|
1
|
Bocher O, Singh A, Huang Y, Võsa U, Reimann E, Arruda A, Barysenska A, Kolde A, Rayner NW, Estonian Biobank research team, Esko T, Mägi R, Zeggini E. Disentangling the consequences of type 2 diabetes on targeted metabolite profiles using causal inference and interaction QTL analyses. PLoS Genet 2024; 20:e1011346. [PMID: 39625957 PMCID: PMC11642953 DOI: 10.1371/journal.pgen.1011346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 12/13/2024] [Accepted: 10/30/2024] [Indexed: 12/14/2024] Open
Abstract
Circulating metabolite levels have been associated with type 2 diabetes (T2D), but the extent to which T2D affects metabolite levels and their genetic regulation remains to be elucidated. In this study, we investigate the interplay between genetics, metabolomics, and T2D risk in the UK Biobank dataset using the Nightingale panel composed of 249 metabolites, 92% of which correspond to lipids (HDL, IDL, LDL, VLDL) and lipoproteins. By integrating these data with large-scale T2D GWAS from the DIAMANTE meta-analysis through Mendelian randomization analyses, we find 79 metabolites with a causal association to T2D, all spanning lipid-related classes except for Glucose and Tyrosine. Twice as many metabolites are causally affected by T2D liability, spanning almost all tested classes, including branched-chain amino acids. Secondly, using an interaction quantitative trait locus (QTL) analysis, we describe four metabolites consistently replicated in an independent dataset from the Estonian Biobank, for which genetic loci in two different genomic regions show attenuated regulation in T2D cases compared to controls. The significant variants from the interaction QTL analysis are significant QTLs for the corresponding metabolites in the general population but are not associated with T2D risk, pointing towards consequences of T2D on the genetic regulation of metabolite levels. Finally, through differential level analyses, we find 165 metabolites associated with microvascular, macrovascular, or both types of T2D complications, with only a few discriminating between complication classes. Of the 165 metabolites, 40 are not causally linked to T2D in either direction, suggesting biological mechanisms specific to the occurrence of complications. Overall, this work provides a map of the consequences of T2D on Nightingale targeted metabolite levels and on their genetic regulation, enabling a better understanding of the T2D trajectory leading to complications.
Collapse
Affiliation(s)
- Ozvan Bocher
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
| | - Archit Singh
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Munich School for Data Science (MUDS), Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Technical University of Munich (TUM), TUM School of Medicine and Health, Graduate School of Experimental Medicine, Munich, Germany
| | - Yue Huang
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Technical University of Munich (TUM), TUM School of Medicine and Health, Graduate School of Experimental Medicine, Munich, Germany
| | - Urmo Võsa
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Ene Reimann
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Ana Arruda
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Munich School for Data Science (MUDS), Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- Technical University of Munich (TUM), TUM School of Medicine and Health, Graduate School of Experimental Medicine, Munich, Germany
| | - Andrei Barysenska
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
| | - Anastassia Kolde
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Nigel W. Rayner
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Tõnu Esko
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München- German Research Center for Environmental Health, Neuherberg, Germany
- TUM school of medicine and health, Technical University Munich and Klinikum Rechts der Isar, Munich, Germany
| |
Collapse
|
|
2
|
Li JJ. Lipids, Genetics, and the Risk of Type 2 Diabetes: More Studies Needed to Uncover the Mysteries. JACC. ASIA 2024; 4:839-841. [PMID: 39619398 PMCID: PMC11604520 DOI: 10.1016/j.jacasi.2024.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Affiliation(s)
- Jian-Jun Li
- Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| |
Collapse
|
|
3
|
Ma Z, Zhong J, Tu W, Li S, Chen J. The functions of apolipoproteins and lipoproteins in health and disease. MOLECULAR BIOMEDICINE 2024; 5:53. [PMID: 39465476 PMCID: PMC11513782 DOI: 10.1186/s43556-024-00218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 10/16/2024] [Indexed: 10/29/2024] Open
Abstract
Lipoproteins and apolipoproteins are crucial in lipid metabolism, functioning as essential mediators in the transport of cholesterol and triglycerides and being closely related to the pathogenesis of multiple systems, including cardiovascular. Lipoproteins a (Lp(a)), as a unique subclass of lipoproteins, is a low-density lipoprotein(LDL)-like particle with pro-atherosclerotic and pro-inflammatory properties, displaying high heritability. More and more strong evidence points to a possible link between high amounts of Lp(a) and cardiac conditions like atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis (AS), making it a risk factor for heart diseases. In recent years, Lp(a)'s role in other diseases, including neurological disorders and cancer, has been increasingly recognized. Although therapies aimed at low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) have achieved significant success, elevated Lp(a) levels remain a significant clinical management problem. Despite the limited efficacy of current lipid-lowering therapies, major clinical advances in new Lp(a)-lowering therapies have significantly advanced the field. This review, grounded in the pathophysiology of lipoproteins, seeks to summarize the wide-ranging connections between lipoproteins (such as LDL-C and HDL-C) and various diseases, alongside the latest clinical developments, special emphasis is placed on the pivotal role of Lp(a) in cardiovascular disease, while also examining its future potential and mechanisms in other conditions. Furthermore, this review discusses Lp(a)-lowering therapies and highlights significant recent advances in emerging treatments, advocates for further exploration into Lp(a)'s pathogenic mechanisms and its potential as a therapeutic target, proposing new secondary prevention strategies for high-risk individuals.
Collapse
Affiliation(s)
- Zijun Ma
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan, China
| | - Jixin Zhong
- Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Key Laboratory of Vascular Aging (HUST), Ministry of Education, Wuhan, 430030, Hubei, China
| | - Wei Tu
- Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Shiliang Li
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jun Chen
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, Shiyan, China.
| |
Collapse
|
|
4
|
Wilson M, Al-Hamid A, Abbas I, Birkett J, Khan I, Harper M, Al-Jumeily Obe D, Assi S. Identification of diagnostic biomarkers used in the diagnosis of cardiovascular diseases and diabetes mellitus: A systematic review of quantitative studies. Diabetes Obes Metab 2024; 26:3009-3019. [PMID: 38637978 DOI: 10.1111/dom.15593] [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: 01/17/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
AIMS To perform a systematic review of studies that sought to identify diagnostic biomarkers for the diagnosis of cardiovascular diseases (CVDs) and diabetes mellitus (DM), which could be used in low- and middle-income countries (LMICs) where there is a lack of diagnostic equipment, treatments and training. MATERIALS AND METHODS Papers were sourced from six databases: the British Nursing Index, Google Scholar, PubMed, Sage, Science Direct and Scopus. Articles published between January 2002 and January 2023 were systematically reviewed by three reviewers and appropriate search terms and inclusion/exclusion criteria were applied. RESULTS A total of 18 studies were yielded, as well as 234 diagnostic biomarkers (74 for CVD and 160 for DM). Primary biomarkers for the diagnosis of CVDs included growth differentiation factor 15 and neurogenic locus notch homologue protein 1 (Notch1). For the diagnosis of DM, alpha-2-macroglobulin, C-peptides, isoleucine, glucose, tyrosine, linoleic acid and valine were frequently reported across the included studies. Advanced analytical techniques, such as liquid chromatography mass spectrometry, enzyme-linked immunosorbent assays and vibrational spectroscopy, were also repeatedly reported in the included studies and were utilized in combination with traditional and alternative matrices such as fingernails, hair and saliva. CONCLUSIONS While advanced analytical techniques are expensive, laboratories in LMICs should carry out a cost-benefit analysis of their use. Alternatively, laboratories may want to explore emerging techniques such as infrared, Fourier transform-infrared and near-infrared spectroscopy, which allow sensitive noninvasive analysis.
Collapse
Affiliation(s)
- Megan Wilson
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Abdullah Al-Hamid
- Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, AlAhsa, Saudi Arabia
| | | | - Jason Birkett
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Iftikhar Khan
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Matthew Harper
- Faculty of Engineering and Technology, School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Dhiya Al-Jumeily Obe
- Faculty of Engineering and Technology, School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Sulaf Assi
- Faculty of Science, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
|
5
|
Nasso G, Vignaroli W, Amodeo V, Bartolomucci F, Larosa C, Contegiacomo G, Demola MA, Girasoli C, Valenzano A, Fiore F, Bonifazi R, Triggiani V, Vitobello V, Errico G, Lamanna A, Hila D, Loizzo T, Franchino R, Sechi S, Valenti G, Diaferia G, Brigiani MS, Arima S, Angelelli M, Curcio A, Greco F, Greco E, Speziale G, Santarpino G. Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results. J Clin Med 2024; 13:2987. [PMID: 38792527 PMCID: PMC11121999 DOI: 10.3390/jcm13102987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study. Until December 2019, 100 patients optimized therapy with statin ± ezetimibe (SG). Since January 2020, 80 matched patients added treatment with Evolocumab every 2 weeks (EG). All 180 patients were followed-up at 3 and 12 months, comparing outcomes. Results: The two groups are homogenous. At 3 months and 1 year, a significant decrease in the parameter mean levels of LDL cholesterol and total cholesterol is detected in the Evolocumab group compared to the standard group. No mortality was detected in either group. No complications or drug discontinuation were recorded. In the SG group, five patients (5%) suffered a myocardial infarction during the 1-year follow-up. In the EG group, two patients (2.5%) underwent PTCA due to myocardial infarction. There is no significant difference in overall survival according to the new treatment (p-value = 0.9), and the hazard ratio is equal to 0.94 (95% C.I.: [0.16-5.43]; p-value = 0.9397). Conclusions: The use of Evolocumab, which was started immediately after coronary artery bypass graft surgery, significantly reduced LDL cholesterol and total cholesterol levels compared to statin treatment alone and is completely safe. However, at one year of follow-up, this result did not have impact on the reduction in major clinical events.
Collapse
Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Walter Vignaroli
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Vincenzo Amodeo
- Department of Cardiology, “Santa Maria degli Ungheresi” Hospital, 89024 Polistena, Italy;
| | - Francesco Bartolomucci
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Claudio Larosa
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Gaetano Contegiacomo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Maria Antonietta Demola
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Cataldo Girasoli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Antongiulio Valenzano
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Flavio Fiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Raffaele Bonifazi
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Vera Triggiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Vincenza Vitobello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Giacomo Errico
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Angela Lamanna
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Dritan Hila
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Tommaso Loizzo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Rosalba Franchino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Stefano Sechi
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Giovanni Valenti
- Department of Cardiology Azienda Ospedaliera B.A.T., Bonomo Hospital, 70031 Andria, Italy; (F.B.); (C.L.); (G.V.)
| | - Giuseppe Diaferia
- Department of Cardiology, “M. Di Miccoli” Hospital, 70051 Barletta, Italy;
| | - Mario Siro Brigiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
| | - Serena Arima
- Department of Human and Social Sciences Unisalento, University of Salento, 73100 Lecce, Italy; (S.A.); (M.A.)
| | - Mario Angelelli
- Department of Human and Social Sciences Unisalento, University of Salento, 73100 Lecce, Italy; (S.A.); (M.A.)
| | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Science, University of Calabria, 87036 Rende, Italy;
| | - Francesco Greco
- Department of Cardiology, “Santissima Annunziata” Hospital, 87100 Cosenza, Italy;
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (G.C.); (M.A.D.); (C.G.); (A.V.); (F.F.); (R.B.); (V.T.); (V.V.); (G.E.); (A.L.); (D.H.); (T.L.); (R.F.); (M.S.B.); (G.S.)
- Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy; (W.V.); (S.S.)
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany
| |
Collapse
|
|
6
|
Heylen D, Peeters J, Aerts J, Ertaylan G, Hooyberghs J. BioMOBS: A multi-omics visual analytics workflow for biomolecular insight generation. PLoS One 2023; 18:e0295361. [PMID: 38096184 PMCID: PMC10721075 DOI: 10.1371/journal.pone.0295361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023] Open
Abstract
One of the challenges in multi-omics data analysis for precision medicine is the efficient exploration of undiscovered molecular interactions in disease processes. We present BioMOBS, a workflow consisting of two data visualization tools integrated with an open-source molecular information database to perform clinically relevant analyses (https://github.com/driesheylen123/BioMOBS). We performed exploratory pathway analysis with BioMOBS and demonstrate its ability to generate relevant molecular hypotheses, by reproducing recent findings in type 2 diabetes UK biobank data. The central visualisation tool, where data-driven and literature-based findings can be integrated, is available within the github link as well. BioMOBS is a workflow that leverages information from multiple data-driven interactive analyses and visually integrates it with established pathway knowledge. The demonstrated use cases place trust in the usage of BioMOBS as a procedure to offer clinically relevant insights in disease pathway analyses on various types of omics data.
Collapse
Affiliation(s)
- Dries Heylen
- Theory Lab, Data Science Institute (DSI), Hasselt University, Diepenbeek, Belgium
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Jannes Peeters
- Data Science Institute (DSI), Hasselt University, Diepenbeek, Belgium
| | - Jan Aerts
- Visual Data Analysis Lab, Department of Biostystems KU Leuven, Leuven, Belgium
| | - Gökhan Ertaylan
- Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Jef Hooyberghs
- Theory Lab, Data Science Institute (DSI), Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
|
7
|
Huang J, Lin H, Wang S, Li M, Wang T, Zhao Z, Xu Y, Xu M, Lu J, Chen Y, Ning G, Wang W, Bi Y, Wang L. Association between serum LDL-C concentrations and risk of diabetes: A prospective cohort study. J Diabetes 2023; 15:881-889. [PMID: 37461165 PMCID: PMC10590678 DOI: 10.1111/1753-0407.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/13/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Low-density lipoprotein cholesterol (LDL-C) and diabetes mellitus are both modifiable risk factors for cardiovascular disease; however, whether elevated LDL-C levels confer a risk for diabetes remains unclear. OBJECTIVE We aimed to examine the association between serum LDL-C concentrations at baseline and the risk of developing diabetes at follow-up in the general population of Chinese adults. METHODS This study included 5274 adults aged ≥ 40 years from a community cohort who were without diabetes and followed for a median of 4.4 years. A standard 75-g oral glucose tolerance test was conducted at baseline and follow-up visits to diagnose diabetes. Logistic regression models and a restricted cubic spline were used to examine the association between baseline serum LDL-C levels and the risk of diabetes development. Subgroup analyses were conducted stratifying on age, sex, body mass index, hypertension, family history of diabetes, and LDL-C levels. RESULTS A total of 652 participants (12%) developed diabetes during the follow-up period. Compared to quartile 1 of serum LDL-C, quartiles 2, 3, and 4 were associated with a 30%, 33%, and 30% significantly higher risk of diabetes, respectively after adjustment for confounders including homeostatic model assessment for insulin resistance. The linear relationship between baseline LDL-C down to 30.1 mg/dL and incident diabetes was demonstrated by restricted cubic spline analysis, and each 1-SD increase in LDL-C concentration (28.5 mg/dL) was associated with a 12% increase in the risk of diabetes (odds ratio 1.12, 95% confidence interval 1.03-1.22). CONCLUSION In this community-based general population, higher serum LDL-C levels were linearly associated with an elevated risk of incident diabetes.
Collapse
Affiliation(s)
- Jiaojiao Huang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hong Lin
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mian Li
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tiange Wang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yu Xu
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Min Xu
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jieli Lu
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuhong Chen
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Guang Ning
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yufang Bi
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Long Wang
- Department of Endocrine and Metabolic DiseasesShanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health CommissionShanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| |
Collapse
|
|
8
|
Lee JH, Jung HD, Choi JD, Kang JY, Yoo TK, Park YW. Non-linear association between testosterone and LDL concentrations in men. Andrology 2023; 11:1107-1113. [PMID: 36681877 DOI: 10.1111/andr.13393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/23/2022] [Accepted: 01/17/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Contradictory data have been reported about the association between testosterone levels and the levels of low-density lipoprotein cholesterol (LDL). OBJECTIVES The aim of this study was to elucidate the association between testosterone and LDL levels. MATERIALS AND METHODS A cross-sectional study was conducted that included 7268 men who had participated in a health examination. Men who took agents that influence serum lipid profiles within the previous 6 months were excluded. A full metabolic work-up and serum testosterone level checks were performed. The main outcome measures included the testosterone level and testosterone <3.5 ng/ml prevalence of each decile of LDL and their polynomial trendlines and the odds ratio (OR) of testosterone <3.5 ng/ml according to the LDL level. RESULTS The polynomial trendline suggests the inverse association of testosterone with the deciles of triglycerides, the positive association of testosterone with the deciles of high-density lipoprotein cholesterol and the inverted U-shaped association between testosterone and the deciles of LDL. The polynomial trendline suggests a U-shaped curvilinear relationship between the deciles of LDL and the prevalence of testosterone <3.5 ng/ml. The adjusted ORs of testosterone <3.5 ng/ml in men in the lowest and highest deciles were significantly higher than those of men in the 10th-90th deciles of LDL (OR [95% CI], < 10th LDL: 1.4[1.2-1.8]; 10th - 90th LDL: 1.0 [reference]; >90th LDL: 1.3[1.0-1.6]), which reinforces the U-shaped curvilinear relationship between LDL levels and the prevalence of testosterone <3.5 ng/ml. DISCUSSION AND CONCLUSION Further research is needed to elucidate the association of very low or very high LDL concentrations with circulating testosterone in men.
Collapse
Affiliation(s)
- Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Hyuk-Dal Jung
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Jae Duck Choi
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Jung Yoon Kang
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Tag Keun Yoo
- Department of Urology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Yeon Won Park
- Department of Urology, National Police Hospital, Seoul, South Korea
| |
Collapse
|
|
9
|
Cefalo CMA, Succurro E, Riccio A, Marini MA, Fiorentino TV, Perticone M, Sciacqua A, Andreozzi F, Sesti G. Low-density lipoprotein cholesterol levels are associated with first-phase insulin release. Diabetes Res Clin Pract 2023; 199:110633. [PMID: 36940794 DOI: 10.1016/j.diabres.2023.110633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/23/2023]
Abstract
AIMS Prior studies provided evidence that low-density lipoprotein (LDL)-cholesterol-lowering statins reduce cardiovascular events while conveying an increased risk of type 2 diabetes. The aim of this study was to investigate the association between LDL levels and both insulin sensitivity and insulin secretion in a cohort of 356 adult first-degree relatives of patients with type 2 diabetes. METHODS Insulin sensitivity was assessed by euglycemic hyperinsulinemic clamp and first-phase insulin secretion was measured by both intravenous glucose tolerance test (IVGTT) and OGTT. RESULTS LDL-cholesterol levels were not independently associated with insulin-stimulated glucose disposal. After adjusting for several potential confounders, LDL-cholesterol concentration exhibited a positive independent association with acute insulin response (AIR) during IVGTT and with the OGTT derived Stumvoll first-phase insulin secretion index. When insulin release was adjusted for the underlying degree of insulin sensitivity, using the disposition index (AIR × insulin-stimulated glucose disposal), β-cell function was significantly associated with LDL-cholesterol levels, even after further adjusting for several potential confounders. CONCLUSIONS The present results suggest that LDL cholesterol is a positive modulator of insulin secretion. The deterioration in glycemic control observed during treatment with statins might thus be explained by an impairment in insulin secretion due to the cholesterol-lowering effect of statins.
Collapse
Affiliation(s)
- Chiara M A Cefalo
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Alessia Riccio
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
| | | | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy.
| |
Collapse
|
|
10
|
Sabouret P, Angoulvant D, Cannon CP, Banach M. Low levels of low-density lipoprotein cholesterol, intracerebral haemorrhage, and other safety issues: is there still a matter of debate? EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac038. [PMID: 36117951 PMCID: PMC9472780 DOI: 10.1093/ehjopen/oeac038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/07/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Although some observational studies suggest a potential association of low levels of low-density lipoprotein cholesterol (LDL-C) with intracerebral haemorrhage (ICH), these analyses have issues of confounding where other factors (e.g. older age, frailty) that likely explain the findings, and the number of events was very low. More recent results from randomized clinical trials have not found an increased risk in ICH, most notably trials using PCSK9 inhibitors that achieve very low levels of LDL-C, but also in the long-term follow-up of the IMPROVE-IT trial. Also, other statin-associated safety issues, including new onset diabetes and the cancer risk should not be the reason of statin discontinuation, especially for the former, the benefits highly outweigh the risk (even 5×), and for the latter, there is no confirmed link suggesting any increased risk, in opposite, data exist suggesting benefits of statin therapy in cancer prevention. Furthermore, use of intensive lipid-lowering strategies with statins and non-statin drugs leads to decrease of ischaemic major adverse cardiac events, without safety concern, in a large population of patients with atherosclerotic cardiovascular disease (ASCVD). These data should promote the concept ‘the earlier, the lower, the longer, the better’ for the lipid management of patients with ASCVD. While few uncertainties remain in several populations that have been underrepresented in clinical trials (African American and Asian patients, low weight individuals), the most recent data with intensive LDL-C lowering with PCSK9 inhibitors are reassuring that the benefit outweighs any possible risk.
Collapse
Affiliation(s)
| | - Denis Angoulvant
- Cardiology Department - Loire Valley Cardiovascular Collaboration and EA4245, CHRU de Tours and Tours University, Tours, France
| | - Christopher P Cannon
- Cardiovascular Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland
| |
Collapse
|
|
11
|
Jung HN, Kim M, Kim HS, Lee WJ, Min SH, Kim Y, Jung CH. Age‐Related Associations of Low‐Density Lipoprotein Cholesterol and Atherosclerotic Cardiovascular Disease: A Nationwide Population‐Based Cohort Study. J Am Heart Assoc 2022; 11:e024637. [PMID: 35492003 PMCID: PMC9238630 DOI: 10.1161/jaha.121.024637] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The relationship between low‐density lipoprotein cholesterol (LDL‐C) and atherosclerotic cardiovascular disease (ASCVD) according to age remains undetermined. Thus, this study aimed to investigate the age‐related association of LDL‐C and ASCVD. Methods and Results Data from the Korean NHIS‐HEALS (National Health Insurance Service‐National Health Screening Cohort) were analyzed. Individuals previously diagnosed with cardiovascular disease or taking lipid‐lowering drugs were excluded. Age‐specific association between LDL‐C and ASCVD was calculated using adjusted Cox proportional hazards models. During a median follow‐up of 6.44 years for 285 119 adults, ASCVD developed in 8996 (3.2%). All age groups showed positive associations between LDL‐C and ASCVD risk, mostly with statistical significance from LDL‐C of 160 mg/dL onward. ASCVD risk did not differ significantly between the age groups (P for interaction=0.489). Correspondingly, subgroup analysis in type 2 diabetes exhibited no difference in the age‐specific association of LDL‐C and ASCVD (P for interaction=0.784). Conclusions The study demonstrated that people aged ≥75 years with higher LDL‐C at baseline still presented increased ASCVD risk, which was not significantly different from the younger groups. These findings support the importance of managing LDL‐C for the prevention of primary ASCVD in the growing elderly population.
Collapse
Affiliation(s)
- Han Na Jung
- Department of Internal Medicine Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
- Asan Diabetes Center Asan Medical Center Seoul Republic of Korea
| | - Min‐Ju Kim
- Department of Clinical Epidemiology and Biostatistics Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Hwi Seung Kim
- Department of Internal Medicine Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
- Asan Diabetes Center Asan Medical Center Seoul Republic of Korea
| | - Woo Je Lee
- Department of Internal Medicine Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
- Asan Diabetes Center Asan Medical Center Seoul Republic of Korea
| | - Se Hee Min
- Department of Internal Medicine Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
- Asan Diabetes Center Asan Medical Center Seoul Republic of Korea
| | - Ye‐Jee Kim
- Department of Clinical Epidemiology and Biostatistics Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Chang Hee Jung
- Department of Internal Medicine Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
- Asan Diabetes Center Asan Medical Center Seoul Republic of Korea
| |
Collapse
|
|
12
|
Ma Y, Zhou Z, Li X, Ding K, Xiao H, Wu Y, Wu T, Chen D. Linear and nonlinear analyses of the association between low-density lipoprotein cholesterol and diabetes: The spurious U-curve in observational study. Front Endocrinol (Lausanne) 2022; 13:1009095. [PMID: 36465637 PMCID: PMC9714469 DOI: 10.3389/fendo.2022.1009095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Hyperlipidemia is traditionally considered a risk factor for diabetes. The effect of low-density lipoprotein cholesterol (LDL-C) is counterintuitive to diabetes. We sought to investigate the relationship between LDL-C and diabetes for better lipid management. METHODS We tested the shape of association between LDL-C and diabetes and created polygenic risk scores of LDL-C and generated linear Mendelian randomization (MR) estimates for the effect of LDL-C and diabetes. We evaluated for nonlinearity in the observational and genetic relationship between LDL-C and diabetes. RESULTS Traditional observational analysis suggested a complex non-linear association between LDL-C and diabetes while nonlinear MR analyses found no evidence for a non-linear association. Under the assumption of linear association, we found a consistently protective effect of LDL-C against diabetes among the females without lipid-lowering drugs use. The ORs were 0.84 (95% CI, 0.72-0.97, P=0.0168) in an observational analysis which was more prominent in MR analysis and suggested increasing the overall distribution of LDL-C in females led to an overall decrease in the risk of diabetes (P=0.0258). CONCLUSIONS We verified the liner protective effect of LDL-C against diabetes among the females without lipid-lowering drug use. Non-linear associations between LDL-C against diabetes in observational analysis are not causal.
Collapse
|
|
13
|
Roncero-Ramos I, Gutierrez-Mariscal FM, Gomez-Delgado F, Villasanta-Gonzalez A, Torres-Peña JD, Cruz-Ares SDL, Rangel-Zuñiga OA, Luque RM, Ordovas JM, Delgado-Lista J, Perez-Martinez P, Camargo A, Alcalá-Diaz JF, Lopez-Miranda J. Beta cell functionality and hepatic insulin resistance are major contributors to type 2 diabetes remission and starting pharmacological therapy: from CORDIOPREV randomized controlled trial. Transl Res 2021; 238:12-24. [PMID: 34298148 DOI: 10.1016/j.trsl.2021.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/17/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022]
Abstract
In order to assess whether previous hepatic IR (Hepatic-IRfasting) and beta-cell functionality could modulate type 2 diabetes remission and the need for starting glucose-lowering treatment, newly-diagnosed type 2 diabetes participants who had never received glucose-lowering treatment (190 out of 1002) from the CORonary Diet Intervention with Olive oil and cardiovascular PREVention study (a prospective, randomized and controlled clinical trial), were randomized to consume a Mediterranean or a low-fat diet. Type 2 diabetes remission was defined according to the American Diabetes Association recommendation for levels of HbA1c, fasting plasma glucose and 2h plasma glucose after oral glucose tolerance test, and having maintained them for at least 2 consecutive years. Patients were classified according to the median of Hepatic-IRfasting and beta-cell functionality, measured as the disposition index (DI) at baseline. Cox proportional hazards regression determined the potential for Hepatic-IRfasting and DI indexes as predictors of diabetes remission and the probability of starting pharmacological treatment after a 5-year follow-up. Low-Hepatic-IRfasting or high-DI patients had a higher probability of diabetes remission than high-Hepatic-IRfasting or low-DI subjects (HR:1.79; 95% CI 1.06-3.05; and HR:2.66; 95% CI 1.60-4.43, respectively) after a dietary intervention with no pharmacological treatment and no weight loss. The combination of low-Hepatic-IRfasting and high-DI presented the highest probability of remission (HR:4.63; 95% CI 2.00-10.70). Among patients maintaining diabetes, those with high- Hepatic-IRfasting and low-DI showed the highest risk of starting glucose-lowering therapy (HR:3.24;95% CI 1.50-7.02). Newly-diagnosed type 2 diabetes patients with better beta-cell functionality and lower Hepatic-IRfasting had a higher probability of type 2 diabetes remission in a dietary intervention without pharmacological treatment or weight loss, whereas among patients not achieving remission, those with worse beta-cell functionality and higher Hepatic-IRfasting index had the highest risk of starting glucose-lowering treatment after 5 years of follow-up.
Collapse
Affiliation(s)
- Irene Roncero-Ramos
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Francisco M Gutierrez-Mariscal
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Francisco Gomez-Delgado
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Alejandro Villasanta-Gonzalez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Jose D Torres-Peña
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Silvia De La Cruz-Ares
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Oriol A Rangel-Zuñiga
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Raul M Luque
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain; Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), Cordoba, Spain; Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Cordoba, Spain
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, J.M.-US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts; IMDEA Alimentacion, CNIC, Madrid, Spain
| | - Javier Delgado-Lista
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Antonio Camargo
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Juan F Alcalá-Diaz
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain
| | - Jose Lopez-Miranda
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Cordoba, Spain.
| |
Collapse
|
|
14
|
Bonilha I, Hajduch E, Luchiari B, Nadruz W, Le Goff W, Sposito AC. The Reciprocal Relationship between LDL Metabolism and Type 2 Diabetes Mellitus. Metabolites 2021; 11:metabo11120807. [PMID: 34940565 PMCID: PMC8708656 DOI: 10.3390/metabo11120807] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022] Open
Abstract
Type 2 diabetes mellitus and insulin resistance feature substantial modifications of the lipoprotein profile, including a higher proportion of smaller and denser low-density lipoprotein (LDL) particles. In addition, qualitative changes occur in the composition and structure of LDL, including changes in electrophoretic mobility, enrichment of LDL with triglycerides and ceramides, prolonged retention of modified LDL in plasma, increased uptake by macrophages, and the formation of foam cells. These modifications affect LDL functions and favor an increased risk of cardiovascular disease in diabetic individuals. In this review, we discuss the main findings regarding the structural and functional changes in LDL particles in diabetes pathophysiology and therapeutic strategies targeting LDL in patients with diabetes.
Collapse
Affiliation(s)
- Isabella Bonilha
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
| | - Eric Hajduch
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, F-75006 Paris, France;
| | - Beatriz Luchiari
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
| | - Wilson Nadruz
- Cardiology Division, Cardiovascular Pathophysiology Laboratory, State University of Campinas (Unicamp), Campinas 13083-887, Brazil;
| | - Wilfried Le Goff
- Unité de Recherche sur les Maladies Cardiovasculaires, le Métabolisme et la Nutrition, ICAN, Inserm, Sorbonne Université, F-75013 Paris, France;
| | - Andrei C. Sposito
- Cardiology Division, Atherosclerosis and Vascular Biology Laboratory (AtheroLab), State University of Campinas (Unicamp), Campinas 13083-887, Brazil; (I.B.); (B.L.)
- Correspondence: ; Tel.: +55-19-3521-7098; Fax: +55-19-3289-410
| |
Collapse
|
|
15
|
Wang L, Zhang X, Meng X, Koskeridis F, Georgiou A, Yu L, Campbell H, Theodoratou E, Li X. Methodology in phenome-wide association studies: a systematic review. J Med Genet 2021; 58:720-728. [PMID: 34272311 DOI: 10.1136/jmedgenet-2021-107696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022]
Abstract
Phenome-wide association study (PheWAS) has been increasingly used to identify novel genetic associations across a wide spectrum of phenotypes. This systematic review aims to summarise the PheWAS methodology, discuss the advantages and challenges of PheWAS, and provide potential implications for future PheWAS studies. Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE) databases were searched to identify all published PheWAS studies up until 24 April 2021. The PheWAS methodology incorporating how to perform PheWAS analysis and which software/tool could be used, were summarised based on the extracted information. A total of 1035 studies were identified and 195 eligible articles were finally included. Among them, 137 (77.0%) contained 10 000 or more study participants, 164 (92.1%) defined the phenome based on electronic medical records data, 140 (78.7%) used genetic variants as predictors, and 73 (41.0%) conducted replication analysis to validate PheWAS findings and almost all of them (94.5%) received consistent results. The methodology applied in these PheWAS studies was dissected into several critical steps, including quality control of the phenome, selecting predictors, phenotyping, statistical analysis, interpretation and visualisation of PheWAS results, and the workflow for performing a PheWAS was established with detailed instructions on each step. This study provides a comprehensive overview of PheWAS methodology to help practitioners achieve a better understanding of the PheWAS design, to detect understudied or overstudied outcomes, and to direct their research by applying the most appropriate software and online tools for their study data structure.
Collapse
Affiliation(s)
- Lijuan Wang
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaomeng Zhang
- Centre for Global Health, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Xiangrui Meng
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Fotios Koskeridis
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Epirus, Greece
| | - Andrea Georgiou
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, Epirus, Greece
| | - Lili Yu
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Harry Campbell
- Centre for Global Health, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Global Health, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK.,Cancer Research UK Edinburgh Centre, The University of Edinburgh MRC Institute of Genetics and Molecular Medicine, Edinburgh, UK
| | - Xue Li
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
|
16
|
Karagiannis AD, Mehta A, Dhindsa DS, Virani SS, Orringer CE, Blumenthal RS, Stone NJ, Sperling LS. How low is safe? The frontier of very low (<30 mg/dL) LDL cholesterol. Eur Heart J 2021; 42:2154-2169. [PMID: 33463677 DOI: 10.1093/eurheartj/ehaa1080] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/16/2020] [Accepted: 12/18/2020] [Indexed: 02/06/2023] Open
Abstract
Low-density lipoprotein cholesterol (LDL-C) is a proven causative factor for developing atherosclerotic cardiovascular disease. Individuals with genetic conditions associated with lifelong very low LDL-C levels can be healthy. We now possess the pharmacological armamentarium (statins, ezetimibe, PCSK9 inhibitors) to reduce LDL-C to an unprecedented extent. Increasing numbers of patients are expected to achieve very low (<30 mg/dL) LDL-C. Cardiovascular event reduction increases log linearly in association with lowering LDL-C, without reaching any clear plateau even when very low LDL-C levels are achieved. It is still controversial whether lower LDL-C levels are associated with significant clinical adverse effects (e.g. new-onset diabetes mellitus or possibly haemorrhagic stroke) and long-term data are needed to address safety concerns. This review presents the familial conditions characterized by very low LDL-C, analyses trials with lipid-lowering agents where patients attained very low LDL-C, and summarizes the benefits and potential adverse effects associated with achieving very low LDL-C. Given the potential for cardiovascular benefit and short-term safe profile of very low LDL-C, it may be advantageous to attain such low levels in specific high-risk populations. Further studies are needed to compare the net clinical benefit of non-LDL-C-lowering interventions with very low LDL-C approaches, in addition to comparing the efficacy and safety of very low LDL-C levels vs. current recommended targets.
Collapse
Affiliation(s)
- Angelos D Karagiannis
- Department of Internal Medicine, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Way NE, Atlanta, GA 30322, USA
| | - Devinder S Dhindsa
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Way NE, Atlanta, GA 30322, USA
| | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA
| | - Carl E Orringer
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, 601 North Caroline Street Suite 7200, Baltimore, MD 21287, USA
| | - Neil J Stone
- Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL 60611, USA
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1462 Clifton Way NE, Atlanta, GA 30322, USA
| |
Collapse
|
|
17
|
Liu G, Shi M, Mosley JD, Weng C, Zhang Y, Lee MTM, Jarvik GP, Hakonarson H, Namjou-Khales B, Sleiman P, Luo Y, Mentch F, Denny JC, Linton MF, Wei WQ, Stein CM, Feng Q. A Mendelian Randomization Approach Using 3-HMG-Coenzyme-A Reductase Gene Variation to Evaluate the Association of Statin-Induced Low-Density Lipoprotein Cholesterol Lowering With Noncardiovascular Disease Phenotypes. JAMA Netw Open 2021; 4:e2112820. [PMID: 34097045 PMCID: PMC8185593 DOI: 10.1001/jamanetworkopen.2021.12820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Observational studies suggest that statins, which inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, may be associated with beneficial effects in many noncardiovascular diseases. OBJECTIVE To construct a weighted HMG-CoA reductase (HMGCR) gene genetic risk score (GRS) using variants in the HMGCR gene affecting low-density lipoprotein cholesterol as an instrumental variable for mendelian randomization analyses to test associations with candidate noncardiovascular phenotypes previously associated with statin use in observational studies. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 53 385 unrelated adults of European ancestry with genome-wide genotypes available from BioVU (a practice-based biobank, used for discovery) and 30 444 unrelated adults with European ancestry available in the Electronic Medical Records and Genomics (eMERGE; a research consortium that conducts genetic research using electronic medical records, used for replication). The study was conducted from February 6, 2015, through April 31, 2019; data analysis was performed from August 26, 2019, through December 22, 2020. INTERVENTIONS An HMGCR GRS was calculated. MAIN OUTCOMES AND MEASURES The association between the HMGCR GRS and the presence or absence of 22 noncardiovascular phenotypes previously associated with statin use in clinical studies. RESULTS Of the 53 385 individuals in BioVU, 29 958 (56.1%) were women; mean (SD) age was 59.9 (15.6) years. The finding between the HMGCR GRS and the noncardiovascular phenotypes of interest in this cohort was significant only for type 2 diabetes. An HMGCR GRS equivalent to a 10-mg/dL decrease in the low-density lipoprotein cholesterol level was associated with an increased risk of type 2 diabetes (odds ratio [OR], 1.09; 95% CI, 1.04-1.15; P = 5.58 × 10-4). The HMGCR GRS was not associated with other phenotypes; the closest were increased risk of Parkinson disease (OR, 1.30; 95% CI, 1.07-1.58; P = .007) and kidney failure (OR, 1.18; 95% CI, 1.05-1.34; P = .008). Of the 30 444 individuals in eMERGE, 16 736 (55.0%) were women; mean (SD) age was 68.7 (15.4) years. The association between the HMGCR GRS and type 2 diabetes was replicated in this cohort (OR, 1.09; 95% CI, 1.01-1.17; P = .02); however, the HMGCR GRS was not associated with Parkinson disease (OR, 0.93; 95% CI, 0.75-1.16; P = .53) and kidney failure (OR, 1.18; 95% CI, 0.98-1.41; P = .08) in the eMERGE cohort. CONCLUSIONS AND RELEVANCE A mendelian randomization approach using variants in the HMGCR gene replicated the association between statin use and increased type 2 diabetes risk but provided no strong evidence for pleiotropic effects of statin-induced decrease of the low-density lipoprotein cholesterol level on other diseases.
Collapse
Affiliation(s)
- Ge Liu
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mingjian Shi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D. Mosley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Medical Center, New York, New York
| | - Yanfei Zhang
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania
- Musculoskeletal Institute, Geisinger, Danville, Pennsylvania
| | - Ming Ta Michael Lee
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania
- Musculoskeletal Institute, Geisinger, Danville, Pennsylvania
| | - Gail P. Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington Medical Center, Seattle
- Department of Genome Sciences, University of Washington, Seattle
| | - Hakon Hakonarson
- The Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bahram Namjou-Khales
- UC Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Patrick Sleiman
- The Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Frank Mentch
- The Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- at the time of the study, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- All of Us Research Program, National Institutes of Health, Bethesda, Maryland
- now, National Institutes of Health, Bethesda, Maryland
| | - MacRae F. Linton
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - C. Michael Stein
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| | - QiPing Feng
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
|
18
|
Merino J, Rotter JI. LDL Cholesterol and Dysglycemia: an Intriguing Physiological Relationship. Diabetes 2020; 69:2058-2060. [PMID: 32958607 PMCID: PMC7506830 DOI: 10.2337/dbi20-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jordi Merino
- Diabetes Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
- Programs in Metabolism and Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Research Unit on Lipids and Atherosclerosis, Universitat Rovira i Virgili, Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Torrance, CA
- Division of Genomic Outcomes, Departments of Pediatrics and Medicine, Harbor-UCLA Medical Center, Torrance, CA
- Departments of Pediatrics and Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
|
19
|
Klimentidis YC, Arora A, Newell M, Zhou J, Ordovas JM, Renquist BJ, Wood AC. Phenotypic and Genetic Characterization of Lower LDL Cholesterol and Increased Type 2 Diabetes Risk in the UK Biobank. Diabetes 2020; 69:2194-2205. [PMID: 32493714 PMCID: PMC7506834 DOI: 10.2337/db19-1134] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/29/2020] [Indexed: 01/03/2023]
Abstract
Although hyperlipidemia is traditionally considered a risk factor for type 2 diabetes (T2D), evidence has emerged from statin trials and candidate gene investigations suggesting that lower LDL cholesterol (LDL-C) increases T2D risk. We thus sought to more comprehensively examine the phenotypic and genotypic relationships of LDL-C with T2D. Using data from the UK Biobank, we found that levels of circulating LDL-C were negatively associated with T2D prevalence (odds ratio 0.41 [95% CI 0.39, 0.43] per mmol/L unit of LDL-C), despite positive associations of circulating LDL-C with HbA1c and BMI. We then performed the first genome-wide exploration of variants simultaneously associated with lower circulating LDL-C and increased T2D risk, using data on LDL-C from the UK Biobank (n = 431,167) and the Global Lipids Genetics Consortium (n = 188,577), and data on T2D from the Diabetes Genetics Replication and Meta-Analysis consortium (n = 898,130). We identified 31 loci associated with lower circulating LDL-C and increased T2D, capturing several potential mechanisms. Seven of these loci have previously been identified for this dual phenotype, and nine have previously been implicated in nonalcoholic fatty liver disease. These findings extend our current understanding of the higher T2D risk among individuals with low circulating LDL-C and of the underlying mechanisms, including those responsible for the diabetogenic effect of LDL-C-lowering medications.
Collapse
Affiliation(s)
- Yann C Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ
| | - Amit Arora
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Michelle Newell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Jin Zhou
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA
- Instituto Madrileño de Estudios Avanzados (IMDEA) Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Benjamin J Renquist
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ
| | - Alexis C Wood
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| |
Collapse
|
|
20
|
Abstract
Diabetes mellitus is a major risk factor for coronary heart disease (CHD). The major form of diabetes mellitus is type 2 diabetes mellitus (T2D), which is thus largely responsible for the CHD association in the general population. Recent years have seen major advances in the genetics of T2D, principally through ever-increasing large-scale genome-wide association studies. This article addresses the question of whether this expanding knowledge of the genomics of T2D provides insight into the etiologic relationship between T2D and CHD. We will investigate this relationship by reviewing the evidence for shared genetic loci between T2D and CHD; by examining the formal testing of this interaction (Mendelian randomization studies assessing whether T2D is causal for CHD); and then turn to the implications of this genetic relationship for therapies for CHD, for therapies for T2D, and for therapies that affect both. In conclusion, the growing knowledge of the genetic relationship between T2D and CHD is beginning to provide the promise for improved prevention and treatment of both disorders.
Collapse
Affiliation(s)
- Mark O. Goodarzi
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences and Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| |
Collapse
|
|
21
|
Huth C, Bauer A, Zierer A, Sudduth-Klinger J, Meisinger C, Roden M, Peters A, Koenig W, Herder C, Thorand B. Biomarker-defined pathways for incident type 2 diabetes and coronary heart disease-a comparison in the MONICA/KORA study. Cardiovasc Diabetol 2020; 19:32. [PMID: 32164753 PMCID: PMC7066738 DOI: 10.1186/s12933-020-01003-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
Background Biomarkers may contribute to our understanding of the pathophysiology of various diseases. Type 2 diabetes (T2D) and coronary heart disease (CHD) share many clinical and lifestyle risk factors and several biomarkers are associated with both diseases. The current analysis aims to assess the relevance of biomarkers combined to pathway groups for the development of T2D and CHD in the same cohort. Methods Forty-seven serum biomarkers were measured in the MONICA/KORA case-cohort study using clinical chemistry assays and ultrasensitive molecular counting technology. The T2D (CHD) analyses included 689 (568) incident cases and 1850 (2004) non-cases from three population-based surveys. At baseline, the study participants were 35–74 years old. The median follow-up was 14 years. We computed Cox regression models for each biomarker, adjusted for age, sex, and survey. Additionally, we assigned the biomarkers to 19 etiological pathways based on information from literature. One age-, sex-, and survey-controlled average variable was built for each pathway. We used the R2PM coefficient of determination to assess the explained disease risk. Results The associations of many biomarkers, such as several cytokines or the iron marker soluble transferrin receptor (sTfR), were similar in strength for T2D and CHD, but we also observed important differences. Lipoprotein (a) (Lp(a)) and N-terminal pro B-type natriuretic peptide (NT-proBNP) even demonstrated opposite effect directions. All pathway variables together explained 49% of the T2D risk and 21% of the CHD risk. The insulin-like growth factor binding protein 2 (IGFBP-2, IGF/IGFBP system pathway) best explained the T2D risk (about 9% explained risk, independent of all other pathway variables). For CHD, the myocardial-injury- and lipid-related-pathways were most important and both explained about 4% of the CHD risk. Conclusions The biomarker-derived pathway variables explained a higher proportion of the T2D risk compared to CHD. The ranking of the pathways differed between the two diseases, with the IGF/IGFBP-system-pathway being most strongly associated with T2D and the myocardial-injury- and lipid-related-pathways with CHD. Our results help to better understand the pathophysiology of the two diseases, with the ultimate goal of pointing out targets for lifestyle intervention and drug development to ideally prevent both T2D and CHD development.
Collapse
Affiliation(s)
- Cornelia Huth
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. .,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Alina Bauer
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Astrid Zierer
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | | | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, UNIKA-T Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Koenig
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| |
Collapse
|
|
22
|
Smit RAJ, Trompet S, Leong A, Goodarzi MO, Postmus I, Warren H, Theusch E, Barnes MR, Arsenault BJ, Li X, Feng Q, Chasman DI, Cupples LA, Hitman GA, Krauss RM, Psaty BM, Rotter JI, Cessie SL, Stein CM, Jukema JW. Statin-induced LDL cholesterol response and type 2 diabetes: a bidirectional two-sample Mendelian randomization study. THE PHARMACOGENOMICS JOURNAL 2019; 20:462-470. [PMID: 31801993 PMCID: PMC7260089 DOI: 10.1038/s41397-019-0125-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 02/07/2023]
Abstract
It remains unclear whether the increased risk of new-onset type 2 diabetes (T2D) seen in statin users is due to low LDL-C concentrations, or due to the statin-induced proportional change in LDL-C. In addition, genetic instruments have not been proposed before to examine whether liability to T2D might cause greater proportional statin-induced LDL-C lowering. Using summary level statistics from the Genomic Investigation of Statin Therapy (GIST, nmax=40,914) and DIAGRAM (nmax=159,208) consortia, we found a positive genetic correlation between LDL-C statin response and T2D using LD score regression (rgenetic=0.36, s.e.=0.13). However, mendelian randomization analyses did not provide support for statin response having a causal effect on T2D risk (OR 1.00 (95%CI: 0.97, 1.03) per 10% increase in statin response), nor that liability to T2D has a causal effect on statin-induced LDL-C response (0.20% increase in response (95%CI: −0.40, 0.80) per doubling of odds of liability to T2D). Although we found no evidence to suggest that proportional statin response influences T2D risk, a definitive assessment should be made in populations comprised exclusively of statin-users, as the presence of non-statin users in the DIAGRAM dataset may have substantially diluted our effect estimate.
Collapse
Affiliation(s)
- Roelof A J Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. .,Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Aaron Leong
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Mark O Goodarzi
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Iris Postmus
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Helen Warren
- William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK.,National Institute for Health Research, Barts Cardiovascular Biomedical Research Center, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Elizabeth Theusch
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr Way, Oakland, CA, 94609, USA
| | - Michael R Barnes
- William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK.,National Institute for Health Research, Barts Cardiovascular Biomedical Research Center, Barts and The London School of Medicine, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Benoit J Arsenault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Xiaohui Li
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - QiPing Feng
- Department of Medicine, Vanderbilt University, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - Daniel I Chasman
- Harvard Medical School, Boston, MA, 02115, USA.,Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, 02215, USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA.,NHLBI Framingham Heart Study, Framingham, MA, 01702, USA
| | - Graham A Hitman
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ronald M Krauss
- Children's Hospital Oakland Research Institute, 5700 Martin Luther King Jr Way, Oakland, CA, 94609, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA, 98101, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.,The Institute for Translational Genomics and Population Sciences, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Section of Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - C Michael Stein
- Department of Medicine, Vanderbilt University, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University, Nashville, TN, USA
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
|
23
|
Cui M, Xiao H, Li Y, Zhang S, Dong J, Wang B, Zhu C, Jiang M, Zhu T, He J, Wang H, Fan S. Sexual Dimorphism of Gut Microbiota Dictates Therapeutics Efficacy of Radiation Injuries. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1901048. [PMID: 31728280 PMCID: PMC6839645 DOI: 10.1002/advs.201901048] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/14/2019] [Indexed: 05/15/2023]
Abstract
Accidental or iatrogenic ionizing radiation exposure precipitates acute and chronic radiation injuries. The traditional paradigm of mitigating radiotherapy-associated adverse side effects has ignored the gender-specific dimorphism of patients' divergent responses. Here, the effects of sexual dimorphism on curative efficiencies of therapeutic agents is examined in murine models of irradiation injury. Oral gavage of simvastatin ameliorates radiation-induced hematopoietic injury and gastrointestinal tract dysfunction in male mice, but adversely deteriorates these radiation syndromes in female animals. In a sharp contrast, feeding animals with high-fat diet (HFD) elicites explicitly contrary results. High-throughput sequencing of microbial 16S rRNA, host miRNA, and mRNA shows that simvastatin or HFD administration preventes radiation-altered enteric bacterial taxonomic structure, preserves miRNA expression profile, and reprogrammes the spectrum of mRNA expression in small intestines of male or female mice, respectively. Notably, faecal microbiota transplantation of gut microbes from opposite sexual donors abrogates the curative effects of simvastatin or HFD in respective genders of animals. Together, these findings demonstrate that curative efficiencies of therapeutic strategies mitigating radiation toxicity might be dependent on the gender of patients, thus simvastatin or HFD might be specifically useful for fighting against radiation toxicity in a sex-dependent fashion partly based on sex-distinct gut microbiota composition in preclinical settings.
Collapse
Affiliation(s)
- Ming Cui
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Huiwen Xiao
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Yuan Li
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Shuqin Zhang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Jiali Dong
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Bin Wang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Changchun Zhu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Mian Jiang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Tong Zhu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Junbo He
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| | - Haichao Wang
- Laboratory of Emergency Medicine Feinstein Institute for Medical Research Manhasset NY 11030 USA
| | - Saijun Fan
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine Institute of Radiation Medicine Chinese Academy of Medical Sciences and Peking Union Medical College 238 Baidi Road Tianjin 300192 China
| |
Collapse
|
|
24
|
Ravnskov U, De Lorgeril M, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B, Hynes N, Kendrick M, Langsjoen PH, Mascitelli L, McCully KS, Okuyama H, Rosch PJ, Schersten T, Sultan S, Sundberg R. Response letter to ‘does high LDL-cholesterol cause cardiovascular disease?’. Expert Rev Clin Pharmacol 2019; 12:93-94. [DOI: 10.1080/17512433.2019.1561102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Michel De Lorgeril
- Laboratoire Coeur et Nutrition, TIMC-IMAG, School of Medicine, University of Grenoble-Alpes, Grenoble, France
| | - David M. Diamond
- Department of Psychology, Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, FL, USA
- Department of Molecular Pharmacology and Physiology, Center for Preclinical and Clinical Research on PTSD, University of South Florida, Tampa, FL, USA
| | - Rokuro Hama
- NPO Japan Institute of Pharmacovigilance, Osaka, Japan
| | - Tomohito Hamazaki
- Department of Internal Medicine, Toyama Jonan Onsen Daini Hospital, University of Toyama, Toyama, Japan
| | | | - Niamh Hynes
- Western Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland
| | - Malcolm Kendrick
- East Cheshire Trust, Macclesfield District General Hospital, Macclesfield, England
| | | | - Luca Mascitelli
- Medical Officer Service, Comando Brigata Alpina “Julia”/Multinational Land Force, Udine, Italy
| | - Kilmer S. McCully
- Pathology and Laboratory Medicine Service, VA Boston Healthcare System, West Roxbury; Harvard Medical School, Boston, MA, USA
| | | | - Paul J. Rosch
- New York Medical College, The American Institute of Stress, New York, NY, USA
| | - Tore Schersten
- Wallenberg Laboratory for Cardiovascluar and Metabolic Research, Sahlgren’s Academy, University of Gothenburg, Gothenburg, Sweden, and Columbia University, NY, USA
| | - Sherif Sultan
- Western Vascular Institute, University Hospital Galway & Galway Clinic, National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital, Galway, Ireland
| | | |
Collapse
|