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Reijnders E, van der Laarse A, Jukema JW, Cobbaert CM. High residual cardiovascular risk after lipid-lowering: prime time for Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive medicine. Front Cardiovasc Med 2023; 10:1264319. [PMID: 37908502 PMCID: PMC10613690 DOI: 10.3389/fcvm.2023.1264319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 11/02/2023] Open
Abstract
As time has come to translate trial results into individualized medical diagnosis and therapy, we analyzed how to minimize residual risk of cardiovascular disease (CVD) by reviewing papers on "residual cardiovascular disease risk". During this review process we found 989 papers that started off with residual CVD risk after initiating statin therapy, continued with papers on residual CVD risk after initiating therapy to increase high-density lipoprotein-cholesterol (HDL-C), followed by papers on residual CVD risk after initiating therapy to decrease triglyceride (TG) levels. Later on, papers dealing with elevated levels of lipoprotein remnants and lipoprotein(a) [Lp(a)] reported new risk factors of residual CVD risk. And as new risk factors are being discovered and new therapies are being tested, residual CVD risk will be reduced further. As we move from CVD risk reduction to improvement of patient management, a paradigm shift from a reductionistic approach towards a holistic approach is required. To that purpose, a personalized treatment dependent on the individual's CVD risk factors including lipid profile abnormalities should be configured, along the line of P5 medicine for each individual patient, i.e., with Predictive, Preventive, Personalized, Participatory, and Psycho-cognitive approaches.
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Affiliation(s)
- E. Reijnders
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - A. van der Laarse
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - C. M. Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands
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Zinn C, McPhee J, Harris N, Williden M, Prendergast K, Schofield G. A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel. Appl Physiol Nutr Metab 2017; 42:1158-1164. [PMID: 28700832 DOI: 10.1139/apnm-2017-0260] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Overweight, obesity, and poor health is becoming a global concern for defence force personnel. Conventional nutrition guidelines are being questioned for their efficacy in achieving optimal body composition and long-term health. This study compared the effects of a 12-week low-carbohydrate, high-fat diet with a conventional, high-carbohydrate, low-fat diet on weight reduction and metabolic health outcomes in at-risk New Zealand Defence Force personnel. In this randomised controlled trial, 41 overweight personnel were assigned to intervention and control groups. Weight, waist circumference, fasting lipids, and glycaemic control were assessed at baseline and at 12 weeks. Within-group change scores were analysed using the t statistic and interpreted using a p < 0.05 level of statistical significance. Between-group mean differences and confidence intervals were analysed using effect sizes and magnitude-based inferences. Twenty-six participants completed the trial (14 intervention, 12 control). Both groups showed statistically significant weight and waist circumference reductions; the intervention group significantly reduced triglycerides and serum glucose and significantly increased high-density lipoprotein cholesterol (HDLc). Relative to control, the intervention group showed small, possibly to likely beneficial effects for weight, triglycerides, glucose, insulin, and homeostasis model assessment of insulin resistance; moderate, likely beneficial effects for HDL cholesterol, triglyceride:HDLc ratio and HbA1c; and a small, likely harmful effect for low-density lipoprotein cholesterol. This dietary approach shows promise for short-term weight loss and improved metabolic health outcomes conditions compared with mainstream recommendations. It should be offered to defence force personnel at least as a viable alternative means to manage their weight and health.
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Affiliation(s)
- Caryn Zinn
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Julia McPhee
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Nigel Harris
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Micalla Williden
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Kate Prendergast
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
| | - Grant Schofield
- AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand.,AUT Human Potential Centre, Faculty of Health & Environmental Sciences, Private Bag 92006, Auckland 1142, New Zealand
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Kurano M, Hara M, Ikeda H, Tsukamoto K, Yatomi Y. Involvement of CETP (Cholesteryl Ester Transfer Protein) in the Shift of Sphingosine-1-Phosphate Among Lipoproteins and in the Modulation of its Functions. Arterioscler Thromb Vasc Biol 2017; 37:506-514. [PMID: 28126827 DOI: 10.1161/atvbaha.116.308692] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 01/11/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Sphingosine-1-phosphate (S1P) is a vasoprotective lipid mediator. About two thirds of plasma S1P rides on high-density lipoprotein (HDL), and several pleiotropic properties of HDL have been ascribed to S1P. In human subjects, CETP (cholesteryl ester transfer protein) greatly influences HDL quantities. In this study, we attempted to elucidate the roles of CETP in the metabolism of S1P. APPROACH AND RESULTS We overexpressed CETP in mice that lacked CETP and found that CETP overexpression decreased the HDL level but failed to modulate the levels of S1P and apolipoprotein M (apoM), a carrier of S1P, in the total plasma. We observed, however, that the distribution of S1P and apoM shifted from HDL to apoB-containing lipoproteins. When we administered C17S1P bound to apoM-containing lipoprotein, C17S1P and apoM were rapidly transferred to apoB-containing lipoproteins in CETP-overexpressing mice. When HDL containing C17S1P was mixed with low-density lipoprotein ex vivo, C17S1P shifted to the low-density lipoprotein fraction independent of the presence of CETP. Concordant with these results, apoM was distributed mainly to the same fraction as apo AI in a CETP-deficient subject, although apoM was also detected in apo AI-poor fractions in a corresponding hypercholesterolemia subject. About the bioactivities of S1P carried on each lipoprotein, S1P riding on apoB-containing lipoproteins induced the phosphorylation of Akt (AKT8 virus oncogene cellular homolog) and eNOS (endothelial nitric oxide synthase) in human umbilical vein endothelial cells, and CETP overexpression increased insulin secretion and sensitivity, which was inhibited by an S1P receptor 1 or 3 antagonist. CONCLUSIONS CETP modulates the distribution of S1P among lipoproteins, which affects the bioactivities of S1P.
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Affiliation(s)
- Makoto Kurano
- From the Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan (M.K., H.I., Y.Y.); Department of Medicine IV, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan (M.H.); and Department of Metabolism, Diabetes and Nephrology, Aizu Medical Center, Fukushima Medical University, Japan (K.T.)
| | - Masumi Hara
- From the Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan (M.K., H.I., Y.Y.); Department of Medicine IV, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan (M.H.); and Department of Metabolism, Diabetes and Nephrology, Aizu Medical Center, Fukushima Medical University, Japan (K.T.)
| | - Hitoshi Ikeda
- From the Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan (M.K., H.I., Y.Y.); Department of Medicine IV, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan (M.H.); and Department of Metabolism, Diabetes and Nephrology, Aizu Medical Center, Fukushima Medical University, Japan (K.T.)
| | - Kazuhisa Tsukamoto
- From the Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan (M.K., H.I., Y.Y.); Department of Medicine IV, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan (M.H.); and Department of Metabolism, Diabetes and Nephrology, Aizu Medical Center, Fukushima Medical University, Japan (K.T.)
| | - Yutaka Yatomi
- From the Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan (M.K., H.I., Y.Y.); Department of Medicine IV, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan (M.H.); and Department of Metabolism, Diabetes and Nephrology, Aizu Medical Center, Fukushima Medical University, Japan (K.T.).
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Pla2g12b and Hpn are genes identified by mouse ENU mutagenesis that affect HDL cholesterol. PLoS One 2012; 7:e43139. [PMID: 22912808 PMCID: PMC3422231 DOI: 10.1371/journal.pone.0043139] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 07/16/2012] [Indexed: 12/20/2022] Open
Abstract
Despite considerable progress understanding genes that affect the HDL particle, its function, and cholesterol content, genes identified to date explain only a small percentage of the genetic variation. We used N-ethyl-N-nitrosourea mutagenesis in mice to discover novel genes that affect HDL cholesterol levels. Two mutant lines (Hlb218 and Hlb320) with low HDL cholesterol levels were established. Causal mutations in these lines were mapped using linkage analysis: for line Hlb218 within a 12 Mbp region on Chr 10; and for line Hlb320 within a 21 Mbp region on Chr 7. High-throughput sequencing of Hlb218 liver RNA identified a mutation in Pla2g12b. The transition of G to A leads to a cysteine to tyrosine change and most likely causes a loss of a disulfide bridge. Microarray analysis of Hlb320 liver RNA showed a 7-fold downregulation of Hpn; sequencing identified a mutation in the 3′ splice site of exon 8. Northern blot confirmed lower mRNA expression level in Hlb320 and did not show a difference in splicing, suggesting that the mutation only affects the splicing rate. In addition to affecting HDL cholesterol, the mutated genes also lead to reduction in serum non-HDL cholesterol and triglyceride levels. Despite low HDL cholesterol levels, the mice from both mutant lines show similar atherosclerotic lesion sizes compared to control mice. These new mutant mouse models are valuable tools to further study the role of these genes, their affect on HDL cholesterol levels, and metabolism.
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Weber O, Bischoff H, Schmeck C, Böttcher MF. Cholesteryl ester transfer protein and its inhibition. Cell Mol Life Sci 2010; 67:3139-49. [PMID: 20556633 PMCID: PMC11115880 DOI: 10.1007/s00018-010-0418-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 04/21/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
Abstract
Cholesteryl ester transfer protein (CETP) is a plasma glycoprotein that facilitates the transfer of cholesteryl esters from the atheroprotective high density lipoprotein (HDL) to the proatherogenic low density lipoprotein cholesterol (LDL) and very low density lipoprotein cholesterol (VLDL) leading to lower levels of HDL but raising the levels of proatherogenic LDL and VLDL. Inhibition of CETP is considered a potential approach to treat dyslipidemia. However, discussions regarding the role of CETP-mediated lipid transfer in the development of atherosclerosis and CETP inhibition as a potential strategy for prevention of atherosclerosis have been controversial. Although many animal studies support the hypothesis that inhibition of CETP activity may be beneficial, negative phase III studies on clinical endpoints with the CETP inhibitor torcetrapib challenged the future perspectives of CETP inhibitors as potential therapeutic agents. The review provides an update on current understanding of the molecular mechanisms involved in CETP activity and its inhibition.
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Affiliation(s)
- Olaf Weber
- Bayer Healthcare AG/Bayer Schering Pharma, 42096, Wuppertal, Germany.
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Davidson MH, Rosenson RS. Novel targets that affect high-density lipoprotein metabolism: the next frontier. Am J Cardiol 2009; 104:52E-7E. [PMID: 19895945 DOI: 10.1016/j.amjcard.2009.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
As the significance of treating coronary artery disease (CAD) remains a high priority in reducing morbidity and mortality worldwide, newer treatment strategies continue to evolve. The efficacy of statin therapy in reducing low-density lipoprotein cholesterol and reducing cardiovascular events is well established. Yet, addressing residual macrovascular risk becomes a compelling rationale for proposing that pharmacologic therapy targeted at low concentrations of high-density lipoprotein (HDL) cholesterol is a rationale target for enhanced management of CAD. This article reviews current options for the therapeutic management of HDL cholesterol, including discussion of novel agents aimed at reducing cardiovascular disease risk in patients with low levels of HDL cholesterol.
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Brown WM, Chiacchia FS. Therapies to Increase ApoA-I and HDL-Cholesterol Levels. Drug Target Insights 2008. [DOI: 10.4137/dti.s447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- William M. Brown
- Resverlogix Corp., 202, 279 Midpark Way SE, Calgary, AB T2X 1M2, Canada
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Abstract
It is well recognized that the lowering of low-density lipoprotein (LDL) cholesterol can substantially reduce coronary artery disease (CAD)-related morbidity and mortality. The prevention and management of CAD has chiefly focused on 1 component of the lipid profile: the reduction of LDL cholesterol. Yet, the majority of patients in both the primary and secondary prevention settings continue to experience significant residual risk for acute cardiovascular events even when their LDL cholesterol is lowered aggressively with combinations of lifestyle modification and pharmacologic intervention. As a result, there is increased focus on targeting and treating low serum levels of high-density lipoprotein (HDL) cholesterol in an effort to further reduce risk for cardiovascular events, including myocardial infarction, unstable angina, ischemic stroke, and death. Epidemiologically high serum levels of HDL cholesterol are associated with reduced risk for the development of atherosclerotic disease. HDL particles are believed to be antiatherogenic secondary to their capacity to drive reverse cholesterol transport and antagonize pathways of inflammation, thrombosis, and oxidation. HDL cholesterol can be quite challenging to raise in many individuals because of the large number of polymorphisms in the genes, enzymes, cell surface receptors, and apoproteins that regulate the serum concentrations, functionality, and patterns of metabolism of HDL particles This article reviews HDL metabolism and established as well as emerging therapeutic approaches to raising serum concentrations of this fascinating and complex lipoprotein.
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