-up was 1·7 years (SD 0·63). After 12 weeks, mean LDL cholesterol decreased from baseline by 20·6% (SD 24·4; mean absolute decrease 1·50 mmol/L [SD 1·92]); these reductions were maintained at week 48. 47 of 72 patients not on apheresis at study entry increased evolocumab dosing to every 2 weeks, with an additional mean reduction in LDL cholesterol of 8·3% (SD 13·0; mean absolute decrease 0·77 mmol/L [SD 1·38]; p=0·0001). In a post-hoc analysis, mean reductions in LDL cholesterol in patients on apheresis were significant at week 12 (p=0·0012) and week 48 (p=0·0032), and did not differ from reductions achieved in patients not on apheresis (p=0·38 at week 12 and p=0·09 at week 48). We noted a small reduction (median -7·7% [IQR -21·6 to 6·8]) in lipoprotein(a) at week 12 (p=0·0015), with some additional reduction at week 48 (-11·9% [-28·0 to 0·0]; p<0·0001). HDL cholesterol was increased by a mean of 7·6% (SD 18·1) at week 12 (p<0·0001) and 7·6% (SD 20·6) at week 48 (p=0·0007). Evolocumab was well tolerated; 82 (77%) patients reported treatment-emergent adverse events, which were mostly minor. The most common were nasopharyngitis (14 patients [13%]), influenza (13 [12%]), headache (11 [10%]), and upper respiratory tract infection (11 [10%]). Serious adverse events occurred in 18 (17%) patients, with the most common being cardiovascular events (four patients [4%]). There were no deaths and four positively adjudicated cardiovascular events, one (3%) among patients on apheresis and three (4%) among patients who did not receive apheresis. INTERPRETATION Our interim results suggest that evolocumab is an effective additional option to reduce LDL cholesterol in patients with homozygous familial hypercholesterolaemia, with or without apheresis. FUNDING Amgen.
Collapse
Affiliation(s)
- Frederick J Raal
- Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - G Kees Hovingh
- Department of Vascular Medicine, Academisch Medisch Centrum, Amsterdam, Netherlands
| | - Dirk Blom
- Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital and Preventive Medicine Center and Cardiology Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Eric Bruckert
- Hôspital Pitié Salpêtrière, Assistance-Publique Hôpitaux de Paris, Paris, France
| | - Patrick Couture
- Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada
| | - Handrean Soran
- Cardiovascular Trials Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Gerald F Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | | | | | | | | | - Evan A Stein
- Metabolic and Atherosclerosis Research Center, Cincinnati, OH, USA.
| |
Collapse
|
28
|
Bugajska J, Berska J, Mamica K, Wachacka K, Sztefko K. Which of low-density lipoprotein cholesterol estimates can be used in children with type 1 diabetes? Diagnosis (Berl) 2017. [PMID: 29536909 DOI: 10.1515/dx-2016-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND One of the strongest risk factors of cardiovascular disease is a high concentration of low-density lipoprotein cholesterol (LDL-C); thus, the accurate measurement of LDL-C concentration in children is important. The aim of this study was to compare the concentration of LDL-C measured by direct method and the LDL-C concentration estimated by different formulas with the modified β-quantification method in children with type 1 diabetes. METHODS Thirty-one serum samples received from diabetic children (15/18; M/F) and 26 serum samples taken from nondiabetic children (18/14; M/F) were used in the study. LDL-C concentrations were determined by direct enzymatic method (LDL-CD) and the modified β-quantification method (LDL-CmBQ). The concentration of LDL-C was also calculated by different formulas. RESULTS The results of LDL-CmBQ and LDL-CD correlated. However, the correlation coefficient obtain in the nondiabetic samples was much higher (r=0.927; p<0.001) than the correlation coefficient for LDL-CmBQ and LDL-CD concentration obtained in the diabetic samples (r=0.691; p<0.001). Additionally, the coefficients of correlation between the LDL-CmBQ concentration and the LDL-C concentrations calculated by different formulas were lower in diabetic (range: 0.514-0.693) than in nondiabetic samples (range: 0.834-0.937). Bland-Altman plots showed much higher confidence intervals for 95% limits of agreement for the differences between LDL-CmBQ and LDL-CD as well as for the differences between LDL-CmBQ and LDL-C estimated by different formulas for samples from the diabetic samples compared with nondiabetic samples. CONCLUSIONS The limitations of methods measurement and of each of the formulas should be taken into account when a medical decision to lower LDL-C is made in the treatment of diabetic children.
Collapse
Affiliation(s)
- Jolanta Bugajska
- 1Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Berska
- 1Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Mamica
- 1Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Karolina Wachacka
- 1Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| | - Krystyna Sztefko
- 1Department of Clinical Biochemistry, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
29
|
Kubo T, Takahashi K, Furujo M, Hyodo Y, Tsuchiya H, Hattori M, Fujinaga S, Urayama K. Usefulness of non-fasting lipid parameters in children. J Pediatr Endocrinol Metab 2017; 30:77-83. [PMID: 27977407 DOI: 10.1515/jpem-2016-0271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/03/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study assessed whether non-fasting lipid markers could be substituted for fasting markers in screening for dyslipidemia, whether direct measurement of non-fasting low-density lipoprotein cholesterol [LDL-C (D)] could be substituted for the calculation of fasting LDL-C [LDL-C (F)], and the utility of measuring non-high-density lipoprotein cholesterol (non-HDL-C). METHODS In 33 children, the lipid profile was measured in the non-fasting and fasting states within 24 h. Correlations were examined between non-fasting LDL-C (D) or non-HDL-C levels and fasting LDL-C (F) levels. RESULTS Non-fasting triglyceride (TG), total cholesterol (TC), HDL-C, LDL-C (D), and non-HDL-C levels were all significantly higher than the fasting levels, but the mean difference was within 10% (except for TG). Non-fasting LDL-C (D) and non-HDL-C levels were strongly correlated with the fasting LDL-C (F) levels. CONCLUSIONS In conclusion, except for TG, non-fasting lipid parameters are useful when screening children for dyslipidemia. Direct measurement of non-fasting LDL-C and calculation of non-fasting non-HDL-C could replace the calculation of fasting LDL-C because of convenience.
Collapse
|
30
|
White J, Swerdlow DI, Preiss D, Fairhurst-Hunter Z, Keating BJ, Asselbergs FW, Sattar N, Humphries SE, Hingorani AD, Holmes MV. Association of Lipid Fractions With Risks for Coronary Artery Disease and Diabetes. JAMA Cardiol 2016; 1:692-9. [PMID: 27487401 PMCID: PMC5642865 DOI: 10.1001/jamacardio.2016.1884] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Low-density lipoprotein cholesterol (LDL-C) is causally related to coronary artery disease (CAD), but the relevance of high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) is uncertain. Lowering of LDL-C levels by statin therapy modestly increases the risk of type 2 diabetes, but it is unknown whether this effect is specific to statins. OBJECTIVE To investigate the associations of 3 routinely measured lipid fractions with CAD and diabetes through mendelian randomization (MR) using conventional MR and making use of newer approaches, such as multivariate MR and MR-Egger, that address the pleiotropy of genetic instruments where relevant. DESIGN, SETTING, AND PARTICIPANTS Published data from genome-wide association studies were used to construct genetic instruments and then applied to investigate associations between lipid fractions and the risk of CAD and diabetes using MR approaches that took into account pleiotropy of genetic instruments. The study was conducted from March 12 to December 31, 2015. MAIN OUTCOMES AND MEASURES Coronary artery disease and diabetes. RESULTS Genetic instruments composed of 130 single-nucleotide polymorphisms (SNPs) were used for LDL-C (explaining 7.9% of its variance), 140 SNPs for HDL-C (6.6% of variance), and 140 SNPs for TGs (5.9% of variance). A 1-SD genetically instrumented elevation in LDL-C levels (equivalent to 38 mg/dL) and TG levels (equivalent to 89 mg/dL) was associated with higher CAD risk; odds ratios (ORs) were 1.68 (95% CI, 1.51-1.87) for LDL-C and 1.28 (95% CI, 1.13-1.45) for TGs. The corresponding OR for HDL-C (equivalent to a 16-mg/dL increase) was 0.95 (95% CI, 0.85-1.06). All 3 lipid traits were associated with a lower risk of type 2 diabetes. The ORs were 0.79 (95% CI, 0.71-0.88) for LDL-C and 0.83 (95% CI, 0.76-0.90) for HDL-C per 1-SD elevation. For TG, the MR estimates for diabetes were inconsistent, with MR-Egger giving an OR of 0.83 (95%CI, 0.72-0.95) per 1-SD elevation. CONCLUSIONS AND RELEVANCE Routinely measured lipid fractions exhibit contrasting associations with the risk of CAD and diabetes. Increased LDL-C, HDL-C, and possibly TG levels are associated with a lower risk of diabetes. This information will be relevant to the design of clinical trials of lipid-modifying agents, which should carefully monitor participants for dysglycemia and the incidence of diabetes.
Collapse
Affiliation(s)
- Jon White
- UCL Genetics Institute, University College London, Gower Street,
London WC1E 6BT
| | - Daniel I Swerdlow
- Farr Institute at University College London, Gower Street, London
WC1E 6BT
- Department of Medicine, Imperial College London, London W12
0HS
| | - David Preiss
- Clinical Trial Service Unit & Epidemiological Studies Unit
(CTSU), Nuffield Department of Population Health, University of Oxford, Richard Doll
Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF
| | - Zammy Fairhurst-Hunter
- The Wellcome Trust Centre for Human Genetics, Roosevelt Drive,
University of Oxford, Oxford, OX3 7BN
| | - Brendan J Keating
- Children’s Hospital of Philadelphia, Philadelphia, PA 19104,
USA
- Department of Surgery, University of Pennsylvania, 3400 Spruce
Street, Philadelphia, PA 19104, ISA
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, UMC
Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart
Institute, Utrecht, the Netherlands
- Institute of Cardiovascular Science, University College London,
Gower Street, London, United Kingdom
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of
Glasgow, Glasgow
| | - Steve E Humphries
- Cardiovascular Genetics, BHF Laboratories, Institute Cardiovascular
Science, University College London, Gower Street, London WC1E 6BT
| | - Aroon D Hingorani
- Farr Institute at University College London, Gower Street, London
WC1E 6BT
- Institute of Cardiovascular Science, University College London,
Gower Street, London, United Kingdom
| | - Michael V Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit
(CTSU), Nuffield Department of Population Health, University of Oxford, Richard Doll
Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF
| |
Collapse
|
31
|
Hirano T. [Small-Dense LDL, HDL2, 3]. Rinsho Byori 2016; 64:636-642. [PMID: 30695317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Low-density lipoprotein (LDL), an established atherogenic lipoprotein, can be fractionated into large buoy- ant (b) and small-dense (sd) particles based on their size and density. An abundance of clinical evidence has shown that sdLDL particles are more atherogenic than lbLDL particles, and the predominance of sdLDL is associated with a three-fold increased risk of coronary artery diseases (CAD). The sdLDL particle is a good substrate for oxidized LDL in the arterial wall. The LDL size is inversely regulated by serum levels of triglycerides (TG) and insulin resistance. Therefore, the level of sdLDL particles is increased in subjects with hypertriglyceridemia, metabolic syndrome, and type 2 diabetes. We established a simple precipitation assay and a homogenous assay for direct measurement of the sdLDL-cholesterol (C) concentration in serum or plasma. Our direct sdLDL assays have been adopted in well-known large cohort studies, and revealed that sdLDL-C more sensitively predicted CAD events than LDL-C or IbLDL-C levels. HDL also has subspecies, namely HDL2 and HDL3. Large cholesterol-rich HDL2 is inversely associated with plasma TG and insulin resistance, whereas small cholesterol-poor HDL3 is not. We established a sim- ple precipitation assay and a homogenous assay for direct measurement of the HDL3-C concentration in se- rum or plasma, which yields HDL2-C by subtracting HDL3-C from HDL-C. The clinical significance of HDL subspecies remains poorly understood, and so should be a subject of further clinical studies. [Review].
Collapse
|
32
|
Bowden J, Davey Smith G, Haycock PC, Burgess S. Consistent Estimation in Mendelian Randomization with Some Invalid Instruments Using a Weighted Median Estimator. Genet Epidemiol 2016; 40:304-14. [PMID: 27061298 PMCID: PMC4849733 DOI: 10.1002/gepi.21965] [Citation(s) in RCA: 3404] [Impact Index Per Article: 425.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/03/2015] [Accepted: 02/04/2016] [Indexed: 12/29/2022]
Abstract
Developments in genome-wide association studies and the increasing availability of summary genetic association data have made application of Mendelian randomization relatively straightforward. However, obtaining reliable results from a Mendelian randomization investigation remains problematic, as the conventional inverse-variance weighted method only gives consistent estimates if all of the genetic variants in the analysis are valid instrumental variables. We present a novel weighted median estimator for combining data on multiple genetic variants into a single causal estimate. This estimator is consistent even when up to 50% of the information comes from invalid instrumental variables. In a simulation analysis, it is shown to have better finite-sample Type 1 error rates than the inverse-variance weighted method, and is complementary to the recently proposed MR-Egger (Mendelian randomization-Egger) regression method. In analyses of the causal effects of low-density lipoprotein cholesterol and high-density lipoprotein cholesterol on coronary artery disease risk, the inverse-variance weighted method suggests a causal effect of both lipid fractions, whereas the weighted median and MR-Egger regression methods suggest a null effect of high-density lipoprotein cholesterol that corresponds with the experimental evidence. Both median-based and MR-Egger regression methods should be considered as sensitivity analyses for Mendelian randomization investigations with multiple genetic variants.
Collapse
Affiliation(s)
- Jack Bowden
- Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - George Davey Smith
- Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Philip C Haycock
- Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
33
|
Zhao XM, Li N, Du CX. [Chemical Constituents of Lowering LDL-C in Effective Part of Oroxylum indicum]. Zhong Yao Cai 2016; 39:555-558. [PMID: 30088885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the chemical constituents of effective part of Oroxylum indicum which related to lowering LDLC action. METHODS The compounds were isolated with chromatography methods such as silica gel,polyamide and Sephadex LH-20. The structures were identified by physiochemical properties and spectral analysis. RESULTS 14 compounds were isolated from 95% alcohol extract and elucidated as β-sitosterol( 1), hexadecanoic acid( 2), oroxin A( 3), oroxin B( 4), chrysin( 5), quercetin( 6),quercetin-3-Orutinoside( 7),5,4’-dihydroxy-3,6,7-trimethoxyflavone( 8), diosmetin( 9), geniposide( 10),isoorientin( 11), quercitroside( 12), apigenin( 13) and gallicacid( 14). CONCLUSION Compounds 2,7 ~ 12 and 14 are reported from this plants for the first time.
Collapse
|
34
|
Sumino H, Nakajima K, Murakami M. [Possibility of New Circulating Atherosclerosis-Related Lipid Markers Measurement in Medical and Complete Medical Checkups: Small Dense Low-Density Lipoprotein Cholesterol and Lipoprotein Lipase]. Rinsho Byori 2016; 64:298-307. [PMID: 27363222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Small dense low-density lipoprotein cholesterol (sdLDL-C) concentrations correlate more strongly with cardiovascular disease (CVD) than other LDL-C and large LDL particle concentrations. Lipoprotein lipase (LPL) plays a central role in triglyceride-rich lipoprotein metabolism by catalyzing the hydrolysis of triglycerides in chylomicrons and very low-density lipoprotein particles and is a useful biomarker in diagnosing Type I, Type IV, and Type V hyperlipidemia. Therefore, the measurement of circulating sdLDL-C and LPL concentrations contributes to the assessment of circulating atherosclerosis-related lipid markers. However, the measurement of these lipids has not been fully adopted in medical and complete medical checkups. Recently, novel automated homogenous assay for measuring sdLDL-C and latex particle-enhanced turbidimetric immunoassay (LTIA) for measuring LPL have been developed, respectively. Using these new assays, sdLDL-C values showed excellent agreement with those obtained by isolation of the d = 1.044 - 1.063 g/mL plasma fraction by sequential ultracentrifugation, and LPL values measured with and without heparin injection were highly correlated with the values measured by the LPL-enzyme-linked immunosorbent assay (ELISA). These assays may be superior to the previous assays for the measurement of sdLDL-C and LPL concentrations due their simplicity and reproducibility. The measurements of sdLDL-C and LPL concentrations may be useful as lipid markers in the assessment of the development and progression of atherosclerosis and the detection of pathological conditions and diseases if these markers are measured in medical and complete medical checkups. We have introduced the possibility of the novel measurement of circulating atherosclerosis-related lipid markers such as sdLDL-C and LPL in medical and complete medical checkups. Further studies are needed to clarify whether sdLDL-C and LPL concentrations are related to the development and progression of atherosclerosis and CVD events.
Collapse
|
35
|
Wang R, Fratiglioni L, Liang Y, Welmer AK, Xu W, Mangialasche F, Johnell K, Qiu C. Prevalence, pharmacological treatment, and control of cardiometabolic risk factors among older people in central Stockholm: a population-based study. PLoS One 2015; 10:e0119582. [PMID: 25799502 PMCID: PMC4370718 DOI: 10.1371/journal.pone.0119582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/22/2015] [Indexed: 02/05/2023] Open
Abstract
Background Cardiometabolic risk factors and related cardiovascular diseases represent major threats to healthy aging. Objective We aimed to estimate distribution, pharmacological treatment, and control of main cardiometabolic risk factors among older people. Methods This population-based study included 3363 participants (age≥60 years, 64.9% women) in the Swedish National study on Aging and Care in Kungsholmen, in central Stockholm, Sweden (2001-2004). Data on demographics, cardiometabolic risk factors (hypertension, obesity, diabetes, and high cholesterol), and medication use were collected through face-to-face interviews, clinical examinations, laboratory tests, and the inpatient register. Cardiometabolic risk factors were defined following the most commonly used criteria. Prevalence was standardized using local census data. Results The age- and sex-standardized prevalence of diabetes, obesity, high cholesterol, and hypertension was 9.5%, 12.8%, 49.7%, and 74.9%, respectively. The prevalence of hypertension and diabetes increased with age, whereas the prevalence of obesity and high cholesterol decreased with age. Forty-nine percent of older adults had two or more cardiometabolic risk factors; 9.8% had three or more. Overall, 55.5% of people with hypertension, 50.3% with diabetes, and 25.0% with high cholesterol received pharmacological treatment. Of those treated pharmacologically, 49.4%, 38.1%, and 85.5% reached therapeutic goals for hypertension (blood pressure<150/90 mmHg), diabetes (glycated haemoglobin<7%), and high cholesterol (total cholesterol<6.22 mmol/l), respectively. Conclusions Hypertension, high cholesterol, and clustering of cardiometabolic risk factors were common among older people in Stockholm, but pharmacological treatment and control of these major factors can be improved. Appropriate management of cardiometabolic profiles among older people may help improve cardiovascular health and achieve healthy aging.
Collapse
Affiliation(s)
- Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- * E-mail: (RW); (CQ)
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Yajun Liang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- School of Public Health, Jining Medical University, Shandong, China
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- Karolinska University Hospital, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Francesca Mangialasche
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Kristina Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- * E-mail: (RW); (CQ)
| |
Collapse
|
36
|
Berryman CE, West SG, Fleming JA, Bordi PL, Kris‐Etherton PM. Effects of daily almond consumption on cardiometabolic risk and abdominal adiposity in healthy adults with elevated LDL-cholesterol: a randomized controlled trial. J Am Heart Assoc 2015; 4:e000993. [PMID: 25559009 PMCID: PMC4330049 DOI: 10.1161/jaha.114.000993] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/24/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence consistently shows that almond consumption beneficially affects lipids and lipoproteins. Almonds, however, have not been evaluated in a controlled-feeding setting using a diet design with only a single, calorie-matched food substitution to assess their specific effects on cardiometabolic risk factors. METHODS AND RESULTS In a randomized, 2-period (6 week/period), crossover, controlled-feeding study of 48 individuals with elevated LDL-C (149±3 mg/dL), a cholesterol-lowering diet with almonds (1.5 oz. of almonds/day) was compared to an identical diet with an isocaloric muffin substitution (no almonds/day). Differences in the nutrient profiles of the control (58% CHO, 15% PRO, 26% total fat) and almond (51% CHO, 16% PRO, 32% total fat) diets were due to nutrients inherent to each snack; diets did not differ in saturated fat or cholesterol. The almond diet, compared with the control diet, decreased non-HDL-C (-6.9±2.4 mg/dL; P=0.01) and LDL-C (-5.3±1.9 mg/dL; P=0.01); furthermore, the control diet decreased HDL-C (-1.7±0.6 mg/dL; P<0.01). Almond consumption also reduced abdominal fat (-0.07±0.03 kg; P=0.02) and leg fat (-0.12±0.05 kg; P=0.02), despite no differences in total body weight. CONCLUSIONS Almonds reduced non-HDL-C, LDL-C, and central adiposity, important risk factors for cardiometabolic dysfunction, while maintaining HDL-C concentrations. Therefore, daily consumption of almonds (1.5 oz.), substituted for a high-carbohydrate snack, may be a simple dietary strategy to prevent the onset of cardiometabolic diseases in healthy individuals. CLINICAL TRIAL REGISTRATION URL www.clinicaltrials.gov; Unique Identifier: NCT01101230.
Collapse
Affiliation(s)
- Claire E. Berryman
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA (C.E.B., S.G.W., J.A.F., P.M.K.E.)
| | - Sheila G. West
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA (C.E.B., S.G.W., J.A.F., P.M.K.E.)
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA (S.G.W.)
| | - Jennifer A. Fleming
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA (C.E.B., S.G.W., J.A.F., P.M.K.E.)
| | - Peter L. Bordi
- Department of Hospitality Management, The Pennsylvania State University, University Park, PA (P.L.B.)
| | - Penny M. Kris‐Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA (C.E.B., S.G.W., J.A.F., P.M.K.E.)
| |
Collapse
|
37
|
Gavalko YV, Peshuk LV, Sineok LL, Romanenko MS, Hashuk AI. [Influence of gerodietetic meat pate on metabolic parameters in the elderly: the role of vitamin B12]. Adv Gerontol 2015; 28:571-578. [PMID: 28509499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many studies indicate essential nature of food in maintaining health. An important factor is the consumption of a variety of essential elements, in particular vitamins. The aim was to determine the relationship of vitamin B12 levels in serum with metabolic parameters and the possibility of correction using gerodietetic meat pate. A total of 23 older people (60-80 years) were surveyed. We determined index mass body, waist circumference, biochemical indicators, vitamin B12 concentration in serum and food consumption (by frequency method). We also measured changes in these parameters under the influence of eating gerodietetic meat pate. The older adults often demonstrate deficient in vitamin B12 in the blood (about 65 % of the surveyed), which may be contributed both by its lack of dietary intake and malabsorption due to pathological changes in the digestive system. The content of vitamin B12 in the blood of the elderly has been closely linked to metabolic indicators and body mass. Using gerodietetic meat pate promoted not only the elimination of vitamin B12 deficiency, but also significantly improved the biochemical markers of protein, and especially lipid metabolism in the elderly (decreased low-density lipoprotein and high density lipoprotein increased).
Collapse
Affiliation(s)
- Yu V Gavalko
- D. F. Chebotarev Institute of Gerontology, NAMS of Ukraine, Kyiv, 04114, Ukraine;
| | - L V Peshuk
- National University of Food Technologies, Kiev, 01601, Ukraine
| | - L L Sineok
- D. F. Chebotarev Institute of Gerontology, NAMS of Ukraine, Kyiv, 04114, Ukraine;
| | - M S Romanenko
- D. F. Chebotarev Institute of Gerontology, NAMS of Ukraine, Kyiv, 04114, Ukraine;
| | - A I Hashuk
- National University of Food Technologies, Kiev, 01601, Ukraine
| |
Collapse
|
38
|
Weerakoon HTW, Ranasinghe JGS, Navaratna A, Sivakanesan R, Galketiya KB, Rosairo S. Can the type of gallstones be predicted with known possible risk factors?: A comparison between mixed cholesterol and black pigment stones. BMC Gastroenterol 2014; 14:88. [PMID: 24884475 PMCID: PMC4017087 DOI: 10.1186/1471-230x-14-88] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/29/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pathogenesis of gallstones (GS) is multifactorial and multiple genetic and environmental factors have been identified in different populations for different types of GS with varying prevalence. However the role of the each aetiological factor on the formation of mixed cholesterol and black pigment GS has not being addressed adequately. Hence in this study we attempted to compare known possible risk factors for mixed cholesterol and black pigment GS among two groups of patients with two types of GS. METHODS The study was done on a cohort of patients with symptomatic GS admitted to the Teaching Hospital Peradeniya, Sri Lanka over a period of 18 months. Clinical and epidemiological data and physical parameters of the patients were recorded and surgically removed GS were analyzed chemically and physically to identify the type of GS. In addition lipid profile was done in all the patients with normal serum bilirubin levels. RESULTS A total of 86 patients were included in the study. Mixed cholesterol GS was significantly common among females than males (χ2 test, p = 0.029). Mixed cholesterol GS was commonly seen among patients belonging to Moor ethnicity (χ2 test, p = 0.009). Majority of patients with mixed cholesterol GS had body mass index above 25 kg/m2 (χ2 test, p = 0.018). Black pigment GS were significantly common among patients with type II diabetes mellitus (Fisher's exact test, p = 0.035). Further all the patients with chronic haemolytic anaemia and alcoholic cirrhosis had black pigment GS. Age, family history, Fasting Blood Glucose, dyslipidaemia, lipid profile, parity and use of oral contraceptive pills in females, smoking and alcohol intake in males did not differ significantly among patients in the two groups. CONCLUSION Gender, ethnicity and body mass index can be used to predict the formation of mixed cholesterol GS and black pigment GS.
Collapse
Affiliation(s)
- Harshi TW Weerakoon
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Ayanthi Navaratna
- Department of Chemistry, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ramaiah Sivakanesan
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kuda B Galketiya
- Department of Surgery, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shanthini Rosairo
- Department of Surgery, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
39
|
Ravnskov U, DiNicolantonio JJ, Harcombe Z, Kummerow FA, Okuyama H, Worm N. The questionable benefits of exchanging saturated fat with polyunsaturated fat. Mayo Clin Proc 2014; 89:451-3. [PMID: 24581756 DOI: 10.1016/j.mayocp.2013.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/09/2013] [Accepted: 11/13/2013] [Indexed: 11/21/2022]
Affiliation(s)
| | | | - Zoë Harcombe
- Faculty of Science and Technology, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, Lanarkshire, United Kingdom
| | - Fred A Kummerow
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana
| | - Harumi Okuyama
- Institute for Consumer Science and Human Life, Kinjo Gakuin University, Moriyamaku, Nagoya, Japan
| | - Nicolai Worm
- German University for Prevention and Health Care Management, Saarbrücken, Germany
| |
Collapse
|
40
|
Cooper JG, Claudi T, Thordarson HB, Løvaas KF, Carlsen S, Sandberg S, Thue G. Treatment of type 1 diabetes in the specialist health service--data from the Norwegian Diabetes Register for Adults. Tidsskr Nor Laegeforen 2014; 133:2257-62. [PMID: 24226332 DOI: 10.4045/tidsskr.13.0153] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The Norwegian Diabetes Register for Adults was established in 2005. The aim of the study is to assess the quality of treatment for adult patients with type 1 diabetes in the specialist health service based on register data. MATERIAL AND METHOD We included patients ≥ 18 years with type 1 diabetes in the specialist health service for whom the register has data for the period from 1 July 2010-to 31 December 2011. The patients were asked to consent to the transfer of data to the register when they attended a routine consultation. As of 31 December 2011, 95% of the patients asked gave their consent. It is not known how large a proportion of patients were asked. RESULTS We included the last registered data for 3,697 patients (46.8% women) from 24 outpatient clinics and specialist centres. The average age was 41.8 years and the average duration of diabetes was 20.8 years. Median HbA1c, systolic blood pressure and LDL cholesterol were 8.0%, 126 mm Hg and 2.8 mmol/l respectively. 9.8% achieved all treatment targets set out in the national guidelines for diabetes. 18% had HbA1c ≤ 7.0%, while 22% had HbA1c ≥ 9%. 39% of patients on statin therapy achieved the treatment target for LDL cholesterol. 19.6% smoked on a daily basis. 14.9% had received treatment for retinopathy and 5.8% had experienced coronary heart disease. There was no record of foot examination or ophthalmoscopy being performed in 33% and 29% of patients. INTERPRETATION The preliminary register data indicate that diabetes treatment should be improved both with respect to the implementation of recommended procedures and the proportion of patients who achieve the treatment targets.
Collapse
|
41
|
Martin SS, Blaha MJ, Elshazly MB, Toth PP, Kwiterovich PO, Blumenthal RS, Jones SR. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA 2013; 310:2061-8. [PMID: 24240933 PMCID: PMC4226221 DOI: 10.1001/jama.2013.280532] [Citation(s) in RCA: 479] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE In clinical and research settings worldwide, low-density lipoprotein cholesterol (LDL-C) is typically estimated using the Friedewald equation. This equation assumes a fixed factor of 5 for the ratio of triglycerides to very low-density lipoprotein cholesterol (TG:VLDL-C); however, the actual TG:VLDL-C ratio varies significantly across the range of triglyceride and cholesterol levels. OBJECTIVE To derive and validate a more accurate method for LDL-C estimation from the standard lipid profile using an adjustable factor for the TG:VLDL-C ratio. DESIGN, SETTING, AND PARTICIPANTS We used a convenience sample of consecutive clinical lipid profiles obtained from 2009 through 2011 from 1,350,908 children, adolescents, and adults in the United States. Cholesterol concentrations were directly measured after vertical spin density-gradient ultracentrifugation, and triglycerides were directly measured. Lipid distributions closely matched the population-based National Health and Nutrition Examination Survey (NHANES). Samples were randomly assigned to derivation (n = 900,605) and validation (n = 450,303) data sets. MAIN OUTCOMES AND MEASURES Individual patient-level concordance in clinical practice guideline LDL-C risk classification using estimated vs directly measured LDL-C (LDL-CD). RESULTS In the derivation data set, the median TG:VLDL-C was 5.2 (IQR, 4.5-6.0). The triglyceride and non-high-density lipoprotein cholesterol (HDL-C) levels explained 65% of the variance in the TG:VLDL-C ratio. Based on strata of triglyceride and non-HDL-C values, a 180-cell table of median TG:VLDL-C values was derived and applied in the validation data set to estimate the novel LDL-C (LDL-CN). For patients with triglycerides lower than 400 mg/dL, overall concordance in guideline risk classification with LDL-CD was 91.7% (95% CI, 91.6%-91.8%) for LDL-CN vs 85.4% (95% CI, 85.3%-85.5%) for Friedewald LDL-C (LDL-CF) (P < .001). The greatest improvement in concordance occurred in classifying LDL-C lower than 70 mg/dL, especially in patients with high triglyceride levels. In patients with an estimated LDL-C lower than 70 mg/dL, LDL-CD was also lower than 70 mg/dL in 94.3% (95% CI, 93.9%-94.7%) for LDL-CN vs 79.9% (95% CI, 79.3%-80.4%) for LDL-CF in samples with triglyceride levels of 100 to 149 mg/dL; 92.4% (95% CI, 91.7%-93.1%) for LDL-CN vs 61.3% (95% CI, 60.3%-62.3%) for LDL-CF in samples with triglyceride levels of 150 to 199 mg/dL; and 84.0% (95% CI, 82.9%-85.1%) for LDL-CN vs 40.3% (95% CI, 39.4%-41.3%) for LDL-CF in samples with triglyceride levels of 200 to 399 mg/dL (P < .001 for each comparison). CONCLUSIONS AND RELEVANCE A novel method to estimate LDL-C using an adjustable factor for the TG:VLDL-C ratio provided more accurate guideline risk classification than the Friedewald equation. These findings require external validation, as well as assessment of their clinical importance. The implementation of these findings into clinical practice would be straightforward and at virtually no cost. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01698489.
Collapse
Affiliation(s)
- Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | | | | | | | | | | | | |
Collapse
|
42
|
Affiliation(s)
- J Michael Gaziano
- VA Boston Healthcare System, Massachusetts 2Associate Editor, JAMA3Brigham and Women's Hospital, Boston, Massachusetts
| | | |
Collapse
|
43
|
Abstract
AIMS To determine the burden of atherogenic apolipoprotein particles in early-onset type 2 diabetes (T2D) compared to those with later-onset disease during statin treatment. METHODS Early and later-onset T2D was defined as current age below and above 40 years respectively. Conventional lipid profile, LDL, non-HDL cholesterol, apolipoprotein B and A1 were determined in those without cardiovascular disease treated with simvastatin to achieve LDL cholesterol <2 mmol/l. RESULTS Fifty subjects were recruited (early-onset n=24 and later-onset n=26). The mean age was 34.5 and 59.6 years and mean age of diagnosis was 29.1 and 49.1 years for early and later-onset T2D respectively. Obesity, dyslipidaemia, microalbuminuria, glycaemic control and diabetes complication burden were similar in both cohorts. Early-onset subjects received non-significantly higher simvastatin dose (37.5 vs. 31.9 mg daily, p=NS). On-treatment LDL cholesterol was similar in both cohorts (early vs. later-onset; 2.12 vs. 1.97 mmol/l, p=NS). Fasting triglyceride, non-HDL, apo B and B/A1 ratio were significantly higher in early-onset cohort. There was no difference in apo A1, HDL and total cholesterol/HDL ratio. Apo B level remained significantly higher among early-onset subjects after adjustment for insulin treatment. Lower current age and age of diagnosis were significant predictors of higher apo B level. CONCLUSION The burden of atherogenic apolipoprotein particles was greater in early-onset T2D despite adequate statin treatment indicating an adverse phenotype for vascular disease.
Collapse
Affiliation(s)
- S H Song
- Diabetes Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
| | | |
Collapse
|
44
|
Descamps OS, De Backer G, Annemans L, Muls E, Scheen AJ. [New European guidelines for the management of dyslipidaemia in cardiovascular prevention]. Rev Med Liege 2012; 67:118-127. [PMID: 22611827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The new guidelines from the European Atherosclerosis Society and the European Society of Cardiology include a number of updated items. In this paper, we summarize 4 of these changes that we consider to be the most pertinent. Firstly, cardiovascular risk is now stratified according to 4 (previously 2) categories: "very high risk" (patients with cardiovascular disease, patients with diabetes > 40 years old who have at least one other risk factor, patients with kidney failure, or patients in primary prevention with a SCORE value > or = 10%); "high risk" (patients in primary prevention with a SCORE value > or = 5% and < 10% or patients with a particularly serious risk factor such as familial hypercholesterolaemia or patients with diabetes < 40 years old without any other risk factor); "moderate risk" (primary prevention with SCORE > or = 1% and < 5%); and "low risk" (primary prevention with SCORE < 1%). The SCORE value for patients in primary prevention is estimated using the SCORE table (calibrated for Belgium). Risk in this table may now be corrected according to HDL cholesterol level. Secondly, the therapeutic targets for each category are now more stringent: LDL cholesterol < 70 mg/dl (or reduced by at least 50%) if the risk is "very high"; < 100 mg/dl if the risk is "high"; and < 115 mg/dl if the risk is "moderate". Thirdly, for patients at "high" or "very high" risk, particularly in patients with combined dyslipidaemia, two further therapeutic targets should be considered: non-HDL cholesterol and apolipoprotein B levels. Fourthly, the follow-up of efficacy (lipid profile) and tolerance (hepatic and muscular enzymes) is described in more details so as to harmonize case management in clinical practice.
Collapse
Affiliation(s)
- O S Descamps
- Centre de Recherche Médicale de Jolimont et Département de Médecine Interne, Hôpital de Jolimont, Haine-Saint-Paul.
| | | | | | | | | |
Collapse
|
45
|
Kawano Y, Tamura A, Kadota J. Association between the severity of obstructive sleep apnea and the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol. Metabolism 2012; 61:186-92. [PMID: 21820142 DOI: 10.1016/j.metabol.2011.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/09/2011] [Accepted: 06/05/2011] [Indexed: 11/28/2022]
Abstract
The positive association between the ratio of serum low-density lipoprotein cholesterol (LDL-C) to serum high-density lipoprotein cholesterol (HDL-C) and cardiovascular events has recently been receiving much attention. However, the association between the severity of obstructive sleep apnea (OSA) and this ratio has not yet been investigated. Accordingly, we sought to clarify this association and the effect of continuous positive airway pressure (CPAP) therapy on the ratio. We performed polysomnography and LDL-C/HDL-C measurements in 215 patients who were suspected of having OSA. Furthermore, LDL-C/HDL-C was again evaluated 6 months after polysomnography in 30 OSA patients for whom CPAP therapy was initiated and continued, and in 11 age- and sex-matched OSA patients for whom the therapy could not be initiated. The LDL-C/HDL-C correlated positively with apnea-hypopnea index (ρ = 0.28, P < .001) and negatively with the lowest arterial oxyhemoglobin saturation (ρ = -0.30, P < .001). Multivariate regression analysis revealed that ln apnea-hypopnea index (or ln lowest arterial oxyhemoglobin saturation) was independently associated with LDL-C/HDL-C. The LDL-C/HDL-C decreased after 6 months in the CPAP group (2.29 ± 0.67 to 2.11 ± 0.74, P = .02), whereas it did not change in the non-CPAP group (2.65 ± 0.82 to 2.62 ± 0.66, P = .81). The severity of OSA was independently associated with LDL-C/HDL-C, and LDL-C/HDL-C was significantly reduced at 6 months after CPAP therapy. These findings suggest that LDL-C/HDL-C increases in proportion to the severity of OSA, which may contribute partly to an increased risk for cardiovascular events in OSA patients.
Collapse
Affiliation(s)
- Yoshiyuki Kawano
- Internal Medicine 2, Faculty of Medicine, Oita University, Yufu 879-5593, Japan.
| | | | | |
Collapse
|
46
|
Stankowiak-Kulpa H, Krzyżanowska P, Kozioł L, Grzymisławski M, Wanic-Kossowska M, Moczko J, Walkowiak J. Vitamin K status in peritoneally dialyzed patients with chronic kidney disease. Acta Biochim Pol 2011; 58:617-620. [PMID: 22187681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/17/2011] [Accepted: 12/16/2011] [Indexed: 05/31/2023]
Abstract
Abnormal vitamin K status was documented in patients with chronic kidney diseases (CKD), especially those undergoing hemodialysis. The data related to patients undergoing peritoneal dialysis (PD) are contradictory. Therefore, in the present study we aimed to evaluate vitamin K status in patients with CKD who are treated with continuous ambulatory PD. Twenty-eight patients entered into the study. Dialysis vintage ranged from 3 to 89 months. Vitamin K status was assessed in all subjects using undercarboxylated prothrombin measurement (PIVKA-II). In addition, total protein and albumin levels, total cholesterol, LDL cholesterol, triglyceride, calcium, urea and creatinine concentrations were determined. PIVKA-II concentrations were abnormal in 13 (46.4 %) subjects. BMI values, both total and LDL cholesterol concentrations were significantly higher in patients with than those without vitamin K deficiency. Moreover, PIVKA II levels correlated with BMI values (r = 0.441, p < 0.019), LDL cholesterol (r = 0.434, p < 0.021) and creatinine (r = 0.406, p< 0.032) concentrations. However, through the use of logistic regression analysis and multiple regression analysis, no clinical factor was documented to be the independent risk factor of vitamin K deficiency. In conclusion, vitamin K deficiency is a frequent condition in peritoneally dialyzed patients. Assessment of vitamin K status should become a standard procedure in this group of patients.
Collapse
Affiliation(s)
- Hanna Stankowiak-Kulpa
- Department of Internal Medicine, Metabolism and Dietetics, Poznań University of Medical Sciences, Poznań, Poland
| | | | | | | | | | | | | |
Collapse
|
47
|
Jin S, Cho KH. Water extracts of cinnamon and clove exhibits potent inhibition of protein glycation and anti-atherosclerotic activity in vitro and in vivo hypolipidemic activity in zebrafish. Food Chem Toxicol 2011; 49:1521-9. [PMID: 21443916 DOI: 10.1016/j.fct.2011.03.043] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 12/22/2022]
Abstract
Advanced glycation end products contribute to the pathogenesis of diabetic complications and atherosclerosis. Aqueous extracts of ground pepper, cinnamon, rosemary, ginger, and clove were analyzed and tested for anti-atherosclerotic activity in vitro and in vivo using hypercholesterolemic zebrafish. Cinnamon and clove extracts (at final 10 μg/mL) had the strongest anti-glycation and antioxidant activity in this study. Cinnamon and clove had the strongest inhibition of activity against copper-mediated low-density lipoprotein (LDL) oxidation and LDL phagocytosis by macrophages. Cinnamon or clove extracts had potent cholesteryl ester transfer protein (CETP) inhibitory activity in a concentration-dependent manner. They exhibited hypolipidemic activity in a hypercholesterolemic zebrafish model; the clove extract-treated group had a 68% and 80% decrease in serum cholesterol and TG levels, respectively. The clove extract-fed group had the smallest increase in body weight and height and the strongest antioxidant activity following a 5-week high cholesterol diet. Hydrophilic ingredients of cinnamon and clove showed potent activities to suppress the incidence of atherosclerosis and diabetes via strong antioxidant potential, prevention of apoA-I glycation and LDL-phagocytosis, inhibition of CETP, and hypolipidemic activity. These results suggest the potential to develop a new functional dietary agent to treat chronic metabolic diseases, such as hyperlipidemia and diabetes.
Collapse
Affiliation(s)
- Seori Jin
- School of Biotechnology, Yeungnam University, Gyeongsan 712-749, Republic of Korea
| | | |
Collapse
|
48
|
Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt-Rasmussen B, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen-Riska C, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377:2181-92. [PMID: 21663949 PMCID: PMC3145073 DOI: 10.1016/s0140-6736(11)60739-3] [Citation(s) in RCA: 1645] [Impact Index Per Article: 126.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infarction, ischaemic stroke, and the need for coronary revascularisation in people without kidney disease, but its effects in people with moderate-to-severe kidney disease are uncertain. The SHARP trial aimed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients. METHODS This randomised double-blind trial included 9270 patients with chronic kidney disease (3023 on dialysis and 6247 not) with no known history of myocardial infarction or coronary revascularisation. Patients were randomly assigned to simvastatin 20 mg plus ezetimibe 10 mg daily versus matching placebo. The key prespecified outcome was first major atherosclerotic event (non-fatal myocardial infarction or coronary death, non-haemorrhagic stroke, or any arterial revascularisation procedure). All analyses were by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00125593, and ISRCTN54137607. FINDINGS 4650 patients were assigned to receive simvastatin plus ezetimibe and 4620 to placebo. Allocation to simvastatin plus ezetimibe yielded an average LDL cholesterol difference of 0·85 mmol/L (SE 0·02; with about two-thirds compliance) during a median follow-up of 4·9 years and produced a 17% proportional reduction in major atherosclerotic events (526 [11·3%] simvastatin plus ezetimibe vs 619 [13·4%] placebo; rate ratio [RR] 0·83, 95% CI 0·74-0·94; log-rank p=0·0021). Non-significantly fewer patients allocated to simvastatin plus ezetimibe had a non-fatal myocardial infarction or died from coronary heart disease (213 [4·6%] vs 230 [5·0%]; RR 0·92, 95% CI 0·76-1·11; p=0·37) and there were significant reductions in non-haemorrhagic stroke (131 [2·8%] vs 174 [3·8%]; RR 0·75, 95% CI 0·60-0·94; p=0·01) and arterial revascularisation procedures (284 [6·1%] vs 352 [7·6%]; RR 0·79, 95% CI 0·68-0·93; p=0·0036). After weighting for subgroup-specific reductions in LDL cholesterol, there was no good evidence that the proportional effects on major atherosclerotic events differed from the summary rate ratio in any subgroup examined, and, in particular, they were similar in patients on dialysis and those who were not. The excess risk of myopathy was only two per 10,000 patients per year of treatment with this combination (9 [0·2%] vs 5 [0·1%]). There was no evidence of excess risks of hepatitis (21 [0·5%] vs 18 [0·4%]), gallstones (106 [2·3%] vs 106 [2·3%]), or cancer (438 [9·4%] vs 439 [9·5%], p=0·89) and there was no significant excess of death from any non-vascular cause (668 [14·4%] vs 612 [13·2%], p=0·13). INTERPRETATION Reduction of LDL cholesterol with simvastatin 20 mg plus ezetimibe 10 mg daily safely reduced the incidence of major atherosclerotic events in a wide range of patients with advanced chronic kidney disease. FUNDING Merck/Schering-Plough Pharmaceuticals; Australian National Health and Medical Research Council; British Heart Foundation; UK Medical Research Council.
Collapse
Affiliation(s)
- Colin Baigent
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Martin J Landray
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Christina Reith
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | | | | | - Christoph Wanner
- Department of Medicine 1, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany
| | - Vera Krane
- Department of Medicine 1, Division of Nephrology, University of Wuerzburg, Wuerzburg, Germany
| | - Alan Cass
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan Craig
- Sydney School of Public Health, Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | - Bruce Neal
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Lixin Jiang
- China Oxford Centre for International Health Research, Fuwai Hospital, Beijing, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Lai Seong Hooi
- Department of Medicine and Haemodialysis Unit, Sultanah Aminah Hospital, Johor Bahru, Malaysia
| | - Adeera Levin
- University of British Columbia, Vancouver, BC, Canada
| | - Lawrence Agodoa
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mike Gaziano
- Harvard Medical School, VA Boston, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Robert Walker
- Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Ziad A Massy
- Division of Clinical Pharmacology and Division of Nephrology, Amiens University Hospital, and INSERM ERI-12, University of Picardie Jules Verne, Amiens, France
| | | | - Udom Krairittichai
- Division of Nephrology, Department of Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Vuddidhej Ophascharoensuk
- Renal Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Hallvard Holdaas
- Renal Section, Department of Organ Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Vladimir Tesar
- Department of Nephrology, First School of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Andrzej Wiecek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland
| | - Diederick Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dick de Zeeuw
- Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - David Lewis
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - William Herrington
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Marion Mafham
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | | | - Karl Wallendszus
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Richard Grimm
- Berman Center for Outcomes and Clinical Research, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Terje Pedersen
- University of Oslo and Centre of Preventive Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Jane Armitage
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Alex Baxter
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Christopher Bray
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Michael Hill
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Carol Knott
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Sarah Parish
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - David Simpson
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Peter Sleight
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, UK
| | - Alan Young
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | | |
Collapse
|
49
|
Austin S, Wolfe BL. The effect of patient reminders and gas station gift cards on patient adherence to testing guidelines for diabetes. WMJ 2011; 110:132-137. [PMID: 21748998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Analysis of the effectiveness of a small financial incentive and a written reminder to encourage test taking among persons with diabetes who have missed glycosylated hemoglobin (HbAlc) and low-density lipoprotein cholesterol (LDL-C) screenings. RESEARCH DESIGN AND METHODS The analysis uses data from the University of Wisconsin Medical Foundation medical records of persons diagnosed with diabetes who had not received an HbA1c screening or had not received an LDL-C screening over the previous year (prior to October 2005). This study uses a quasi-experimental design comparing 464 diabetic patients (cases) who received a letter reminder of screening and financial incentive for undergoing screening, and 693 controls who did not receive a letter or financial incentive. The treated patients (464) all were seen in 1 of 4 clinics while those not treated used different clinics within the same system of care. Propensity scores served as the matching procedure using the following covariates: age, gender, ethnicity, marital status, number of HbA1c tests and number of LDL-C tests in the year prior to pilot program, mean HbA1c levels in the year prior to the pilot program (when available), census income data, and a comorbidity measure. RESULTS During the 2 years following the pilot program, on average the target or "treated" population received significantly more screenings--3.34-compared to 2.69 screenings for the matched comparison group, and a far smaller proportion of the target population had no screening at all. CONCLUSIONS The results provide evidence that a small financial incentive coupled with a written reminder work to increase test taking (especially the HbA1c screening) and suggest greater control of HbA1c levels among persons who had previously missed screenings.
Collapse
Affiliation(s)
- Sam Austin
- Department of Economics, La Follette School of Public Affairs, University of Wisconsin-Madison, 53706, USA
| | | |
Collapse
|
50
|
More evidence support benefits of statins for low-risk patients. Study adds more fuel to the debate on whether to prescribe statins for patients with low levels of C-reactive protein and LDL cholesterol. Duke Med Health News 2011; 17:6. [PMID: 21766532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|