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Taskinen MR, Björnson E, Kahri J, Söderlund S, Matikainen N, Porthan K, Ainola M, Hakkarainen A, Lundbom N, Fermanelli V, Fuchs J, Thorsell A, Kronenberg F, Andersson L, Adiels M, Packard CJ, Borén J. Effects of Evolocumab on the Postprandial Kinetics of Apo (Apolipoprotein) B100- and B48-Containing Lipoproteins in Subjects With Type 2 Diabetes. Arterioscler Thromb Vasc Biol 2020; 41:962-975. [PMID: 33356392 DOI: 10.1161/atvbaha.120.315446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Increased risk of atherosclerotic cardiovascular disease in subjects with type 2 diabetes is linked to elevated levels of triglyceride-rich lipoproteins and their remnants. The metabolic effects of PCSK9 (proprotein convertase subtilisin/kexin 9) inhibitors on this dyslipidemia were investigated using stable-isotope-labeled tracers. Approach and Results: Triglyceride transport and the metabolism of apos (apolipoproteins) B48, B100, C-III, and E after a fat-rich meal were investigated before and on evolocumab treatment in 13 subjects with type 2 diabetes. Kinetic parameters were determined for the following: apoB48 in chylomicrons; triglyceride in VLDL1 (very low-density lipoprotein) and VLDL2; and apoB100 in VLDL1, VLDL2, IDL (intermediate-density lipoprotein), and LDL (low-density lipoprotein). Evolocumab did not alter the kinetics of apoB48 in chylomicrons or apoB100 or triglyceride in VLDL1. In contrast, the fractional catabolic rates of VLDL2-apoB100 and VLDL2-triglyceride were both increased by about 45%, which led to a 28% fall in the VLDL2 plasma level. LDL-apoB100 was markedly reduced by evolocumab, which was linked to metabolic heterogeneity in this fraction. Evolocumab increased clearance of the more rapidly metabolized LDL by 61% and decreased production of the more slowly cleared LDL by 75%. ApoC-III kinetics were not altered by evolocumab, but the apoE fractional catabolic rates increased by 45% and the apoE plasma level fell by 33%. The apoE fractional catabolic rates was associated with the decrease in VLDL2- and IDL-apoB100 concentrations. CONCLUSIONS Evolocumab had only minor effects on lipoproteins that are involved in triglyceride transport (chylomicrons and VLDL1) but, in contrast, had a profound impact on lipoproteins that carry cholesterol (VLDL2, IDL, LDL). Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02948777.
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Affiliation(s)
- Marja-Riitta Taskinen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine (M.-R.T., J.K., S.S., N.M., K.P., M. Ainola), University of Helsinki, Finland
| | - Elias Björnson
- Department of Molecular and Clinical Medicine (E.B., L.A., M. Adiels, J.B.), University of Gothenburg, Sweden
| | - Juhani Kahri
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine (M.-R.T., J.K., S.S., N.M., K.P., M. Ainola), University of Helsinki, Finland
| | - Sanni Söderlund
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine (M.-R.T., J.K., S.S., N.M., K.P., M. Ainola), University of Helsinki, Finland.,Department of Endocrinology, Abdominal Center (S.S., N.M.), Helsinki University Hospital, Finland
| | - Niina Matikainen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine (M.-R.T., J.K., S.S., N.M., K.P., M. Ainola), University of Helsinki, Finland.,Department of Endocrinology, Abdominal Center (S.S., N.M.), Helsinki University Hospital, Finland
| | - Kimmo Porthan
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine (M.-R.T., J.K., S.S., N.M., K.P., M. Ainola), University of Helsinki, Finland
| | - Mari Ainola
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine (M.-R.T., J.K., S.S., N.M., K.P., M. Ainola), University of Helsinki, Finland
| | - Antti Hakkarainen
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital (A.H., N.L.), University of Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (A.H.)
| | - Nina Lundbom
- Department of Radiology, HUS Medical Imaging Center, Helsinki University Hospital (A.H., N.L.), University of Helsinki, Finland
| | | | - Johannes Fuchs
- Proteomics Core Facility (J.F., A.T.), University of Gothenburg, Sweden
| | - Annika Thorsell
- Proteomics Core Facility (J.F., A.T.), University of Gothenburg, Sweden
| | - Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Austria (F.K.)
| | - Linda Andersson
- Department of Molecular and Clinical Medicine (E.B., L.A., M. Adiels, J.B.), University of Gothenburg, Sweden
| | - Martin Adiels
- Department of Molecular and Clinical Medicine (E.B., L.A., M. Adiels, J.B.), University of Gothenburg, Sweden.,Department of Biostatistics, School of Public Health and Community Medicine (M. Adiels), University of Gothenburg, Sweden
| | - Chris J Packard
- Isnstitute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (C.J.P.)
| | - Jan Borén
- Department of Molecular and Clinical Medicine (E.B., L.A., M. Adiels, J.B.), University of Gothenburg, Sweden.,Department of Cardiology, Wallenberg Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden (J.B.)
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David Spence J. Dietary cholesterol and egg yolk should be avoided by patients at risk of vascular disease. J Transl Int Med 2016; 4:20-24. [PMID: 28191513 DOI: 10.1515/jtim-2016-0005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Recent recommendations that limits to dietary cholesterol be dropped were probably heavily influenced by propaganda from the egg industry. After conviction for false advertising, the industry has spent hundreds of millions of dollars to convince the public, physicians, and policy makers that dietary cholesterol and egg yolk are harmless. However, there are good reasons for longstanding recommendations that dietary cholesterol be limited to <200 mg/ day in persons at risk of vascular disease. It is seldom understood that this essentially means all people in developed countries who expect to attain an advanced age. There is abundant evidence that dietary cholesterol increases cardiovascular risk. The misdirection of the egg industry focuses on fasting levels of LDL cholesterol, which are only raised by ~ 10% by consumption of egg yolks. However, the main effect of diet is on the post-prandial state: for ~ 4 hours after a high fat/high cholesterol meal, there is oxidative stress, endothelial dysfunction, and arterial inflammation. One large (65 g) egg yolk contains 237 mg of cholesterol, well above the recommended limit-nearly as much as a 12-ounce hamburger. Besides the very high cholesterol content of egg yolk, the phosphatidylcholine in egg yolk leads, via action of the intestinal microbiome, to production of trimethylamine n-oxide (TMAO), which causes atherosclerosis in animal models. Levels of TMAO in the top quartile after a test dose of two egg yolks were associated with a 2.5-fold increase in the 3-year risk of stroke, death, or myocardial infarction among patients referred for coronary angiography. Persons at risk of cardiovascular disease should limit their intake of cholesterol and egg yolk.
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Affiliation(s)
- J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON N6G 2V2, Canada
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Almeda-Valdes P, Cuevas-Ramos D, Mehta R, Muñoz-Hernandez L, Cruz-Bautista I, Perez-Mendez O, Tusie-Luna MT, Gomez-Perez FJ, Pajukanta P, Matikainen N, Taskinen MR, Aguilar-Salinas CA. Factors associated with postprandial lipemia and apolipoprotein A-V levels in individuals with familial combined hyperlipidemia. BMC Endocr Disord 2014; 14:90. [PMID: 25425215 PMCID: PMC4253986 DOI: 10.1186/1472-6823-14-90] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 11/17/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Alterations in postprandial metabolism have been described in familial combined hyperlipidemia (FCH); however, their underlying mechanisms are not well characterized. We aimed to identify factors related to the magnitude of postprandial lipemia and apolipoprotein (apo) A-V levels in subjects with FCH. METHODS FCH cases (n = 99) were studied using a standardized meal test. Abdominal obesity was assessed using the waist to hip ratio (WHR). A linear regression model was performed to investigate the variables associated with the triglycerides incremental area under the curve (iAUC). Independent associations between metabolic variables and apo A-V iAUC were also investigated in a randomly selected subgroup (n = 44). The study sample was classified according to the presence of fasting hypertriglyceridemia (≥150 mg/dL) and abdominal obesity (WHR ≥0.92 in men and ≥0.85 in women) to explore differences in parameters. RESULTS The fasting apo B-48 levels (r = 0.404), and the WHR (r = 0.359) were independent factors contributing to the triglycerides iAUC (r2 = 0.29, P < 0.001). The triglycerides iAUC was independently associated with the apo A-V iAUC (r2 = 0.54, P < 0.01). Patients with both hypertriglyceridemia and abdominal obesity showed the most robust triglycerides and apo A-V postprandial responses. CONCLUSIONS In patients with FCH the fasting apo B-48 level is the main factor associated with postprandial lipemia. Abdominal obesity also contributes to the magnitude of the postprandial response.The triglycerides postprandial increment is the principal factor associated with the apo A-V postprandial response.
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Affiliation(s)
- Paloma Almeda-Valdes
- />Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Daniel Cuevas-Ramos
- />Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Roopa Mehta
- />Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Liliana Muñoz-Hernandez
- />Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Ivette Cruz-Bautista
- />Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Oscar Perez-Mendez
- />Department of Molecular Biology, Instituto Nacional de Cardiologia Ignacio A. Chavez, Mexico City, Mexico
| | - Maria Teresa Tusie-Luna
- />Molecular Biology and Genomic Medicine Units. Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. Biomedical Investigation Institute, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Francisco J Gomez-Perez
- />Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Päivi Pajukanta
- />Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Niina Matikainen
- />Diabetes and Obesity Units, Heart and Lung Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Marja-Riitta Taskinen
- />Diabetes and Obesity Units, Heart and Lung Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Carlos A Aguilar-Salinas
- />Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Chang SJ, Hsu SC, Tien KJ, Hsiao JY, Lin SR, Chen HC, Hsieh MC. Metabolic syndrome associated with toenail onychomycosis in Taiwanese with diabetes mellitus. Int J Dermatol 2008; 47:467-72. [PMID: 18412863 DOI: 10.1111/j.1365-4632.2008.03606.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis is a complication of diabetes mellitus (DM), which has a deleterious impact on the quality of life. Aim To explore the prevalence of onychomycosis amongst Taiwanese diabetics, and to analyze the factors associated with onychomycosis after adjusting for age and sex. METHODS A total of 1245 Taiwanese diabetics were enrolled, and a nested case-control study was performed by onychomycosis outcome and the exposures were compared. RESULTS The overall prevalence of onychomycosis among DM patients was 30.76% (383/1245), with a significantly higher prevalence in men than in women (P = 0.024). The factors associated with onychomycosis in matched pairs by gender and age were analyzed in 375 pairs. It was found that metabolic syndrome, obesity, triglyceride (TG) levels, and glycosylated hemoglobin (HbA1c) were associated with onychomycosis (P < 0.05). CONCLUSION Higher prevalence rates of onychomycosis were found in men and older DM patients. Metabolic syndrome, obesity, high TG levels, and poor glycemic control were associated with onychomycosis.
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Affiliation(s)
- Shun-Jen Chang
- Department of Public Health, Faculty of Medicine, College of Medicine, Graduate Institute of Medical Genetics, and Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hwu CM, Lin MW, Liou TL, Hsiao LC, Liang KW, Tsai TT, Ho LT. Fasting triglyceride is a major determinant of postprandial triglyceride response in postmenopausal women. Menopause 2008; 15:150-6. [PMID: 17549035 DOI: 10.1097/gme.0b013e31800577856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of the study was to examine the relative influences of fasting lipids, insulin resistance, and waist circumference (WC) on postprandial lipemia in postmenopausal women. DESIGN Forty-nine naturally postmenopausal women were recruited for the study. Each woman underwent a 75-g oral glucose tolerance test to measure insulin resistance and a 1,000-kcal high-fat mixed meal test for postprandial triglyceride (TG) response. RESULTS The participants were divided into three groups by tertiles of incremental TG response in the mixed meal test. The three groups were comparable in weight, WC, and fasting high-density lipoprotein cholesterol (HDL-C) levels. There were significant differences in fasting TG and non-HDL-C concentrations among the three groups. The women in the high-tertile group were more insulin resistant than those in the low-tertile group, indicated by higher homeostasis model assessment for insulin resistance (HOMA-IR) values. The postprandial TG response was significantly correlated with Log(fasting TG), fasting non-HDL-C and Log(HOMA-IR), but not with WC, in univariate regression analyses. Log(fasting TG) was the only variable that remained significantly related to incremental TG response when all the above were entered into multiple regression models. Subsequently, we found that Log(HOMA-IR) and fasting non-HDL-C independently predicted the variance of Log(fasting TG) in stepwise multiple regression. CONCLUSIONS Our data demonstrated that the fasting TG level is a major determinant of postprandial TG response in postmenopausal women. Insulin resistance and non-HDL-C may contribute independently to the fasting TG level. The influences of WC on postprandial lipemia seemed to be insignificant.
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Affiliation(s)
- Chii-Min Hwu
- Section of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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