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Underappreciated Opportunities for High-Density Lipoprotein Particles in Risk Stratification and Potential Targets of Therapy. Cardiovasc Drugs Ther 2015; 29:41-50. [DOI: 10.1007/s10557-014-6567-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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152
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Abstract
Purpose In addition to lowering hemoglobin A1C, colesevelam has been shown to improve the atherogenic lipoprotein profile of subjects with type 2 diabetes mellitus (T2DM) when used in combination with metformin and/or sulfonylureas. A recent study evaluated the effects of colesevelam as antidiabetes monotherapy in adults with T2DM who had inadequate glycemic control (hemoglobin A1C ≥7.5 to ≤9.5 %) with diet and exercise alone; we report here the effects on lipoprotein particle subclasses. Methods Subjects were randomized to receive oral colesevelam 3.75 g/day (n = 176) or placebo (n = 181) for 24 weeks. Changes in lipoprotein particle subclasses were determined by nuclear magnetic resonance spectroscopy. Results At Week 24 with last observation carried forward, colesevelam produced a reduction in total low-density lipoprotein (LDL) particle concentration (baseline: 1,611 nmol/L; least-squares [LS] mean treatment difference: −143 nmol/L, p < 0.0001) versus placebo; reductions were also seen in large, small, and very small LDL particle concentrations (all p < 0.05). There was also a reduction in total very low-density lipoprotein (VLDL) and chylomicron particle concentration (baseline: 88 nmol/L; LS mean treatment difference: −1 nmol/L, p = 0.82) that resulted from a lowering in small VLDL particle concentration (baseline: 45 nmol/L; LS mean treatment difference: −5 nmol/L, p = 0.03). In addition, with colesevelam there was an increase in total high-density lipoprotein (HDL) particle concentration versus placebo (baseline: 31 μmol/L; LS mean treatment difference: +0.6 μmol/L, p = 0.20), due to increases in the large (baseline: 5 μmol/L; LS mean treatment difference: +0.5 μmol/L, p = 0.007) and medium (baseline: 3 μmol/L; LS mean treatment difference: +0.8 μmol/L, p = 0.02) HDL subclasses. Conclusions Colesevelam monotherapy in subjects with T2DM resulted in generally favorable changes in certain lipoprotein subclass profiles compared with placebo.
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153
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García-Sánchez C, Posadas-Romero C, Posadas-Sánchez R, Carreón-Torres E, Rodríguez-Pérez JM, Juárez-Rojas JG, Martínez-Sánchez C, Fragoso JM, González-Pacheco H, Vargas-Alarcón G, Pérez-Méndez Ó. Low concentrations of phospholipids and plasma HDL cholesterol subclasses in asymptomatic subjects with high coronary calcium scores. Atherosclerosis 2015; 238:250-5. [DOI: 10.1016/j.atherosclerosis.2014.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/28/2014] [Accepted: 12/02/2014] [Indexed: 12/28/2022]
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154
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Hafiane A, Genest J. High density lipoproteins: Measurement techniques and potential biomarkers of cardiovascular risk. BBA CLINICAL 2015; 3:175-88. [PMID: 26674734 PMCID: PMC4661556 DOI: 10.1016/j.bbacli.2015.01.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/16/2015] [Accepted: 01/26/2015] [Indexed: 12/31/2022]
Abstract
Plasma high density lipoprotein cholesterol (HDL) comprises a heterogeneous family of lipoprotein species, differing in surface charge, size and lipid and protein compositions. While HDL cholesterol (C) mass is a strong, graded and coherent biomarker of cardiovascular risk, genetic and clinical trial data suggest that the simple measurement of HDL-C may not be causal in preventing atherosclerosis nor reflect HDL functionality. Indeed, the measurement of HDL-C may be a biomarker of cardiovascular health. To assess the issue of HDL function as a potential therapeutic target, robust and simple analytical methods are required. The complex pleiotropic effects of HDL make the development of a single measurement challenging. Development of laboratory assays that accurately HDL function must be developed validated and brought to high-throughput for clinical purposes. This review discusses the limitations of current laboratory technologies for methods that separate and quantify HDL and potential application to predict CVD, with an emphasis on emergent approaches as potential biomarkers in clinical practice.
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Key Words
- 2D-PAGGE, two dimensional polyacrylamide gradient gel electrophoresis
- ApoA-I, apolipoprotein A-I
- Apolipoprotein A-I
- Atherosclerosis
- Biomarkers of cardiovascular risk
- CHD, coronary heart disease
- CVD, cardiovascular disease
- Cellular cholesterol efflux
- Coronary artery disease
- HDL, high density lipoprotein
- HPLC, High Performance Liquid Chromatography
- High density lipoproteins
- LCAT, lecithin–cholesterol acyltransferase
- LDL, low density lipoprotein
- MALDI, matrix-assisted laser desorption/ionization
- MOP, myeloperoxidase
- MS/MS, tandem-mass spectrometry
- ND-PAGGE, non-denaturant polyacrylamide gradient gel electrophoresis
- NMR, nuclear magnetic resonance
- PEG, polyethylene glycol
- PON1, paraoxonase 1
- SELDI, surface enhanced laser desorption/ionization
- TOF, time-of-flight
- UTC, ultracentrifugation
- Vascular endothelial function
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Affiliation(s)
- Anouar Hafiane
- McGill University Health Center, Royal Victoria Hospital, 687 Avenue des Pins West, Montreal, QC H3A 1A1, Canada
| | - Jacques Genest
- McGill University Health Center, Royal Victoria Hospital, 687 Avenue des Pins West, Montreal, QC H3A 1A1, Canada
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155
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Gomaraschi M, Adorni MP, Banach M, Bernini F, Franceschini G, Calabresi L. Effects of established hypolipidemic drugs on HDL concentration, subclass distribution, and function. Handb Exp Pharmacol 2015; 224:593-615. [PMID: 25523003 DOI: 10.1007/978-3-319-09665-0_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The knowledge of an inverse relationship between plasma high-density lipoprotein cholesterol (HDL-C) concentrations and rates of cardiovascular disease has led to the concept that increasing plasma HDL-C levels would be protective against cardiovascular events. Therapeutic interventions presently available to correct the plasma lipid profile have not been designed to specifically act on HDL, but have modest to moderate effects on plasma HDL-C concentrations. Statins, the first-line lipid-lowering drug therapy in primary and secondary cardiovascular prevention, have quite modest effects on plasma HDL-C concentrations (2-10%). Fibrates, primarily used to reduce plasma triglyceride levels, also moderately increase HDL-C levels (5-15%). Niacin is the most potent available drug in increasing HDL-C levels (up to 30%), but its use is limited by side effects, especially flushing.The present chapter reviews the effects of established hypolipidemic drugs (statins, fibrates, and niacin) on plasma HDL-C levels and HDL subclass distribution, and on HDL functions, including cholesterol efflux capacity, endothelial protection, and antioxidant properties.
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Affiliation(s)
- Monica Gomaraschi
- Center E. Grossi Paoletti, Department of Pharmacological and Biomolecular Sciences, University of Milano, Via Balzaretti 9, 20133, Milan, Italy,
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156
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Pisaniello AD, Scherer DJ, Kataoka Y, Nicholls SJ. Ongoing challenges for pharmacotherapy for dyslipidemia. Expert Opin Pharmacother 2014; 16:347-56. [PMID: 25476544 DOI: 10.1517/14656566.2014.986094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While increasing evidence has led to lipid-modifying therapy achieving an important role in the treatment guidelines for the prevention of cardiovascular disease, these agents are suboptimally used and there remains a considerable risk of clinical events. Accordingly, there is a need to develop more effective lipid-modifying approaches in many patients. AREAS COVERED A literature search was performed of topical manuscripts focusing on factors influencing use of established therapies and new agents in development that target a range of lipid factors. EXPERT OPINION More intensive efforts are required to ensure that statin use is maximized in higher risk patients. A range of novel therapies, including proprotein convertase subtilisin kexin-type 9 and cholesteryl ester transfer protein inhibitors, may provide additional protection, although this remains to be established by clinical trials.
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Affiliation(s)
- Anthony D Pisaniello
- University of Adelaide, South Australian Health and Medical Research Institute , PO Box 11060, Adelaide, SA, 5001 , Australia +61 8 8128 4510 ;
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157
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Santos-Gallego CG, Badimon JJ, Rosenson RS. Beginning to understand high-density lipoproteins. Endocrinol Metab Clin North Am 2014; 43:913-47. [PMID: 25432389 DOI: 10.1016/j.ecl.2014.08.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This article reconciles the classic view of high-density lipoproteins (HDL) associated with low risk for cardiovascular disease (CVD) with recent data (genetics studies and randomized clinical trials) casting doubt over the widely accepted beneficial role of HDL regarding CVD risk. Although HDL cholesterol has been used as a surrogate measure to investigate HDL function, the cholesterol content in HDL particles is not an indicator of the atheroprotective properties of HDL. Thus, more precise measures of HDL metabolism are needed to reflect and account for the beneficial effects of HDL particles. Current and emerging therapies targeting HDL are discussed.
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Affiliation(s)
- Carlos G Santos-Gallego
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1030, New York, NY 10029, USA
| | - Juan J Badimon
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1030, New York, NY 10029, USA
| | - Robert S Rosenson
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1030, New York, NY 10029, USA.
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158
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Varvel SA, Dayspring TD, Edmonds Y, Thiselton DL, Ghaedi L, Voros S, McConnell JP, Sasinowski M, Dall T, Warnick GR. Discordance between apolipoprotein B and low-density lipoprotein particle number is associated with insulin resistance in clinical practice. J Clin Lipidol 2014; 9:247-55. [PMID: 25911082 DOI: 10.1016/j.jacl.2014.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/13/2014] [Accepted: 11/23/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Discordance between measures of atherogenic lipoprotein particle number (apolipoprotein B [ApoB] and low-density lipoprotein [LDL] particle number by nuclear magnetic resonance spectroscopy [LDL-PNMR]) is not well understood. Appropriate treatment considerations in such cases are unclear. OBJECTIVES To assess discordance between apoB determined by immunoassay and LDL-PNMR in routine clinical practice, and to characterize biomarker profiles and other clinical characteristics of patients identified as discordant. METHODS Two retrospective cohorts were evaluated. First, 412,013 patients with laboratory testing performed by Health Diagnostic Laboratory, Inc., as part of routine care; and second, 1411 consecutive patients presenting for risk assessment/reduction at 6 US outpatient clinics. Discordance was quantified as a percentile difference (LDL-PNMR percentile - apoB percentile) and attainment of percentile cutpoints (LDL-PNMR ≥ 1073 nmol/L or apoB ≥ 69 mg/dL). A wide range of cardiovascular risk factors were compared. RESULTS ApoB and LDL-PNMR values were highly correlated (R(2) = 0.79), although substantial discordance was observed. Similar numbers of patients were identified as at-risk by LDL-PNMR when apoB levels were < 69 mg/dL (5%-6%) and by apoB values when LDL-PNMR was < 1073 nmol/L (6%-7%). Discordance (LDL-PNMR > apoB) was associated with insulin resistance, smaller LDL particle size, increased systemic inflammation, and low circulating levels of "traditional" lipids, whereas discordance (apoB > LDL-PNMR) was associated with larger LDL particle size, and elevated levels of lipoprotein(a) and lipoprotein-associated phospholipase A2 (Lp-PLA2). CONCLUSION Discordance between apoB and LDL-PNMR in routine clinical practice is more widespread than currently recognized and may be associated with insulin resistance.
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Affiliation(s)
| | | | | | | | - Leila Ghaedi
- Health Diagnostic Laboratory, Inc., Richmond, VA, USA
| | - Szilard Voros
- Health Diagnostic Laboratory, Inc., Richmond, VA, USA
| | | | | | - Tara Dall
- Health Diagnostic Laboratory, Inc., Richmond, VA, USA
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159
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Puri R, Nissen SE, Shao M, Uno K, Kataoka Y, Kapadia SR, Tuzcu EM, Nicholls SJ. Impact of baseline lipoprotein and C-reactive protein levels on coronary atheroma regression following high-intensity statin therapy. Am J Cardiol 2014; 114:1465-72. [PMID: 25282317 DOI: 10.1016/j.amjcard.2014.08.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 01/22/2023]
Abstract
Guidelines now recommend high-intensity statin therapy in all patients with proven atherosclerotic disease. Yet the impact of baseline lipoprotein and C-reactive protein (CRP) levels on measures of disease regression to this therapy are unknown. The aim of this study was to test the hypothesis that high-intensity statin therapy causes equivalent degrees of coronary atheroma regression irrespective of baseline lipoprotein and CRP levels. In 8 prospective randomized trials using serial coronary intravascular ultrasound, 1,881 patients who maintained or switched to 18- to 24 months of high-intensity statin therapy (rosuvastatin 40 mg or atorvastatin 80 mg) were stratified according to baseline lipoprotein and CRP levels. Changes in coronary percentage atheroma volume (PAV) and total atheroma volume (TAV) were evaluated. High-intensity statin therapy produced significant reductions from baseline in low-density lipoprotein cholesterol by 38.4%, non-high-density lipoprotein (HDL) cholesterol by 33.6%, triglycerides by 13.1%, and CRP by 33.3%, while increasing HDL cholesterol by 11.7% (p <0.001 for all). This was associated with regression of PAV by 0.7% and of TAV by 8.2 mm(3) (p <0.001 for both). No significant differences of changes in PAV and TAV were observed across baseline quintiles of low-density lipoprotein cholesterol, HDL cholesterol, non-HDL cholesterol, triglycerides, or CRP. Moreover, across all measured lipoproteins and CRP, most patients demonstrated plaque regression (defined as any change from baseline in PAV or TAV <0). In conclusion, high-intensity statin therapy attenuated the natural progression of coronary atherosclerosis in all strata of patients with coronary artery disease irrespective of baseline lipoprotein or CRP levels. These findings provide support for the latest United States guideline recommendations for the broad use of high-intensity statin therapy in all patients with atherosclerosis, regardless of baseline lipid status.
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Affiliation(s)
- Rishi Puri
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Steven E Nissen
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mingyuan Shao
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
| | - Kiyoko Uno
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
| | - Yu Kataoka
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Stephen J Nicholls
- South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia.
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160
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Heffron SP, Singh A, Zagzag J, Youn HA, Underberg JA, Fielding GA, Ren-Fielding CJ. Laparoscopic gastric banding resolves the metabolic syndrome and improves lipid profile over five years in obese patients with body mass index 30-40 kg/m(2.). Atherosclerosis 2014; 237:183-90. [PMID: 25240114 DOI: 10.1016/j.atherosclerosis.2014.08.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 08/05/2014] [Accepted: 08/11/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obesity, metabolic syndrome (MS) and dyslipidemia are independent risk factors for cardiovascular disease. Bariatric surgery is increasingly recognized as an effective intervention for improving each of these risk factors. There are sparse data on the long-term durability of metabolic changes associated with bariatric surgery, in particular with laparoscopic gastric banding (LGB). Our objective was to evaluate the durability of metabolic changes associated with LGB in nonmorbid obesity. METHODS Fifty obese patients (BMI 30-40) with ≥1 obesity-related comorbidity were prospectively followed for five years. At follow-up, subjects underwent fasting blood measures, including lipid NMR spectroscopy and standard lipid profile. RESULTS Forty-seven patients (45 female, mean age 43.8 years) completed four years follow-up (46 completed five years). Baseline BMI was 35.1 ± 2.6. Subjects exhibited mean weight loss of 22.3 ± 7.9 kg (22.9 ± 7.4%) at year one and maintained this (19.8 ± 10.2%) over five years. At baseline, 43% (20/47) of subjects met criteria for MS. This was reduced to 15% (7/47) at year one and remained reduced over five years (13%, 6/46) (p < 0.001). There were reductions in triglycerides (p < 0.001) and increases in HDL cholesterol (HDL-C, p < 0.001) and HDL particle concentration (p = 0.02), with a trend toward increased HDL particle size (p = 0.06) at year five. Changes in triglycerides and HDL-C were more prominent in patients with MS at baseline, but unassociated with weight loss or waist circumference. Changes in HDL particle size and concentration were not associated with MS status, weight loss, waist circumference, or statin use. CONCLUSIONS LGB produces significant weight loss, resolution of MS and changes in lipid profile suggestive of beneficial HDL remodeling. These changes persist five years following LGB.
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Affiliation(s)
- Sean P Heffron
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University, New York, NY 10016, USA.
| | - Amita Singh
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University, New York, NY 10016, USA.
| | - Jonathan Zagzag
- Department of Surgery, New York University, New York, NY 10016, USA.
| | - Heekoung A Youn
- Department of Surgery, New York University, New York, NY 10016, USA.
| | - James A Underberg
- Department of Medicine, General Internal Medicine Division, New York University, New York, NY 10016, USA.
| | - George A Fielding
- Department of Surgery, New York University, New York, NY 10016, USA.
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161
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Emmons RR, Cirnigliaro CM, Kirshblum SC, Bauman WA. The relationship between the postprandial lipemic response and lipid composition in persons with spinal cord injury. J Spinal Cord Med 2014; 37:765-73. [PMID: 24961488 PMCID: PMC4231965 DOI: 10.1179/2045772314y.0000000231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine the influence of lipid concentration, lipid particle size, and total abdominal fat (TAF) on postprandial lipemic response (PPLr) in persons with spinal cord injury (SCI). METHODS Thirty-five persons with SCI (17 paraplegia, 18 tetraplegia) and 18 able-bodied (AB) individuals participated. Following a 10-hour fast, blood was drawn for lipids, apolipoprotein (apo) A1 and B concentrations, and low-density (LSP) and high-density (HSP) lipoprotein particle sizes. A high-fat milkshake was consumed (∼1.3 g fat/kg). Blood was drawn at 2, 4, and 6 hours to determine PPLr, (triglyceride (TG) area under the curve). TAF and visceral (VF) fat were measured by ultrasonography; total body fat (TBF) by dual-energy X-ray absorptiometry. Differences between the groups were determined by independent sample t-tests. Pearson correlation coefficients determined the relationship among PPLr and lipids, and TAF. RESULTS There were no significant differences in fasting TG, low-density lipoprotein (LDL), apoB, TAF, or PPLr values between the groups. In SCI, PPLr significantly correlated with: apoB (r = 0.63, P < 0.01, LSP (r = 0.57, P < 0.01), and TAF (r = 0.36, P < 0.01). After controlling for age and duration of injury, PPLr significantly correlated with apoB (r = 0.66, P = 0.001), TBF (r = 0.45, P = 0.03), VF (r = 0.66, P = 0.02), and TAF (r = 0.56, P = 0.007). CONCLUSIONS Although concentrations of LDL cholesterol and apoB were not different between SCI and AB groups, LSP, apoB, and TAF correlated with PPLr in persons with SCI. ApoB was associated with a greater PPLr in those with motor complete SCI, after controlling for age and duration of injury.
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Affiliation(s)
- Racine R. Emmons
- Correspondence to: Racine R. Emmons, Department of Kinesiology, William Paterson University, 300 Pompton Road, Wayne, NJ 07470, USA.
| | - Christopher M. Cirnigliaro
- Department of Veterans Affairs, Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA
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162
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Saikumar JH, Kovesdy CP. What is the Role of Lipid Measurements in End-Stage Renal Disease? Semin Dial 2014; 27:549-52. [DOI: 10.1111/sdi.12264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Csaba P. Kovesdy
- University of Tennessee Health Science Center; Memphis Tennessee
- Memphis VA Medical Center; Memphis Tennessee
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163
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Millán Núñez-Cortés J, Pedro-Botet Montoya J, Pintó Sala X. [Atherogenic dyslipidemia and residual risk. State of the art in 2014]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:287-92. [PMID: 25450326 DOI: 10.1016/j.arteri.2014.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 09/30/2014] [Indexed: 11/26/2022]
Abstract
Pandemics of metabolic síndrome, obesity, and type 2 diabetes is a major challenge for the next years and supported the grat burden of cardiovascular diseases. The R3i (Residual Risk Reduction initiative) has previously highlighted atherogenic dyslipidaemia as an important and modifiable contributor to the lipid related residual cardiovascular risk. Atherogenic dyslipidaemia is defined as an imbalance between proatherogenic triglycerides-rich apoB-containing lipoproteins and antiatherogenic AI containing lipoproteins. To improve clinical management of atherogenic dyslipidaemia a despite of lifestyle intervention includes pharmacological approach, and fibrates is the main option for combination with a statin to further reduce non-HDL cholesterol.
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164
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Rankin NJ, Preiss D, Welsh P, Burgess KEV, Nelson SM, Lawlor DA, Sattar N. The emergence of proton nuclear magnetic resonance metabolomics in the cardiovascular arena as viewed from a clinical perspective. Atherosclerosis 2014; 237:287-300. [PMID: 25299963 PMCID: PMC4232363 DOI: 10.1016/j.atherosclerosis.2014.09.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/01/2014] [Accepted: 09/03/2014] [Indexed: 11/20/2022]
Abstract
The ability to phenotype metabolic profiles in serum has increased substantially in recent years with the advent of metabolomics. Metabolomics is the study of the metabolome, defined as those molecules with an atomic mass less than 1.5 kDa. There are two main metabolomics methods: mass spectrometry (MS) and proton nuclear magnetic resonance (1H NMR) spectroscopy, each with its respective benefits and limitations. MS has greater sensitivity and so can detect many more metabolites. However, its cost (especially when heavy labelled internal standards are required for absolute quantitation) and quality control is sub-optimal for large cohorts. 1H NMR is less sensitive but sample preparation is generally faster and analysis times shorter, resulting in markedly lower analysis costs. 1H NMR is robust, reproducible and can provide absolute quantitation of many metabolites. Of particular relevance to cardio-metabolic disease is the ability of 1H NMR to provide detailed quantitative data on amino acids, fatty acids and other metabolites as well as lipoprotein subparticle concentrations and size. Early epidemiological studies suggest promise, however, this is an emerging field and more data is required before we can determine the clinical utility of these measures to improve disease prediction and treatment. This review describes the theoretical basis of 1H NMR; compares MS and 1H NMR and provides a tabular overview of recent 1H NMR-based research findings in the atherosclerosis field, describing the design and scope of studies conducted to date. 1H NMR metabolomics-CVD related research is emerging, however further large, robustly conducted prospective, genetic and intervention studies are needed to advance research on CVD risk prediction and to identify causal pathways amenable to intervention. 1H NMR metabolomics is being increasingly applied to large cohort studies. Studies have identified potentially novel lipoprotein and metabolite predictors for CVD. Potential exists for the use of metabolomics in cardiovascular clinical practice. Current findings are too preliminary to translate into clinical recommendations. Further large scale studies are now needed to advance the field in a robust manner.
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Affiliation(s)
- Naomi J Rankin
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK; Glasgow Polyomics, Joseph Black Building, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - David Preiss
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
| | - Paul Welsh
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
| | - Karl E V Burgess
- Glasgow Polyomics, Joseph Black Building, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, G12 8TA, UK
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK; School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.
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165
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Hernáez Á, Fernández-Castillejo S, Farràs M, Catalán Ú, Subirana I, Montes R, Solà R, Muñoz-Aguayo D, Gelabert-Gorgues A, Díaz-Gil Ó, Nyyssönen K, Zunft HJF, de la Torre R, Martín-Peláez S, Pedret A, Remaley AT, Covas MI, Fitó M. Olive Oil Polyphenols Enhance High-Density Lipoprotein Function in Humans. Arterioscler Thromb Vasc Biol 2014; 34:2115-9. [DOI: 10.1161/atvbaha.114.303374] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective—
Olive oil polyphenols have shown beneficial properties against cardiovascular risk factors. Their consumption has been associated with higher cholesterol content in high-density lipoproteins (HDL). However, data on polyphenol effects on HDL quality are scarce. We, therefore, assessed whether polyphenol-rich olive oil consumption could enhance the HDL main function, its cholesterol efflux capacity, and some of its quality-related properties, such HDL polyphenol content, size, and composition.
Approach and Results—
A randomized, crossover, controlled trial with 47 healthy European male volunteers was performed. Participants ingested 25 mL/d of polyphenol-poor (2.7 mg/kg) or polyphenol-rich (366 mg/kg) raw olive oil in 3-week intervention periods, preceded by 2-week washout periods. HDL cholesterol efflux capacity significantly improved after polyphenol-rich intervention versus the polyphenol-poor one (+3.05% and −2.34%, respectively;
P
=0.042). Incorporation of olive oil polyphenol biological metabolites to HDL, as well as large HDL (HDL
2
) levels, was higher after the polyphenol-rich olive oil intervention, compared with the polyphenol-poor one. Small HDL (HDL
3
) levels decreased, the HDL core became triglyceride-poor, and HDL fluidity increased after the polyphenol-rich intervention.
Conclusions—
Olive oil polyphenols promote the main HDL antiatherogenic function, its cholesterol efflux capacity. These polyphenols increased HDL size, promoted a greater HDL stability reflected as a triglyceride-poor core, and enhanced the HDL oxidative status, through an increase in the olive oil polyphenol metabolites content in the lipoprotein. Our results provide for the first time a first-level evidence of an enhancement in HDL function by polyphenol-rich olive oil.
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Affiliation(s)
- Álvaro Hernáez
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Sara Fernández-Castillejo
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Marta Farràs
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Úrsula Catalán
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Isaac Subirana
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Rosa Montes
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Rosa Solà
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Daniel Muñoz-Aguayo
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Anna Gelabert-Gorgues
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Óscar Díaz-Gil
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Kristiina Nyyssönen
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Hans-Joachim F. Zunft
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Rafael de la Torre
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Sandra Martín-Peláez
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Anna Pedret
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Alan T. Remaley
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - María-Isabel Covas
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
| | - Montserrat Fitó
- From the Cardiovascular Risk and Nutrition Research Group, REGICOR Study Group, CIBER de Fisiopatología de la Nutrición y la Obesidad (CIBEROBN) (A.H., M.F., D.M.-A., A.G.-G., O.D.-G., S.M.-P., M.-I.C., M.F.), Cardiovascular Epidemiology and Genetics Research Group, REGICOR Study Group, CIBER de Epidemiología y Salud Pública (CIBERESP) (I.S.), and Human Pharmacology and Clinical Neurosciences Research Group (R.d.l.T.), IMIM-Research Institute Hospital del Mar, Barcelona, Spain; Ph.D program of Food
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166
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Folse HJ, Goswami D, Rengarajan B, Budoff M, Kahn R. Clinical- and cost-effectiveness of LDL particle-guided statin therapy: A simulation study. Atherosclerosis 2014; 236:154-61. [DOI: 10.1016/j.atherosclerosis.2014.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/26/2014] [Accepted: 06/28/2014] [Indexed: 11/29/2022]
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167
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Rosenson RS, Brewer HB, Rader DJ. Lipoproteins as biomarkers and therapeutic targets in the setting of acute coronary syndrome. Circ Res 2014; 114:1880-9. [PMID: 24902972 DOI: 10.1161/circresaha.114.302805] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The period following an acute coronary syndrome (ACS) represents a critical time frame with a high risk for recurrent events and death. The pathogenesis of this increase in clinical cardiovascular disease events after ACS is complex, with molecular mechanisms including increased thrombosis and inflammation. Dyslipoproteinemia is common in patients with ACS and predictive of recurrent cardiovascular disease events after presentation with an ACS event. Although randomized clinical trials have provided fairly convincing evidence that high-dose statins reduce the risk of recurrent cardiovascular events after ACS, there remain questions about how aggressively to reduce low-density lipoprotein cholesterol levels in ACS. Furthermore, no other lipid-related interventions have yet been proven to be effective in reducing major cardiovascular events after ACS. Here, we review the relationship of lipoproteins as biomarkers to cardiovascular risk after ACS, the evidence for lipid-targeted interventions, and the potential for novel therapeutic approaches in this arena.
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Affiliation(s)
- Robert S Rosenson
- From the Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, Medstar Research Institute, Washington Hospital Center, DC (H.B.B.); and Departments of Medicine and Genetics and Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia (D.J.R.)
| | - H Bryan Brewer
- From the Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, Medstar Research Institute, Washington Hospital Center, DC (H.B.B.); and Departments of Medicine and Genetics and Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia (D.J.R.)
| | - Daniel J Rader
- From the Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, Medstar Research Institute, Washington Hospital Center, DC (H.B.B.); and Departments of Medicine and Genetics and Cardiovascular Institute, Perelman School of Medicine of the University of Pennsylvania, Philadelphia (D.J.R.).
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168
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Yan F, Tian L, Yu H, Baskota A, Gao Y, Li S, Fu M, Tian H. Association of lipoprotein subclasses and carotid intima-media thickness in the Chinese population. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.14.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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169
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Kelsey DE, Toher JL, Foster MT, Boulanger JA, Cervinski MA. Laboratory validation of a low density lipoprotein apolipoprotein-B assay. Clin Biochem 2014; 47:211-5. [PMID: 25079242 DOI: 10.1016/j.clinbiochem.2014.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Numerous publications have shown strong association between CHD risk and either apolipoprotein B (Apo-B) or low density lipoprotein (LDL) particle number (LDL-P). It is however unknown if Apo-B or LDL-P has a stronger predictive ability for future CHD. This uncertainty may be due to the inability of current Apo-B assays to separate the contribution of very low-density lipoprotein particles from the total Apo-B concentration. As such we have performed a laboratory validation of the Maine Standards LDL Apo-B assay on the Roche Cobas 6000 analyzer. DESIGN AND METHODS Imprecision, linear range, and limit of quantitation studies were performed using quality control materials. Plasma samples collected for lipid profile analysis were analyzed via the LDL Apo-B assay and compared to the LDL cholesterol (LDL-C) concentration determined via direct LDL assay and Friedewald equation. RESULTS The LDL Apo-B within-run imprecision was 2.3% at 62 mg/dL and 2.2% at 109 mg/dL. The within-laboratory imprecision was 9.7% at 57 mg/dl and 6.1% at 104 mg/dL. Linear regression analysis of LDL Apo-B versus calculated and measured LDL-c resulted in equations of LDL Apo-B=0.620∗(LDL)+45.4, R=0.9063 and LDL-Apo-B=0.607∗(LDL)+38.8, R=0.9393, respectively. Bias plot analyses revealed that at low LDL-C concentration, there was a tendency for a higher than anticipated LDL Apo-B concentration. CONCLUSIONS The Maine Standards LDL Apo-B assay is a precise automated assay and comparison of LDL Apo-B to LDL-c concentration demonstrates that low LDL-C concentrations may still carry residual risk of CHD due to increased concentration of small dense LDL particles.
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Affiliation(s)
| | | | - Michael T Foster
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James A Boulanger
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mark A Cervinski
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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170
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Matyus SP, Braun PJ, Wolak-Dinsmore J, Jeyarajah EJ, Shalaurova I, Xu Y, Warner SM, Clement TS, Connelly MA, Fischer TJ. NMR measurement of LDL particle number using the Vantera Clinical Analyzer. Clin Biochem 2014; 47:203-10. [PMID: 25079243 DOI: 10.1016/j.clinbiochem.2014.07.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/17/2014] [Accepted: 07/19/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Vantera Clinical Analyzer was developed to enable fully-automated, high-throughput nuclear magnetic resonance (NMR) spectroscopy measurements in a clinical laboratory setting. NMR-measured low-density lipoprotein particle number (LDL-P) has been shown to be more strongly associated with cardiovascular disease outcomes than LDL cholesterol (LDL-C) in individuals for whom these alternate measures of LDL are discordant. OBJECTIVE The aim of this study was to assess the analytical performance of the LDL-P assay on the Vantera Clinical Analyzer as per Clinical Laboratory Standards Institute (CLSI) guidelines. RESULTS Sensitivity and linearity were established within the range of 300-3500 nmol/L. For serum pools containing low, medium and high levels of LDL-P, the inter-assay, intra-assay precision and repeatability gave coefficients of variation (CVs) between 2.6 and 5.8%. The reference interval was determined to be 457-2282 nmol/L and the assay was compatible with multiple specimen collection tubes. Of 30 substances tested, only 2 exhibited the potential for assay interference. Moreover, the LDL-P results from samples run on two NMR platforms, Vantera Clinical Analyzer and NMR Profiler, showed excellent correlation (R(2)=0.96). CONCLUSIONS The performance characteristics suggest that the LDL-P assay is suitable for routine testing in the clinical laboratory on the Vantera Clinical Analyzer, the first automated NMR platform that supports NMR-based clinical assays.
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Affiliation(s)
| | | | | | | | | | - Yuan Xu
- LipoScience Inc., Raleigh, NC, USA
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171
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Brown WV, Ansell BJ, Mackey RH, Toth PP. JCL Roundtable: HDL in the primary care setting. J Clin Lipidol 2014; 8:364-72. [DOI: 10.1016/j.jacl.2014.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 12/25/2022]
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173
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174
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von Zychlinski A, Williams M, McCormick S, Kleffmann T. Absolute quantification of apolipoproteins and associated proteins on human plasma lipoproteins. J Proteomics 2014; 106:181-90. [DOI: 10.1016/j.jprot.2014.04.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/14/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
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175
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Kingwell BA, Chapman MJ, Kontush A, Miller NE. HDL-targeted therapies: progress, failures and future. Nat Rev Drug Discov 2014; 13:445-64. [DOI: 10.1038/nrd4279] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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176
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Toth PP, Grabner M, Punekar RS, Quimbo RA, Cziraky MJ, Jacobson TA. Cardiovascular risk in patients achieving low-density lipoprotein cholesterol and particle targets. Atherosclerosis 2014; 235:585-91. [PMID: 24956532 DOI: 10.1016/j.atherosclerosis.2014.05.914] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/30/2014] [Accepted: 05/01/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Previous research suggests that LDL particle number (LDL-P) may be a better tool than LDL cholesterol (LDL-C) to guide LDL-lowering therapy. Using real-world data, this study has two objectives: [1] to determine the incidence of CHD across LDL-P thresholds; and [2] to compare CHD/stroke events among patients achieving comparably low LDL-P or LDL-C levels. METHODS A claims analysis was conducted among high-risk patients identified from the HealthCore Integrated Research Database(SM). The impact of LDL levels on risk was compared across cohorts who achieved LDL-P <1000 nmol/L or LDL-C <100 mg/dL. Cohorts were matched to balance demographic and comorbidity differences. RESULTS Among 15,569 patients with LDL-P measurements, the risk of a CHD event increased by 4% for each 100 nmol/L increase in LDL-P level (HR 1.04; 95% CI 1.02-1.05, p < .0001). The comparative analysis included 2,094 matched patients with ≥12 months of follow-up, 1,242 with ≥24 months and 705 with ≥36 months. At all time periods, patients undergoing LDL-P measurement were more likely to receive intensive lipid-lowering therapy and had a lower risk of CHD/stroke than those in the LDL-C cohort (HR: 0.76; 95% CI: 0.61-0.96; at 12 months). CONCLUSIONS In this real-world sample of commercially insured patients, higher LDL-P levels were associated with increased CHD risk. Moreover, high-risk patients who achieved LDL-P <1000 nmol/L received more aggressive lipid-lowering therapy than patients achieving LDL-C <100 mg/dL, and these differences in lipids and therapeutic management were associated with a reduction in CHD/stroke events over 12, 24 and 36 months follow-up.
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Affiliation(s)
- Peter P Toth
- CGH Medical Center, 100 E Le Fevre Rd, Sterling, IL 61081, USA; University of Illinois School of Medicine, 1 Illini Dr, Peoria, IL 61605, USA.
| | - Michael Grabner
- HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA.
| | | | - Ralph A Quimbo
- HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA.
| | - Mark J Cziraky
- HealthCore, Inc., 800 Delaware Avenue, Fifth Floor, Wilmington, DE 19801, USA.
| | - Terry A Jacobson
- Emory University, 49 Jesse Hill Jr Drive SE, Atlanta, GA 30303, USA.
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177
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Rosenson RS, Underberg JA. Systematic review: Evaluating the effect of lipid-lowering therapy on lipoprotein and lipid values. Cardiovasc Drugs Ther 2014; 27:465-79. [PMID: 23893306 PMCID: PMC3777154 DOI: 10.1007/s10557-013-6477-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose This systematic review was performed to summarize published experience using low density lipoprotein particle number (LDL-P) to monitor the efficacy of lipid-lowering pharmacotherapies. Methods Studies were identified from a literature search of MEDLINE (January 1, 2000 – June 30, 2012); and abstract searches of select conferences. All accepted studies reported mean (or median) nuclear magnetic resonance (NMR)-based LDL-P values for at least 10 subjects receiving lipid lowering pharmacotherapy. Results Searches revealed 36 studies (with 61 treatment arms) in which LDL-P measurements were reported pre- and post-treatment. Most studies also reported changes in low-density lipoprotein cholesterol (LDL-C), but fewer studies reported changes in apolipoprotein B (apoB)(n = 20) and non-HDL-C (n = 28). Treatments included statins (22 arms/15 studies), fibrates (7 arms/7studies), niacin (7 arms/6 studies), bile acid sequestrants (5 arms/2 studies), an anti-apoB oligonucleotide (2 arms/2 studies), combination therapies (8 arms/6 studies), anti-diabetics (5 arms/4 studies), and, other treatments (5 arms/2 studies). Lipid-lowering pharmacotherapy resulted in reductions in mean LDL-P in all but two studies. In several statin studies, the percent reductions in LDL-P were smaller than reductions in LDL-C, comparable changes were reported when LDL-P and apoB, were reported. Conclusions Study-level data from this systemic review establish that different lipid lowering agents can lead to discordance between LDL-P and LDL-C, therefore, basing LDL-lowering therapy only on the achievement of cholesterol goals may result in a treatment gap. Therefore, the use of LDL-P for monitoring lipid-lowering therapy, particularly for statins, can provide a more accurate assessment of residual cardiovascular risk.
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178
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Dullaart RPF, Otvos JD, James RW. Serum paraoxonase-1 activity is more closely related to HDL particle concentration and large HDL particles than to HDL cholesterol in Type 2 diabetic and non-diabetic subjects. Clin Biochem 2014; 47:1022-7. [PMID: 24769273 DOI: 10.1016/j.clinbiochem.2014.04.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/19/2014] [Accepted: 04/11/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We determined relationships of the anti-oxidative enzyme, paraoxonase-1 (PON-1), with high density lipoprotein (HDL) subfractions, and tested whether these relationships are stronger than those with HDL cholesterol and apolipoprotein A-I (apoA-I) in subjects with and without type 2 diabetes mellitus (T2DM). DESIGN AND METHODS Serum PON-1 (arylesterase activity) and HDL subfractions (nuclear magnetic resonance spectroscopy) were determined in 67 T2DM patients and in 56 non-diabetic subjects. RESULTS PON-1 activity, HDL cholesterol and apoA-I were decreased in T2DM (all p<0.05). The HDL particle concentration was unaltered, but large HDL particles, medium HDL particles and HDL particle size were decreased, whereas small HDL particles were increased in T2DM (all p<0.05). PON-1 was more closely related to HDL cholesterol than to apoA-I (p=0.001). In turn, the positive relationship of PON-1 with the HDL particle concentration and with large HDL particles was stronger than that with HDL cholesterol (both p<0.01). The inverse relationship of PON-1 with T2DM was only modestly attenuated by HDL cholesterol or HDL particle characteristics. CONCLUSIONS PON-1 activity is more closely related to the HDL particle concentration or large HDL particles than to HDL cholesterol. Impaired PON-1 activity in T2DM is not to a considerable extent explained by altered HDL subfraction levels.
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Affiliation(s)
- Robin P F Dullaart
- Department of Endocrinology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Richard W James
- Division of Endocrinology, Diabetology, Hypertension and Nutrition, University Hospital Geneva, Switzerland.
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179
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Berthold HK, Rizzo M, Spenrath N, Montalto G, Krone W, Gouni-Berthold I. Effects of lipid-lowering drugs on high-density lipoprotein subclasses in healthy men-a randomized trial. PLoS One 2014; 9:e91565. [PMID: 24662777 PMCID: PMC3963857 DOI: 10.1371/journal.pone.0091565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 02/11/2014] [Indexed: 11/18/2022] Open
Abstract
CONTEXT AND OBJECTIVE Investigating the effects of lipid-lowering drugs on HDL subclasses has shown ambiguous results. This study assessed the effects of ezetimibe, simvastatin, and their combination on HDL subclass distribution. DESIGN AND PARTICIPANTS A single-center randomized parallel 3-group open-label study was performed in 72 healthy men free of cardiovascular disease with a baseline LDL-cholesterol of 111±30 mg/dl (2.9±0.8 mmol/l) and a baseline HDL-cholesterol of 64±15 mg/dl (1.7±0.4 mmol/l). They were treated with ezetimibe (10 mg/day, n = 24), simvastatin (40 mg/day, n = 24) or their combination (n = 24) for 14 days. Blood was drawn before and after the treatment period. HDL subclasses were determined using polyacrylamide gel-tube electrophoresis. Multivariate regression models were used to determine the influence of treatment and covariates on changes in HDL subclass composition. RESULTS Baseline HDL subclasses consisted of 33±10% large, 48±6% intermediate and 19±8% small HDL. After adjusting for baseline HDL subclass distribution, body mass index, LDL-C and the ratio triglycerides/HDL-C, there was a significant increase in large HDL by about 3.9 percentage points (P<0.05) and a decrease in intermediate HDL by about 3.5 percentage points (P<0.01) in both simvastatin-containing treatment arms in comparison to ezetimibe. The parameters obtained after additional adjustment for the decrease in LDL-C indicated that about one third to one half of these effects could be explained by the extent of LDL-C-lowering. CONCLUSIONS In healthy men, treatment with simvastatin leads to favorable effects on HDL subclass composition, which was not be observed with ezetimibe. Part of these differential effects may be due to the stronger LDL-C-lowering effects of simvastatin. TRIAL REGISTRATION ClinicalTrials.gov NCT00317993.
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Affiliation(s)
- Heiner K. Berthold
- Department of Internal Medicine and Geriatrics, Bielefeld Evangelical Hospital (EvKB), Bielefeld, Germany
- * E-mail:
| | - Manfredi Rizzo
- BioMedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Nadine Spenrath
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | - Giuseppe Montalto
- BioMedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Wilhelm Krone
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
| | - Ioanna Gouni-Berthold
- Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany
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180
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Grammer TB, Kleber ME, März W, Silbernagel G, Siekmeier R, Wieland H, Pilz S, Tomaschitz A, Koenig W, Scharnagl H. Low-density lipoprotein particle diameter and mortality: the Ludwigshafen Risk and Cardiovascular Health Study. Eur Heart J 2014; 36:31-8. [DOI: 10.1093/eurheartj/ehu055] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tanja B. Grammer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Marcus E. Kleber
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Winfried März
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, Graz A-8036, Austria
- Synlab Academy, Mannheim, Germany
| | - Günther Silbernagel
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, University of Bern, Bern, Switzerland
| | | | - Heinrich Wieland
- Division of Clinical Chemistry, University Medical Center Freiburg, Freiburg, Germany
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Specialist Clinic for Rehabilitation PVA Bad Aussee, Bad Aussee, Austria
| | - Wolfgang Koenig
- Department of Internal Medicine II – Cardiology, University of Ulm Medical Centre, Ulm, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, Graz A-8036, Austria
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181
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Mäntyselkä P, Niskanen L, Kautiainen H, Saltevo J, Würtz P, Soininen P, Kangas AJ, Ala-Korpela M, Vanhala M. Cross-sectional and longitudinal associations of circulating omega-3 and omega-6 fatty acids with lipoprotein particle concentrations and sizes: population-based cohort study with 6-year follow-up. Lipids Health Dis 2014; 13:28. [PMID: 24507090 PMCID: PMC3922432 DOI: 10.1186/1476-511x-13-28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/06/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cross-sectional studies have suggested that serum omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) are related to favorable lipoprotein particle concentrations. We explored the associations of serum n-3 and n-6 PUFAs with lipoprotein particle concentrations and sizes in a general population cohort at baseline and after 6 years. FINDINGS The cohort included 665 adults (274 men) with a 6-year follow-up. Nutritional counseling was given at baseline. Serum n-3 and n-6 PUFAs and lipoprotein particle concentrations and the mean particle sizes of VLDL, LDL, and HDL were quantified by nuclear magnetic resonance (NMR) spectroscopy for all baseline and follow-up samples at the same time. Concentrations of n-3 and n-6 PUFAs were expressed relative to total fatty acids. At baseline, n-3 PUFAs were not associated with lipoprotein particle concentrations. A weak negative association was observed for VLDL (P = 0.021) and positive for HDL (P = 0.011) particle size. n-6 PUFA was negatively associated with VLDL particle concentration and positively with LDL (P < 0.001) and HDL particle size (P < 0.001). The 6-year change in n-3 PUFA correlated positively with the change in particle size for HDL and LDL lipoproteins but negatively with VLDL particle size. An increase in 6-year levels of n-6 PUFAs was negatively correlated with the change in VLDL particle concentration and size, and positively with LDL particle size. CONCLUSION Change in circulating levels of both n-3 and n-6 PUFAs, relative to total fatty acids, during 6 years of follow-up are associated with changes in lipoprotein particle size and concentrations at the population level.
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Affiliation(s)
- Pekka Mäntyselkä
- Faculty of Health Sciences, School of Medicine, University of Eastern Finland, Kuopio 70211, Finland.
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182
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Rizvi AA, Nikolic D, Sallam HS, Montalto G, Rizzo M, Abate N. Adipokines and Lipoproteins: Modulation by Antihyperglycemic and Hypolipidemic Agents. Metab Syndr Relat Disord 2014; 12:1-10. [DOI: 10.1089/met.2013.0090] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ali A. Rizvi
- Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Hanaa S. Sallam
- Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Internal Medicine, Division of Endocrinology, University of Texas Medical Branch, Galveston, Texas
| | - Giuseppe Montalto
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Manfredi Rizzo
- Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine, Columbia, South Carolina
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
- Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
| | - Nicola Abate
- Department of Internal Medicine, Division of Endocrinology, University of Texas Medical Branch, Galveston, Texas
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183
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O’Sullivan A, Armstrong P, Schuster GU, Pedersen TL, Allayee H, Stephensen CB, Newman JW. Habitual diets rich in dark-green vegetables are associated with an increased response to ω-3 fatty acid supplementation in Americans of African ancestry. J Nutr 2014; 144:123-31. [PMID: 24259553 PMCID: PMC3901419 DOI: 10.3945/jn.113.181875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Although substantial variation exists in individual responses to omega-3 (ω-3) (n-3) fatty acid supplementation, the causes for differences in response are largely unknown. Here we investigated the associations between the efficacy of ω-3 fatty acid supplementation and a broad range of nutritional and clinical factors collected during a double-blind, placebo-controlled trial in participants of African ancestry, randomly assigned to receive either 2 g eicosapentaenoic acid (EPA) + 1 g docosahexaenoic acid (n = 41) or corn/soybean oil placebo (n = 42) supplements for 6 wk. Food-frequency questionnaires were administered, and changes in erythrocyte lipids, lipoproteins, and monocyte 5-lipoxygenase-dependent metabolism were measured before and after supplementation. Mixed-mode linear regression modeling identified high (n = 28) and low (n = 13) ω-3 fatty acid response groups on the basis of changes in erythrocyte EPA abundance (P < 0.001). Compliance was equivalent (∼88%), whereas decreases in plasma triglycerides and VLDL particle sizes and reductions in stimulated monocyte leukotriene B4 production were larger in the high-response group. Although total diet quality scores were similar, the low-response group showed lower estimated 2005 Healthy Eating Index subscores for dark-green and orange vegetables and legumes (P = 0.01) and a lower intake of vegetables (P = 0.02), particularly dark-green vegetables (P = 0.002). Because the findings reported here are associative in nature, prospective studies are needed to determine if dietary dark-green vegetables or nutrients contained in these foods can enhance the efficacy of ω-3 fatty acid supplements. This trial was registered at clinicaltrials.gov as NCT00536185.
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Affiliation(s)
| | | | | | | | - Hooman Allayee
- Institute for Genetic Medicine and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Charles B. Stephensen
- Nutrition, University of California, Davis, Davis, CA,Immunity and Disease Prevention Research Unit, Western Human Nutrition Research Center, Agricultural Research Service, USDA, Davis, CA
| | - John W. Newman
- Nutrition, University of California, Davis, Davis, CA,Obesity and Metabolism Research Unit, and,To whom correspondence should be addressed. E-mail:
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184
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Kilic H, Atalar E, Lay I, Yazihan N, Buyukcam F, Saygisunar U, Aksoy M, Gunduz H, Akdemir R. High-density lipoprotein subfractions and influence of endothelial lipase in a healthy Turkish population: a study in a land of low high-density lipoprotein cholesterol. Scand J Clin Lab Invest 2014; 74:278-84. [PMID: 24479875 DOI: 10.3109/00365513.2013.879992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Low concentration of high-density lipoprotein (HDL) is prevalent in Turkey. Endothelial lipase (EL) regulates lipoprotein metabolism. Small, lipid-poor HDL particles represent more-efficient cholesterol acceptors than their large, lipid-rich counterparts. The aim of this study was to investigate HDL subfractions and the effect of EL on HDL concentrations in healthy Turkish population. METHODS 102 healthy subjects were included in the study (mean age 33.6 ± 10.3 years, 42 female). HDL subfractions were assayed by single precipitation method and EL concentrations were measured by competitive enzyme immunoassay. RESULTS Mean HDL concentrations were 1.45 ± 0.37 mmol/L in women, 1.10 ± 0.30 mmol/L in men. Small HDL subfraction levels did not differ statistically between < 1 mmol/L and ≥ 1.6 mmol/L total HDL groups. Small HDL was not correlated with EL, low density lipoprotein cholesterol (LDL), triglyceride (TG) and age but positively correlated with total cholesterol and HDL (r = 0.2, p = 0.017; r = 0.2, p = 0.028, respectively). Large HDL was not correlated with age, EL and total cholesterol, and negatively correlated with HDL, LDL, TG (r = - 0.7, p < 0.001; r = - 0.2, p = 0.045; r = - 0.3, p < 0.001, respectively). If subjects were divided into two groups as HDL< 1 mmol/L and HDL > 1.6 mmol/L, mean EL concentrations were 475.83 ± 521.77 nmol/L and 529.71 ± 276.92 nmol/L, respectively (p = 0.086). CONCLUSION There were no differences between small HDL concentrations in the HDL low and high groups. Our data did not support EL to be the reason for low HDL in a healthy Turkish population. Our results in a healthy population may serve as a reference for clinical studies on HDL subfractions.
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Affiliation(s)
- Harun Kilic
- Department of Cardiology, Faculty of Medicine, Sakarya University , Sakarya
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185
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Williams PT, Zhao XQ, Marcovina SM, Otvos JD, Brown BG, Krauss RM. Comparison of four methods of analysis of lipoprotein particle subfractions for their association with angiographic progression of coronary artery disease. Atherosclerosis 2014; 233:713-720. [PMID: 24603218 DOI: 10.1016/j.atherosclerosis.2014.01.034] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Compare gradient gel electrophoresis (GGE), vertical auto profile ultracentrifugation (VAP-II), nuclear magnetic resonance spectroscopy (NMR), and ion mobility for their ability to relate low- (LDL), intermediate- (IDL), very-low-density (VLDL) and high-density lipoprotein (HDL) subfraction concentrations to atherosclerotic progression. METHODS AND RESULTS Regression analyses of 136 patients who received baseline and follow-up coronary angiographies and subfraction measurements by all four methods in the HDL Atherosclerosis Treatment Study. Prior analyses have shown that the intervention primarily affected disease progression in proximal arteries with <30% stenoses at baseline. Three-year increases in percent stenoses were consistently associated with higher on-study plasma concentrations of small, dense LDL as measured by GGE (LDLIIIb, P=10(-6); LDLIVa, P=0.006; LDLIVb, P=0.02), VAP-II (LDL4, P=0.002), NMR (small LDL, P=0.001), and ion mobility (LDL IIb, P=0.04; LDLIIIa, P=0.002; LDLIIIb, P=0.0007; LDLIVa, P=0.05). Adjustment for triglycerides, HDL-cholesterol, and LDL-cholesterol failed to eliminate the statistical significance for on-study GGE estimated LDLIIIb (P=10(-5)) and LDLIVa (P=0.04); NMR-estimated small LDL (P=0.03); or ion mobility estimated large VLDL (P=0.02), LDLIIIa (P=0.04) or LDLIIIb (P=0.02). All methods show that the effects were significantly greater for the on-study than the baseline small, dense LDL concentrations, thus establishing that the values concurrent to the progression of disease were responsible. The rate of disease progression was also related to individual VLDL, IDL, and HDL subclasses to differing extents among the various analytic methods. CONCLUSION Four methodologies confirm the association of small, dense LDL with greater coronary atherosclerosis progression, and GGE, NMR, and ion mobility confirm that the associations were independent of standard lipid measurements. CLINICAL TRIAL REGISTRATION clinicaltrials.gov/ct2/show/NCT00000553.
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Affiliation(s)
- Paul T Williams
- Life Sciences Division, Lawrence Berkeley Laboratory, Berkeley, CA, USA
| | - Xue-Qiao Zhao
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Santica M Marcovina
- Department of Medicine, Northwest Lipid Research Laboratories, University of Washington, Seattle, WA, USA
| | | | - B Greg Brown
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Ronald M Krauss
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr Way, Oakland, CA 94609, USA.
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186
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Fruchart JC, Davignon J, Hermans MP, Al-Rubeaan K, Amarenco P, Assmann G, Barter P, Betteridge J, Bruckert E, Cuevas A, Farnier M, Ferrannini E, Fioretto P, Genest J, Ginsberg HN, Gotto AM, Hu D, Kadowaki T, Kodama T, Krempf M, Matsuzawa Y, Núñez-Cortés JM, Monfil CC, Ogawa H, Plutzky J, Rader DJ, Sadikot S, Santos RD, Shlyakhto E, Sritara P, Sy R, Tall A, Tan CE, Tokgözoğlu L, Toth PP, Valensi P, Wanner C, Zambon A, Zhu J, Zimmet P. Residual macrovascular risk in 2013: what have we learned? Cardiovasc Diabetol 2014; 13:26. [PMID: 24460800 PMCID: PMC3922777 DOI: 10.1186/1475-2840-13-26] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/07/2013] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.
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Affiliation(s)
- Jean-Charles Fruchart
- R3i Foundation, St. Alban-Anlage 46, Basel, CH 4010, Switzerland
- Fondation Cœur et Artères, Lille, France
| | - Jean Davignon
- Institut de recherches cliniques de Montréal; Centre Hospitalier de l’Université de Montréal and Department of Experimental Medicine, McGill University, Montreal, Canada
| | | | - Khalid Al-Rubeaan
- University Diabetes Center, King Saud University, Riyadh, Saudi Arabia
| | - Pierre Amarenco
- Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France
| | - Gerd Assmann
- Assmann-Stiftung für Prävention, Münster, Germany
| | - Philip Barter
- Centre for Vascular Research, University of New South Wales, Sydney, Australia
| | | | - Eric Bruckert
- Department of Endocrinology and Cardiovascular Disease Prevention, Institut of CardioMetabolism and Nutrition (ICAN) Hôpital Pitié-Salpêtrière, Paris, France
| | - Ada Cuevas
- Nutrition Center, Clínica Las Condes, Santiago, Chile
| | | | - Ele Ferrannini
- University of Pisa School of Medicine, and Metabolism Unit of the National Research Council (CNR) Institute of Clinical Physiology, Pisa, Italy
| | - Paola Fioretto
- Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
| | - Jacques Genest
- McGill University and Center for Innovative Medicine, McGill University Health Center/Royal Victoria Hospital, Montreal, Canada
| | - Henry N Ginsberg
- Department of Medicine and Irving Institute for Clinical and Translational Research, Columbia University, New York, USA
| | - Antonio M Gotto
- Weill Cornell Medical College, Cornell University, New York, USA
| | - Dayi Hu
- Heart Institute, People Hospital of Peking University, Beijing, China
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases Unit, The University of Tokyo, Tokyo, Japan
| | - Tatsuhiko Kodama
- Department of Systems Biology and Medicine, The University of Tokyo, Tokyo, Japan
| | - Michel Krempf
- Human Nutritional Research Center and Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Nantes, Nantes, France
| | | | | | | | - Hisao Ogawa
- Department of Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan
| | - Jorge Plutzky
- Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - Daniel J Rader
- Division of Translational Medicine and Human Genetics, Smilow Center for Translational Research, Penn Cardiovascular Institute, Philadelphia, PA, USA
| | | | - Raul D Santos
- Unidade Clínica de Lipides InCor-HCFMUSP, Sao Paulo, Brazil
| | - Evgeny Shlyakhto
- Federal Almazov Heart Blood Endocrinology Centre, St Petersburg, Russia
| | | | - Rody Sy
- University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - Alan Tall
- Specialized Center of Research (SCOR) in Molecular Medicine and Atherosclerosis, Columbia University, College of Physicians & Surgeons, New York, USA
| | | | | | - Peter P Toth
- Sterling Rock Falls Clinic, CGH Medical Center, Sterling and University of Illinois School of Medicine, Peoria, IL, USA
| | - Paul Valensi
- Hôpital Jean Verdier, Department of Endocrinology Diabetology Nutrition, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France
| | | | - Alberto Zambon
- Department of Medical and Surgical Sciences, University of Padova, Padova, Italy
| | - Junren Zhu
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Paul Zimmet
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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187
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Marais AD, Solomon GAE, Blom DJ. Dysbetalipoproteinaemia: a mixed hyperlipidaemia of remnant lipoproteins due to mutations in apolipoprotein E. Crit Rev Clin Lab Sci 2014; 51:46-62. [PMID: 24405372 DOI: 10.3109/10408363.2013.870526] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Atherosclerosis is strongly associated with dyslipoproteinaemia, and especially with increasing concentrations of low-density lipoprotein and decreasing concentrations of high-density lipoproteins. Its association with increasing concentrations of plasma triglyceride is less clear but, within the mixed hyperlipidaemias, dysbetalipoproteinaemia (Fredrickson type III hyperlipidaemia) has been identified as a very atherogenic entity associated with both premature ischaemic heart disease and peripheral arterial disease. Dysbetalipoproteinaemia is characterized by the accumulation of remnants of chylomicrons and of very low-density lipoproteins. The onset occurs after childhood and usually requires an additional metabolic stressor. In women, onset is typically delayed until menopause. Clinical manifestations may vary from no physical signs to severe cutaneous and tendinous xanthomata, atherosclerosis of coronary and peripheral arteries, and pancreatitis when severe hypertriglyceridaemia is present. Rarely, mutations in apolipoprotein E are associated with lipoprotein glomerulopathy, a condition characterized by progressive proteinuria and renal failure with varying degrees of plasma remnant accumulation. Interestingly, predisposing genetic causes paradoxically result in lower than average cholesterol concentration for most affected persons, but severe dyslipidaemia develops in a minority of patients. The disorder stems from dysfunctional apolipoprotein E in which mutations result in impaired binding to low-density lipoprotein (LDL) receptors and/or heparin sulphate proteoglycans. Apolipoprotein E deficiency may cause a similar phenotype. Making a diagnosis of dysbetalipoproteinaemia aids in assessing cardiovascular risk correctly and allows for genetic counseling. However, the diagnostic work-up may present some challenges. Diagnosis of dysbetalipoproteinaemia should be considered in mixed hyperlipidaemias for which the apolipoprotein B concentration is relatively low in relation to the total cholesterol concentration or when there is significant disparity between the calculated LDL and directly measured LDL cholesterol concentrations. Genetic tests are informative in predicting the risk of developing the disease phenotype and are diagnostic only in the context of hyperlipidaemia. Specialised lipoprotein studies in reference laboratory centres can also assist in diagnosis. Fibrates and statins, or even combination treatment, may be required to control the dyslipidaemia.
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Affiliation(s)
- A D Marais
- Department of Chemical Pathology, Health Science Faculty, University of Cape Town , Cape Town , South Africa
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188
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HIV/hepatitis C virus coinfection ameliorates the atherogenic lipoprotein abnormalities of HIV infection. AIDS 2014; 28:49-58. [PMID: 24136113 DOI: 10.1097/qad.0000000000000026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Higher levels of small low-density lipoprotein (LDL) and lower levels of high-density lipoprotein (HDL) subclasses have been associated with increased risk of cardiovascular disease. The extent to which HIV infection and HIV/hepatitis C virus (HCV) coinfection are associated with abnormalities of lipoprotein subclasses is unknown. METHODS Lipoprotein subclasses were measured by nuclear magnetic resonance (NMR) spectroscopy in plasma samples from 569 HIV-infected and 5948 control participants in the Fat Redistribution and Metabolic Change in HIV Infection (FRAM), Coronary Artery Risk Development in Young Adults (CARDIA), and Multi-Ethnic Study of Atherosclerosis (MESA) studies. Multivariable regression was used to estimate the association of HIV and HIV/HCV coinfection with lipoprotein measures with adjustment for demographics, lifestyle factors, and waist-to-hip ratio. RESULTS Relative to controls, small LDL levels were higher in HIV-monoinfected persons (+381 nmol/l, P <0.0001), with no increase seen in HIV/HCV coinfection (-16.6 nmol/l). Levels of large LDL levels were lower (-196 nmol/l, P <0.0001) and small HDL were higher (+8.2 μmol/l, P < 0.0001) in HIV monoinfection with intermediate values seen in HIV/HCV coinfection. Large HDL levels were higher in HIV/HCV-coinfected persons relative to controls (+1.70 μmol/l, P <0.0001), whereas little difference was seen in HIV-monoinfected persons (+0.33, P = 0.075). Within HIV-infected participants, HCV was associated independently with lower levels of small LDL (-329 nmol/l, P <0.0001) and small HDL (-4.6 μmol/l, P <0.0001), even after adjusting for demographic and traditional cardiovascular risk factors. CONCLUSION HIV-monoinfected participants had worse levels of atherogenic LDL lipoprotein subclasses compared with controls. HIV/HCV coinfection attenuates these changes, perhaps by altering hepatic factors affecting lipoprotein production and/or metabolism. The effect of HIV/HCV coinfection on atherosclerosis and the clinical consequences of low small subclasses remain to be determined.
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189
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Vickers KC, Remaley AT. HDL and cholesterol: life after the divorce? J Lipid Res 2014; 55:4-12. [PMID: 23515282 PMCID: PMC3927467 DOI: 10.1194/jlr.r035964] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/08/2013] [Indexed: 12/16/2022] Open
Abstract
For decades, HDL and HDL-cholesterol (HDL-C) levels were viewed as synonymous, and modulation of HDL-C levels by drug therapy held great promise for the prevention and treatment of cardiovascular disease. Nevertheless, recent failures of drugs that raise HDL-C to reduce cardiovascular risk and the now greater understanding of the complexity of HDL composition and biology have prompted researchers in the field to redefine HDL. As such, the focus of HDL has now started to shift away from a cholesterol-centric view toward HDL particle number, subclasses, and other alternative metrics of HDL. Many of the recently discovered functions of HDL are, in fact, not strictly conferred by its ability to promote cholesterol flux but by the other molecules it transports, including a diverse set of proteins, small RNAs, hormones, carotenoids, vitamins, and bioactive lipids. Based on HDL's ability to interact with almost all cells and transport and deliver fat-soluble cargo, HDL has the remarkable capacity to affect a wide variety of endocrine-like systems. In this review, we characterize HDL's unique cargo and address the functional relevance and consequences of HDL transport and delivery of noncholesterol molecules to recipient cells and tissues.
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Affiliation(s)
- Kasey C. Vickers
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Alan T. Remaley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
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190
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Martin GG, McIntosh AL, Huang H, Gupta S, Atshaves BP, Landrock KK, Landrock D, Kier AB, Schroeder F. The human liver fatty acid binding protein T94A variant alters the structure, stability, and interaction with fibrates. Biochemistry 2013; 52:9347-57. [PMID: 24299557 PMCID: PMC3930105 DOI: 10.1021/bi401014k] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although the human liver fatty acid binding protein (L-FABP) T94A variant arises from the most commonly occurring single-nucleotide polymorphism in the entire FABP family, there is a complete lack of understanding regarding the role of this polymorphism in human disease. It has been hypothesized that the T94A substitution results in the complete loss of ligand binding ability and function analogous to that seen with L-FABP gene ablation. This possibility was addressed using the recombinant human wild-type (WT) T94T and T94A variant L-FABP and cultured primary human hepatocytes. Nonconservative replacement of the medium-sized, polar, uncharged T residue with a smaller, nonpolar, aliphatic A residue at position 94 of the human L-FABP significantly increased the L-FABP α-helical structure content at the expense of β-sheet content and concomitantly decreased the thermal stability. T94A did not alter the binding affinities for peroxisome proliferator-activated receptor α (PPARα) agonist ligands (phytanic acid, fenofibrate, and fenofibric acid). While T94A did not alter the impact of phytanic acid and only slightly altered that of fenofibrate on the human L-FABP secondary structure, the active metabolite fenofibric acid altered the T94A secondary structure much more than that of the WT T94T L-FABP. Finally, in cultured primary human hepatocytes, the T94A variant exhibited a significantly reduced extent of fibrate-mediated induction of PPARα-regulated proteins such as L-FABP, FATP5, and PPARα itself. Thus, while the T94A substitution did not alter the affinity of the human L-FABP for PPARα agonist ligands, it significantly altered the human L-FABP structure, stability, and conformational and functional response to fibrate.
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Affiliation(s)
- Gregory G. Martin
- Department of Physiology and Pharmacology, Texas A&M University, TVMC College Station, TX 77843-4466
| | - Avery L. McIntosh
- Department of Physiology and Pharmacology, Texas A&M University, TVMC College Station, TX 77843-4466
| | - Huan Huang
- Department of Physiology and Pharmacology, Texas A&M University, TVMC College Station, TX 77843-4466
| | - Shipra Gupta
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI 48824
| | - Barbara P. Atshaves
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI 48824
| | - Kerstin K. Landrock
- Department of Pathobiology, Texas A&M University, TVMC College Station, TX 77843-4467
| | - Danilo Landrock
- Department of Pathobiology, Texas A&M University, TVMC College Station, TX 77843-4467
| | - Ann B. Kier
- Department of Pathobiology, Texas A&M University, TVMC College Station, TX 77843-4467
| | - Friedhelm Schroeder
- Department of Physiology and Pharmacology, Texas A&M University, TVMC College Station, TX 77843-4466
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191
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Pérez-Méndez Ó, Pacheco HG, Martínez-Sánchez C, Franco M. HDL-cholesterol in coronary artery disease risk: function or structure? Clin Chim Acta 2013; 429:111-22. [PMID: 24333390 DOI: 10.1016/j.cca.2013.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/29/2013] [Accepted: 12/01/2013] [Indexed: 12/29/2022]
Abstract
High-density lipoproteins (HDL) are inversely related with coronary artery disease (CAD) and HDL-cholesterol is the only standardized and reproducible parameter available to estimate plasma concentration of these lipoproteins. However, pharmacological interventions intended to increase HDL-cholesterol have not been consistently associated to an effective CAD risk reduction. Among patients with a myocardial infarction, 43 and 44% of men and women, respectively, had normal plasma levels of HDL-cholesterol, whereas genetic studies have failed to show a causal association between HDL-cholesterol and CAD risk. Instead, HDL functionality seems to be the target to be evaluated, but the existing methods are still poorly reproducible and far to be adapted to the clinical laboratory. HDL subclasses rise as a potential alternative for the evaluation of CAD risk; HDL subclasses are a surrogate of intravascular metabolism of these lipoproteins and probably of their functionality. Low levels of large HDL and increased proportions of small particles are the most remarkable features associated to an increased risk of type 2 diabetes mellitus (T2DM) or CAD. However, inflammation and other environmental factors are related with abnormal HDL structure, and, as a consequence, more prospective studies are needed to better support the clinical usefulness of HDL subclasses. New insights from proteome and lipidome profiles of HDL will provide potential HDL-related biomarkers in the coming years.
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Affiliation(s)
- Óscar Pérez-Méndez
- Department of Molecular Biology, National Institute of Cardiology "Ignacio Chávez", Mexico, DF, Mexico.
| | - Héctor González Pacheco
- Department of Emergency, National Institute of Cardiology "Ignacio Chávez", Mexico, DF, Mexico
| | - Carlos Martínez-Sánchez
- Department of Emergency, National Institute of Cardiology "Ignacio Chávez", Mexico, DF, Mexico
| | - Martha Franco
- Department of Molecular Biology, National Institute of Cardiology "Ignacio Chávez", Mexico, DF, Mexico
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Siddiqui MS, Sterling RK, Luketic VA, Puri P, Stravitz RT, Bouneva I, Boyett S, Fuchs M, Sargeant C, Warnick GR, Grami S, Sanyal AJ. Association between high-normal levels of alanine aminotransferase and risk factors for atherogenesis. Gastroenterology 2013; 145:1271-9.e1-3. [PMID: 23973920 PMCID: PMC3840068 DOI: 10.1053/j.gastro.2013.08.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Liver disease has been associated with cardiovascular disorders, but little is known about the relationship between serum levels of alanine aminotransferase (ALT) and markers of atherogenesis. We investigated the relationship between low-normal and high-normal levels of ALT and an extended panel of cardiovascular risk factors among individuals with no known diseases in a primary care setting. METHODS We performed a retrospective analysis of data collected from 6442 asymptomatic patients at wellness visits to a primary care setting in central Virginia from 2010 through 2011. Serum levels of ALT were compared with levels of lipids and lipoproteins, as well as metabolic, inflammatory, and coagulation-related factors associated with risk for cardiovascular disease. RESULTS Serum levels of ALT were higher than 40 IU/L in 12% of subjects, and in the high-normal range (19-40 IU/L in women and 31-40 IU/L in men) in 25% of subjects. ALT level was associated with the apolipoprotein B level, concentration and particle size of very-low-density lipoproteins, concentration of low-density lipoprotein (LDL) particles (LDL-P), and percentages of small dense LDL (sdLDL) and sdLDL-cholesterol (sdLDL-C) (P < .0001 for all). A high-normal level of ALT was associated with higher levels of LDL-C, LDL-P, sdLDL-C, and sdLDL particles (P < .001 for all). These effects were independent of age, body mass index, and hyperinsulinemia. Increasing levels of ALT and fasting hyperinsulinemia (>12 μU/mL) synergized with increasing levels of triglycerides, very-low-density lipoprotein particles, LDL-P, sdLDL-C, and percentage of sdLDL-C. Levels of APOA1, high-density lipoprotein-cholesterol, and high-density lipoprotein-class 2 were associated inversely with serum level of ALT (P < .0001 for all). CONCLUSIONS In an analysis of asymptomatic individuals, increased serum levels of ALT (even high-normal levels) are associated with markers of cardiovascular disease.
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Affiliation(s)
- M. Shadab Siddiqui
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | - Richard K. Sterling
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | - Velimir A. Luketic
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | - Puneet Puri
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | - Richard T. Stravitz
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | - Iliana Bouneva
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | - Sherry Boyett
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | - Michael Fuchs
- Division of Gastroenterology & Hepatology, McGuire Veteran’s Administration Medical Center, Richmond, VA
| | - Carol Sargeant
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
| | | | | | - Arun J. Sanyal
- Division of Gastroenterology & Hepatology, Virginia Commonwealth University, Richmond, VA
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Akinkuolie AO, Paynter NP, Padmanabhan L, Mora S. High-density lipoprotein particle subclass heterogeneity and incident coronary heart disease. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2013; 7:55-63. [PMID: 24248942 DOI: 10.1161/circoutcomes.113.000675] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Raising the cholesterol of high-density lipoprotein (HDL) particles is targeted as a cardiovascular disease prevention strategy. However, HDL particles are heterogeneous in composition and structure, which may relate to differences in antiatherogenic potential. We prospectively evaluated the association of HDL subclasses, defined by a recently proposed nomenclature, with incident coronary heart disease (CHD). METHODS AND RESULTS Baseline HDL particle concentrations were measured by nuclear magnetic resonance spectroscopy and categorized into 5 subclasses (very large, large, medium, small, and very small) among 26 332 initially healthy women. During a median follow-up of 17 years, 969 cases of incident CHD (myocardial infarction, revascularization, and CHD death) were ascertained. In Cox models that adjusted for age, race/ethnicity, blood pressure, smoking, postmenopausal status, and hormone therapy, associations with incident CHD were inverse (P trend<0.0001) for concentrations of very large (hazard ratio for top versus bottom quartile, 0.49; 95% confidence interval, 0.41-0.60), large (0.54; 0.45-0.64), and medium (0.69; 0.58-0.83) HDL subclasses. Conversely, hazard ratios (95% confidence intervals) for small and very small HDL were 1.22 (1.01-1.46; P trend=0.08) and 1.67 (1.39-2.02; P trend<0.0001), respectively. However, after additionally adjusting for metabolic and lipoprotein variables, associations for the spectrum of large, medium, and small HDL subclasses were inverse (P trend<0.05 for large and small and 0.07 for medium), whereas subclasses at either end of the spectrum were not associated with CHD (P trend=0.97 for very large and 0.21 for very small HDL). CONCLUSIONS In this prospective study, associations with incident CHD differed by HDL particle subclass, which may be relevant for developing HDL-modulating therapies. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000479.
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Affiliation(s)
- Akintunde O Akinkuolie
- Divisions of Preventive Medicine and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Tsai MY, Steffen BT, Guan W, McClelland RL, Warnick R, McConnell J, Hoefner DM, Remaley AT. New automated assay of small dense low-density lipoprotein cholesterol identifies risk of coronary heart disease: the Multi-ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol 2013; 34:196-201. [PMID: 24233487 DOI: 10.1161/atvbaha.113.302401] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Coronary heart disease (CHD) is the leading cause of death in the United States, yet assessing risk of its development remains challenging. The present study evaluates a new automated assay of small dense low-density lipoprotein cholesterol content (sdLDL-C) and whether sdLDL-C is a risk factor for CHD compared with LDL-C or small LDL particle concentrations derived from nuclear magnetic resonance spectroscopy. APPROACH AND RESULTS sdLDL-C was measured using a new automated enzymatic method, and small LDL concentrations were obtained by nuclear magnetic resonance in 4387 Multi-Ethnic Study of Atherosclerosis participants. Cox regression analysis estimated hazard ratios for developing CHD for 8.5 years after adjustments for age, race, sex, systolic blood pressure, hypertension medication use, high-density lipoprotein cholesterol, and triglycerides. Elevated sdLDL-C was a risk factor for CHD in normoglycemic individuals. Those in the top sdLDL-C quartile showed higher risk of incident CHD (hazard ratio, 2.41; P=0.0037) compared with those in the bottom quartile and indicated greater CHD risk than the corresponding quartile of LDL-C (hazard ratio, 1.75; P=0.019). The association of sdLDL-C with CHD risk remained significant when LDL-C (<2.57 mmol/L) was included in a multivariate model (hazard ratio, 2.37; P=0.012). Nuclear magnetic resonance-derived small LDL concentrations did not convey a significant risk of CHD. Those with impaired fasting glucose or diabetes mellitus showed higher sdLDL-C and small LDL concentrations but neither was associated with higher CHD risk in these individuals. CONCLUSIONS This new automated method for sdLDL-C identifies risk for CHD that would remain undetected using standard lipid measures, but only in normoglycemic, nondiabetic individuals.
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Affiliation(s)
- Michael Y Tsai
- From the Department of Laboratory Medicine and Pathology (M.Y.T., B.T.S.) and Division of Biostatistics (W.G.), University of Minnesota School of Public Health, Minneapolis, MN; Department of Biostatistics, University of Washington, Seattle, WA (R.L.M.); Health Diagnostic Laboratory, Inc, Richmond, VA (R.W., J.M., D.M.H.); and National Institutes of Health Molecular Disease Branch, National Heart, Lung, and Blood Institute, Bethesda, MD (A.T.R.)
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195
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Shen H, Zhou J, Shen G, Yang H, Lu Z, Wang H. Correlation between serum levels of small, dense low-density lipoprotein cholesterol and carotid stenosis in cerebral infarction patients >65 years of age. Ann Vasc Surg 2013; 28:375-80. [PMID: 24200130 DOI: 10.1016/j.avsg.2013.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/08/2013] [Accepted: 01/23/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND We studied the relationship between serum levels of small, dense low-density lipoprotein cholesterol (sdLDL-C) and carotid stenosis in elderly patients with ischemic cerebral infarction. METHODS All patients >65 years of age with newly diagnosed ischemic cerebral infarction were enrolled. None received statins before enrollment. Patients were examined for carotid stenosis by ultrasound color Doppler, and serum sdLDL-C levels were measured using an automated method. RESULTS The 149 patients were distributed according to their carotid stenosis as without (n = 61) or with mild (n = 30), moderate (n = 34), or severe (n = 24) carotid stenosis. sdLDL-C levels increased significantly with increasing stenosis severity (0.54 ± 0.19, 0.71 ± 0.18, 0.98 ± 0.19, and 1.32 ± 0.17 mmol/L, respectively). Spearman rank correlation analysis revealed that sdLDL-C levels and degree of carotid stenosis were positively correlated (r = 0.411; P < 0.001). Male sex, body mass index, diabetes, hypertension, hyperlipidemia, drinking, smoking, and sdLDL-C levels were positively correlated with carotid stenosis. Logistic regression analysis revealed that sdLDL-C levels are an independent risk factor of carotid stenosis (P = 0.041). CONCLUSIONS sdLDL-C levels are positively correlated with the severity of carotid stenosis, and are an independent risk factor in elderly patients with ischemic cerebral infarction.
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Affiliation(s)
- Hao Shen
- Center of Laboratory Medicine, The First People's Hospital of Wujiang, Wujiang, China
| | - Jun Zhou
- Emergency Department, The First People's Hospital of Wujiang, Wujiang, China
| | - Guorong Shen
- Center of Laboratory Medicine, The First People's Hospital of Wujiang, Wujiang, China
| | - Honglin Yang
- Center of Laboratory Medicine, The First People's Hospital of Wujiang, Wujiang, China
| | - Zhaoyang Lu
- Ultrasonography Department, The First People's Hospital of Wujiang, Wujiang, China
| | - Huimin Wang
- Center of Laboratory Medicine, Affliated Hospital of Nantong University, Nantong, China.
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Managing to low-density lipoprotein particles compared with low-density lipoprotein cholesterol: A cost-effectiveness analysis. J Clin Lipidol 2013; 7:642-52. [DOI: 10.1016/j.jacl.2013.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 05/30/2013] [Accepted: 06/10/2013] [Indexed: 12/17/2022]
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197
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Li C, Zhang W, Zhou F, Chen C, Zhou L, Li Y, Liu L, Pei F, Luo H, Hu Z, Cai J, Zeng C. Cholesteryl ester transfer protein inhibitors in the treatment of dyslipidemia: a systematic review and meta-analysis. PLoS One 2013; 8:e77049. [PMID: 24204732 PMCID: PMC3810261 DOI: 10.1371/journal.pone.0077049] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/29/2013] [Indexed: 01/14/2023] Open
Abstract
Cholesteryl ester transfer protein (CETP) inhibitors are gaining substantial research interest for raising high density lipoprotein cholesterol levels. The aim of the research was to estimate the efficacy and safety of cholesteryl ester transfer protein inhibitors as novel lipid modifying drugs. Systematic searches of English literature for randomized controlled trials (RCT) were collected from MEDLINE, EBASE, CENTRAL and references listed in eligible studies. Two independent authors assessed the search results and only included the double-blind RCTs by using cholesteryl ester transfer protein inhibitors as exclusively or co-administrated with statin therapy irrespective of gender in enrolled adult subjects. Two independent authors extracted the data by using predefined data fields. Of 503 studies identified, 14 studies met the inclusion criteria, and 12 studies were included into the final meta-analysis. Our meta-analysis revealed that CETP inhibitors increased the HDL-c levels (n = 2826, p<0.00001, mean difference (MD) = 20.47, 95% CI [19.80 to 21.15]) and total cholesterol (n = 3423, p = 0.0002, MD = 3.57, 95%CI [1.69 to 5.44] to some extent combined with a reduction in triglyceride (n = 3739, p<0.00001, MD = -10.47, 95% CI [-11.91 to -9.03]) and LDL-c (n = 3159, p<0.00001, MD = -17.12, 95% CI [-18.87 to -15.36]) irrespective of mono-therapy or co-administration with statins. Subgroup analysis suggested that the lipid modifying effects varied according to the four currently available CETP inhibitors. CETP inhibitor therapy did not increase the adverse events when compared with control. However, we observed a slight increase in blood pressure (SBP, n = 2384, p<0.00001, MD = 2.73, 95% CI [2.14 to 3.31], DBP, n = 2384, p<0.00001, MD = 1.16, 95% CI [0.73 to 1.60]) after CETP inhibitor treatment, which were mainly ascribed to the torcetrapib treatment subgroup. CETP inhibitors therapy is associated with significant increase in HDL-c and decrease in triglyceride and LDL-c with satisfactory safety and tolerability in patients with dyslipidemia. However, the side-effect on blood pressure deserves more consideration in future studies.
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Affiliation(s)
- Chuanwei Li
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
| | - Wen Zhang
- Department of Respiratory, Xinqiao Hospital, The Third Military Medical University, Chongqing, PR China
| | - Faying Zhou
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
| | - Caiyu Chen
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
| | - Liang Zhou
- Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Yafei Li
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Third Military Medical University, Chongqing, PR China
| | - Ling Liu
- Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, Chongqing, PR China
| | - Fang Pei
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
| | - Hao Luo
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
| | - Zhangxue Hu
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
| | - Jing Cai
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, The Third Military Medical University, Chongqing, PR China
- Chongqing Institute of Cardiology, Chongqing, PR China
- * E-mail:
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Goldberg R, Temprosa M, Otvos J, Brunzell J, Marcovina S, Mather K, Arakaki R, Watson K, Horton E, Barrett-Connor E. Lifestyle and metformin treatment favorably influence lipoprotein subfraction distribution in the Diabetes Prevention Program. J Clin Endocrinol Metab 2013; 98:3989-98. [PMID: 23979954 PMCID: PMC3790618 DOI: 10.1210/jc.2013-1452] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022]
Abstract
CONTEXT Although intensive lifestyle change (ILS) and metformin reduce diabetes incidence in subjects with impaired glucose tolerance (IGT), their effects on lipoprotein subfractions have not been studied. OBJECTIVE The objective of the study was to characterize the effects of ILS and metformin vs placebo interventions on lipoprotein subfractions in the Diabetes Prevention Program. DESIGN This was a randomized clinical trial, testing the effects of ILS, metformin, and placebo on diabetes development in subjects with IGT. PARTICIPANTS Selected individuals with IGT randomized in the Diabetes Prevention Program participated in the study. INTERVENTIONS Interventions included randomization to metformin 850 mg or placebo twice daily or ILS aimed at a 7% weight loss using a low-fat diet with increased physical activity. MAIN OUTCOME MEASURES Lipoprotein subfraction size, density, and concentration measured by magnetic resonance and density gradient ultracentrifugation at baseline and 1 year were measured. RESULTS ILS decreased large and buoyant very low-density lipoprotein, small and dense low-density lipoprotein (LDL), and small high-density lipoprotein (HDL) and raised large HDL. Metformin modestly reduced small and dense LDL and raised small and large HDL. Change in insulin resistance largely accounted for the intervention-associated decreases in large very low-density lipoprotein, whereas changes in body mass index (BMI) and adiponectin were strongly associated with changes in LDL. Baseline and a change in adiponectin were related to change in large HDL, and BMI change associated with small HDL change. The effect of metformin to increase small HDL was independent of adiponectin, BMI, and insulin resistance. CONCLUSION ILS and metformin treatment have favorable effects on lipoprotein subfractions that are primarily mediated by intervention-related changes in insulin resistance, BMI, and adiponectin. Interventions that slow the development of diabetes may also retard the progression of atherosclerosis.
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Affiliation(s)
- R Goldberg
- MD, c/o The Diabetes Prevention Program Coordinating Center, Biostatistics Center, George Washington University, 6110 Executive Boulevard, Suite 750, Rockville, Maryland 20852.
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Furusyo N, Ai M, Okazaki M, Ikezaki H, Ihara T, Hayashi T, Hiramine S, Ura K, Kohzuma T, Schaefer EJ, Hayashi J. Serum cholesterol and triglyceride reference ranges of twenty lipoprotein subclasses for healthy Japanese men and women. Atherosclerosis 2013; 231:238-45. [PMID: 24267234 DOI: 10.1016/j.atherosclerosis.2013.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/27/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
AIM This epidemiological study was done to generate normal ranges for the cholesterol and triglyceride levels in serum lipoprotein subclasses isolated from healthy adults based on gender and menopausal status. METHODS Cholesterol and triglyceride levels in 20 lipoprotein subclasses as separated by high performance liquid chromatography were measured in serum obtained from 825 fasting healthy subjects (267 men, 558 women). RESULTS For serum cholesterol, 13.7% was found in very low density lipoprotein (VLDL) subclasses, 55.6% in low density lipoprotein (LDL) subclasses, and 30.4% in high density lipoprotein (HDL) subclasses. For serum triglycerides, these values were 52.1%, 27.9%, and 17.4%, respectively. Levels of cholesterol in some VLDL subclasses were inversely correlated with the levels of some HDL subclasses, while for triglycerides, elevated levels in any one subclass were generally strongly associated with elevated levels in all other subclasses. Men had significantly higher large VLDL-cholesterol levels than women (P < 0.05), while women had significantly higher small VLDL-cholesterol levels than men (P < 0.001). Women had significantly higher large LDL- and large and medium HDL-cholesterol levels than men (P < 0.001). Men had significantly higher chylomicron (CM), large and medium VLDL-, and small LDL-triglyceride levels than women (P < 0.001). Women had significantly higher very large and large HDL-triglyceride levels than men (P < 0.01). Postmenopausal women had significantly higher CM, all VLDL, and large, medium and small LDL-cholesterol levels, and significantly higher all VLDL, LDL, and HDL-triglyceride levels than premenopausal women (P < 0.001). CONCLUSIONS Our data document important gender and menopausal status differences in cholesterol and triglyceride subclass levels, as well as significant correlations between values in the various serum lipoprotein subclasses.
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Affiliation(s)
- Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan.
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Rosenson RS, Brewer HB, Ansell B, Barter P, Chapman MJ, Heinecke JW, Kontush A, Tall AR, Webb NR. Translation of High-Density Lipoprotein Function Into Clinical Practice. Circulation 2013; 128:1256-67. [DOI: 10.1161/circulationaha.113.000962] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Robert S. Rosenson
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - H. Bryan Brewer
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - Benjamin Ansell
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - Philip Barter
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - M. John Chapman
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - Jay W. Heinecke
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - Anatol Kontush
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - Alan R. Tall
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
| | - Nancy R. Webb
- From the Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.S.R.); Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, Washington, DC (H.B.B.); Atherosclerosis Research Unit, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA (B.A.); Centre for Vascular Research at the University of New South Wales, Sydney, Australia (P.B.); Dyslipidemia, Atherosclerosis and Inflammation Research Unit 939, National
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