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Liu Y, Jin X, Fu K, Li J, Xue W, Tian L, Teng W. Non-traditional lipid profiles and the risk of stroke: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2023; 33:698-714. [PMID: 36737357 DOI: 10.1016/j.numecd.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/10/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
AIMS An increasing number of studies on non-traditional lipid profiles have been investigated in recent years. However, the associations between non-traditional lipid profiles and the risk of stroke remained inconsistent. Therefore, this meta-analysis aimed to evaluate the associations between non-traditional lipid profiles and the risk of stroke and clarify the dose-response relations. DATA SYNTHESIS We performed a systematic literature search in PubMed, Embase, and Web of Science databases until 1 November 2022 for relevant studies. Relative risks and 95% confidence intervals were pooled by random-effects or fixed-effects models. A total of 26 full-text studies with 676678 participants and 18057 stroke cases were eligible for the final study. We found a positive association between the risk of stroke and total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio (RR = 1.19,95%CI = 1.00-1.40, I2 = 74.6%), triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio (RR = 1.24,95%CI = 1.10-1.41, I2 = 62.8%) or low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio (RR = 1.24, 95%CI = 1.11-1.39, I2 = 49.4%). When focusing on the stroke subtype, a more significant association was observed between the risk of ischemic stroke and four non-traditional lipid profiles. In dose-response analysis, we found a linear association between TC/HDL-C ratio and the risk of stroke (RR = 1.16,95%CI = 1.07-1.26). CONCLUSIONS Elevated non-traditional lipid profiles were associated with an increased risk of ischemic stroke. The linear association showed the risk of stroke increased by 16% when the pooled RR of TC/HDL-C ratio per 1-unit increased. REGISTRATION NUMBER IN PROSPERO CRD42022321251.
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Affiliation(s)
- Yueting Liu
- Department of Neurology, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xiaolin Jin
- Department of Neurology, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Kailei Fu
- Department of Neurology, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jinwei Li
- Department of Neurology, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Weishuang Xue
- Department of Neurology, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital, China Medical University, Shenyang, China.
| | - Weiyu Teng
- Department of Neurology, the First Affiliated Hospital, China Medical University, Shenyang, China.
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Chang JHY, Hwang LC, Tsou MT, Chang BCC. Association Between Premorbid Metabolic Syndrome and Coronary Arterial Stenosis: Results from One Medical Center in Taiwan. Metab Syndr Relat Disord 2023; 21:57-62. [PMID: 36383133 DOI: 10.1089/met.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Although the relationship between metabolic syndrome (MetS) and cardiovascular disease is already well-established, there is limited evidence as to whether individuals are at risk for cardiovascular disease during the premorbid state of MetS. The aim of this study is to explore the relationship between coronary arterial stenosis and MetS in a nonhypertensive and nondiabetic population. Methods: In this cross-sectional study, we analyzed the data of participants who underwent annual health checkups in a medical center. These data were collected from physical examination, blood tests, cardiac computed tomography examinations, and medical charts. We excluded those with established hypertension or diabetes and age of <50 or >75 years. Results: This study recruited 700 participants with a mean age of 59.5 years. More than 31% had MetS, and the overall prevalence of coronary arterial stenosis was 48.0% (grade 1, 2, 3, 4: 16.3%, 20.9%, 8.4%, 2.4%, respectively). In univariate analysis, older age, male sex, smoking, body mass index, elevated fasting plasma glucose (FPG), elevated triglyceride, lower level of high-density lipoprotein cholesterol, and presence of MetS were all positively correlated with coronary arterial stenosis. After adjustment for confounding factors, MetS still showed strong association with high grades of coronary arterial stenosis [odds ratio (OR) 2.86, confidence interval (95% CI) 1.30-4.01]. Specific components of MetS, such as elevated triglyceride [OR 2.02, 95% CI 1.14-3.57] and elevated FPG [OR 2.25, 95% CI 1.31-3.88], were also associated with coronary arterial stenosis. Conclusion: Our study concluded that premorbid MetS was significantly associated with coronary arterial stenosis. As for the individual components, elevated triglyceride and elevated FPG were both correlated with coronary arterial stenosis. Early preventive measures would be suggested at this stage of MetS to prevent future cardiovascular events.
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Affiliation(s)
- Jason Hong-Yi Chang
- Department of Medical Education and MacKay Memorial Hospital, Taipei City, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital, Taipei City, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei City, Taiwan
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Bloomgarden ZT. The World Congress of Insulin Resistance, Diabetes and Cardiovascular Disease (WCIRDC). J Diabetes 2023; 15:4-6. [PMID: 36610044 PMCID: PMC9870730 DOI: 10.1111/1753-0407.13349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
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Akin F, Altun İ, Ayca B, Kose N, Altun İ. Associations of non-HDL-C and triglyceride/HDL-C ratio with coronary plaque burden and plaque characteristics in young adults. Bosn J Basic Med Sci 2022; 22:1025-1032. [PMID: 35531978 PMCID: PMC9589308 DOI: 10.17305/bjbms.2022.7142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023] Open
Abstract
Coronary artery disease (CAD) is uncommon in young adult patients. However, these patients have different risk factor profiles and high-risk coronary plaques are more common. The aim of this study was to examine the relations between the coronary plaque burden, plaque composition, serum non-high-density lipoprotein cholesterol (non-HDL-C) levels, and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio in young adults. We analyzed a total of 551 patients under age 45 who had undergone coronary computed tomography angiography (CCTA). Coronary plaque characteristics were analyzed using CCTA. Multivariate linear regression analysis was used to assess the predictors of non-calcified plaque (NCB) and calcified plaque (CB) burdens. Serum non-HDL-C levels and TG/HDL-C ratio were higher in the coronary atherosclerosis patient group. Serum non-HDL-C levels and the TG/HDL-C ratio were higher in the obstructive CAD patient group. The plaque burden was positively correlated with non-HDL-C (r = 0.30; p < 0.001), and TG/HDL-C ratio (r = 0.18; p < 0.001). NCB was positively correlated with age, gender, smoking status, fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, serum triglycerides, hbA1c, non-HDL-C, and TG/HDL-C ratio. Non-HDL-C (β coefficient = 0.13; p = 0.023) and TG/HDL-C ratio (β = 0.10; p = 0.042) were independent predictors of NCB. Serum non-HDL-C levels and TG/HDL-C were significantly associated with the presence and burden of coronary plaques. Serum non-HDL-C and TG/HDL-C ratios were independently associated with NCB, suggesting their use as easy-to-compute markers for identifying high-risk groups in young adults.
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Affiliation(s)
- Fatih Akin
- Department of Cardiology, Muğla Sıtkı Kocman University School of Medicine, Muğla, Turkey,Corresponding author: Fatih Akin, Department of Cardiology, Muğla Sıtkı Kocman University School of Medicine, Muğla, 48000, Turkey. E-mail:
| | - İbrahim Altun
- Department of Cardiology, Muğla Sıtkı Kocman University School of Medicine, Muğla, Turkey
| | - Burak Ayca
- Department of Cardiology, İstanbul Education and Research Hospital, Istanbul, Turkey
| | - Nuri Kose
- Department of Cardiology, Muğla Yucelen Hospital, Muğla, Turkey
| | - İlknur Altun
- Department of Radiology, Muğla Sıtkı Kocman University School of Medicine, Muğla, Turkey
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Jialal I, Adams-Huet B, Remaley AT. A comparison of the ratios of C-reactive protein and triglycerides to high-density lipoprotein-cholesterol as biomarkers of metabolic syndrome in African Americans and non-Hispanic Whites. J Diabetes Complications 2022; 36:108231. [PMID: 35718599 DOI: 10.1016/j.jdiacomp.2022.108231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
AIMS The ratio of triglycerides (TG) to high density lipoprotein-cholesterol (HDL-C) is a validated biomarker of insulin resistance and metabolic syndrome (MetS). In African-Americans (AA) there is concern about this ratio because their mean TG level is lower than the general population. As an alternative approach, we examined the CRP:HDL-C ratio in both AA and non-Hispanic whites (NHW) in the NHANES study for its association with MetS. METHODS A total of n = 3541 individuals were studied from the NHANES data. Fasting blood samples were obtained for lipids, insulin, and CRP. TG and CRP ratios to HDL-C were calculated. RESULTS The TG:HDL-C ratio was significantly increased in NHW compared to AA, but the CRP:HDL-C ratio did not differ between NHW and AA groups. Both ratios were significantly increased in MetS patients versus controls (both races) and increased with greater severity of MetS. Receiver Operating Characteristic (ROC) curve analysis showed that the TG:HDL-C area under the curve was superior to CRP:HDL-C in predicting MetS in both AA and NHW patients. CONCLUSION In this large NHANES study, the TG:HDL-C ratio is a superior predictor of MetS in both AA and NHW persons despite the lower TG levels in AA persons.
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Affiliation(s)
- Ishwarlal Jialal
- Veterans Affairs Medical Center, Mather, CA, United States of America.
| | | | - Alan T Remaley
- Translational Vascular Medicine Branch, NHLBI, NIH, Bethesda, MD, United States of America
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Chen Y, Chang Z, Liu Y, Zhao Y, Fu J, Zhang Y, Liu Y, Fan Z. Triglyceride to high-density lipoprotein cholesterol ratio and cardiovascular events in the general population: A systematic review and meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis 2022; 32:318-329. [PMID: 34953633 DOI: 10.1016/j.numecd.2021.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 01/06/2023]
Abstract
AIMS The ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) has been regarded as a novel surrogate indicator of insulin resistance and the atherogenic index of plasma. This meta-analysis aimed to evaluate the association between the TG/HDL-C ratio and the incidence of cardiovascular events in the general population. DATA SYNTHESIS Cohort studies reporting the association between the TG/HDL-C ratio and cardiovascular events in the general population were obtained by a systematic literature search of PubMed, Embase and Web of Science databases until April 11, 2021. 13 cohort studies with a total of 207,515 participants were included in this meta-analysis. In a random-effects model, compared with those with the lowest category of the TG/HDL-C ratio, participants with the highest category were independently associated with a higher risk of cardiovascular events (pooled HR: 1.43, 95%CI: 1.26-1.62, I2 = 72.9%). For the presence of publication bias detected by the Egger's test (p = 0.011), correction for publication bias using the trim-and-fill method reduced the HR to 1.26 (95%CI: 1.11-1.44). This result was consistent with the finding of the TG/HDL-C ratio analyzed as a continuous variable (pooled HR per unit increment of the TG/HDL-C ratio: 1.08, 95%CI: 1.04-1.12, I2 = 67.0%). Subgroup analyses indicated that population gender, geographical region, duration of follow-up, adjustment for other lipid parameters, adjustment for diabetes and categorical number did not significantly vary the relationship. CONCLUSION Elevated TG/HDL-C ratio may be independently associated with an increased risk of cardiovascular events in the general population. More well-designed studies are needed to confirm the current findings. REGISTRATION NUMBER IN PROSPERO CRD42021244583.
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Affiliation(s)
- Yuxiong Chen
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China
| | - Zhen'ge Chang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China
| | - Yijie Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China
| | - Yakun Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China
| | - Jia Fu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China
| | - Yongqiao Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China
| | - Yanbo Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China
| | - Zhongjie Fan
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
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Jekell A, Kalani M, Kahan T. Skin microvascular reactivity and subendocardial viability ratio in relation to dyslipidemia and signs of insulin resistance in non-diabetic hypertensive patients. Microcirculation 2021; 29:e12747. [PMID: 34936176 DOI: 10.1111/micc.12747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/11/2021] [Accepted: 12/14/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of dyslipidemia and insulin resistance for the development of microvascular dysfunction in non-diabetic primary hypertension. METHODS Seventy-one patients with untreated primary hypertension were included. Skin microvascular reactivity was evaluated by laser Doppler fluxmetry with iontophoresis (acetylcholine, ACh and sodium nitroprusside, SNP) and heat-induced hyperemia. Myocardial microvascular function was estimated by the subendocardial viability ratio (SEVR) calculated from pulse wave analysis and applanation tonometry. Triglyceride x glucose (TyG index) and triglyceride/HDL cholesterol ratio were used as measurements of insulin resistance. RESULTS Skin microvascular dysfunction was associated with low HDL cholesterol, where Ach-mediated peak flux (r = .27, p = .025) and heat-induced peak flux (r = .29, p = .017) related to HDL cholesterol levels. ACh peak flux was inversely related to TG/HDL ratio (r = -.29, p = .016), while responses to local heating and SNP did not. SEVR did not relate to HDL and was unrelated to markers of insulin resistance. These findings were confirmed by multivariable analyses, including potential confounders. CONCLUSIONS Early microvascular dysfunction can be detected in non-diabetic hypertensive patients and is related to dyslipidemia and to signs of insulin resistance, thus predicting future cardiovascular risk.
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Affiliation(s)
- Andreas Jekell
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Majid Kalani
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Jialal I, Adams-Huet B. The Ratios of Triglycerides and C-reactive protein to High density-lipoprotein -cholesterol as valid biochemical markers of the Nascent Metabolic Syndrome. Endocr Res 2021; 46:196-202. [PMID: 34080928 DOI: 10.1080/07435800.2021.1930039] [Citation(s) in RCA: 1] [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: 10/21/2022]
Abstract
Aims: Metabolic syndrome (MetS), a cardiometabolic cluster, is a major global problem. The ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) is a good biomarker of MetS in certain populations C-reactive protein (CRP) has also been also shown to be a biomarker of MetS. Since CRP captures inflammation, we compared the ratios of TG to HDL-C and CRP to HDL-C in patients with nascent MetS.Methods: Patients with MetS (n = 58) and matched controls (n = 44) were recruited. Fasting blood samples were obtained for routine laboratories, insulin, and adipokines. TG and CRP ratios to HDL-C were calculated. Data were analyzed statistically.Results: Both the TG to HDL-C and CRP to HDL-C ratios were significantly increased in MetS and both increased with increasing severity of MetS. Whilst both correlated with cardiometabolic features and insulin resistance, only the CRP to HDL-C ratio correlated significantly with adiponectin and leptin. Receiver operating characteristic curve analysis showed that both ratios showed excellent discrimination for MetS with no significant differences between ratios.Conclusions: Thus both the TG to HDL-C and CRP to HDL-C ratios are significantly increased in patients with nascent MetS and appear to be valid biomarkers of MetS. However, these preliminary findings with CRP: HDL-C need confirmation in large prospective studies and could have important implications for assessing cardiometabolic risk in African Americans, an under-served population.
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Affiliation(s)
- Ishwarlal Jialal
- Section of Clinical Chemistry, Department of Pathology, Veterans Affairs Medical Center, Mather, CA, USA
| | - Beverley Adams-Huet
- Department of Clinical Sciences , UT Southwestern Medical Center, Dallas, TX, USA
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9
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Sears B, Saha AK. Dietary Control of Inflammation and Resolution. Front Nutr 2021; 8:709435. [PMID: 34447777 PMCID: PMC8382877 DOI: 10.3389/fnut.2021.709435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/13/2021] [Indexed: 12/18/2022] Open
Abstract
The healing of any injury requires a dynamic balance of initiation and resolution of inflammation. This hypothesis-generating review presents an overview of the various nutrients that can act as signaling agents to modify the metabolic responses essential for the optimal healing of injury-induced inflammation. In this hypothesis-generating review, we describe a defined nutritional program consisting of an integrated interaction of a calorie-restricted anti-inflammatory diet coupled with adequate levels of omega-3 fatty acids and sufficient levels of dietary polyphenols that can be used in clinical trials to treat conditions associated with insulin resistance. Each dietary intervention works in an orchestrated systems-based approach to reduce, resolve, and repair the tissue damage caused by any inflammation-inducing injury. The orchestration of these specific nutrients and their signaling metabolites to facilitate healing is termed the Resolution Response. The final stage of the Resolution Response is the activation of intracellular 5' adenosine monophosphate-activated protein kinase (AMPK), which is necessary to repair tissue damaged by the initial injury-induced inflammation. The dietary optimization of the Resolution Response can be personalized to the individual by using standard blood markers. Once each of those markers is in their appropriate ranges, activation of intracellular AMPK will be facilitated. Finally, we outline how the resulting activation of AMPK will affect a diverse number of other intercellular signaling systems leading to an extended healthspan.
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Affiliation(s)
- Barry Sears
- Inflammation Research Foundation, Peabody, MA, United States
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Higashiyama A, Wakabayashi I, Okamura T, Kokubo Y, Watanabe M, Takegami M, Honda-Kohmo K, Okayama A, Miyamoto Y. The Risk of Fasting Triglycerides and its Related Indices for Ischemic Cardiovascular Diseases in Japanese Community Dwellers: the Suita Study. J Atheroscler Thromb 2021; 28:1275-1288. [PMID: 34053965 PMCID: PMC8629703 DOI: 10.5551/jat.62730] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim:
A prospective cohort study in a Japanese urban general population was performed to investigate whether triglyceride (TG) and its related indices were associated with the risk for the incidence of ischemic cardiovascular disease (CVD) after the adjustment for low-density lipoprotein cholesterol (LDL-C) in Asian community dwellers.
Methods:
A 15.1-year prospective cohort study was performed in 6,684 Japanese community dwellers aged 30–79 years without a history of CVD and whose fasting TG levels were <400 mg/dL. After adjusting for covariates, including LDL-C, the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of the deciles (D) of TG and those of 1-standard deviation (SD) increment of log-transformed TG (1-SD of TG) according to LDL-C level (≥ 140 and <140 mg/dL) for ischemic CVD incidence were estimated. The multivariable-adjusted HRs and 95%CIs of the quintiles (Q) of TG, TG/HDL-C, and the cardiometabolic index (CMI) for ischemic CVD were also estimated.
Results:
In 101,230 person-years, 464 ischemic CVD cases occurred. For D
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of TG, the HR (95%CI) was 1.56 (1.05–2.32), and for 1-SD of TG, it was 1.30 (1.00–1.70) in participants with LDL-C <140 mg/dL and 1.07 (0.77–1.50) in those with LDL-C ≥ 140 mg/dL. For Q
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of the CMI, the multivariable-adjusted HR was higher than those of TG and TG/HDL-C.
Conclusions:
Fasting TG was an independent predictor for ischemic CVD incidence after adjusting for LDL-C in Japanese community dwellers with TG <400 mg/dL. Among TG, TG/HDL-C, and the CMI, the CMI could be the most powerful predictor for ischemic CVD.
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Affiliation(s)
- Aya Higashiyama
- Department of Hygiene, Wakayama Medical University.,Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Makoto Watanabe
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Misa Takegami
- Department of Preventive Medicine, National Cerebral and Cardiovascular Center
| | - Kyoko Honda-Kohmo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
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Ameer OZ, Salman IM, Alwadi AY, Ouban A, Abu-Owaimer FM, AlSharari SD, Bukhari IA. Regional functional and structural abnormalities within the aorta as a potential driver of vascular disease in metabolic syndrome. Exp Physiol 2021; 106:771-788. [PMID: 33450088 DOI: 10.1113/ep089213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is aortic dysfunction, a significant contributor to cardiovascular disease in metabolic syndrome, expressed uniformly across both the thoracic and abdominal aorta? What is the main finding and its importance? Our study shows that, in the setting of metabolic syndrome, functional and structural deficits in the aorta are differentially expressed along its length, with the abdominal portion displaying more extensive vascular abnormalities. It is, therefore, likely that early interventional strategies targeting the abdominal aorta might alleviate cardiovascular pathologies driven by the metabolic syndrome. ABSTRACT The extent of vascular dysfunction associated with metabolic syndrome might vary along the length of the aorta. In this study, we investigated regional functional and structural changes in the thoracic and abdominal aorta of a rat model of metabolic syndrome, namely, high-fat diet (HFD) streptozotocin-induced diabetes mellitus (HFD-D). Four-week-old male Wistar albino rats were fed with either HFD or control diet (CD) for 10 weeks. At week 6, 40 mg/kg streptozotocin and its vehicle were injected i.p. into HFD and CD groups, respectively. At the end of the feeding period, rats were euthanised and aortic segments collected for assessment of vascular functional responses and histomorphometry. Tail-cuff systolic blood pressures (154 ± 6 vs. 110 ± 4 mmHg) and areas under the curve for oral glucose and i.p. insulin tolerance tests were greater in HFD-D versus CD rats. Abdominal aortic vasoconstriction in response to noradrenaline and KCl was greater in HFD-D compared with CD rats. Thoracic vasoconstrictor responses to noradrenaline, but not KCl, were greater in the HFD-D group. Abdominal, but not thoracic, endothelium-dependent vasorelaxation in response to acetylcholine was blunted in HFD-D relative to CD rats; however, nitric oxide-dependent vasorelaxation in HFD-D rats was impaired in both thoracic and abdominal segments. The abdominal aorta of HFD-D rats showed deranged interlamellar spacing and increased lipid plaque deposition. In conclusion, vascular dysfunction in metabolic syndrome is expressed differentially along the length of the aorta, with the abdominal aorta exhibiting increased susceptibility to vasoconstrictors and greater deficits in endothelium-dependent relaxation. These vascular functional abnormalities could potentially underlie the development of hypertensive cardiovascular disease associated with the metabolic syndrome.
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Affiliation(s)
- Omar Z Ameer
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim M Salman
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Aiman Y Alwadi
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abderrahman Ouban
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Shakir D AlSharari
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ishfaq A Bukhari
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Eriksson H, Koskinen S, Nuotio K, Heikkilä HM, Vikatmaa P, Silvennoinen H, Valanne L, Mäyränpää MI, Kovanen PT, Soinne L, Lindsberg PJ, Ijäs P. Predictive Factors for Pre-operative Recurrence of Cerebrovascular Symptoms in Symptomatic Carotid Stenosis. Eur J Vasc Endovasc Surg 2020; 60:809-815. [PMID: 33039297 DOI: 10.1016/j.ejvs.2020.08.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Across stroke subtypes, carotid artery stroke carries the highest risk of recurrence. Despite initiation of best medical therapy (BMT), some patients suffer recurrent neurological events before undergoing carotid endarterectomy (CEA). The aim was to identify clinical predictors of early recurrent events in patients with symptomatic carotid stenosis (sCS) awaiting CEA on modern BMT. METHODS The Helsinki Carotid Endarterectomy Study 2 (HeCES2) is a cross sectional, longitudinal, prospective, and consecutive cohort study, which enrolled 500 symptomatic or asymptomatic patients with carotid stenosis scheduled for CEA in a tertiary stroke centre. Symptomatic patients were included for this analysis (n = 324). RESULTS Of all 324 patients with sCS, 39 (12%) had a recurrent cerebrovascular event at a median of six days after the index symptom: four had an ischaemic stroke (1.2%), 16 a hemispheric transient ischaemic attack (TIA; 4.9%), and 19 amaurosis fugax (AFX; 5.9%). The recurrence rate was 4.0 % (n = 13) within 48 h and 9.9% (n = 32) within two weeks. None of the patients (n = 108) presenting with ocular symptoms (AFX or retinal artery occlusion) suffered recurrent hemispheric TIA or stroke. In Cox regression analysis, comorbid hypertension (hazard ratio [HR] 6.58, 95% confidence interval [CI] 1.33-32.47), hemispheric TIA as the index symptom (HR 3.42, 95% CI 1.70-6.90), the number of prior attacks (HR 1.12, 95% CI 1.08-1.15), and high low density lipoprotein/high density lipoprotein ratio (HR 1.51, 95% CI 1.09-2.11) were independently associated with an increased risk of recurrent event, while a history of major cardiovascular event (HR 0.33, 95% CI 0.11-0.96) and high serum fibrinogen level (HR 0.59, 95% CI 0.41-0.86) were associated with a decreased risk. CONCLUSION More than every tenth patient with sCS experienced an early recurrent cerebrovascular event prior to scheduled CEA, despite optimal medication. However, stroke recurrence was lower than in earlier observational studies, which could be explained by improved care pathways, more aggressive medication, and expedited CEA. All recurrent strokes occurred in patients initially presenting with minor stroke.
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Affiliation(s)
- Henrietta Eriksson
- Neurology, Neurocentre, Helsinki University Hospital, Helsinki, Finland; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
| | - Suvi Koskinen
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland; Department of Radiology, Hospital District of Helsinki and Uusimaa Medical Imaging Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Krista Nuotio
- Neurology, Neurocentre, Helsinki University Hospital, Helsinki, Finland
| | - Hanna M Heikkilä
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Pirkka Vikatmaa
- Department of Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Heli Silvennoinen
- Department of Radiology, Hospital District of Helsinki and Uusimaa Medical Imaging Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Valanne
- Department of Radiology, Hospital District of Helsinki and Uusimaa Medical Imaging Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko I Mäyränpää
- Department of Pathology, University of Helsinki and HUSLAB, Division of Pathology, Helsinki University Hospital, Helsinki, Finland
| | | | - Lauri Soinne
- Neurology, Neurocentre, Helsinki University Hospital, Helsinki, Finland
| | - Perttu J Lindsberg
- Neurology, Neurocentre, Helsinki University Hospital, Helsinki, Finland; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Petra Ijäs
- Neurology, Neurocentre, Helsinki University Hospital, Helsinki, Finland; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
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13
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Zhou L, Mai J, Li Y, Guo M, Wu Y, Gao X, Wu Y, Liu X, Zhao L. Triglyceride to high-density lipoprotein cholesterol ratio and risk of atherosclerotic cardiovascular disease in a Chinese population. Nutr Metab Cardiovasc Dis 2020; 30:1706-1713. [PMID: 32811737 DOI: 10.1016/j.numecd.2020.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio may play a role in predicting cardiovascular events. We aimed to prospectively explore the association between the TG/HDL-C ratio and atherosclerotic cardiovascular disease (ASCVD), ischemic stroke, as well as coronary heart disease (CHD) in a Chinese population. METHODS AND RESULTS This prospective cohort study included 9368 participants from four Chinese populations in the People's Republic of China-United States of America (PRC-USA) Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology. Over a follow-up period of 20 years, 624 cases of ASCVD events including 458 ischemic stroke events and 166 CHD events were recorded. The relationship between the TG/HDL-C ratio and the endpoints was evaluated through multivariate Cox proportional hazard models adjusted for potential confounding variables, including age, sex, urban or rural residence, northern or southern China, occupational type, education, physical exercise, smoking status, drinking status, body mass index, hypertension, high low-density lipoprotein cholesterol, diabetes, and antihypertensive medication use at baseline. With the lowest TG/HDL-C tertile as the reference, the middle and highest tertiles had the hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.13 (0.91, 1.40), 1.36 (1.10, 1.67) respectively for ASCVD (p for trend = 0.0028), and 1.19 (0.93, 1.54),1.47 (1.15, 1.87) respectively for ischemic stroke (p for trend = 0.0016). However, no significant association was found for CHD events. CONCLUSION TG/HDL-C ratio was positively associated with the risk of ASCVD and ischemic stroke events in the Chinese population.
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Affiliation(s)
- Long Zhou
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Jinzhuang Mai
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Li
- Department of Epidemiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Guo
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Wu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiangmin Gao
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Xiaoqing Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Liancheng Zhao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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14
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Reiner Ž. Triglyceride-Rich Lipoproteins and Novel Targets for Anti-atherosclerotic Therapy. Korean Circ J 2018; 48:1097-1119. [PMID: 30403015 PMCID: PMC6221868 DOI: 10.4070/kcj.2018.0343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022] Open
Abstract
Although elevated serum low-density lipoprotein-cholesterol (LDL-C) is without any doubts accepted as an important risk factor for cardiovascular disease (CVD), the role of elevated triglycerides (TGs)-rich lipoproteins as an independent risk factor has until recently been quite controversial. Recent data strongly suggest that elevated TG-rich lipoproteins are an independent risk factor for CVD and that therapeutic targeting of them could possibly provide further benefit in reducing CVD morbidity, events and mortality, apart from LDL-C lowering. Today elevated TGs are treated with lifestyle interventions, and with fibrates which could be combined with omega-3 fatty acids. There are also some new drugs. Volanesorsen, is an antisense oligonucleotid that inhibits the production of the Apo C-III which is crucial in regulating TGs metabolism because it inhibits lipoprotein lipase (LPL) and hepatic lipase activity but also hepatic uptake of TGs-rich particles. Evinacumab is a monoclonal antibody against angiopoietin-like protein 3 (ANGPTL3) and it seems that it can substantially lower elevated TGs levels because ANGPTL3 also regulates TGs metabolism. Pemafibrate is a selective peroxisome proliferator-activated receptor alpha modulator which also decreases TGs, and improves other lipid parameters. It seems that it also has some other possible antiatherogenic effects. Alipogene tiparvovec is a nonreplicating adeno-associated viral vector that delivers copies of the LPL gene to muscle tissue which accelerates the clearance of TG-rich lipoproteins thus decreasing extremely high TGs levels. Pradigastat is a novel diacylglycerol acyltransferase 1 inhibitor which substantially reduces extremely high TGs levels and appears to be promising in treatment of the rare familial chylomicronemia syndrome.
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Affiliation(s)
- Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia.
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