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Glavinovic T, Thanassoulis G, de Graaf J, Couture P, Hegele RA, Sniderman AD. Physiological Bases for the Superiority of Apolipoprotein B Over Low-Density Lipoprotein Cholesterol and Non-High-Density Lipoprotein Cholesterol as a Marker of Cardiovascular Risk. J Am Heart Assoc 2022; 11:e025858. [PMID: 36216435 DOI: 10.1161/jaha.122.025858] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In 2019, the European Society of Cardiology/European Atherosclerosis Society stated that apolipoprotein B (apoB) was a more accurate marker of cardiovascular risk than low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol. Since then, the evidence has continued to mount in favor of apoB. This review explicates the physiological mechanisms responsible for the superiority of apoB as a marker of the cardiovascular risk attributable to the atherogenic apoB lipoprotein particles chylomicron remnants, very low-density lipoprotein, and low-density lipoprotein particles. First, the nature and relative numbers of these different apoB particles will be outlined. This will make clear why low-density lipoprotein particles are almost always the major determinants of cardiovascular risk and why the concentrations of triglycerides and LDL-C may obscure this relation. Next, the mechanisms that govern the number of very low-density lipoprotein and low-density lipoprotein particles will be outlined because, except for dysbetalipoproteinemia, the total number of apoB particles determines cardiovascular risk, Then, the mechanisms that govern the cholesterol mass within very low-density lipoprotein and low-density lipoprotein particles will be reviewed because these are responsible for the discordance between the mass of cholesterol within apoB particles, measured either as LDL-C or non-high-density lipoprotein cholesterol, and the number of apoB particles measured as apoB, which creates the superior predictive power of apoB over LDL-C and non-high-density lipoprotein cholesterol. Finally, the major apoB dyslipoproteinemias will be briefly outlined. Our objective is to provide a physiological framework for health care givers to understand why apoB is a more accurate marker of cardiovascular risk than LDL-C or non-high-density lipoprotein cholesterol.
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Affiliation(s)
- Tamara Glavinovic
- Division of Nephrology, Department of Medicine McGill University Health Centre Montreal Quebec Canada
| | - George Thanassoulis
- Mike and Valeria Centre for Cardiovascular Prevention, Department of Medicine McGill University Health Centre Montreal Quebec Canada
| | - Jacqueline de Graaf
- University of Nijmegen Radboud University Medical Center Department of General Internal Medicine Nijmegen the Netherlands
| | - Patrick Couture
- Université Laval Centre Hospitalier Universitaire de Québec Quebec Canada
| | - Robert A Hegele
- Robarts Research Institute and Department of Medicine, Schulich School of Medicine and Dentistry Western University London Ontario Canada
| | - Allan D Sniderman
- Mike and Valeria Centre for Cardiovascular Prevention, Department of Medicine McGill University Health Centre Montreal Quebec Canada
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Vaverková H, Karásek D, Halenka M, Cibíčková L, Kubíčková V. Inverse association of lipoprotein (a) with markers of insulin resistance in dyslipidemic subjects. Physiol Res 2017; 66:S113-S120. [PMID: 28379036 DOI: 10.33549/physiolres.933583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lipoprotein (a) [Lp(a)] is an LDL-like particle that contains an apolipoprotein B100 molecule covalently bound to a plasminogen-like glycoprotein, apolipoprotein (a) [apo(a)]. Epidemiological evidence supports a direct and causal association between Lp(a) levels and coronary risk. On the contrary, a few prospective findings demonstrate inverse association of Lp(a) levels with risk of type 2 diabetes (T2DM). The aim of our study was to evaluate the association of Lp(a) with indicators of insulin resistance (IR) and metabolic syndrome (MS), which precede development of T2DM. We enrolled 607 asymptomatic dyslipidemic subjects (295 men and 312 women, mean age 45.6+/-14.0 years) into our cross-sectional study. Lp(a) concentrations correlated inversely with TG, AIP, insulin, HOMA, C-peptide, BMI, waist circumference, and number of MS components (p<0.01 for all). Subjects with MS had significantly lower Lp(a) concentrations in comparison with those without the presence of this phenotype (p<0.0001). Serum concentrations of Lp(a) in the lower (1(th)-3(rd)) quartiles of insulin and HOMA were significantly higher than in the 4(th) quartile of these insulin resistance markers (p<0.001). Odds ratios of having increased markers of IR (TG, HOMA) and MS in top quartile of Lp(a) also indicate inverse association of Lp(a) with IR. The results of our study support an inverse association of Lp(a) levels with IR and MS that precedes overt T2DM diagnosis.
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Affiliation(s)
- H Vaverková
- Third Department of Internal Medicine - Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
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Martinez-Hervas S, Artero A, Martinez-Ibañez J, Tormos MC, Gonzalez-Navarro H, Priego A, Martinez-Valls JF, Saez GT, Real JT, Carmena R, Ascaso JF. Increased thioredoxin levels are related to insulin resistance in familial combined hyperlipidaemia. Eur J Clin Invest 2016; 46:636-42. [PMID: 27208733 DOI: 10.1111/eci.12642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/18/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Thioredoxins (TRX) are major cellular protein disulphide reductases that are critical for redox regulation. Oxidative stress and inflammation play promoting roles in the genesis and progression of atherosclerosis, but until now scarce data are available considering the influence of TRX activity in familial combined hyperlipidaemia (FCH). Since FCH is associated with high risk of cardiovascular disease, the objective of the present study was to assess oxidative stress status in FCH patients, and evaluate the influence of insulin resistance (IR). MATERIALS AND METHODS A cohort of 35 control subjects and 35 non-related FCH patients were included, all of them nondiabetic, normotensive and nonsmokers. We measured lipid profile, glucose and insulin levels in plasma, and markers of oxidative stress and inflammation such as oxidized glutathione (GSSG), reduced glutathione (GSH) and TRX. RESULTS Familial combined hyperlipidaemia subjects showed significantly higher levels of GSSG, GSSG/GSH ratio and TRX than controls. In addition, FCH individuals with IR showed the worst profile of oxidative stress status compared to controls and FCH patients without IR (P < 0·01). TRX levels correlated with higher insulin resistance. CONCLUSION Familial combined hyperlipidaemia patients showed increased TRX levels. TRX was positively correlated with IR. These data could partially explain the increased risk of cardiovascular events in primary dyslipidemic patients.
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Affiliation(s)
- Sergio Martinez-Hervas
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
| | - Ana Artero
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain
| | - Juncal Martinez-Ibañez
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain
| | | | - Herminia Gonzalez-Navarro
- CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain.,Institute of Health Research-INCLIVA, Valencia, Spain
| | - Antonia Priego
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Jose F Martinez-Valls
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain
| | - Guillermo T Saez
- Department of Biochemistry and Molecular Biology, University of Valencia-INCLIVA, Valencia, Spain.,Service of Clinical Analysis, Dr. Peset University Hospital, Valencia, Spain
| | - Jose T Real
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
| | - Rafael Carmena
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
| | - Juan F Ascaso
- Service of Endocrinology and Nutrition, University Clinic Hospital of Valencia, Valencia, Spain.,Department of Medicine, University of Valencia, Valencia, Spain.,CIBERDEM, Biomedical Network Research Centre in Diabetes and Metabolic Related Diseases, Madrid, Spain
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Medeiros AM, Alves AC, Bourbon M. Mutational analysis of a cohort with clinical diagnosis of familial hypercholesterolemia: considerations for genetic diagnosis improvement. Genet Med 2015; 18:316-24. [DOI: 10.1038/gim.2015.71] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/21/2015] [Indexed: 11/09/2022] Open
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Skoumas J, Liontou C, Chrysohoou C, Masoura C, Aznaouridis K, Pitsavos C, Stefanadis C. Statin therapy and risk of diabetes in patients with heterozygous familial hypercholesterolemia or familial combined hyperlipidemia. Atherosclerosis 2014; 237:140-5. [PMID: 25238223 DOI: 10.1016/j.atherosclerosis.2014.08.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/15/2014] [Accepted: 08/21/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Controversial findings exist regarding potential influence of statin therapy on diabetic incidence. Aim of this study was to investigate the role of long duration statin treatment on diabetes mellitus (DM) incidence of Heterozygous Familial Hypercholesterolemia (hFH) and Familial Combined Hyperlipidemia (FCH) patients. METHODS Study population consisted of 212 hFH and 147 FCH patients that visited Lipid Outpatient Department (mean follow up of 11 and 10 years respectively). Several clinical data such as history of DM, cardiovascular disease, thyroid function, metabolic syndrome, glucose levels, lipid profile and lifestyle data were obtained. In order to compare the effects of different doses of different types of statins, a "statin treatment intensity product" was used. RESULTS 14% of FCH and only 1% of hFH patients developed DM during follow up. Although univariate analysis showed a statistical trend (p = 0.06) in the association between new onset DM and statin treatment intensity (STI) in the FCH subgroup of patients with normal baseline glucose levels, this was no longer significant after adjusting for several confounders. Furthermore, the type of statins used did not seem to play a role in the development of DM either in hFH or FCH patients. CONCLUSION Long duration of high STI does not seem to be associated with diabetic risk in hFH patients. High STI used in the FCH population is not associated with increased risk of new onset DM compared to low STI. Further studies are required in order to clarify the potential diabetogenic effects of statins in these high risk populations.
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Affiliation(s)
- John Skoumas
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vasilissis Sofias str., 115 27, Athens, Greece.
| | - Catherine Liontou
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vasilissis Sofias str., 115 27, Athens, Greece.
| | - Christina Chrysohoou
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vasilissis Sofias str., 115 27, Athens, Greece.
| | - Constantina Masoura
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vasilissis Sofias str., 115 27, Athens, Greece.
| | - Konstantinos Aznaouridis
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vasilissis Sofias str., 115 27, Athens, Greece.
| | - Christos Pitsavos
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vasilissis Sofias str., 115 27, Athens, Greece.
| | - Christodoulos Stefanadis
- First Department of Cardiology, Athens Medical School, Hippokration Hospital, 114 Vasilissis Sofias str., 115 27, Athens, Greece
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Verduci E, Agostoni C, Radaelli G, Banderali G, Riva E, Giovannini M. Blood lipids profile in hyperlipidemic children undergoing different dietary long chain polyunsaturated supplementations: a preliminary clinical trial. Int J Food Sci Nutr 2013; 65:375-9. [PMID: 24228803 DOI: 10.3109/09637486.2013.858239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this preliminary study was to explore the effect size of different dietary long chain polyunsaturated supplementations on blood lipid profile in children with primary hyperlipidemia. Thirty-six children (8-13 years) were recruited. After an 8-week stabilization period on the Step I diet, they were randomized to additionally receive for a 16-week period one capsule (500 mg) daily of docosahexaenoic acid (DHA) alone or a DHA plus eicosapentaenoic acid (EPA) mixture (45.6% DHA; 41.6% EPA) or wheat germ oil (control). An effect size (as percentage change from baseline) of +8%, -12% and -16% for high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio and triglycerides was observed in children supplemented with DHA, compared to +2%, -8% and -12%, respectively, in children supplemented with DHA plus EPA. This preliminary study suggests powered trials appear feasible and are warranted to evaluate efficacy of n-3 long-chain polyunsaturated fatty acid dietary supplementations on the blood lipid profile of children with primary hyperlipidemia.
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Affiliation(s)
- Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, University of Milan , Milan , Italy
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7
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Genetic analysis of familial hypercholesterolaemia in Western Australia. Atherosclerosis 2012; 224:430-4. [DOI: 10.1016/j.atherosclerosis.2012.07.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 01/22/2023]
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Kusters DM, Vissers MN, Wiegman A, Kastelein JJP, Hutten BA. Treatment of dyslipidaemia in childhood. Expert Opin Pharmacother 2010; 11:739-53. [DOI: 10.1517/14656561003592169] [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]
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Abstract
BACKGROUND There is limited data available on characteristics of profiles of lipids in children. The purpose of our investigation, therefore, was to determine the lipid profile, and analyze the prevalence of dyslipidaemia, in subgroups of children according to different gender, districts of residence, and ages in Beijing, China. METHODS AND RESULTS We included 18,944 school children, aged from 7 to 18 years, in our community-based cross-sectional study, measuring the levels of total cholesterol and triglyceride in capillary blood, and at the same time determining their weight and height. Weights, heights, circumference at the waist, and body mass index proved to be significantly greater for the boys than the girls. The levels of total cholesterol of boys and girls were 3.98 +/- 0.35, and 4.02 +/- 0.35 mmol/L, respectively, while the comparable levels of triglycerides were 1.08 +/- 0.52, and 1.18 +/- 0.66 mmol/L, respectively. The percentages of hypercholesterolaemia, hypertriglyceridaemia, combined dyslipidaemia, and hyperlipidaemia were 1.2, 8.8, 0.4, and 9.7%, respectively. The incidences of hypertriglyceridaemia, combined dyslipidaemia, and hyperlipidaemia of girls were higher than boys. The levels of triglycerides for boys aged from 11 to 18 years living in an urban setting were higher than those for boys living in rural settings, as were the levels of total cholesterol for boys aged from 12 to 16 years. CONCLUSION Our study provides the newest current profiles of lipids for children living in Beijing. We found significant influences of age, districts of residence, and genders on the levels of lipids, features which need further attention in the prevention and treatment of dyslipidaemia.
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Adachi M, Muroya K, Asakura Y. Unfavorable lipoprotein profile in childhood cancer survivors with suprasellar brain tumors--a high Apo B level and increased small dense LDL-cholesterol. Childs Nerv Syst 2009; 25:669-75. [PMID: 19263058 DOI: 10.1007/s00381-009-0837-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 12/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate atherosclerotic potency among childhood cancer survivors (CCS) with suprasellar tumors. STUDY DESIGN Patients with remitted suprasellar tumors were recruited. A total of 17 subjects with simple obesity of similar ages served as obese controls. Fasting sera were subjected to determination of lipids and apolipoproteins (Apo), including small dense LDL-cholesterol (sdLDL-C). RESULTS Twenty-three patients (4-22 years old) were enrolled. Patients, 12/23, had a body mass index (BMI) above the 90th percentile and were designated as 'obese patients'. Obese patients had lower BMI scores (mean 26.4 kg/m(2), p < 0.01) compared to obese controls (mean 31.5 kg/m(2)). Both groups had identical levels of total cholesterol, triglycerides, LDL-C, and HDL-C. However, obese patients were found to have a higher incidence of Apo B/Apo A1 ratio elevation (6/12) than obese controls (0/17, p < 0.01). In addition, obese patients had higher sdLDL-C level (47.6 +/- 14.8 mg/dL) than obese controls (28.3 +/- 7.1 mg/dL, p < 0.01). BMI showed strong correlations with both the Apo B/Apo A1 ratio (r = 0.663, p < 0.001) and sdLDL-C (r = 0.606, p < 0.01). CONCLUSION CCS with suprasellar tumors, especially patients with a high BMI, had an unfavorable lipoprotein profile characterized by increased Apo B and sdLDL-C.
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Affiliation(s)
- Masanori Adachi
- Department of Endocrinology and Metabolism, Clinical Research Institute, Kanagawa Children's Medical Center, Minami-ku, Yokohama, Japan.
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Wiesbauer F, Blessberger H, Azar D, Goliasch G, Wagner O, Gerhold L, Huber K, Widhalm K, Abdolvahab F, Sodeck G, Maurer G, Schillinger M. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (<=40 years of age). Eur Heart J 2009; 30:1073-9. [DOI: 10.1093/eurheartj/ehp051] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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12
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Pitsavos C, Skoumas I, Masoura C, Aznaouridis K, Papadimitriou L, Chrysohoou C, Giotsas N, Toutouza M, Stefanadis C. Prevalence and determinants of coronary artery disease in males and females with familial combined hyperlipidaemia. Atherosclerosis 2008; 199:402-7. [DOI: 10.1016/j.atherosclerosis.2007.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 11/10/2007] [Accepted: 11/15/2007] [Indexed: 10/22/2022]
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van Himbergen TM, van Tits LJ, ter Avest E, Roest M, Voorbij HA, de Graaf J, Stalenhoef AF. Paraoxonase (PON1) is associated with familial combined hyperlipidemia. Atherosclerosis 2008; 199:87-94. [DOI: 10.1016/j.atherosclerosis.2007.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 10/01/2007] [Accepted: 10/22/2007] [Indexed: 10/22/2022]
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Skoumas J, Papadimitriou L, Pitsavos C, Masoura C, Giotsas N, Chrysohoou C, Toutouza M, Panagiotakos D, Stefanadis C. Metabolic syndrome prevalence and characteristics in Greek adults with familial combined hyperlipidemia. Metabolism 2007; 56:135-41. [PMID: 17161236 DOI: 10.1016/j.metabol.2006.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 09/18/2006] [Indexed: 12/14/2022]
Abstract
Familial combined hyperlipidemia (FCH) is closely related with metabolic syndrome (MetSyn), and coronary artery disease (CAD) is positively associated to MetSyn and FCH. In this study, we evaluated the prevalence of MetSyn and its components between patients with FCH and a control group. We also investigated the role of MetSyn and diabetes mellitus (DM) on the incidence of CAD within the FCH group. Our study population consisted of 463 male and 243 female patients with FCH who were not receiving any hypolipidemic treatment, and 1128 men and 1154 women who came from the same geographical region. The prevalence of MetSyn was 42% and 19.8% among FCH subjects and controls, respectively, whereas MetSyn increased with age in both groups. The prevalence of CAD was 15.3% in the FCH group. Moreover, after dividing FCH patients into 3 subgroups, with and without MetSyn and with DM, CAD prevailed at a percentage of 15.2%, 11.1%, and 26.5%, respectively. However, statistically significant differences in the prevalence of CAD were observed only between FCH subjects with DM compared with the other 2 subgroups, even when an adjustment for age, sex, and smoking was conducted. People with FCH and MetSyn differed in several anthropometric, biochemical, and clinical characteristics, compared with the non-MetSyn subgroup of FCH. MetSyn is more prevalent in the FCH than in the control group. Among subjects with FCH, only DM was significantly associated with an increase in the prevalence of CAD in this subgroup compared with FCH individuals with or without MetSyn.
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Affiliation(s)
- John Skoumas
- First Cardiology Department, School of Medicine, University of Athens, Athens 11527, Greece
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van der Vleuten GM, Isaacs A, Zeng WW, ter Avest E, Talmud PJ, Dallinga-Thie GM, van Duijn CM, Stalenhoef AFH, de Graaf J. Haplotype analyses of the APOA5 gene in patients with familial combined hyperlipidemia. Biochim Biophys Acta Mol Basis Dis 2006; 1772:81-8. [PMID: 17157483 DOI: 10.1016/j.bbadis.2006.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 10/15/2006] [Accepted: 10/20/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Familial combined hyperlipidemia (FCH) is the most common genetic lipid disorder with an undefined genetic etiology. Apolipoprotein A5 gene (APOA5) variants were previously shown to contribute to FCH. The aim of the present study was to evaluate the association of APOA5 variants with FCH and its related phenotypes in Dutch FCH patients. Furthermore, the effects of variants in the APOA5 gene on carotid intima-media thickness (IMT) and cardiovascular disease (CVD) were examined. MATERIALS AND METHODS The study population consisted of 36 Dutch families, including 157 FCH patients. Two polymorphisms in the APOA5 gene (-1131T>C and S19W) were genotyped. RESULTS Haplotype analysis of APOA5 showed an association with FCH (p=0.029), total cholesterol (p=0.031), triglycerides (p<0.001), apolipoprotein B (p=0.011), HDL-cholesterol (p=0.013), small dense LDL (p=0.010) and remnant-like particle cholesterol (p=0.001). Compared to S19 homozygotes, 19W carriers had an increased risk of FCH (OR=1.6 [1.0-2.6]; p=0.026) and a more atherogenic lipid profile, reflected by higher triglyceride (+22%) and apolipoprotein B levels (+5%), decreased HDL-cholesterol levels (-7%) and an increased prevalence of small dense LDL (16% vs. 26%). In carriers of the -1131C allele, small dense LDL was more prevalent than in -1131T homozygotes (29% vs. 16%). No association of the APOA5 gene with IMT and CVD was evident. CONCLUSION In Dutch FCH families, variants in the APOA5 gene are associated with FCH and an atherogenic lipid profile.
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Affiliation(s)
- Gerly M van der Vleuten
- Department of Medicine, Division of General Internal Medicine, 463, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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van der Vleuten GM, Isaacs A, Hijmans A, van Duijn CM, Stalenhoef AFH, de Graaf J. The involvement of upstream stimulatory factor 1 in Dutch patients with familial combined hyperlipidemia. J Lipid Res 2006; 48:193-200. [PMID: 17065663 DOI: 10.1194/jlr.m600184-jlr200] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recently, the upstream stimulatory factor 1 gene (USF1) was proposed as a candidate gene for familial combined hyperlipidemia (FCH). In this study, we examined the previously identified risk haplotype of USF1 with respect to FCH and its related phenotypes in 36 Dutch FCH families. The diagnosis of FCH was based on both the traditional diagnostic criteria and a nomogram. The two polymorphisms, USF1s1 and USF1s2, were in complete linkage disequilibrium. No association was found for the individual single nucleotide polymorphisms (SNPs) with FCH defined by the nomogram (USF1s1, P = 0.53; USF1s2, P = 0.53), whereas suggestive associations were found when using the traditional diagnostic criteria for FCH (USF1s1, P = 0.08; USF1s2, P = 0.07). USF1 was associated with total cholesterol (USF1s1, P = 0.05; USF1s2, P = 0.04) and apolipoprotein B (USF1s1, P = 0.06; USF1s2, P = 0.04). Small dense LDL showed a suggestive association (USF1s1, P = 0.10; USF1s2, P = 0.09). The results from the haplotype analyses supported the results obtained for the individual SNPs. In conclusion, the previously identified risk haplotype of USF1 showed a suggestive association with FCH and contributed to the related lipid traits in our Dutch FCH families.
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Affiliation(s)
- Gerly M van der Vleuten
- Department of Medicine, Division of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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van der Vleuten GM, Kluijtmans LA, Hijmans A, Blom HJ, Stalenhoef AFH, de Graaf J. The Gln223Arg polymorphism in the leptin receptor is associated with familial combined hyperlipidemia. Int J Obes (Lond) 2006; 30:892-8. [PMID: 16432543 DOI: 10.1038/sj.ijo.0803234] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Familial combined hyperlipidemia (FCH) is characterized by elevated levels of total cholesterol (TC), triglycerides (TG) and apolipoprotein B (apo B) and is associated with premature cardiovascular disease (CVD). Other features of FCH are obesity and insulin resistance. Serum leptin levels have also been associated with obesity, insulin resistance and atherosclerosis. Leptin exerts its effect through the leptin receptor (LEPR). The aim of this study is to determine whether the Gln223Arg polymorphism in the LEPR gene contributes to FCH and its associated phenotypes. METHODS The study population consists of 37 families, comprising 644 subjects, of whom 158 subjects were diagnosed as FCH. The FCH diagnosis was based on plasma TC and TG levels, adjusted for age and gender, and absolute apo B levels, according to our recently published nomogram. The Gln223Arg polymorphism was studied by restriction fragment length polymorphism-PCR. RESULTS Carriers of one or two Arg alleles had an increased risk of FCH, compared to subjects homozygous for the Gln allele (OR=1.6 [95% CI 1.0-2.4]). A difference in high-density lipoprotein cholesterol (HDL-c) levels was present between carriers and non-carriers of an Arg allele, 1.21 vs 1.28 mmol/l, respectively (P=0.04), but no differences in obesity, insulin resistance and other lipid parameters were found. CONCLUSION The Gln223Arg polymorphism in the LEPR gene is associated with FCH, which is supported by a significant association between HDL-c levels and the LEPR gene.
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Affiliation(s)
- G M van der Vleuten
- Department of Medicine, Division of General Internal Medicine, Nijmegen, The Netherlands.
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van der Vleuten GM, van Tits LJH, den Heijer M, Lemmers H, Stalenhoef AFH, de Graaf J. Decreased adiponectin levels in familial combined hyperlipidemia patients contribute to the atherogenic lipid profile. J Lipid Res 2005; 46:2398-404. [PMID: 16106049 DOI: 10.1194/jlr.m500212-jlr200] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Familial combined hyperlipidemia (FCH) is characterized by increased levels of total cholesterol, triglycerides, and/or apolipoprotein B. Other features of FCH are obesity and insulin resistance. Adiponectin is a secretory product of the adipose tissue. Low levels of adiponectin are associated with insulin resistance and accelerated atherosclerosis. The aim of this study was to determine whether decreased adiponectin levels are associated with FCH and its phenotypes. The study population comprised 644 subjects, including 158 patients with FCH. Serum adiponectin levels were determined using a commercially available ELISA. For both males and females, the mean adiponectin level (microg/ml) was significantly lower in FCH patients [2.0 (1.8-2.2) and 2.5 (2.3-2.8), respectively] compared with normolipidemic relatives [2.3 (2.2-2.5) and 3.1 (2.8-3.3), respectively] and spouses [2.4 (2.1-2.7) and 3.2 (2.8-3.6), respectively]. These differences remain significant after adjusting for waist circumference and insulin resistance. Low adiponectin level in FCH patients was a superior independent predictor of the atherogenic lipid profile, including high triglyceride levels, low HDL-cholesterol levels, and the amount of small, dense LDL present, compared with both obesity and insulin resistance. Low adiponectin levels may contribute to the atherogenic lipid profile in FCH, independent of insulin resistance and obesity, as measured by waist circumference. This finding implies a role of adipose tissue metabolism in the pathophysiology of FCH.
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Affiliation(s)
- Gerly M van der Vleuten
- Department of Medicine and Division of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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