1
|
Higgins V, Adeli K. Postprandial dyslipidemia in insulin resistant states in adolescent populations. J Biomed Res 2020; 34:328-342. [PMID: 32934193 PMCID: PMC7540238 DOI: 10.7555/jbr.34.20190094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity and the metabolic syndrome are becoming increasingly prevalent not only in adults, but also in adolescents. The metabolic syndrome, a complex cluster of metabolic abnormalities, increases one's risk of developing type 2 diabetes and cardiovascular disease (CVD). Dyslipidemia, a key component of the metabolic syndrome, is highly associated with insulin resistance and contributes to increased CVD risk. Dyslipidemia has traditionally been assessed using a fasting lipid profile [i.e. fasting triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)]. However, the postprandial state predominates over the course of a day and non-fasting triglycerides independently predict CVD risk. In insulin resistant states, the intestine overproduces triglyceride-rich lipoprotein (TRL) particles, termed chylomicrons (CMs), following ingestion of a fat-containing meal, as well as in the fasting state. Along with elevated hepatic TRLs (i.e. very-low density lipoproteins), CMs contribute to remnant lipoprotein accumulation, small dense LDL particles, and reduced HDL-C, which collectively increase CVD risk. Given the early genesis of atherosclerosis and physiological metabolic changes during adolescence, studying postprandial dyslipidemia in the adolescent population is an important area of study. Postprandial dyslipidemia in the pediatric population poses a significant public health concern, warranting a better understanding of its pathogenesis and association with insulin resistance and CVD. This review discusses the metabolic syndrome, focusing on the link between insulin resistance, postprandial dyslipidemia, and CVD risk. Furthermore, the clinical significance and functional assessment of postprandial dyslipidemia, specifically in the adolescent population, is discussed in more detail.
Collapse
Affiliation(s)
- Victoria Higgins
- Molecular Medicine and Pediatric Laboratory Medicine, Research Institute, The Hospital for Sick Children
| | - Khosrow Adeli
- Molecular Medicine and Pediatric Laboratory Medicine, Research Institute, The Hospital for Sick Children
| |
Collapse
|
2
|
Engelberg H. State-of the-Art Review : Endogenous Heparin Activity Deficiency and Atherosclerosis. Clin Appl Thromb Hemost 2016. [DOI: 10.1177/107602969600200202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Hyman Engelberg
- Cedars-Sinai Medical Center, Los Angeles, California; and Thrombosis Research Institute, Loyola Medical School, Maywood, Illinois, U.S.A
| |
Collapse
|
3
|
Batluk J, Leonards CO, Grittner U, Lange KS, Schreiber SJ, Endres M, Ebinger M. Triglycerides and carotid intima-media thickness in ischemic stroke patients. Atherosclerosis 2015; 243:186-91. [DOI: 10.1016/j.atherosclerosis.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 08/26/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
|
4
|
Le NA, Farkas-Epperson M, Sweeney ME, Wilson PWF, Virgil Brown W. Effect of ABT-335 (fenofibric acid) on meal-induced oxidative stress in patients with metabolic syndrome. Atherosclerosis 2013; 231:268-73. [PMID: 24267238 DOI: 10.1016/j.atherosclerosis.2013.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/23/2013] [Accepted: 09/25/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Examine the effect of ABT-335 (fenofibric acid) on postprandial lipemia and susceptibility of plasma lipoproteins to Cu(++)-mediated oxidation in patients with metabolic syndrome. METHODS AND RESULTS This is a randomized double-blind, placebo-controlled study with cross-over and includes a 4-week wash-out period between the two treatment periods. At the end of each 8-week treatment period, subjects were challenged with a standardized mixed meal followed by blood collection over the ensuing 6 h. Plasma lipoproteins were isolated by a combination of ultracentrifugation and FPLC for the continuous monitoring of conjugated dienes formation as an assessment of oxidative susceptibility. Fasting plasma TG was reduced by 20% (p < 0.0002) and there was a modest reduction in hsCRP (6.1%, p < 0.06). There was no change in either HDLc or LDLc in these subjects. Postprandial lipemia was reduced with ABT-335 as demonstrated by a 28.5% reduction (p < 0.0005) in incremental area under the curve for TG during the 6-h period after the meal challenge. Lag times for both fasting LDL (+16%) and postprandial LDL (+28%) were increased with the ABT-335 therapy, suggestive of reduced oxidative susceptibility. Co-incubation with autologous HDL did not reduced LDL oxidative susceptibility in these patients. CONCLUSION ABT-335 therapy reduced fasting and postprandial triglycerides in patients with metabolic syndrome. Autologous HDL may be dysfunctional in these patients as co-incubation with HDL failed to reduce oxidative susceptibility of LDL. During ABT-335 therapy, LDL was less susceptible to Cu(++)-mediated oxidative modification, in spite of the lack of changes in LDLc levels.
Collapse
Affiliation(s)
- Ngoc-Anh Le
- Biomarker Core Laboratory, Atlanta VA Medical Center, Decatur, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | | | | | | | | |
Collapse
|
5
|
Ktari N, Mnafgui K, Nasri R, Hamden K, Bkhairia I, Ben Hadj A, Boudaouara T, Elfeki A, Nasri M. Hypoglycemic and hypolipidemic effects of protein hydrolysates from zebra blenny (Salaria basilisca) in alloxan-induced diabetic rats. Food Funct 2013; 4:1691-9. [DOI: 10.1039/c3fo60264h] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
6
|
Abstract
Background and Objective: The increased risk for coronary artery disease observed in postmenopausal (PoW) women is partly explained by a more atherogenic lipoprotein profile. Moreover, natural menopause has been associated with an altered postprandial lipid profile. This study was designed to test the hypothesis that young premenopausal (PrW) and PoW may be independently associated with postprandial lipemia and indirectly associated with atherosclerosis. Patients and Methods: A total of 46 healthy PrW and 44 healthy PoW participated in a 5-h intervention study. Blood samples were taken at the baseline and at 1, 2, 3, and 4 h after eating. Total cholesterol, LDL-cholesterol, HDL-cholesterol, fasting, and postprandial triglycerides (PPTG) were determined sequentially in blood samples. Results: PPTG presented significant higher values in PoW compared to PrW (P < 0.05), but other lipids did not significantly differ between groups. PPTG concentrations in PoW were significantly higher than in PrW (P < 0.05). There was a significant time influence (P < 0.05) in TG in PrW and PoW, while time to peak and peak concentration were significantly higher in PoW than PrW. Other lipids were also decreased more in PrW than PoW, but not significantly so. Cholesterol concentrations showed a significant reduction after 2 h, to reach values similar to the baseline after 4 h in PrW but not in PoW. HDL-cholesterol concentration was decreased more in PoW compared to PrW but it was not significant. Conclusions: Lipid postprandial response indicates a higher cardiovascular risk pattern in PoW compared to PrW.
Collapse
Affiliation(s)
- Gaffar S Zaman
- Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | | |
Collapse
|
7
|
Sutherland JP, McKinley B, Eckel RH. The metabolic syndrome and inflammation. Metab Syndr Relat Disord 2012; 2:82-104. [PMID: 18370640 DOI: 10.1089/met.2004.2.82] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The metabolic syndrome (MS) is a clustering of cardiovascular risk factors, with insulin resistance as a major feature. This syndrome has been variously defined, but generally consists of 3 or more of the following components: hyperglycemia, hypertension, hypertriglyceridemia, low HDL, and increased abdominal circumference and/or BMI at >30 kg/m(2). The WHO criteria require the presence of insulin resistance to make the diagnosis. The current review focuses particularly on the association of the MS and the proinflammatory state as well as treatment options to prevent the development of coronary heart disease (CHD). Chronic inflammation is frequently associated with the MS. Inflammatory markers that have been associated with MS include hs-CRP, TNF-alpha, fibrinogen, and IL-6, among others. The link between inflammation and the MS is not fully understood. One postulated mechanism is that these cytokines are released into the circulation by adipose tissue, stimulating hepatic CRP production. The prothrombotic molecule PAI-1 is also increased in the MS. Adiponectin, produced exclusively by adipocytes, is decreased in obesity. The association of these proinflammatory and prothrombotic markers with the MS is discussed in detail. The general goals of treatment of the MS are prevention of CHD events and diabetes if not already present. The approach to treatment of those with the MS should include lifestyle changes, including weight loss and exercise as well as appropriate pharmacological therapies. Certain medications, which may be used in persons with MS, have been shown to have beneficial effects on clinical outcome and/or anti-inflammatory effects.
Collapse
|
8
|
Samson CE, Galia ALB, Llave KIC, Zacarias MB, Mercado-Asis LB. Postprandial Peaking and Plateauing of Triglycerides and VLDL in Patients with Underlying Cardiovascular Diseases Despite Treatment. Int J Endocrinol Metab 2012; 10:587-93. [PMID: 23843828 PMCID: PMC3693638 DOI: 10.5812/ijem.4783] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/19/2012] [Accepted: 05/23/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Dyslipidemia is associated with cardiovascular morbidities and mortality. Currently, fasting lipid profile determination is used to monitor treatment response. Recently, postprandial lipemia is of increasing interest because of its atherogenic and thrombogenic potential and also was found to be more predictive for cardiovascular diseases. OBJECTIVES To demonstrate postprandial lipemia among patients with cardiovascular diseases despite low fat diet, normal fasting lipid profile and even statin regimen. PATIENTS AND METHODS Patients aged 40-80 years old with cardiovascular diseases (i.e. coronary artery disease and cerebrovascular disease) more than 6 months, on statin treatment for more than 6 months and normal fasting lipid profile (according to NCEP ATP III guidelines) were included. Study exclusion criteria were pregnancy, acute cardiovascular events < 6 months, hepatic or renal failure. Finally, twelve patients were included. RESULTS The triglyceride level showed a significant rise from fasting to 2 hours after breakfast with a mean difference of 23.86 mg/dL (P =0.012). The level peaked at 4 hours after breakfast with a mean difference (MD) of 72.02 mg/dL (P =0.002). Subsequent triglyceride levels plateaued and were significantly higher than the baseline (P <0.05) until the 12th hour of observation. VLDL levels showed a similar pattern. Levels increased significantly from fasting to 2h after breakfast (mean difference: 4.49 mg/dL, P = 0.007), then plateaued and further increased 4 hours after breakfast (MD: 14.01 mg/dL, P = 0.002). VLDL levels were significantly higher than fasting (P < 0.05) and did not return to baseline until the 12th hour of observation. In contrast, the levels of total cholesterol, HDL and LDL decreased postprandially. CONCLUSIONS Triglyceride and VLDL peaking and plateauing were observed in patients with cardiovascular diseases despite low fat diet, normal fasting lipid profile and statin regimen. These findings may raise more attentions in monitoring and management of dyslipidemia in patients with cardiovascular and cerebrovascular events.
Collapse
Affiliation(s)
- Clarissa E. Samson
- Section of Endocrinology and Metabolism, University Of Santo Tomas Hospital, Manila, Philippines
| | - Ana Lyza B. Galia
- Section of Endocrinology and Metabolism, University Of Santo Tomas Hospital, Manila, Philippines
| | | | - Manuel B. Zacarias
- Section of Cardiology, University of Santo Tomas Hospital, Manila, Philippines
| | - Leilani B. Mercado-Asis
- Section of Endocrinology and Metabolism, University Of Santo Tomas Hospital, Manila, Philippines
| |
Collapse
|
9
|
Hanada H, Mugii S, Okubo M, Maeda I, Kuwayama K, Hidaka Y, Kitazume-Taneike R, Yamashita T, Kawase R, Nakaoka H, Inagaki M, Yuasa-Kawase M, Nakatani K, Tsubakio-Yamamoto K, Masuda D, Ohama T, Matsuyama A, Ishigami M, Nishida M, Komuro I, Yamashita S. Establishment of chemiluminescence enzyme immunoassay for apolipoprotein B-48 and its clinical applications for evaluation of impaired chylomicron remnant metabolism. Clin Chim Acta 2012; 413:160-5. [DOI: 10.1016/j.cca.2011.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/08/2011] [Accepted: 09/09/2011] [Indexed: 11/29/2022]
|
10
|
Peroxisome proliferator activated receptors and lipoprotein metabolism. PPAR Res 2011; 2008:132960. [PMID: 18288277 PMCID: PMC2220040 DOI: 10.1155/2008/132960] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Accepted: 09/03/2007] [Indexed: 12/24/2022] Open
Abstract
Plasma lipoproteins are responsible for carrying triglycerides and cholesterol in the blood and ensuring their delivery to target organs. Regulation of lipoprotein metabolism takes place at numerous levels including via changes in gene transcription. An important group of transcription factors that mediates the effect of dietary fatty acids and certain drugs on plasma lipoproteins are the peroxisome proliferator activated receptors (PPARs). Three PPAR isotypes can be distinguished, all of which have a major role in regulating lipoprotein metabolism. PPARalpha is the molecular target for the fibrate class of drugs. Activation of PPARalpha in mice and humans markedly reduces hepatic triglyceride production and promotes plasma triglyceride clearance, leading to a clinically significant reduction in plasma triglyceride levels. In addition, plasma high-density lipoprotein (HDL)-cholesterol levels are increased upon PPARalpha activation in humans. PPARgamma is the molecular target for the thiazolidinedione class of drugs. Activation of PPARgamma in mice and human is generally associated with a modest increase in plasma HDL-cholesterol and a decrease in plasma triglycerides. The latter effect is caused by an increase in lipoprotein lipase-dependent plasma triglyceride clearance. Analogous to PPARalpha, activation of PPARbeta/delta leads to increased plasma HDL-cholesterol and decreased plasma triglyceride levels. In this paper, a fresh perspective on the relation between PPARs and lipoprotein metabolism is presented. The emphasis is on the physiological role of PPARs and the mechanisms underlying the effect of synthetic PPAR agonists on plasma lipoprotein levels.
Collapse
|
11
|
Kassem HS, Zantout MS, Azar ST. Gemfibrozil Improves Postprandial Hypertriglyceridemia in Patients with Isolated Low HDL. Lipid Insights 2011. [DOI: 10.4137/lpi.s5722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AimTo assess the response of postprandial (PP) hypertriglyceridemia to genfibrozil in healthy male subjects with isolated low HDL-Cholesterol but without the metabolic syndrome (MS).Patients and methods14 male subjects with isolated low HDL (HDL-C ≤ 33), normal fasting triglycerides and LDL-C levels and without any feature of the MS, were studied. 13 male subjects with HDL-C > 38 mg/dl served as controls. They also had normal fasting triglycerides and LDL-C levels and without any feature of the MS. The 2 groups were statistically similar with respect to age, blood pressure, BMI, body fat composition, waist circumference, waist to hip ratio, fasting insulin, fasting and PP blood sugar, baseline fasting TG level and baseline LDL-C. Postprandial TG levels were measured at 2, 4, and 6 hours following a morning meal. Ten of the patients with PP hypertriglyceridemia were treated with gemfibrozil 600 mg PO twice/day for one month.ResultsPatients had markedly higher levels of the peak PP TG at 4 hours compared to controls (296.0 ± 37.7 vs. 206.7 ± 29.9 mg/dl; P < 0.05) the other two postprandial levels were also higher in patients but the difference was not significant. Treatment with gemfibrozil significantly decreased the levels of fasting and postprandial TG and increased HDL-C by around 3.6 mg/dl (11.7%) without affecting LDL-C.ConclusionPostprandial increase in serum TG may be present in patients with isolated HDL-C without the MS. Treatment of patients with PP hypertriglyceridemia with gemfibrozil improves the low HDL-C and postprandial rise in TG.
Collapse
Affiliation(s)
- Hania S. Kassem
- Division of Nephrology, New York University Medical Center, NY, USA
| | - Mira S. Zantout
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut-Medical Center, NY, USA
| | - Sami T. Azar
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut-Medical Center, NY, USA
| |
Collapse
|
12
|
Reaven GM. Insulin Resistance, Compensatory Hyperinsulinemia, and Coronary Heart Disease: Syndrome X Revisited. Compr Physiol 2011. [DOI: 10.1002/cphy.cp070238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
13
|
Rudkowska I, Caron-Dorval D, Verreault M, Couture P, Deshaies Y, Barbier O, Vohl MC. PPARalpha L162V polymorphism alters the potential of n-3 fatty acids to increase lipoprotein lipase activity. Mol Nutr Food Res 2010; 54:543-50. [PMID: 19937854 DOI: 10.1002/mnfr.200900085] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Omega-3 fatty acids (FAs) may accelerate plasma triglyceride (TG) clearance by altering lipoprotein lipase (LPL) activity. Yet, the ability of n-3 FAs to increase LPL activity is dependent on transcription factors such as peroxisome proliferator-activated receptor alpha (PPARalpha). The objective was to examine the effects of n-3 FAs on LPL activity considering the occurrence of PPARalpha L162V polymorphism. First, 14 pairs of men either L162 homozygotes or carriers of the V162 allele were supplemented with n-3 FAs. Second, transient transfections in HepG2 cells, for the L162- and V162-PPARalpha variants with the peroxisome proliferator-response element from the human LPL gene, were transactivated with n-3 FAs. In vivo results demonstrate that the LPL activity increased non-significantly by 14.4% in L162 homozygotes compared with 6.6% in carriers of the PPARalpha-V162 allele, after n-3 FA supplementation. Additionally, the L162 homozygotes tended towards an inverse correlation between LPL activities and plasma TG levels. Conversely, carriers of the V162 allele showed no such relationship. In vitro data demonstrates that transcription rates of LPL tended to be higher for the L162-PPARalpha than V162-PPARalpha after n-3 FAs activation. Overall, these results indicate that n-3 FA supplementation increases the transcription rate of LPL to a greater extent in L162-PPARalpha than V162-PPARalpha.
Collapse
Affiliation(s)
- Iwona Rudkowska
- Lipid Research Center, CHUL Research Center, Sainte-Foy, Québec, Canada
| | | | | | | | | | | | | |
Collapse
|
14
|
Chapman MJ, Redfern JS, McGovern ME, Giral P. Niacin and fibrates in atherogenic dyslipidemia: pharmacotherapy to reduce cardiovascular risk. Pharmacol Ther 2010; 126:314-45. [PMID: 20153365 DOI: 10.1016/j.pharmthera.2010.01.008] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 01/15/2010] [Indexed: 12/16/2022]
Abstract
Although statin therapy represents a cornerstone of cardiovascular disease (CVD) prevention, a major residual CVD risk (60-70% of total relative risk) remains, attributable to both modifiable and non-modifiable risk factors. Among the former, low levels of HDL-C together with elevated triglyceride (TG)-rich lipoproteins and their remnants represent major therapeutic targets. The current pandemic of obesity, metabolic syndrome, and type 2 diabetes is intimately associated with an atherogenic dyslipidemic phenotype featuring low HDL-C combined with elevated TG-rich lipoproteins and small dense LDL. In this context, there is renewed interest in pharmacotherapeutic strategies involving niacin and fibrates in monotherapy and in association with statins. This comprehensive, critical review of available data in dyslipidemic subjects indicates that niacin is more efficacious in raising HDL-C than fibrates, whereas niacin and fibrates reduce TG-rich lipoproteins and LDL comparably. Niacin is distinguished by its unique capacity to effectively lower Lp(a) levels. Several studies have demonstrated anti-atherosclerotic action for both niacin and fibrates. In contrast with statin therapy, the clinical benefit of fibrates appears limited to reduction of nonfatal myocardial infarction, whereas niacin (frequently associated with statins and/or other agents) exerts benefit across a wider range of cardiovascular endpoints in studies involving limited patient numbers. Clearly the future treatment of atherogenic dyslipidemias involving the lipid triad, as exemplified by the occurrence of the mixed dyslipidemic phenotype in metabolic syndrome, type 2 diabetes, renal, and auto-immune diseases, requires integrated pharmacotherapy targeted not only to proatherogenic particles, notably VLDL, IDL, LDL, and Lp(a), but also to atheroprotective HDL.
Collapse
Affiliation(s)
- M John Chapman
- Dyslipidemia, Inflammation and Atherosclerosis Research Unit, UMR-S939, National Institute for Health and Medical Research (INSERM), Hôpital de la Pitié-Salpetriere, Paris, France.
| | | | | | | |
Collapse
|
15
|
Chapman MJ, Le Goff W, Guerin M, Kontush A. Cholesteryl ester transfer protein: at the heart of the action of lipid-modulating therapy with statins, fibrates, niacin, and cholesteryl ester transfer protein inhibitors. Eur Heart J 2009; 31:149-64. [PMID: 19825813 PMCID: PMC2806550 DOI: 10.1093/eurheartj/ehp399] [Citation(s) in RCA: 226] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Subnormal plasma levels of high-density lipoprotein cholesterol (HDL-C) constitute a major cardiovascular risk factor; raising low HDL-C levels may therefore reduce the residual cardiovascular risk that frequently presents in dyslipidaemic subjects despite statin therapy. Cholesteryl ester transfer protein (CETP), a key modulator not only of the intravascular metabolism of HDL and apolipoprotein (apo) A-I but also of triglyceride (TG)-rich particles and low-density lipoprotein (LDL), mediates the transfer of cholesteryl esters from HDL to pro-atherogenic apoB-lipoproteins, with heterotransfer of TG mainly from very low-density lipoprotein to HDL. Cholesteryl ester transfer protein activity is elevated in the dyslipidaemias of metabolic disease involving insulin resistance and moderate to marked hypertriglyceridaemia, and is intimately associated with premature atherosclerosis and high cardiovascular risk. Cholesteryl ester transfer protein inhibition therefore presents a preferential target for elevation of HDL-C and reduction in atherosclerosis. This review appraises recent evidence for a central role of CETP in the action of current lipid-modulating agents with HDL-raising potential, i.e. statins, fibrates, and niacin, and compares their mechanisms of action with those of pharmacological agents under development which directly inhibit CETP. New CETP inhibitors, such as dalcetrapib and anacetrapib, are targeted to normalize HDL/apoA-I levels and anti-atherogenic activities of HDL particles. Further studies of these CETP inhibitors, in particular in long-term, large-scale outcome trials, will provide essential information on their safety and efficacy in reducing residual cardiovascular risk.
Collapse
Affiliation(s)
- M John Chapman
- INSERM, UMR S939, Dyslipidemia, Inflammation and Atherosclerosis Research Unit, University Pierre and Marie Curie-Paris 6, Pavillon Benjamin Delessert, Hôpital de la Pitié, 83 Boulevard de l'Hôpital, Paris Cedex 13, France.
| | | | | | | |
Collapse
|
16
|
Su JW, Nzekwu MMU, Cabezas MC, Redgrave T, Proctor SD. Methods to assess impaired post-prandial metabolism and the impact for early detection of cardiovascular disease risk. Eur J Clin Invest 2009; 39:741-54. [PMID: 19563468 DOI: 10.1111/j.1365-2362.2009.02179.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Post-prandial lipaemia has emerged as a key contributor to cardiovascular disease (CVD) risk and progression. Specifically, delayed clearance of chylomicrons (CM) and their remnants increase the delivery of triglyceride and cholesteryl ester to the vessel wall and can accelerate the progression of atherosclerosis, which may be particularly pertinent to individuals with insulin resistance and/or obesity. As the number of studies linking post-prandial metabolism and chronic disease increases, interest has grown in the use of parameters reflecting CM metabolism as a possible indicator of early CVD risk. This, in turn has raised the question of what method might be most appropriate to detect CM and their remnants in plasma accurately. However, the handful of techniques able to measure CM metabolism (triglyceride-rich lipoprotein fractions; remnant-lipoprotein cholesterol; retinyl esters, CM-like emulsion; sodium dodecyl sulphate-polyacrylamide gel electrophoresis; immunoblotting, enzyme-linked immunoabsorbent assays; C(13) breath test; capillary finger prick) differ in their specificity, cost and applicability in research and in the clinical setting. In this review, we explore the scientific and clinical implications of CM methodology to better understand early risk assessment of CVD. We raise ongoing issues of the need to appreciate differential separation of very low-density lipoprotein and CM fractions, as well as to identify the technical basis for imprecision between assays for apolipoprotein B48. We also highlight emerging issues with respect to the practicality of measuring post-prandial metabolism in large clinical studies and offer opinions on the appropriateness of existing techniques in this field.
Collapse
Affiliation(s)
- J W Su
- Alberta Institute for Human Nutrition, University of Alberta, AB, Canada
| | | | | | | | | |
Collapse
|
17
|
Abbasi F, Lamendola C, Leary ET, Reaven GM. Pioglitazone decreases postprandial accumulation of remnant lipoproteins in insulin-resistant smokers. Diabetes Obes Metab 2009; 11:779-85. [PMID: 19476476 DOI: 10.1111/j.1463-1326.2009.01041.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fasting hypertriglyceridaemia has been reported to occur commonly in cigarette smokers and is thought to increase cardiovascular disease (CVD) risk in these individuals. More recently, it has been suggested that an increase in non-fasting triglycerides, rather than fasting hypertriglyceridaemia, is an independent CVD risk factor. METHODS In this study, we divided 24 smokers into insulin-resistant (IR) and insulin-sensitive (IS) groups by determining their steady-state plasma glucose concentrations during the insulin suppression test and compared fasting and daylong postprandial accumulation of total triglycerides and remnant lipoprotein (RLP) concentrations, before and after 3 months of pioglitazone (PIO) administration. RESULTS The two groups were similar in age, body mass index, race and gender distribution, but differed dramatically in insulin sensitivity. Baseline fasting and postprandial triglyceride, RLP cholesterol and RLP triglyceride concentrations were significantly higher in the IR smokers (p=0.01 to <0.01). Insulin resistance [corrected] and both fasting and postprandial triglyceride and RLP triglyceride levels decreased significantly (p=0.05 to 0.01) [corrected] in PIO-treated IR smokers, without any significant increase in weight instead of insulin sensitivity and both fasting and postprandial triglyceride and RLP triglyceride levels decreased significantly (p = 0.05 to, 0.01) in PIO-treated IR smokers, without any significant increase in weight. [corrected] CONCLUSIONS The postprandial accumulation of RLP particles is increased in the IR subset of smokers and is likely to contribute to the increased CVD risk in these individuals. Furthermore, PIO administration provides a possible therapeutic approach to decreasing postprandial lipaemia and CVD risk in IR smokers who are unwilling or unable to stop smoking.
Collapse
Affiliation(s)
- F Abbasi
- Department of Medicine, Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5406, USA.
| | | | | | | |
Collapse
|
18
|
Chatterjee C, Young EK, Pussegoda KA, Twomey EE, Pandey NR, Sparks DL. Hepatic High-Density Lipoprotein Secretion Regulates the Mobilization of Cell-Surface Hepatic Lipase. Biochemistry 2009; 48:5994-6001. [DOI: 10.1021/bi802009e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - Nihar R. Pandey
- Lipoprotein and Atherosclerosis Research Group, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | | |
Collapse
|
19
|
Reyes-Soffer G, Holleran S, Karmally W, Ngai CI, Chen NT, Torres M, Ramakrishnan R, Blaner WS, Berglund L, Ginsberg HN, Tuck C. Measures of postprandial lipoproteins are not associated with coronary artery disease in patients with type 2 diabetes mellitus. J Lipid Res 2009; 50:1901-9. [PMID: 19429886 DOI: 10.1194/jlr.m900092-jlr200] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Individuals with type 2 diabetes mellitus (DM) characteristically have elevated fasting and postprandial (PP) plasma triglycerides (TG). Previous case-control studies indicated that PPTG levels predict the presence of coronary artery disease (CAD) in people without DM; however, the data for patients with DM are conflicting. Therefore, we conducted a case-control study in DM individuals, 84 with (+) and 80 without (-) CAD. Our hypothesis was that DM individuals with or without CAD would have similar PPTG levels, but CAD+ individuals would have more small d<1.006 g/L lipoprotein particles. Several markers of PP lipid metabolism were measured over 10 h after a fat load. PP lipoprotein size and particle number were also determined. There was no significant difference in any measure of PP lipid metabolism between CAD+ and CAD-, except for apoB48, which was actually higher in CAD-. We followed 69 CAD- participants for a mean 8.7 years; 33 remained free of any cardiovascular event. There were no PP differences at baseline between these 33 who remained CAD- and either the 36 original CAD- who subsequently developed CAD or the original CAD+ group.PP measurements of TG-rich lipoproteins do not predict the presence of CAD in individuals with DM.
Collapse
Affiliation(s)
- Gissette Reyes-Soffer
- Departments of Medicine, Columbia University Medical Center, New York, NY 10032, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Rudkowska I, Verreault M, Barbier O, Vohl MC. Differences in transcriptional activation by the two allelic (L162V Polymorphic) variants of PPARα after Omega-3 fatty acids treatment. PPAR Res 2009; 2009:369602. [PMID: 19266045 PMCID: PMC2649533 DOI: 10.1155/2009/369602] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 11/26/2008] [Accepted: 12/21/2008] [Indexed: 02/08/2023] Open
Abstract
Omega-3 fatty acids (FAs) have the potential to regulate gene expression via the peroxisome proliferator-activated receptor α (PPARα); therefore, genetic variations in this gene may impact its transcriptional activity on target genes. It is hypothesized that the transcriptional activity by wild-type L162-PPARα is enhanced to a greater extent than the mutated variant (V162-PPARα) in the presence of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) or a mixture of EPA:DHA. To examine the functional difference of the two allelic variants on receptor activity, transient co-transfections were performed in human hepatoma HepG2 cells activated with EPA, DHA and EPA:DHA mixtures. Results indicate that the addition of EPA or DHA demonstrate potential to increase the transcriptional activity by PPARα with respect to basal level in both variants. Yet, the EPA:DHA mixtures enhanced the transcriptional activity to a greater extent than individual FAs indicating possible additive effects of EPA and DHA. Additionally, the V162 allelic form of PPARα demonstrated consistently lower transcriptional activation when incubated with EPA, DHA or EPA:DHA mixtures than, the wild-type variant. In conclusion, both allelic variants of the PPARα L162V are activated by omega-3 FAs; however, the V162 allelic form displays a lower transcriptional activity than the wild-type variant.
Collapse
Affiliation(s)
- Iwona Rudkowska
- Lipid Research Center, CHUL Research Center, QC, Canada G1V 4G2
- Department of Food Science and Nutrition, Laval University, QC, Canada G1V 0A6
- Nutraceuticals and Functional Foods Institute (INAF), Laval University, QC, Canada G1V 0A6
| | - Mélanie Verreault
- Laboratory of Molecular Pharmacology, Oncology and Genomic Research Center, CHUL Research Center, QC, Canada G1V 4G2
- Faculty of Pharmacy, Laval University, QC, Canada G1V 0A6
| | - Olivier Barbier
- Laboratory of Molecular Pharmacology, Oncology and Genomic Research Center, CHUL Research Center, QC, Canada G1V 4G2
- Faculty of Pharmacy, Laval University, QC, Canada G1V 0A6
| | - Marie-Claude Vohl
- Lipid Research Center, CHUL Research Center, QC, Canada G1V 4G2
- Department of Food Science and Nutrition, Laval University, QC, Canada G1V 0A6
- Nutraceuticals and Functional Foods Institute (INAF), Laval University, QC, Canada G1V 0A6
| |
Collapse
|
21
|
De Lima JJ, Latrilha MDC, Toffoletto O, Ianhez LE, Krieger EM, Maranhão RC. Plasma kinetics of chylomicron-like emulsion in renal transplant patients receiving cyclosporin-based immunosuppression. Clin Cardiol 2009; 21:411-3. [PMID: 9631270 PMCID: PMC6655711 DOI: 10.1002/clc.4960210608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is prevalent among renal transplant patients. Increase in serum total cholesterol, low-density lipoprotein, and very low-density lipoprotein is common in those patients. Alterations in chylomicron metabolism, however, are also related to atherogenesis and were not studied in renal transplant. HYPOTHESIS The aim of this study was to evaluate chylomicron metabolism in renal transplant recipients receiving cyclosporin-based immunosuppression. We determined the plasma kinetics of triglyceride-rich emulsions labeled with [3H]triolein and [14C]cholesteryl oleate that are known to mimic the chylomicron metabolism when injected into the blood stream. METHODS Fourteen renal transplant recipients with normal renal function (10 men, 4 women, aged 40 +/- 6.1 years) and 17 age- and gender-matched healthy controls received bolus injections of the chylomicron-like emulsion. Plasma samples were then taken at regular intervals during 60 min. Disappearance curves of the labels and the respective fractional clearance rates (FCR) were calculated in order to measure lipolysis and chylomicron remnant removal from the plasma. RESULTS Fasting serum lipid levels did not differ in the two groups. The difference between Median FCR of [3H]triolein emulsion in renal transplant patients and that obtained in the controls (0.07 vs. 0.11 min-1, NS) was not statistically significant. Median FCR of [14C]cholesteryl oleate also did not differ between the groups (patients: 0.044; controls: 0.046, NS). CONCLUSION These results indicate that neither chylomicron lipolysis nor remnant removal are affected in stable renal transplant patients treated with cyclosporin-based immunosuppression.
Collapse
Affiliation(s)
- J J De Lima
- Hypertension Unit, Hospital das Clínicas, São Paulo University Medical School, Brazil
| | | | | | | | | | | |
Collapse
|
22
|
Kolovou GD, Kostakou PM, Anagnostopoulou KK, Cokkinos DV. Therapeutic effects of fibrates in postprandial lipemia. Am J Cardiovasc Drugs 2009; 8:243-55. [PMID: 18690758 DOI: 10.2165/00129784-200808040-00004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hypertriglyceridemia is observed in many metabolic diseases such as the metabolic syndrome, diabetes mellitus, or mixed dyslipidemia frequently leading to premature coronary heart disease (CHD). Additionally, several studies have shown that postprandial hypertriglyceridemia is pronounced in patients with CHD, metabolic syndrome, hypertension, and other pathologic conditions. The triglyceride-rich lipoprotein remnants accumulating in the postprandial state seem to be involved in atherogenesis and in events leading to thrombosis. Since abnormal postprandial lipemia is associated with pathologic conditions, its treatment is of clinical importance.Fibrates are of significant help in managing hypertriglyceridemia. This review summarizes the effect of fibric acid derivatives on postprandial lipemia. Fibrates decrease the production of and enhance the catabolism of triglyceride-rich lipoproteins through the activation of peroxisome proliferator-activated receptor-alpha. Results of clinical studies with fibrates have confirmed their action in decreasing postprandial triglyceride levels by increasing lipoprotein lipase activity, decreasing apolipoprotein CIII production, and by increasing fatty acid oxidation in the liver.It is concluded that fibrates are effective agents in lowering the postprandial increase in remnant lipoprotein particles and retinyl palmitate. Furthermore, fibrates can also affect the postprandial lipid profile by increasing hepatic lipase levels and in some cases, by reducing cholesterol ester transfer protein activity. The main target of fibrate therapy is to improve fasting hypertriglyceridemia, which is an essential component associated with improving postprandial lipemia. Fibrates are well tolerated by patients and adverse effects have been reported rarely after their administration.
Collapse
Affiliation(s)
- Genovefa D Kolovou
- 1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
| | | | | | | |
Collapse
|
23
|
Möller NP, Scholz-Ahrens KE, Roos N, Schrezenmeir J. Bioactive peptides and proteins from foods: indication for health effects. Eur J Nutr 2008; 47:171-82. [DOI: 10.1007/s00394-008-0710-2] [Citation(s) in RCA: 290] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 04/28/2008] [Indexed: 08/30/2023]
|
24
|
|
25
|
Nielsen NS, Pedersen A, Sandström B, Marckmann P, Høy CE. Different effects of diets rich in olive oil, rapeseed oil and sunflower-seed oil on postprandial lipid and lipoprotein concentrations and on lipoprotein oxidation susceptibility. Br J Nutr 2007. [DOI: 10.1079/bjn2002567] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elevated concentrations of fasting and non-fasting triacylglycerol-rich lipoproteins (TRL) as well as oxidative changes of lipoproteins may increase the risk of ischaemic heart disease. To compare the effects of different diets rich in unsaturated fatty acids on the concentrations andin vitrooxidation of fasting and postprandial lipoproteins eighteen males consumed diets enriched with rapeseed oil (RO), olive oil (OO), or sunflower-seed oil (SO) in randomised order for periods of 3 weeks followed by a RO test meal. In the postprandial state the concentrations of cholesterol and triacylglycerol (TAG) in TRL were higher after consumption of OO compared with RO and SO (P<0·04), possibly related to differences in the fasting state. The propagation rates for VLDL and LDL oxidation were higher in the postprandial compared with the fasting state irrespective of diet. In the fasting state, the propagation rates were highest after SO (P<0·001), and in the postprandial state, SO gave rise to a shorter VLDL lag time (P=0·03) and a higher propagation rate than OO consumption (P=0·04). Overall, the SO diet resulted in a higher postprandial propagation rate of LDL (P<0·001) compared with RO and OO, while there was no effect of diet on LDL oxidation lag time. Our results suggest that RO and SO diets lower the postprandial cholesterol and TAG concentrations compared with OO, while RO and OO diets result in similar and lowerin vitrosusceptibility to oxidation of lipoproteins than SO.
Collapse
|
26
|
Postprandial lipoprotein, glucose and insulin responses after two consecutive meals containing rapeseed oil, sunflower oil or palm oil with or without glucose at the first meal. Br J Nutr 2007. [DOI: 10.1017/s0007114599001245] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is increasing evidence that the degree of postprandial lipaemia may be of importance in the development of atherosclerosis and IHD. Postprandial lipid, lipoprotein, glucose, insulin and non-esterified fatty acid (NEFA) concentrations were investigated in eleven healthy young males after randomized ingestion of meals containing rapeseed oil, sunflower oil or palm oil with or without a glucose drink. On six occasions each subject consumed consecutive meals (separated by 1·75 h) containing 70 g (15 g and 55 g respectively) of each oil. On one occasion with each oil 50 g glucose was taken with the first meal. One fasting and fifteen postprandial blood samples were taken over 9 h. There were no statistically significant differences in lipoprotein and apolipoprotein responses after rapeseed, sunflower and palm oils, whereas insulin responses were lower after sunflower oil than after rapeseed oil (ANOVA, P = 0·04). The NEFA and triacylglycerol concentrations at 1·5 h were reduced when 50 g glucose was taken with the first meal (ANOVA, P < 0·0001 and P < 0·05 respectively), regardless of meal fatty acid composition. In conclusion, the consumption of glucose with a mixed meal containing either rapeseed, sunflower or palm oil influenced the immediate triacylglycerol and NEFA responses compared with the same meal without glucose, whereas no significant effect on postprandial lipaemia after a subsequent meal was observed. The fatty acid composition of the meal did not significantly affect the lipid and lipoprotein responses, whereas an effect on insulin responses was observed.
Collapse
|
27
|
Heath RB, Karpe F, Milne RW, Burdge GC, Wootton SA, Frayn KN. Dietary fatty acids make a rapid and substantial contribution to VLDL-triacylglycerol in the fed state. Am J Physiol Endocrinol Metab 2007; 292:E732-9. [PMID: 17090753 DOI: 10.1152/ajpendo.00409.2006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Exaggerated postprandial lipemia is associated with coronary heart disease and type II diabetes, yet few studies have examined the effect of sequential meals on lipoprotein metabolism. We have used 13C-labeled fatty acids to trace the incorporation of fatty acid derived from a meal into apolipoprotein B-100 (apoB-100)-containing lipoproteins and plasma nonesterified fatty acids (NEFA) following two consecutive meals. Healthy volunteers (n=8) were given breakfast labeled with [1-(13)C]palmitic acid, eicosapentaenoic acid, and docosahexaenoic acid, followed 5 h later by lunch containing [1-(13)C]oleic acid. Blood samples were taken over a 9-h period. ApoB-100-containing lipoproteins were isolated by immunoaffinity chromatography. Chylomicron-triacylglycerol (TG) concentrations peaked at 195 min following breakfast but at 75 min following lunch (P<0.001). VLDL-TG concentrations, in contrast, rose to a broad peak after breakfast and then fell steadily after lunch. Breakfast markers followed chylomicron-TG concentrations and appeared in plasma NEFA with a similar profile, whereas [1-(13)C]oleic acid peaked 2 h after lunch in plasma TG and NEFA. Breakfast markers appeared steadily in VLDL, peaking 1-3 h after lunch, whereas [1-(13)C]oleic acid was still accumulating in VLDL at 9 h. Around 17% of VLDL-TG originated from recent dietary fat 5 h after breakfast, and around 40% at the end of the experiment. We conclude that there is rapid flux of fatty acids from the diet into endogenous pools. Further study of these processes may open up new targets for intervention to reduce VLDL-TG concentrations and postprandial lipemia.
Collapse
Affiliation(s)
- Richard B Heath
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK
| | | | | | | | | | | |
Collapse
|
28
|
Abstract
Increased postprandial lipemia or elevated levels of triglyceride-rich remnant lipoproteins in fasting plasma are associated with increased risk of coronary artery disease. Despite many studies showing that postprandial triglyceride-rich lipoproteins play a central role in the pathogenesis of atherosclerosis, suitably standardized methods to measure postprandial lipemia or remnant lipoproteins in the clinical setting are lacking. This approach for cardiovascular risk assessment is confined to research laboratories and for the time being is not a standard procedure in clinical practice.
Collapse
Affiliation(s)
- Jeffrey S Cohn
- Nutrition and Metabolism Group, Heart Research Institute, 114 Pyrmont Bridge Road, Camperdown, NSW 2050, Australia.
| |
Collapse
|
29
|
Noto D, Rizzo M, Barbagallo CM, Cefalù AB, Verde AL, Fayer F, Notarbartolo A, Averna MR. Low-density lipoproteins generated during an oral fat load in mild hypertriglyceridemic and healthy subjects are smaller, denser, and have an increased low-density lipoprotein receptor binding affinity. Metabolism 2006; 55:1308-16. [PMID: 16979400 DOI: 10.1016/j.metabol.2006.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
Abstract
Triglyceride-rich lipoproteins generated during the postprandial phase are atherogenic. Large very low-density lipoproteins (LDLs) or chylomicrons (CMs) are not as atherogenic as their remnants (Rem). Small and dense LDLs are associated with cardiovascular disease. Low-density lipoprotein size is partly under genetic control and is considered as a relatively stable LDL feature. In this article, we present data on retinyl palmitate kinetics correlated with the modification of LDL features in terms of size, density, and in vitro receptor binding affinity after an oral fat load. Six nondiabetic, hypertriglyceridemic (HTG) patients and 6 healthy controls were examined. Low-density lipoprotein size was assessed by gradient gel electrophoresis, and LDL density by density gradient ultracentrifugation. Low-density lipoprotein binding affinity was tested by in vitro competition binding assay on normal human skin fibroblasts (HSFs) and hepatoma cells (HepG2). Kinetic parameters were estimated in CM and Rem fractions by compartmental modeling. Hypertriglyceridemic patients showed significantly higher triglyceride area and a slower CM fractional catabolic rate. Postprandial LDL density increased both in HTG patients and in the control group with a significant difference between groups at 6 hours. Fasting LDL size was lower in HTG patients vs controls but decreased similarly in the postprandial phase. Low-density lipoprotein size and density postprandial modifications were not correlated with any investigated parameter. Postprandial LDLs were internalized more efficiently by HSF than baseline LDL only in the HTG group. In conclusion, postprandial LDLs are smaller and denser compared with fasting LDLs after an oral fat load. Postprandial LDLs also slightly increased their affinity to the HSF cell receptors.
Collapse
Affiliation(s)
- Davide Noto
- Department of Internal Medicine, University of Palermo, I-90127 Palermo, Italy
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Tziomalos K, Athyros VG. Fenofibrate: a novel formulation (Triglide) in the treatment of lipid disorders: a review. Int J Nanomedicine 2006; 1:129-47. [PMID: 17722529 PMCID: PMC2426786 DOI: 10.2147/nano.2006.1.2.129] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cardiovascular disease is the major cause of mortality worldwide and accounts for approximately 40% of all deaths. Dyslipidemia is one of the primary causes of atherosclerosis and effective interventions to correct dyslipidemia should form an integral component of any strategy aimed at preventing cardiovascular disease. Fibrates have played a major role in the treatment of hyperlipidemia for more than two decades. Fenofibrate is one of the most commonly used fibrates worldwide. Since fenofibrate was first introduced in clinical practice, a major drawback has been its low bioavailability when taken under fasting conditions. Insoluble Drug Delivery-Microparticle fenofibrate is a new formulation that has an equivalent extent of absorption under fed or fasting conditions. In this review, we will discuss the clinical pharmacology of fenofibrate, with particular emphasis on this novel formulation, as well as its lipid-modulating and pleiotropic actions. We will also analyze the major trial that evaluated fibrates for primary and secondary prevention of cardiovascular disease, the safety and efficacy profile of fibrate-statin combination treatment, and the current recommendations regarding the use of fibrates in clinical practice.
Collapse
Affiliation(s)
- Konstantinos Tziomalos
- Atherosclerosis and Metabolic Syndrome Units, 2nd Prop. Department of Internal Medicine, Aristotelian University, Hippokration Hospital, Thessaloniki, Greece
| | | |
Collapse
|
31
|
Carstensen M, Thomsen C, Gotzsche O, Holst JJ, Schrezenmeir J, Hermansen K. Differential postprandial lipoprotein responses in type 2 diabetic men with and without clinical evidence of a former myocardial infarction. Rev Diabet Stud 2005; 1:175-84. [PMID: 17491702 PMCID: PMC1783690 DOI: 10.1900/rds.2004.1.175] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Postprandial lipemia plays an important role in the development of coronary heart disease through an elevation of triglyceride-rich lipoproteins. In type 2 diabetic male subjects, our aim was to compare postprandial lipemia in a high-risk population with former myocardial infarction (MI) with that of a lower risk population free of clinically detectable heart disease. 32 male type 2 diabetic subjects were included in the study. We matched 17 cases with a verified history of MI with 15 controls according to age, BMI, HbA1c, diabetes duration, smoking, and treatment of diabetes. Ongoing metformin, insulin, or lipid lowering pharmacological treatment were exclusion criteria. After a maximal exercise tolerance test and echocardiography, the subjects underwent a hyperinsulinemic, euglycemic clamp and a vitamin A fat loading test. Plasma triglyceride levels in the case group were significantly higher after 360 minutes (4.6 +/- 3.1 vs. 2.8 +/- 1.8 mmol/l, p = 0.04) and 480 minutes (3.6 +/- 2.2 vs. 2.4 +/- 2.4 mmol/l, p = 0.03), as was the incremental Area Under the Curve (iAUC) for the whole period (560 +/- 452 vs. 297 +/- 214 mmol x 480 min./l; p = 0.048). In addition, the retinyl palmitate responses in the chylomicron-fraction from the case group were significantly higher (iAUC 311,502 +/- 194,933 vs. 187,004 +/- 102,928 ng x 480 min./ml; p = 0.035). Type 2 diabetic males with prior MI had higher postprandial triglyceride-rich lipoprotein responses than those without MI, indicating that high responses may be a marker for a high-risk population.
Collapse
Affiliation(s)
- Marius Carstensen
- Department of Endocrinology and Metabolism C, Aarhus University Hospital, Aarhus Sygehus THG, Tage-Hansens Gade 2, DK-8000 Aarhus, Denmark.
| | | | | | | | | | | |
Collapse
|
32
|
Giannattasio C, Zoppo A, Gentile G, Failla M, Capra A, Maggi FM, Catapano A, Mancia G. Acute Effect of High-Fat Meal on Endothelial Function in Moderately Dyslipidemic Subjects. Arterioscler Thromb Vasc Biol 2005; 25:406-10. [PMID: 15576637 DOI: 10.1161/01.atv.0000152231.93590.17] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hypercholesterolemia markedly impairs endothelial function. Whether this is the case for hypertriglyceridemia is less clear, however, and limited evidence exists on the effect of an acute increase in triglyceridemia caused by a high-fat meal. METHODS AND RESULTS In 16 normotensive subjects with an untreated mild hypertriglyceridemia and dyslipidemia and in 7 normal controls, we measured radial artery diameter and blood flow by an echo-tracking device (NIUS02). Data were obtained at baseline, at the release of a 4-minute ischemia of the hand, which causes an increase in arterial diameter dependent on nitric oxide (NO) secretion, and at the release of a 12-minute exclusion of the arm by an arm cuff to obtain a larger increase in arterial diameter mainly of nonendothelial nature. Measurements were performed before and 6 hours after a high-fat meal (680 kcal/m(2) body surface; 82% lipids). In mild dyslipidemic hypertriglyceridemic subjects, the high-fat meal did not alter baseline blood pressure (beat-to-beat finger measurement), heart rate, radial artery diameter, and blood flow. It also did not alter the increase in blood flow induced by the 4-minute ischemia (+42.7+/-10.4 and +43.7+/-10.4 mL/min), whereas it markedly attenuated the concomitant increase in arterial diameter (+0.31+/-0.06 versus 0.13+/-0.06 mm; P<0.05). The alteration of the diameter response did not correlate with changes in total cholesterol, but it showed a significant correlation with the increase in serum triglycerides induced by high-fat meal (r=0.49, P<0.05). This attenuation was not seen in control subjects and in subjects in whom measurements were repeated after a 6-hour observation period. It was also not paralleled by an alteration of the endothelially independent response to a 12-minute ischemia whose larger effects on arterial diameter and blood flow were similar before and after the high-fat meal. CONCLUSIONS Endothelial function is markedly impaired by a high-fat meal that causes an acute hypertriglyceridemia. This impairment is evident in dyslipidemic patients with baseline hypertriglyceridemia but not in normotriglyceridemic controls. An oral fat load was administered to 55 HIV-positive and 10 HIV-negative individuals. Postprandial clearance of triglyceride-rich lipoproteins was delayed in HIV-positive individuals. Compared with HIV-positive subjects not on PIs, those taking PIs do not have increased postprandial triglyceride-rich lipoproteins but do have increased postprandial intermediate-density and low-density lipoproteins. Hypercholesterolemia impairs endothelial function, whereas the effect of hypertriglyceridemia is less clear. In normotensive subjects with an untreated hypertriglyceridemia and hypercholesterolemia, we measured endothelial function before and 6 hours after a high-fat meal. The results demonstrate that in moderately dyslipidemic patients, endothelial function is impaired by acute hypertriglyceridemia.
Collapse
Affiliation(s)
- C Giannattasio
- Clinica Medica, University of Milano-Bicocca and San Gerardo Hospital, Monza, Italy
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Kondo S, Xiao JZ, Takahashi N, Miyaji K, Iwatsuki K, Kokubo S. Suppressive effects of dietary fiber in yogurt on the postprandial serum lipid levels in healthy adult male volunteers. Biosci Biotechnol Biochem 2005; 68:1135-8. [PMID: 15170121 DOI: 10.1271/bbb.68.1135] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study assessed the effect of partially hydrolyzed guar gum (PHGG) in yogurt on the elevation of postprandial serum lipid levels. Eleven healthy adult male subjects were given yogurt with or without 6 g of PHGG in a fat tolerance test as a crossover study. Supplementation with 6 g of PHGG significantly suppressed the incremental peaks and areas under the incremental curve (AUIC) of postprandial serum remnant-like lipoprotein particle cholesterol (RLP-C) and triglyceride (TG). The results suggest the potential of PHGG to reduce the risk of hyperlipemia.
Collapse
Affiliation(s)
- Shizuki Kondo
- Food Research and Development Laboratory, Morinaga Milk Industry Co, Ltd, Zama, Japan
| | | | | | | | | | | |
Collapse
|
34
|
Ueshima K, Akihisa-Umeno H, Nagayoshi A, Takakura S, Matsuo M, Mutoh S. A gastrointestinal lipase inhibitor reduces progression of atherosclerosis in mice fed a western-type diet. Eur J Pharmacol 2004; 501:137-42. [PMID: 15464072 DOI: 10.1016/j.ejphar.2004.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 08/03/2004] [Accepted: 08/05/2004] [Indexed: 11/15/2022]
Abstract
To investigate whether gastrointestinal lipase inhibition reduces the progression of a western-type diet induced atherosclerosis, male apolipoprotein-E knockout (apoE KO) mice were administered orlistat ((S)-1-[[(S, 2S, 3S)-3-hexyl-4-oxo-2-oxetanyl] methyl]dodecyl-(S)-2-formamido-4-methylvalerate) mixed with a western-type diet for 8 weeks. Orlistat significantly reduced plasma triglyceride levels, but not total cholesterol levels, at 4 and 8 weeks of treatment. Increase in plasma triglyceride levels after oral olive oil loading in the mice fed a western-type diet was significantly suppressed in the orlistat treated group at 4 weeks of treatment. After 8 weeks treatment, atherosclerotic lesion area in the aorta of the orlistat treated group was significantly smaller than that of the control group. These results suggest that gastrointestinal lipase inhibition reduces the progression of atherosclerosis through a triglyceride-lowering effect, via inhibition of fat absorption.
Collapse
Affiliation(s)
- Koji Ueshima
- Medicinal Biology Research Laboratories, Fujisawa Pharmaceutical Co., Ltd., Kashima 2-1-6, Yodogawa-ku, Osaka 532-8514, Japan.
| | | | | | | | | | | |
Collapse
|
35
|
Marchesi S, Lupattelli G, Lombardini R, Roscini AR, Siepi D, Vaudo G, Pirro M, Sinzinger H, Schillaci G, Mannarino E. Effects of fenofibrate on endothelial function and cell adhesion molecules during post-prandial lipemia in hypertriglyceridemia. J Clin Pharm Ther 2004; 28:419-24. [PMID: 14632967 DOI: 10.1046/j.0269-4727.2003.00512.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fasting and post-prandial hypertriglyceridemia have been associated with endothelial dysfunction. OBJECTIVE To investigate the effects of a 3-month treatment with fenofibrate (200 mg daily) on endothelial reactivity and inflammatory state in hypertriglyceridemic patients at fast and after an oral fat load. METHODS Brachial flow-mediated vasodilation (FMV) and the circulating levels of intercellular adhesion molecule (ICAM) and vascular cellular adhesion molecule (VCAM) were determined in 10 hypertriglyceridemic patients. RESULTS Before treatment, post-prandial phase was characterized by an increase in triglycerides (3.7 +/- 1 mmol/L at baseline vs. 4.2 +/- 1, 6.5 +/- 1, 6.6 +/- 2, and 5.3 +/- 2 mmol/L after 2, 4, 6, and 8 h), a decrease in FMV (4.3 +/- 2% at baseline vs. 2.8 +/- 1, 2.2 +/- 1, and 1.3 +/- 1% after 2, 4, and 6 h), and an increase in ICAM and VCAM. After fenofibrate there was a significant reduction in fasting triglycerides (3.7 +/- 1.3 vs. 2.1 +/- 0.8 mmol/L), ICAM (480 +/- 113 vs. 269 +/- 65 ng/mL) and VCAM (1821 +/- 570 vs. 1104 +/- 376 ng/mL), and an increase in FMV (4.3 +/- 2 vs. 7.1 +/- 2%). Post-prandially triglycerides increased (2.1 +/- 1 at baseline vs. 2.4 +/- 2 and 3.6 +/- 1 mmol/L after 4 and 6 h), FMV decreased (7.1 +/- 2 at baseline vs. 5.8 +/- 2, 5.5 +/- 2, 5.9 +/- 2, 6.4 +/- 2% after 2, 4, 6, and 8 h), and there was an increase of ICAM and VCAM. Before therapy post-prandial changes in FMV had an inverse correlation with the changes in triglycerides (r = -0.34; P < 0.05) and ICAM (r = -0.66; P < 0.001). CONCLUSIONS The transient endothelial dysfunction observed in hypertriglyceridemic subjects during post-prandial lipemia is mediated by post-prandial triglyceride increase and by the activation of inflammatory response. The anti-inflammatory activity of fenofibrate may represent an additional mechanism of its favorable action on the endothelial function during fasting and the post-prandial phase.
Collapse
Affiliation(s)
- S Marchesi
- Unit of Internal Medicine, Angiology and Atherosclerosis, University of Perugia, Perugia, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Chacra APM, Santos RD, Amâncio RF, Schreiber R, Ramires JAF, Maranhão RC. Clearance of a 3H-labeled chylomicron-like emulsion following the acute phase of myocardial infarction. Int J Cardiol 2004; 93:181-7. [PMID: 14975545 DOI: 10.1016/s0167-5273(03)00159-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2002] [Revised: 01/24/2003] [Accepted: 03/04/2003] [Indexed: 11/18/2022]
Abstract
BACKGROUND Plasma lipids may be altered during acute myocardial infarction and may not reflect patient baseline lipid profile. The metabolism of chylomicrons, the lipoproteins that carry the dietary lipids in the bloodstream has not yet been studied in acute myocardial infarction patients. METHODS In this study, a lipidic emulsion that mimics the intravascular behavior of chylomicrons labeled with cholesteryl oleate ((3)H-CO) was injected intravenously in 17 normolipidemic patients on the seventh and on the 45th day post-non complicated acute myocardial infarction after a 12-h fast. The plasma decay curve of the emulsion label was determined from blood samples collected during 60 min. Data were also compared with a group of 10 patients with chronic coronary artery disease. RESULTS In the acute myocardial infarction group, the plasma fractional catabolic rates of the emulsion (3)H-CO, expressed as median and confidence intervals, did not change from the seventh to the 45th day after the acute event [0.0773 (0.061, 0.1025) min(-1) vs. 0.0672 (0.00507, 0.1009) min(-1) P=0.61] and was similar to that determined in chronic coronary artery disease patients. High-density lipoprotein cholesterol and apolipoprotein AI were lower on the seventh day when compared to the 45th day post acute myocardial infarction (P=0.01 and P=0.004, respectively). No changes were found in LDL and total cholesterol as well as in plasma triglycerides in myocardial infarction group. CONCLUSIONS No changes were found in chylomicron metabolism is in the acute phase of myocardial infarction.
Collapse
Affiliation(s)
- Ana Paula M Chacra
- Heart Institute (InCor) University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
37
|
Bilz S, Wagner S, Schmitz M, Bedynek A, Keller U, Demant T. Effects of atorvastatin versus fenofibrate on apoB-100 and apoA-I kinetics in mixed hyperlipidemia. J Lipid Res 2004; 45:174-85. [PMID: 14523053 DOI: 10.1194/jlr.m300309-jlr200] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Kinetics of apo B and apo AI were assessed in 8 patients with mixed hyperlipidemia at baseline and after 8 weeks of atorvastatin 80 mg q.d. and micronised fenofibrate 200 mg q.d. in a cross-over study. Both increased hepatic production and decreased catabolism of VLDL accounted for elevated cholesterol and triglyceride concentrations at baseline. Atorvastatin significantly decreased triglyceride, total, VLDL and LDL cholesterol and apo B concentrations (-65%, -36%, -57%, -40% and -33%, respectively, P<0.05). Kinetic analysis revealed that atorvastatin stimulated the catabolism of apo B containing lipoproteins, enhanced the delipidation of VLDL1 and decreased VLDL1 production. Fenofibrate lowered triglycerides and VLDL cholesterol (-57% and -64%, respectively, P<0.05) due to enhanced delipidation of VLDL1 and VLDL2 and increased VLDL1 catabolism. Changes of HDL particle composition accounted for the increase of HDL cholesterol during atorvastatin and fenofibrate (18% and 23%, P<0.01). Only fenofibrate increased apo AI concentrations through enhanced apo AI synthesis (45%, P<0.05). We conclude that atorvastatin exerts additional beneficial effects on the metabolism of apo B containing lipoproteins unrelated to an increase in LDL receptor activity. Fenofibrate but not atorvastatin increases apo AI production and plasma turnover.
Collapse
Affiliation(s)
- Stefan Bilz
- Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
38
|
Almeida KA, Schreiber R, Amâncio RF, Bydlowski SP, Debes-Bravo A, Issa JS, Strunz CMC, Maranhão RC. Metabolism of chylomicron-like emulsions in carriers of the S447X lipoprotein lipase polymorphism. Clin Chim Acta 2003; 335:157-63. [PMID: 12927697 DOI: 10.1016/s0009-8981(03)00289-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lipoprotein lipase catalyzes the hydrolysis of the triglycerides contained in both very-low-density lipoproteins and chylomicrons for storage in the adipose tissue and muscle of fats of both hepatic and dietary origin. The S447X-Stop lipoprotein lipase is the most common polymorphism of the enzyme, affecting roughly 20% of the population and is accompanied by normal or diminished fasting triglycerides and perhaps lower incidence of coronary artery disease (CAD). Delay in the removal of chylomicron and remnant is now an established risk factor for CAD. METHODS Currently, the chylomicron metabolism has been evaluated in 12 normolipidemic subjects with the S447X-Stop and in 13 age- and sex-paired control subjects with no mutation. The doubly labeled chylomicron-like emulsion method was used to evaluate chylomicron metabolism. The emulsions labeled with cholesteryl-oleate (14C-CE) and tri[9,10-3H]oleate (3H-Tg) were injected intravenously and the decay curves of the labels were determined by blood sampling over 60 min followed by radioactive counting. RESULTS The fractional clearance rate (FCR, min(-1)) of the labels was not different in the S447X carriers compared with the noncarriers (FCR 3H-Tg 0.035 +/- 0.019 and 0.030 +/- 0.009; FCR 14C-CE 0.008 +/- 0.007 and 0.009 +/- 0.007, respectively). CONCLUSIONS The chylomicron intravascular lipolysis monitored by the 3H-Tg emulsion and the remnant removal monitored by the 14C-CE emulsion were not altered by the presence of this polymorphism of great populational impact.
Collapse
Affiliation(s)
- Katia A Almeida
- Faculty of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
The purpose of this report is to synthesize the results from studies examining the effect of exercise on postprandial lipemia to summarize the existing data and provide direction for future research. A quantitative review of the literature was performed using meta-analytic methods to quantify the effect sizes. Moderator analyses were performed to examine features of the studies that could potentially influence the effect of exercise on postprandial lipemia. Thirty-eight effects from 555 people were retrieved from 29 studies. The mean weighted effect was moderate as indicated by Cohen's d (d = -0.57; 95% confidence interval [CI], -0.71 to -0.43), indicating that people who perform exercise before meal ingestion exhibit a 0.5 standard deviation reduction in the postprandial triglyceride (TG) response relative to persons in comparison groups. There was no significant effect of study design, gender, age, type of meal ingested, exercise intensity, exercise duration, or timing of exercise on the postprandial response (P >.05). There was, however, significant variation in the effect sizes, for women for exercise performed within 24 hours of meal ingestion, and for exercise performed more than 24 hours before meal ingestion (P <.01). For studies that reported the energy expenditure of exercise, there was a significant relationship between effect size and energy expenditure (r = -.62, P =.02). Results from this quantitative review of the literature suggest that exercise has a moderate effect on the postprandial lipemic response and that the energy expenditure of prior exercise may play a role in the magnitude of this effect. Other factors that may affect the response remain to be clarified.
Collapse
Affiliation(s)
- Darby S Petitt
- Department of Exercise Science, University of Georgia, Athens, USA
| | | |
Collapse
|
40
|
Bae JH, Schwemmer M, Lee IK, Lee HJ, Park KR, Kim KY, Bassenge E. Postprandial hypertriglyceridemia-induced endothelial dysfunction in healthy subjects is independent of lipid oxidation. Int J Cardiol 2003; 87:259-67. [PMID: 12559548 DOI: 10.1016/s0167-5273(02)00347-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND To analyze the effects of postprandial hypertriglyceridemia with or without antioxidant supplementation-on endothelial function as related to lipid oxidation in healthy young subjects. METHODS AND RESULTS Ten healthy male subjects (mean age: 26 years) were examined three times in fasting state (10 hours) following a high-fat meal, a low-fat meal, or a high-fat meal with additional antioxidant vitamin E (800 IU), respectively. Serum triglycerides significantly increased 2 and 4 hours after eating the high-fat meal with or without additional vitamin E. Endothelium-dependent, flow-mediated brachial artery vasodilations (FMD; percentage change in diameter) changed from 13.3+/-1.1% to 6.6+/-1.1% (p<0.05), 7.1+/-0.6% (p<0.05), or 13.2+/-0.8% at 2, 4, or 6 hours after eating a high-fat meal. However, there were no changes of FMD observed following either a low-fat meal or a high-fat meal with additional vitamin E. The flow-dependent vasodilation inversely correlated to postprandial hypertriglyceridemia (r=-0.54, p<0.05). Serum malondialdehydes (MDA; lipid oxidation products) did not significantly change following ingestion of any of the 3 types of meal. CONCLUSIONS This study suggests that postprandial hypertriglyceridemia-induced endothelial dysfunction is not associated with lipid oxidation and that the protective effects of vitamin E on endothelial function may be due to some alternative, as of yet unknown, mechanism.
Collapse
Affiliation(s)
- Jang-Ho Bae
- Division of Cardiology, College of Medicine, Konyang University Hospital, Daejeon, South Korea.
| | | | | | | | | | | | | |
Collapse
|
41
|
Cavallero E, Dachet C, Assadolahi F, Martin C, Navarro N, Ansquer JC, Corda C, Foucher C, Juhan-Vague I, Jacotot B. Micronized fenofibrate normalizes the enhanced lipidemic response to a fat load in patients with type 2 diabetes and optimal glucose control. Atherosclerosis 2003; 166:151-61. [PMID: 12482562 DOI: 10.1016/s0021-9150(02)00321-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study evaluated the postprandial (PP) response to an oral fat load in 28 male patients with type 2 diabetes (mean HbA1c of 5.1%), all receiving metformin and performing physical exercise, compared with healthy subjects. The effects of micronized fenofibrate (200 mg once daily) on triglycerides (TG) and retinyl palmitate (RP) responses, lipoprotein mass concentrations, post-heparin lipase activities and coagulation factors were investigated after a 16-week double-blind, placebo-controlled period. Higher and delayed TG response after the oral fat load (P<0.001) corresponding to increases in both intestinally and endogenous TG-rich lipoproteins and lower lipoprotein lipase (LPL) activity 30 and 60 min post-heparin injection (P<0.05) were observed in the patients as compared with controls. Fasting PAI-1 activity, 6 h PP Factor VII and PAI-1 activities were higher in patients (P=0.036, P=0.032 and P=0.017, respectively). After fenofibrate treatment, TG and RP responses and peak LPL activity were no more significantly different from controls at baseline. Compared with placebo, fasting TG-rich lipoproteins and HDL(3) mass concentrations were significantly lower and higher, respectively; PP chylomicrons and very low density lipoprotein (VLDL) mass concentrations were lower; fasting and PP fibrinogen levels were significantly reduced after fenofibrate treatment. Diabetes control was unchanged throughout the study. Fenofibrate normalized the abnormal PP response and improved the fasting lipoprotein abnormalities in patients with type 2 diabetes and optimal glucose control.
Collapse
Affiliation(s)
- Elisabeth Cavallero
- Service de Médecine Interne, Nutrition, Métabolisme lipidique, CHU Henri-Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Zhou L, Xu N, Nilsson A. Association of prothrombin and protein S with plasma triglyceride-rich lipoproteins in humans after test meals rich in milk fat or soybean oil. Thromb Res 2002; 108:209-13. [PMID: 12617983 DOI: 10.1016/s0049-3848(03)00062-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Prothrombin can associate with rat chylomicrons in vitro. This enhances a platelet factor Xa mediated prothrombin activation when the chylomicron-prothrombin complex is exposed to platelets. Vitamin K-dependent pro- and anti-coagulation proteins are associated with TG-rich lipoproteins obtained from human plasma. In the present study, we examined the effects of saturated and unsaturated fat meals on the association of prothrombin and protein S with TG-rich lipoproteins in vivo. MATERIALS AND METHODS Human EDTA plasma was separated from normal subjects after overnight fasting and 2.5 h after ingestion of either a saturated fat meal (butter and cream) or an unsaturated fat meal (soybean oil) containing 54-80 g fat (60.2 E%). The prothrombin and protein S in delipidated lipoproteins were determined by SDS-PAGE combined with Western blotting. RESULTS Both prothrombin and protein S associated with TG-rich lipoproteins in fasting and in postprandial samples. The levels of prothrombin and protein S in postprandial TG-rich lipoproteins, especially after ingestion of a saturated fat meal, were higher than those in fasting TG-rich lipoproteins. CONCLUSIONS The levels of both prothrombin and protein S in TG-rich lipoproteins in plasma increased after a single fat meal. This association is more pronounced after saturated fat meals and one may hypothesize that it can be linked to atherogenic properties of TG-rich lipoproteins.
Collapse
Affiliation(s)
- Li Zhou
- Gastroenterology Division, Department of Medicine, Lund University, Tornavägen, Sweden.
| | | | | |
Collapse
|
43
|
Guerin M, Egger P, Soudant C, Le Goff W, van Tol A, Dupuis R, Chapman MJ. Cholesteryl ester flux from HDL to VLDL-1 is preferentially enhanced in type IIB hyperlipidemia in the postprandial state. J Lipid Res 2002; 43:1652-60. [PMID: 12364549 DOI: 10.1194/jlr.m200135-jlr200] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Postprandial triglyceride-rich lipoproteins (TRL) exert proatherogenic effects at the arterial wall, including lipid deposition. Following consumption of a mixed meal (1200 kcal), plasma-mediated cellular free cholesterol (FC) efflux, lecithin:cholesterol acyltransferase (LCAT), and cholesteryl ester transfer protein (CETP) activities were determined in subjects (n = 12) displaying type IIB hyperlipidemia and compared with those in a normolipidemic control group (n = 14). The relative capacity of plasma to induce FC efflux from Fu5AH cells via the SR-BI receptor was significantly increased 4 h postprandially (+23%; P < 0.005) in the type IIB group, whereas it remained unchanged for postprandial plasma from normolipidemic subjects. LCAT activity was significantly elevated 2 h postprandially in both the IIB and control groups, (+46% and +36%, respectively; P < 0.005 vs. respective baseline value). In type IIB subjects, total cholesteryl ester (CE) mass transfer from HDL to total TRL [chylomicrons (CMs) + VLDL-1 + VLDL-2 + IDL] increased progressively from 15 +/- 2 micro g CE/h/ml at baseline to 28 +/- 2 micro g CE transferred/h/ml (+87%; P = 0.0004) at 4 h postprandially. CE transfer to CMs and VLDL-1 was preferentially stimulated (2.6-fold and 2.3-fold respectively) at 4 h in IIB subjects and occurred concomitantly with elevation in mass and particle number of both CMs (2.3-fold) and VLDL-1 (1.3-fold). Furthermore, in type IIB subjects, CETP-mediated total CE flux over the 8 h postprandial period from HDL to potentially atherogenic TRL was significantly enhanced, and notably to VLDL-1 (32-fold elevation; P < 0.005), relative to control subjects. Such CE transfer flux was reflected in a significant postprandial increase in CE-TG ratio in both CMs and VLDL-1 in type IIB plasmas. In conclusion, HDL-CE is preferentially targeted to VLDL-1 via the action of CETP during alimentary lipemia, thereby favoring formation and accumulation of atherogenic CE-rich remnant particles.
Collapse
Affiliation(s)
- Maryse Guerin
- Institut National de la Santé et de la Recherche Médicale, INSERM Unité 551, Dyslipoproteinemia and Atherosclerosis, Hôpital de la Pitié, 75651 Paris, France.
| | | | | | | | | | | | | |
Collapse
|
44
|
Khan S, Minihane AM, Talmud PJ, Wright JW, Murphy MC, Williams CM, Griffin BA. Dietary long-chain n-3 PUFAs increase LPL gene expression in adipose tissue of subjects with an atherogenic lipoprotein phenotype. J Lipid Res 2002. [DOI: 10.1016/s0022-2275(20)30473-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
45
|
Abstract
Exaggerated postprandial hyperlipidemia has been associated with cardiovascular disease. The mechanisms underlying this association are likely to depend on a multitude of effects. Potentially atherogenic remnants of triglyceride-rich lipoproteins (TRL) accumulate in the postprandial state. In addition, TRL may promote the formation of small dense LDL. There are some indications that the postprandial period is a hypercoagulable state and endothelial function seems to be hampered after acute fat intake. Conventional lipid lowering drugs such as statins and fibrates have the potency of reducing postprandial hyperlipidemia, but the fibrates seem to be more effective in this respect. There is a complete lack of prospective studies linking inefficient postprandial lipid metabolism with clinical endpoints and there is also a need to include investigations of postprandial lipid metabolism in the evaluation of novel drugs affecting lipid metabolism and insulin resistance.
Collapse
Affiliation(s)
- Fredrik Karpe
- Oxford Lipid Metabolism Group, Oxford Centre for Diabetes, Metabolism and Endocrinology, Radcliffe infirmary, UK.
| |
Collapse
|
46
|
Boquist S, Karpe F, Danell-Toverud K, Hamsten A. Effects of atorvastatin on postprandial plasma lipoproteins in postinfarction patients with combined hyperlipidaemia. Atherosclerosis 2002; 162:163-70. [PMID: 11947910 DOI: 10.1016/s0021-9150(01)00689-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Enhanced and prolonged postprandial lipaemia is implicated in coronary and carotid artery disease. This study assessed the effects of atorvastatin, a 3-hydroxy-3-methylglutaryl-CoA reductase inhibitor, on postprandial plasma concentrations of triglyceride-rich lipoproteins (TRLs). Sixteen middle-aged men with combined hyperlipidaemia (baseline low density lipoprotein (LDL) cholesterol and plasma triglyceride concentrations (median (interquartile range) of 4.54 (4.17-5.26)) and 2.66 (2.04-3.20) mmol/l, respectively) and previous myocardial infarction were randomised to atorvastatin 40 mg or placebo once daily for 8 weeks in a double-blind, cross-over design. The apolipoprotein (apo) B-48 and B-100 contents were determined in subfractions of TRLs as a measure of chylomicron remnant and very low density lipoprotein (VLDL) particle concentrations (expressed as mg apo B-48 or apo B-100 per litre of plasma), in the fasting state and after intake of a mixed meal. Atorvastatin treatment reduced significantly the fasting plasma concentrations of VLDL cholesterol, LDL cholesterol and VLDL triglycerides (median% change) by 29, 44 and 27%, respectively, and increased high density lipoprotein (HDL) cholesterol by 19%, compared with baseline. The postprandial plasma concentrations of large (Svedberg flotation rate (Sf) 60-400) and small (Sf 20-60) VLDLs and chylomicron remnants were almost halved compared with baseline (mean 0-6 h plasma concentrations were reduced by 48% for Sf 60-400 apo B-100, by 46% for Sf 60-400 apo B-48, by 46% for Sf 20-60 apo B-100 and by 27% for Sf 20-60 apo B-48), and the postprandial triglyceridaemia was reduced by 23% during active treatment. In conclusion, atorvastatin 40 mg once daily causes profound reductions of postprandial plasma concentrations of all TRLs in combined hyperlipidaemic patients with premature coronary artery disease.
Collapse
Affiliation(s)
- Susanna Boquist
- Atherosclerosis Research Unit, King Gustaf V Research Institute, Karolinska Institutet, Karolinska Hospital, S-171 76 Stockholm, Sweden.
| | | | | | | |
Collapse
|
47
|
Ballantyne CM, Rangaraj GR. The evolving role of high-density lipoprotein in reducing cardiovascular risk. PREVENTIVE CARDIOLOGY 2002; 4:65-72. [PMID: 11828202 DOI: 10.1111/j.1520-037x.2001.00556.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In many patients with coronary artery disease, a low level of high-density lipoprotein cholesterol (HDL-C), rather than substantially elevated low-density lipoprotein cholesterol (LDL-C), is often the predominant lipid abnormality. Although the National Cholesterol Education Program treatment guidelines include HDL-C concentration as a major risk factor for primary prevention, the guidelines' emphasis on LDL-C as the primary target of therapy may cause uncertainty as to whether risk reduction strategies should focus on lowering LDL-C or raising HDL-C in high-risk patients with low HDL-C. Recent clinical trial evidence and epidemiologic data suggest that HDL-C should play a more important role in risk assessment, and that the definition of low HDL-C may need adjustment from the current National Cholesterol Education Program definition of <35 mg/dL to perhaps <40 mg/dL in men and <45 mg/dL in women. Patients with low HDL-C should receive aggressive risk factor modification, and more emphasis on increasing HDL-C may be warranted in addition to lowering LDL-C. (c) 2001 by CHF, Inc.
Collapse
Affiliation(s)
- C M Ballantyne
- Section of Atheroscelorsis, Department of Medicine, Baylor College of Medicine, Houston, TX 77030
| | | |
Collapse
|
48
|
Funada JI, Sekiya M, Hamada M, Hiwada K. Postprandial elevation of remnant lipoprotein leads to endothelial dysfunction. Circ J 2002; 66:127-32. [PMID: 11999636 DOI: 10.1253/circj.66.127] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent studies have demonstrated that elevated levels of cholesterol in the form of remnant-like particles (RLP-C) induce deterioration of endothelial function during the fasting state, but it is not known whether postprandial RLP-C elevation has the same effect. The objective of this study was to assess the effect of postprandial RLP-C elevation on endothelial function in 24 fasting normolipidemic subjects. Flow-mediated dilatation (FMD) during reactive hyperemia in the brachial artery was investigated. Serum lipids and lipoproteins during fasting and 4h after regular fat-loading were measured. Subjects were divided into 2 groups: the high responders (postprandial RLP-C level >7.5mg/dl, n=8) and the normal responders (postprandial RLP-C level < or =7.5mg/dl, n=16). Significant increases in the level of both triglycerides and RLP-C were observed in the high responders. Basal FMD in the high responders (4.3+/-3.0%) was significantly lower than that in the normal responders (8.3+/-2.4%) (p<0.01), but FMD after the fat-loading in both groups did not change significantly. The change in RLP-C levels during the fat-loading test correlated significantly with basal FMD (r=-0.588, p<0.01). Multiple regression analysis showed a significant correlation between basal FMD and the change in RLP-C levels (r=-0.488, p<0.02). The results of this study suggest that postprandial RLP-C elevation could be associated with atherosclerotic progression even in normolipidemic subjects.
Collapse
Affiliation(s)
- Jun-ichi Funada
- Department of Cardiology, Ehime National Hospital, Ehime University School of Medicine, Japan.
| | | | | | | |
Collapse
|
49
|
Abstract
One-fifth of all humans who have survived beyond the age of 65 are alive today, and in the industrialized world the elderly segment of the population is expanding most rapidly. In biological terms, these survivors are healthier than the elderly of previous generations. However 'there are no diseases peculiar to old age and very few from which it is exempt' (Alfred Worcester, 1855-1951), and so society will inevitably accumulate a significant share of degenerative diseases within the ranks of its senior citizens. In the last two decades, the prevalence of stroke, diabetes mellitus, arthritis and heart disease has increased significantly as a tangible index of ageing in the population, and these diseases have been accompanied by degenerating cognitive function and physical disability, both of which are adding increasing stress to community healthcare and social services. Policy-makers need to understand and monitor these trends in order to make informed and cogent decisions about the management of this growing problem. This review highlights some of the key health issues facing the elderly in regard to coronary artery disease, insulin resistance, redox status, and statin therapy, in the hope that enlightened debate will inform decision making on resource allocation for this important and growing segment of society.
Collapse
Affiliation(s)
- J Shepherd
- Institute of Biochemistry, Royal Infirmary, Glasgow, Scotland, UK.
| |
Collapse
|
50
|
Ai M, Tanaka A, Ogita K, Sekinc M, Numano F, Numano F, Reaven GM. Relationship between plasma insulin concentration and plasma remnant lipoprotein response to an oral fat load in patients with type 2 diabetes. J Am Coll Cardiol 2001; 38:1628-32. [PMID: 11704373 DOI: 10.1016/s0735-1097(01)01611-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate the relative effects of hyperglycemia and hyperinsulinemia on postprandial remnant lipoprotein (RLP) concentrations in newly diagnosed type 2 diabetics. BACKGROUND Increases in fasting RLP concentration have been described in type 2 diabetics, as well as in insulin-resistant nondiabetics. Given the atherogenicity of RLPs, we have extended these observations by assessing postprandial RLP concentrations and observing that hyperglycemia was necessary for the increase in RLP concentrations. METHODS Patients with type 2 diabetes were subdivided on the basis of their plasma insulin response to oral glucose into hyperinsulinemic (H-DM) and normoinsulinemic (N-DM) groups of 15 patients each. Plasma triglyceride (TG), RLP-TG and RLP cholesterol (RLP-C) concentrations were determined before and 2 and 4 h after an oral fat load in these patients and 10 control (CTL) subjects. RESULTS Plasma TG, RLP-TG and RLP-C concentrations peaked 2 h after the fat load in the CTL group, returning to baseline within 4 h. In contrast, concentrations of these variables increased throughout the 4-h study in both groups of patients with type 2 diabetes. Total integrated plasma RLP-TG and RLP-C responses above baseline after the oral fat load were significantly higher in the H-DM group compared with the CTL (p = 0.019 and 0.009, respectively) or N-DM (p = 0.026 and 0.029, respectively) groups. Post-heparin lipoprotein lipase activities and apo E phenotypes were similar in the H-DM and N-DM groups. CONCLUSIONS Remnant lipoprotein response to an oral fat load is significantly increased in hyperinsulinemic patients with type 2 diabetes. These changes may increase the risk of coronary heart disease in these individuals.
Collapse
Affiliation(s)
- M Ai
- Third Department of Internal Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|