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Laupsa-Borge J, Grytten E, Bohov P, Bjørndal B, Strand E, Skorve J, Nordrehaug JE, Berge RK, Rostrup E, Mellgren G, Dankel SN, Nygård OK. Sex-specific responses in glucose-insulin homeostasis and lipoprotein-lipid components after high-dose supplementation with marine n-3 PUFAs in abdominal obesity: a randomized double-blind crossover study. Front Nutr 2023; 10:1020678. [PMID: 37404855 PMCID: PMC10315503 DOI: 10.3389/fnut.2023.1020678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Background Clinical studies on effects of marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFAs), mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the plant-derived omega-6 (n-6) PUFA linoleic acid (LA) on lipoprotein-lipid components and glucose-insulin homeostasis have shown conflicting results, which may partly be explained by differential responses in females and males. However, we have lacked data on sexual dimorphism in the response of cardiometabolic risk markers following increased consumption of n-3 or n-6 PUFAs. Objective To explore sex-specific responses after n-3 (EPA + DHA) or n-6 (LA) PUFA supplementation on circulating lipoprotein subfractions, standard lipids, apolipoproteins, fatty acids in red blood cell membranes, and markers of glycemic control/insulin sensitivity among people with abdominal obesity. Methods This was a randomized double-blind crossover study with two 7-week intervention periods separated by a 9-week washout phase. Females (n = 16) were supplemented with 3 g/d of EPA + DHA (fish oil) or 15 g/d of LA (safflower oil), while males (n = 23) received a dose of 4 g/d of EPA + DHA or 20 g/d of LA. In fasting blood samples, we measured lipoprotein particle subclasses, standard lipids, apolipoproteins, fatty acid profiles, and markers of glycemic control/insulin sensitivity. Results The between-sex difference in relative change scores was significant after n-3 for total high-density lipoproteins (females/males: -11%*/-3.3%, p = 0.036; *: significant within-sex change), high-density lipoprotein particle size (+2.1%*/-0.1%, p = 0.045), and arachidonic acid (-8.3%*/-12%*, p = 0.012), and after n-6 for total (+37%*/+2.1%, p = 0.041) and small very-low-density lipoproteins (+97%*/+14%, p = 0.021), and lipoprotein (a) (-16%*/+0.1%, p = 0.028). Circulating markers of glucose-insulin homeostasis differed significantly after n-3 for glucose (females/males: -2.1%/+3.9%*, p = 0.029), insulin (-31%*/+16%, p < 0.001), insulin C-peptide (-12%*/+13%*, p = 0.001), homeostasis model assessment of insulin resistance index 2 (-12%*/+14%*, p = 0.001) and insulin sensitivity index 2 (+14%*/-12%*, p = 0.001), and quantitative insulin sensitivity check index (+4.9%*/-3.4%*, p < 0.001). Conclusion We found sex-specific responses after high-dose n-3 (but not n-6) supplementation in circulating markers of glycemic control/insulin sensitivity, which improved in females but worsened in males. This may partly be related to the sex differences we observed in several components of the lipoprotein-lipid profile following the n-3 intervention. Clinical trial registration https://clinicaltrials.gov/, identifier [NCT02647333].
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Affiliation(s)
- Johnny Laupsa-Borge
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elise Grytten
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Pavol Bohov
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elin Strand
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jon Skorve
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rolf K. Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Espen Rostrup
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Research Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Simon N. Dankel
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Research Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ottar K. Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Dhar I, Svingen GF, Bjørnestad EØ, Ulvik A, Saeed S, Nygård OK. B-vitamin treatment modifies the mortality risk associated with calcium channel blockers in patients with suspected stable angina pectoris: A prospective cohort study. Am J Clin Nutr 2023:S0002-9165(23)48891-0. [PMID: 37121550 PMCID: PMC10375456 DOI: 10.1016/j.ajcnut.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Calcium channel blockers (CCBs) are used for the treatment of cardiovascular disease (CVD), including angina pectoris, and hypertension; however, the effect on survival remains uncertain. CCBs impair fibrinolysis and have been linked to elevated plasma homocysteine (Hcy), a CVD risk marker. OBJECTIVE We explored the association between CCB use and mortality in a large prospective cohort of patients with suspected stable angina pectoris (SAP), and potential effect modifications by Hcy-lowering B-vitamin treatment (folic acid, B12 and/or B6) as 61.8% of the patients participated in a randomized placebo-controlled B-vitamin intervention trial. METHODS Patient baseline continuous characteristics according to CCB treatment were tested by linear regression. Hazard ratios (HRs) for mortality associated with CCB treatment, also according to B-vitamin intervention, were examined using Cox regression analysis. The multivariable model included cardiovascular risk factors, medical histories, and use of CVD medications. RESULTS A total of 3991 patients (71.5 % men) were included, of whom 907 were prescribed CCBs at discharge. During 10.3 years of median follow-up, 20.6% died and 8.9% from cardiovascular- and 11.6% from non-cardiovascular causes. Patients treated with CCBs had higher plasma Hcy, fibrinogen levels and erythrocyte sedimentation rate (all P<0.001). Further, CCB use was positively associated with mortality, also after multivariable adjustments (HRs [95% CIs]: 1.34 [1.15-1.57], 1.35 [1.08-1.70] and 1.33 [1.09-1.64] for total, CVD and non-CVD death, respectively). Numerically stronger associations were observed among patients not treated with B-vitamins (HR [95% CI]: 1.54 [1.25-1.88], 1.69 [1.25-2.30] and 1.41 [1.06- 1.86] for total, CVD and non-CVD death, respectively), whereas, no association was seen in patients treated with B-vitamins (HR [95% CI]: 1.15 [0.91-1.46], 1.09 [0.76-1.57] and 1.20 [0.88-1.65]). CONCLUSIONS In patients with suspected SAP, CCB treatment was associated with increased mortality risk primarily among patients not treated with B-vitamins. CLINICAL TRIAL REGISTRATION-URL https://clinicaltrials.gov/ct2/show/NCT00354081?term=NCT00354081&draw=2&rank=1. Clinical Trial Registration-Unique identifier (NCT number): NCT00354081.
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Affiliation(s)
- Indu Dhar
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway; Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Norway.
| | - Gard Ft Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Espen Ø Bjørnestad
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ottar K Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway; Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Dhar I, Lysne V, Ulvik A, Svingen GFT, Pedersen ER, Bjørnestad EØ, Olsen T, Borsholm R, Laupsa-Borge J, Ueland PM, Tell GS, Berge RK, Mellgren G, Bønaa KH, Nygård OK. Plasma methylmalonic acid predicts risk of acute myocardial infarction and mortality in patients with coronary heart disease: A prospective 2-cohort study. J Intern Med 2023; 293:508-519. [PMID: 36682040 DOI: 10.1111/joim.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Elevated plasma methylmalonic acid (MMA) is reported in patients with established coronary heart disease (CHD) and is considered a marker of vitamin B12 deficiency. Moreover, MMA-dependent reactions have been linked to alterations in mitochondrial energy metabolism and oxidative stress, key features in the pathophysiology of cardiovascular diseases (CVDs). OBJECTIVES We examined whether plasma MMA prospectively predicted the long-term risk of acute myocardial infarction (AMI) and mortality. METHODS AND RESULTS Using Cox modeling, we estimated hazard ratios (HRs) for endpoints according to per 1-SD increment of log-transformed plasma MMA in two independent populations: the Western Norway Coronary Angiography Cohort (WECAC) (patients evaluated for CHD; n = 4137) and the Norwegian Vitamin Trial (NORVIT) (patients hospitalized with AMI; n = 3525). In WECAC and NORVIT, 12.8% and 18.0% experienced an AMI, whereas 21.8% and 19.9% died, of whom 45.5% and 60.3% from CVD-related causes during follow-up (range 3-11 years), respectively. In WECAC, age- and gender-adjusted HRs (95% confidence interval) were 1.18 (1.09-1.28), 1.25 (1.18-1.33), and 1.28 (1.17-1.40) for future AMI, total mortality, and CVD mortality, respectively. Corresponding risk estimates were 1.19 (1.10-1.28), 1.22 (1.14-1.31), and 1.30 (1.19-1.42) in NORVIT. These estimates were only slightly attenuated after multivariable adjustments. Across both cohorts, the MMA-risk association was stronger in older adults, women, and non-smokers. CONCLUSIONS Elevated MMA was associated with an increased risk of AMI and mortality in patients with suspected or verified CHD.
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Affiliation(s)
- Indu Dhar
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway
| | - Vegard Lysne
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Espen Ø Bjørnestad
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Robert Borsholm
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Johnny Laupsa-Borge
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolf K Berge
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Kaare H Bønaa
- Department of Circulation and medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic for Heart Diseases, St. Olav's University Hospital, Trondheim, Norway
| | - Ottar K Nygård
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Van Parys A, Sæle J, Puaschitz NG, Anfinsen ÅM, Karlsson T, Olsen T, Haugsgjerd TR, Vinknes KJ, Holven KB, Dierkes J, Nygård OK, Lysne V. The association between dairy intake and risk of cardiovascular disease and mortality in patients with stable angina pectoris. Eur J Prev Cardiol 2023; 30:219-229. [PMID: 36134600 DOI: 10.1093/eurjpc/zwac217] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022]
Abstract
AIMS The association of dairy products with cardiovascular disease and mortality risk remains heavily debated. We aimed to investigate the association between intake of total dairy and dairy products and the risk of acute myocardial infarction (AMI), stroke, and cardiovascular and all-cause mortality. METHODS AND RESULTS We included 1929 patients (80% men, mean age 62 years) with stable angina pectoris from the Western Norway B-vitamin Intervention Trial. Dietary data were obtained via a 169-item food frequency questionnaire. Risk associations were estimated using Cox proportional hazard regression models adjusted for relevant covariates. Non-linear associations were explored visually. The mean (±SD) dairy intake in the study population was 169 ± 108 g/1000 kcal. Median follow-up times were 5.2, 7.8, and 14.1 years for stroke, AMI, and mortality, respectively. Higher intake of total dairy and milk were positively associated with stroke risk [HR (95% CI): 1.14 (1.02, 1.27) and 1.13 (1.02, 1.27), cardiovascular mortality 1.06 (1.00, 1.12) and 1.07 (1.01, 1.13)] and all-cause mortality [1.07 (1.03, 1.11) and 1.06 (1.03, 1.10)] per 50 g/1000 kcal. Higher cheese intake was inversely associated with AMI risk [0.92 (0.83, 1.02)] per 10 g/1000 kcal. Butter was associated with increased AMI risk [1.10 (0.97, 1.24)] and all-cause mortality [1.10 (1.00, 1.20) per 5 g/1000 kcal. CONCLUSION Higher dairy and milk consumption were associated with increased risk of mortality and stroke. Cheese was associated with decreased, and butter with increased, risk of AMI. Dairy is a heterogenous food group with divergent health effects and dairy products should therefore be investigated individually.
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Affiliation(s)
- Anthea Van Parys
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Haukelandsbakken 15, 5021 Bergen, Norway
| | - Jostein Sæle
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Haukelandsbakken 15, 5021 Bergen, Norway
| | - Nathalie G Puaschitz
- Centre of Care Research (West), Western Norway University of Applied Sciences (HVL), Årstadveien 17, 5009 Bergen, Norway
| | - Åslaug Matre Anfinsen
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Haukelandsbakken 15, 5021 Bergen, Norway
- Mohn Nutrition Research Laboratory, University of Bergen, Haukelandsbakken 15, 5121 Bergen, Norway
| | - Therese Karlsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Vita Stråket SU, 41345 Gothenburg, Sweden
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Teresa R Haugsgjerd
- Centre for Research on Cardiac Disease in Women, Department of Clinical Science, University of Bergen, Laboratory Building, Haukelandsbakken, 5009 Bergen, Norway
| | - Kathrine J Vinknes
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, 0372 Oslo, Norway
- National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Trondheimsveien 235, 0586 Oslo, Norway
| | - Jutta Dierkes
- Mohn Nutrition Research Laboratory, University of Bergen, Haukelandsbakken 15, 5121 Bergen, Norway
- Centre for Nutrition, Department of Clinical Medicine, University of Bergen, Haukelandsbakken 15, 5121 Bergen, Norway
- Department of Laboratory Medicine and Pathology, Haukeland University Hospital, Laboratory Building, 5009 Bergen, Norway
| | - Ottar K Nygård
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Haukelandsbakken 15, 5021 Bergen, Norway
- Mohn Nutrition Research Laboratory, University of Bergen, Haukelandsbakken 15, 5121 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
| | - Vegard Lysne
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Haukelandsbakken 15, 5021 Bergen, Norway
- Mohn Nutrition Research Laboratory, University of Bergen, Haukelandsbakken 15, 5121 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
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Dhar I, Svingen GFT, Pedersen EKR, Ulvik A, Bjørnestad EØ, Dankel SN, Mellgren G, Nygård OK. Physical activity and risk of all-cause mortality in patients with stable angina pectoris: Effect modification by β-blocker treatment. Int J Cardiol Cardiovasc Risk Prev 2022; 15:200150. [PMID: 36573185 PMCID: PMC9789355 DOI: 10.1016/j.ijcrp.2022.200150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 12/30/2022]
Abstract
Background Physical activity (PA) influences sympathetic stimulation, platelet activation as well as vascular function, and has been associated with improved health outcomes in patients with coronary heart disease. β-blocker therapy reduces sympathetic activity and improves platelet and endothelial function. We investigated if β-blocker treatment modifies the association of self-reported PA with the risk of all-cause mortality. Methods A total of 2284 patients undergoing elective coronary angiography for suspected stable angina pectoris (SAP) were studied. Using Cox modeling, we examined associations between PA (categorized as 'sedentary/inactive', 'low', 'moderate', and 'high') and all-cause mortality according to β-blocker therapy. Results During a median follow-up of 10.3 years, 390 patients (17.1%) died. Higher PA was generally associated with a more favorable cardiovascular risk profile. Compared to the patients who were sedentary or inactive, the age and sex adjusted HRs (95% CI) for all-cause mortality were 0.89 (0.66-1.20), 0.73 (0.57-0.95) and 0.72 (0.55-0.95) in the low, moderate and high PA group, respectively. However, and notably, these risk estimates were 0.85 (0.60-1.20), 0.65 (0.47-0.89) and 0.58 (0.41-0.81) in β-blocker treated subjects vs. 1.00 (0.57-1.78), 0.96 (0.61-1.52) and 1.20 (0.74-1.95) in non-treated groups (P interaction = 0.018). The results were essentially similar in the multivariable adjusted models. Conclusions In patients with suspected SAP, increased PA was associated with reduced mortality risk primarily in patients treated with β-blockers.
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Affiliation(s)
- Indu Dhar
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway,Corresponding author. Department of Clinical Science, University of Bergen, Laboratory Building, 9th floor, Haukeland University Hospital, Jonas Lies vei 87, Bergen N‐5021, Norway.
| | - Gard FT. Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eva KR. Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Simon N. Dankel
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway,Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway,Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Ottar K. Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Hilvo M, Dhar I, Lääperi M, Lysne V, Sulo G, Tell GS, Jousilahti P, Nygård OK, Brenner H, Schöttker B, Laaksonen R. Primary cardiovascular risk prediction by LDL-cholesterol in Caucasian middle-aged and older adults: a joint analysis of three cohorts. Eur J Prev Cardiol 2021; 29:e128-e137. [PMID: 34060615 DOI: 10.1093/eurjpc/zwab075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022]
Abstract
AIMS Low-density lipoprotein cholesterol (LDL-C) is an established causal driver of atherosclerotic cardiovascular disease (ASCVD), but its performance and age-dependency as a biomarker for incident events and mortality arising from ASCVD is less clear. The aim was to determine the value of LDL-C as a susceptibility/risk biomarker for incident coronary heart disease (CHD), ASCVD, and stroke events and deaths, for the age groups <50 and ≥50 years. METHODS AND RESULTS The performance of LDL-C was evaluated in three cohorts, FINRISK 2002 (n = 7709), HUSK (n = 5431), and ESTHER (n = 4559), by Cox proportional hazards models, C-statistics, and net reclassification index calculations. Additionally, the hazard ratios (HRs) for the three cohorts were pooled by meta-analysis. The most consistent association was observed for CHD [95% confidence interval (CI) for HRs per standard deviation ranging from 0.99 to 1.37], whereas the results were more modest for ASCVD (0.96-1.18) due to lack of association with stroke (0.77-1.24). The association and discriminatory value of LDL-C with all endpoints in FINRISK 2002 and HUSK were attenuated in subjects 50 years and older [HRs (95% CI) obtained from meta-analysis 1.11 (1.04-1.18) for CHD, 1.15 (1.02-1.29) for CHD death, 1.02 (0.98-1.06) for ASCVD, 1.12 (1.02-1.23) for ASCVD death, and 0.97 (0.89-1.05) for stroke]. CONCLUSION In middle-aged and older adults, associations between LDL-C and all the studied cardiovascular endpoints were relatively weak, while LDL-C showed stronger association with rare events of pre-mature CHD or ASCVD death among middle-aged adults. The predictive performance of LDL-C also depends on the studied cardiovascular endpoint.
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Affiliation(s)
- Mika Hilvo
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Indu Dhar
- Department of Clinical Science, Centre for Nutrition, University of Bergen, Klinisk institutt 1, Postboks 7804, 5020 Bergen, Norway
| | - Mitja Lääperi
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Vegard Lysne
- Department of Clinical Science, Centre for Nutrition, University of Bergen, Klinisk institutt 1, Postboks 7804, 5020 Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Gehard Sulo
- Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Zander Kaaesgate 7, 5015 Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5020 Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5808 Bergen, Norway
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Ottar K Nygård
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Hermann Brenner
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Bergheimer Strasse 20, 69115 Heidelberg, Germany
| | - Reijo Laaksonen
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland.,Finnish Cardiovascular Research Center, University of Tampere, Tampere University Hospital, Arvo Ylpön Katu 34, 33520 Tampere, Finland
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7
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Grytten E, Laupsa-Borge J, Bohov P, Bjørndal B, Strand E, Skorve J, Nordrehaug JE, Berge RK, Rostrup E, Mellgren G, Dankel SN, Nygård OK. Changes in lipoprotein particle subclasses, standard lipids, and apolipoproteins after supplementation with n-3 or n-6 PUFAs in abdominal obesity: A randomized double-blind crossover study. Clin Nutr 2021; 40:2556-2575. [PMID: 33933722 DOI: 10.1016/j.clnu.2021.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFAs), mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), lower circulating levels of triacylglycerols (TAGs), and the plant-derived omega-6 (n-6) PUFA linoleic acid (LA) may reduce cholesterol levels. Clinical studies on effects of these dietary or supplemental PUFAs on other blood fat fractions are few and have shown conflicting results. This study aimed to determine effects of high-dose supplemental n-3 (EPA + DHA) and n-6 (LA) PUFAs from high-quality oils on circulating lipoprotein subfractions and standard lipids (primary outcomes), as well as apolipoproteins, fatty acids, and glycemic control (secondary outcomes), in females and males with abdominal obesity. METHODS This was a randomized double-blind crossover study with two 7-wk intervention periods separated by a 9-wk washout phase. Females (n = 16) were supplemented with 3 g/d of EPA + DHA (TAG fish oil) or 15 g/d of LA (safflower oil), while males (n = 23) received a dose of 4 g/d of EPA + DHA or 20 g/d of LA. In fasting blood samples, we investigated lipoprotein particle subclasses by nuclear magnetic resonance spectroscopy, as well as standard lipids, apolipoproteins, fatty acid profiles, and glucose and insulin. Data were analyzed by linear mixed-effects modeling with 'subjects' as the random factor. RESULTS The difference between interventions in relative change scores was among the lipoprotein subfractions significant for total very-low-density lipoproteins (VLDLs) (n-3 vs. n-6: -38%∗ vs. +16%, p < 0.001; ∗: significant within-treatment change score), large VLDLs (-58%∗ vs. -0.91%, p < 0.001), small VLDLs (-57%∗ vs. +41%∗, p < 0.001), total low-density lipoproteins (LDLs) (+5.8%∗ vs. -4.3%∗, p = 0.002), large LDLs (+23%∗ vs. -2.1%, p = 0.004), total high-density lipoproteins (HDLs) (-6.0%∗ vs. +3.7%, p < 0.001), large HDLs (+11%∗ vs. -5.3%, p = 0.001), medium HDLs (-24%∗ vs. +6.2%, p = 0.030), and small HDLs (-9.9%∗ vs. +9.6%∗, p = 0.002), and among standard lipids for TAGs (-16%∗ vs. -2.6%, p = 0.014), non-esterified fatty acids (-19%∗ vs. +5.5%, p = 0.033), and total cholesterol (-0.28% vs. -4.4%∗, p = 0.042). A differential response in relative change scores was also found for apolipoprotein (apo)B (+0.40% vs. -6.0%∗, p = 0.008), apoA-II (-6.0%∗ vs. +1.5%, p = 0.001), apoC-II (-11%∗ vs. -1.7%, p = 0.025), and apoE (+3.3% vs. -3.8%, p = 0.028). CONCLUSIONS High-dose supplementation of high-quality oils with n-3 (EPA + DHA) or n-6 (LA) PUFAs was followed by reductions in primarily TAG- or cholesterol-related markers, respectively. The responses after both interventions point to changes in the lipoprotein-lipid-apolipoprotein profile that have been associated with reduced cardiometabolic risk, also among people with TAG or LDL-C levels within the normal range. REGISTRATION Registered under ClinicalTrials.gov Identifier: NCT02647333. CLINICAL TRIAL REGISTRATION Registered at https://clinicaltrials.gov/ct2/show/NCT02647333.
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Affiliation(s)
- Elise Grytten
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Johnny Laupsa-Borge
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Pavol Bohov
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Elin Strand
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Jon Skorve
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Jan Erik Nordrehaug
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Rolf K Berge
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Espen Rostrup
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Simon N Dankel
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Ottar K Nygård
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
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8
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Dhar I, Svingen GFT, Olsen T, Lysne V, Bjørnestad EØ, Ueland PM, Nygård OK. β-blocker use and risk of all-cause mortality in patients with coronary heart disease: effect modification by serum vitamin A. Eur J Prev Cardiol 2021; 28:1897-1902. [PMID: 33709106 DOI: 10.1093/eurjpc/zwaa158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/21/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022]
Abstract
AIMS Blockade of β-adrenoceptors reduces sympathetic nervous system activity and improves survival in patients with heart failure with reduced left ventricular ejection fraction (HFrEF); however, any improvement in longevity among patients with coronary heart disease (CHD) but without HFrEF remains uncertain. Vitamin A has been linked to the activation of tyrosine hydroxylase, the rate-limiting enzyme in the catecholamine synthesis pathway. We investigated if vitamin A status modified the association of β-blocker use with the risk of all-cause mortality. METHODS AND RESULTS A total of 4118 patients undergoing elective coronary angiography for suspected stable angina pectoris, of whom the majority had normal left ventricular ejection fraction (LVEF) were studied. Hazard ratios (HRs) of all-cause mortality comparing treatment vs. non-treatment of β-blockers according to the tertiles of serum vitamin A were explored in Cox proportional hazards regression models. During a median follow-up of 10.3 years, 897 patients (21.8%) died. The overall LVEF was 65% and 283 (6.9%) had anamnestic HF. After multivariable adjustments for traditional risk factors, medical history, and drug therapies of cardiovascular disease, β-blocker treatment was inversely associated with the risk of all-cause mortality [HR : 0.84; 95% CI (confidence interval), 0.72-0.97]. However, the inverse association was generally stronger among patients in the upper serum vitamin A tertile (HR :0.66; 95% CI, 0.50-0.86; Pinteraction = 0.012), which remained present after excluding patients with LVEF < 40%. CONCLUSION In patients with suspected CHD, β-blocker treatment was associated with improved survival primarily among patients with high serum vitamin A levels.
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Affiliation(s)
- Indu Dhar
- Mohn Nutrition Research Laboratory, Department of Clinical Sciences, University of Bergen, N-5021 Bergen, Norway
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vegard Lysne
- Mohn Nutrition Research Laboratory, Department of Clinical Sciences, University of Bergen, N-5021 Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Espen Ø Bjørnestad
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Ottar K Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Sciences, University of Bergen, N-5021 Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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9
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Tjora HL, Steiro OT, Langørgen J, Bjørneklett R, Nygård OK, Skadberg Ø, Bonarjee VVS, Collinson P, Omland T, Vikenes K, Aakre KM. Cardiac Troponin Assays With Improved Analytical Quality: A Trade-Off Between Enhanced Diagnostic Performance and Reduced Long-Term Prognostic Value. J Am Heart Assoc 2020; 9:e017465. [PMID: 33238783 PMCID: PMC7763786 DOI: 10.1161/jaha.120.017465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Cardiac troponin (cTn) permits early rule‐out/rule‐in of patients admitted with possible non–ST‐segment–elevation myocardial infarction. In this study, we developed an admission and a 0/1 hour rule‐out/rule‐in algorithm for a troponin assay with measurable results in >99% of healthy individuals. We then compared its diagnostic and long‐term prognostic properties with other protocols. Methods and Results Blood samples were collected at 0, 1, 3, and 8 to 12 hours from patients admitted with possible non–ST‐segment–elevation myocardial infarction. cTnT (Roche Diagnostics), cTnI(Abbott) (Abbott Diagnostics), and cTnI(sgx) (Singulex Clarity System) were measured in 971 admission and 465 1‐hour samples. An admission and a 0/1 hour rule‐out/rule‐in algorithm were developed for the cTnI(sgx) assay and its diagnostic properties were compared with cTnTESC (European Society of Cardiology), cTnI(Abbott)ESC, and 2 earlier cTnI(sgx) algorithms. The prognostic composite end point was all‐cause mortality and future nonfatal myocardial infarction during a median follow‐up of 723 days. non–ST‐segment–elevation myocardial infarction prevalence was 13%. The novel cTnI(sgx) algorithms showed similar performance regardless of time from symptom onset, and area under the curve was significantly better than comparators. The cTnI(sgx)0/1 hour algorithm classified 92% of patients to rule‐in or rule‐out compared with ≤78% of comparators. Patients allocated to rule‐out by the prior published 0/1 hour algorithms had significantly fewer long‐term events compared with the rule‐in and observation groups. The novel cTnI(sgx)0/1 hour algorithm used a higher troponin baseline concentration for rule‐out and did not allow for prognostication. Conclusions Increasingly sensitive troponin assays may improve identification of non–ST‐segment–elevation myocardial infarction but could rule‐out patients with subclinical chronic myocardial injury. Separate protocols for diagnosis and risk prediction seem appropriate.
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Affiliation(s)
- Hilde L Tjora
- Emergency Care Clinic Haukeland University Hospital Bergen Norway
| | - Ole-Thomas Steiro
- Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Jørund Langørgen
- Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Rune Bjørneklett
- Emergency Care Clinic Haukeland University Hospital Bergen Norway.,Department of Clinical Medicine University of Bergen Norway
| | - Ottar K Nygård
- Department of Heart Disease Haukeland University Hospital Bergen Norway.,Department of Clinical Science University of Bergen Norway
| | - Øyvind Skadberg
- Laboratory of Medical Biochemistry Stavanger University Hospital Stavanger Norway
| | | | - Paul Collinson
- Departments of Clinical Blood Sciences and Cardiology St Georges University Hospitals NHS Foundation Trust and St George's University of London London United Kingdom
| | - Torbjørn Omland
- Division of Medicine Akershus University Hospital Oslo Norway.,Center for Heart Failure Research Institute of Clinical Medicine University of Oslo Norway
| | - Kjell Vikenes
- Department of Heart Disease Haukeland University Hospital Bergen Norway.,Department of Clinical Science University of Bergen Norway
| | - Kristin M Aakre
- Department of Heart Disease Haukeland University Hospital Bergen Norway.,Department of Clinical Science University of Bergen Norway.,Department of Medical Biochemistry and Pharmacology Haukeland University Hospital Bergen Norway
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10
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Steiro OT, Tjora HL, Langørgen J, Bjørneklett R, Nygård OK, Skadberg Ø, Bonarjee VVS, Lindahl B, Omland T, Vikenes K, Aakre KM. Clinical risk scores identify more patients at risk for cardiovascular events within 30 days as compared to standard ACS risk criteria: the WESTCOR study. Eur Heart J Acute Cardiovasc Care 2020; 10:287-301. [PMID: 33620429 DOI: 10.1093/ehjacc/zuaa016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/26/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
AIMS Troponin-based algorithms are made to identify myocardial infarctions (MIs) but adding either standard acute coronary syndrome (ACS) risk criteria or a clinical risk score may identify more patients eligible for early discharge and patients in need of urgent revascularization. METHODS AND RESULTS Post-hoc analysis of the WESTCOR study including 932 patients (mean 63 years, 61% male) with suspected NSTE-ACS. Serum samples were collected at 0, 3, and 8-12 h and high-sensitivity cTnT (Roche Diagnostics) and cTnI (Abbott Diagnostics) were analysed. The primary endpoint was MI, all-cause mortality, and unplanned revascularizations within 30 days. Secondary endpoint was non-ST-elevation myocardial infarction (NSTEMI) during index hospitalization. Two combinations were compared: troponin-based algorithms (ESC 0/3 h and the High-STEACS algorithm) and either ACS risk criteria recommended in the ESC guidelines, or one of eleven clinical risk scores, HEART, mHEART, CARE, GRACE, T-MACS, sT-MACS, TIMI, EDACS, sEDACS, Goldman, and Geleijnse-Sanchis. The prevalence of primary events was 21%. Patients ruled out for NSTEMI and regarded low risk of ACS according to ESC guidelines had 3.8-4.9% risk of an event, primarily unplanned revascularizations. Using HEART score instead of ACS risk criteria reduced the number of events to 2.2-2.7%, with maintained efficacy. The secondary endpoint was met by 13%. The troponin-based algorithms without evaluation of ACS risk missed three-index NSTEMIs with a negative predictive value (NPV) of 99.5% and 99.6%. CONCLUSION Combining ESC 0/3 h or the High-STEACS algorithm with standardized clinical risk scores instead of ACS risk criteria halved the prevalence of rule-out patients in need of revascularization, with maintained efficacy.
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Affiliation(s)
- Ole-Thomas Steiro
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Hilde L Tjora
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ottar K Nygård
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Øyvind Skadberg
- Laboratory of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | | | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala, Sweden
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Oslo, Norway.,Faculty of Medicine, Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjell Vikenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kristin M Aakre
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
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11
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Haugsgjerd TR, Egeland GM, Nygård OK, Vinknes KJ, Sulo G, Lysne V, Igland J, Tell GS. Association of dietary vitamin K and risk of coronary heart disease in middle-age adults: the Hordaland Health Study Cohort. BMJ Open 2020; 10:e035953. [PMID: 32444431 PMCID: PMC7247390 DOI: 10.1136/bmjopen-2019-035953] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The role of vitamin K in the regulation of vascular calcification is established. However, the association of dietary vitamins K1 and K2 with risk of coronary heart disease (CHD) is inconclusive. DESIGN Prospective cohort study. SETTING We followed participants in the community-based Hordaland Health Study from 1997 - 1999 through 2009 to evaluate associations between intake of vitamin K and incident (new onset) CHD. Baseline diet was assessed by a past-year food frequency questionnaire. Energy-adjusted residuals of vitamin K1 and vitamin K2 intakes were categorised into quartiles. PARTICIPANTS 2987 Norwegian men and women, age 46-49 years. METHODS Information on incident CHD events was obtained from the nationwide Cardiovascular Disease in Norway (CVDNOR) Project. Multivariable Cox regression estimated HRs and 95% CIs with test for linear trends across quartiles. Analyses were adjusted for age, sex, total energy intake, physical activity, smoking and education. A third model further adjusted K1 intake for energy-adjusted fibre and folate, while K2 intake was adjusted for energy-adjusted saturated fatty acids and calcium. RESULTS During a median follow-up time of 11 years, we documented 112 incident CHD cases. In the adjusted analyses, there was no association between intake of vitamin K1 and CHD (HRQ4vsQ1 = 0.92 (95% CI 0.54 to 1.57), p for trend 0.64), while there was a lower risk of CHD associated with higher intake of energy-adjusted vitamin K2 (HRQ4vsQ1 = 0.52 (0.29 to 0.94), p for trend 0.03). Further adjustment for potential dietary confounders did not materially change the association for K1, while the association for K2 was slightly attenuated (HRQ4vsQ1 = 0.58 (0.28 to 1.19)). CONCLUSIONS A higher intake of vitamin K2 was associated with lower risk of CHD, while there was no association between intake of vitamin K1 and CHD. TRIAL REGISTRATION NUMBER NCT03013725.
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Affiliation(s)
- Teresa R Haugsgjerd
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Grace M Egeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Health Registries, Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Ottar K Nygård
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Centre for nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Gerhard Sulo
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Vegard Lysne
- Centre for nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
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12
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Dhar I, Siddique S, R Pedersen E, F T Svingen G, Lysne V, Olsen T, Nilsen DW, Nordrehaug JE, Midttun Ø, M Ueland P, S Tell G, K Nygård O. Lipid parameters and vitamin A modify cardiovascular risk prediction by plasma neopterin. Heart 2020; 106:1073-1079. [PMID: 32398245 DOI: 10.1136/heartjnl-2019-316165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Oxidised cholesterol metabolites are linked to increased production of the active vitamin A (Vit-A) form and monocyte/macrophage activation, which may be reflected by neopterin, a marker of both interferon-γ-mediated immune activation and coronary artery disease risk. We examined the influence of serum lipid parameters and Vit-A on the risk association between neopterin and incident acute myocardial infarction (AMI). METHODS We included 4130 patients with suspected stable angina pectoris (SAP), of whom 80% received lipid-lowering treatment with statins. Risk associations between plasma neopterin and AMI are given as HRs per SD increase in log-transformed neopterin. RESULTS During a median follow-up of 7.5 years, 530 (12.8%) patients experienced an AMI. In age-adjusted and sex-adjusted analysis, plasma neopterin was positively associated with incident AMI (HR (95% CI) per SD: 1.26 (1.17 to 1.35)). However, the estimates were most pronounced in patients with serum low-density lipoprotein cholesterol (LDL-C) or apolipoprotein (apo) B100 below-median (HR (95% CI) per SD: 1.35 (1.24 to 1.48) and 1.42 (1.27 to 1.58), respectively; both pinteraction ≤0.03). We also observed a particularly strong risk association in those with above-median Vit-A (HR (95% CI) per SD: 1.32 (1.21 to 1.44); pinteraction=0.03). The estimates were slightly modified after multivariable adjustment. CONCLUSIONS In patients with suspected SAP, the majority of whom receiving statin therapy, high plasma neopterin was associated with increased risk of AMI particularly among those with low LDL-C and apoB100 or high Vit-A levels. The particularly strong relationship of plasma neopterin with residual cardiovascular risk in patients with low lipid levels should be further investigated.
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Affiliation(s)
- Indu Dhar
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sumia Siddique
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Vegard Lysne
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Dennis W Nilsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ottar K Nygård
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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13
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Van Parys A, Lysne V, Svingen GFT, Ueland PM, Dhar I, Øyen J, Dierkes J, Nygård OK. Dietary choline is related to increased risk of acute myocardial infarction in patients with stable angina pectoris. Biochimie 2019; 173:68-75. [PMID: 31707100 DOI: 10.1016/j.biochi.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/02/2019] [Indexed: 02/06/2023]
Abstract
High plasma choline has been associated with the metabolic syndrome and risk of chronic diseases, including cardiovascular disease. However, dietary choline is not correlated with choline plasma concentrations, and there are few studies and contradictory evidence regarding dietary choline and cardiovascular events. In addition, a recommended dietary allowance for choline has not been established and remains a point of contention. This study assessed the association between dietary choline, including choline forms, and risk of incident acute myocardial infarction (AMI) in patients with suspected stable angina pectoris (SAP). In total 1981 patients (80% men, median age 62) from the Western Norway B Vitamin Intervention Trial were included in this analysis. Information on dietary choline was obtained using a 169-item food frequency questionnaire. The Cardiovascular Disease in Norway project provided data on AMI. Risk associations were estimated using Cox-regression analysis using energy-adjusted choline intake. Median (25th, 75th percentile) total energy-adjusted choline intake was 288 (255, 326) mg/d. During a median (25th, 75th percentile) follow-up of 7.5 (6.3, 8.8) years, 312 (15.7%) patients experienced at least one AMI. Increased intakes of energy-adjusted choline (HR [95% CI] per 50 mg increase 1.11 [1.03, 1.20]), phosphatidylcholine (HR per 50 mg increase 1.24 [1.08, 1.42]) and sphingomyelin (HR per 5 mg increase 1.16 [1.02, 1.31]) were associated with higher AMI risk. In conclusion, higher dietary intakes of total choline, phosphatidylcholine and sphingomyelin were associated with increased risk of AMI in patients with SAP. Future studies are necessary to explore underlying mechanisms for this observation.
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Affiliation(s)
- Anthea Van Parys
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Vegard Lysne
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | - Indu Dhar
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Jutta Dierkes
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Laboratory Medicine and Pathology, Haukeland University Hospital, Bergen, Norway
| | - Ottar K Nygård
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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14
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Lindquist C, Bjørndal B, Bakke HG, Slettom G, Karoliussen M, Rustan AC, Thoresen GH, Skorve J, Nygård OK, Berge RK. A mitochondria-targeted fatty acid analogue influences hepatic glucose metabolism and reduces the plasma insulin/glucose ratio in male Wistar rats. PLoS One 2019; 14:e0222558. [PMID: 31550253 PMCID: PMC6759202 DOI: 10.1371/journal.pone.0222558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022] Open
Abstract
A fatty acid analogue, 2-(tridec-12-yn-1-ylthio)acetic acid (1-triple TTA), was previously shown to have hypolipidemic effects in rats by targeting mitochondrial activity predominantly in liver. This study aimed to determine if 1-triple TTA could influence carbohydrate metabolism. Male Wistar rats were treated for three weeks with oral supplementation of 100 mg/kg body weight 1-triple TTA. Blood glucose and insulin levels, and liver carbohydrate metabolism gene expression and enzyme activities were determined. In addition, human myotubes and Huh7 liver cells were treated with 1-triple TTA, and glucose and fatty acid oxidation were determined. The level of plasma insulin was significantly reduced in 1-triple TTA-treated rats, resulting in a 32% reduction in the insulin/glucose ratio. The hepatic glucose and glycogen levels were lowered by 22% and 49%, respectively, compared to control. This was accompanied by lower hepatic gene expression of phosphenolpyruvate carboxykinase, the rate-limiting enzyme in gluconeogenesis, and Hnf4A, a regulator of gluconeogenesis. Gene expression of pyruvate kinase, catalysing the final step of glycolysis, was also reduced by 1-triple TTA. In addition, pyruvate dehydrogenase activity was reduced, accompanied by 10-15-fold increased gene expression of its regulator pyruvate dehydrogenase kinase 4 compared to control, suggesting reduced entry of pyruvate into the TCA cycle. Indeed, the NADPH-generating enzyme malic enzyme 1 (ME1) catalysing production of pyruvate from malate, was increased 13-fold at the gene expression level. Despite the decreased glycogen level, genes involved in glycogen synthesis were not affected in livers of 1-triple TTA treated rats. In contrast, the pentose phosphate pathway seemed to be increased as the hepatic gene expression of glucose-6-phosphate dehydrogenase (G6PD) was higher in 1-triple TTA treated rats compared to controls. In human Huh7 liver cells, but not in myotubes, 1-triple-TTA reduced glucose oxidation and induced fatty acid oxidation, in line with previous observations of increased hepatic mitochondrial palmitoyl-CoA oxidation in rats. Importantly, this work recognizes the liver as an important organ in glucose homeostasis. The mitochondrially targeted fatty acid analogue 1-triple TTA seemed to lower hepatic glucose and glycogen levels by inhibition of gluconeogenesis. This was also linked to a reduction in glucose oxidation accompanied by reduced PHD activity and stimulation of ME1 and G6PD, favouring a shift from glucose- to fatty acid oxidation. The reduced plasma insulin/glucose ratio indicate that 1-triple TTA may improve glucose tolerance in rats.
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Affiliation(s)
- Carine Lindquist
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hege G. Bakke
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Grete Slettom
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Marie Karoliussen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Arild C. Rustan
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - G. Hege Thoresen
- Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
- Department of Pharmacology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Skorve
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ottar K. Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rolf Kristian Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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15
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Tjora HL, Steiro OT, Langørgen J, Bjørneklett R, Nygård OK, Renstrøm R, Skadberg Ø, Bonarjee VVS, Lindahl B, Collinson P, Omland T, Vikenes K, Aakre KM. Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain-the WESTCOR study: study design. SCAND CARDIOVASC J 2019; 53:280-285. [DOI: 10.1080/14017431.2019.1634280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Hilde L. Tjora
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Ole-Thomas Steiro
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Bjørneklett
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ottar K. Nygård
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Renate Renstrøm
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Skadberg
- Laboratory of Medical Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | | | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Paul Collinson
- Departments of Clinical Blood Sciences and Cardiology, St Georges University Hospitals NHS Foundation Trust and St George’s University of London, London, UK
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Oslo, Norway
- Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjell Vikenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kristin M. Aakre
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
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16
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Dhar I, Lysne V, Svingen GFT, Ueland PM, Gregory JF, Bønaa KH, Nygård OK. Elevated plasma cystathionine is associated with increased risk of mortality among patients with suspected or established coronary heart disease. Am J Clin Nutr 2019; 109:1546-1554. [PMID: 31005968 DOI: 10.1093/ajcn/nqy391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/26/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Elevated circulating cystathionine levels are related to atherosclerotic cardiovascular disease, a leading cause of death globally. OBJECTIVE We investigated whether plasma cystathionine was associated with mortality in patients with suspected or established coronary heart disease (CHD). METHODS Data from 2 independent cohorts of patients with suspected stable angina pectoris (SAP) (3033 patients; median 10.7 y follow-up; 648 deaths) or acute myocardial infarction (AMI) (3670 patients; median 7.0 y follow-up; 758 deaths) were included. Hazard ratios with 95% CIs per SD increment of log-transformed cystathionine were calculated using Cox regression modeling. Endpoint data was obtained from a national health registry. RESULTS Among patients with SAP, there was a positive association between plasma cystathionine and death (age- and sex-adjusted HRs [95% CI] per SD: 1.23 [1.14, 1.32], 1.29 [1.16, 1.44], and 1.17 [1.05, 1.29] for total, cardiovascular, and noncardiovascular mortality, respectively). Corresponding risk estimates were 1.28 (1.19, 1.37) for all-cause, 1.33 (1.22, 1.45) for cardiovascular, and 1.19 (1.06, 1.34) for noncardiovascular death among AMI patients. In both cohorts, estimates were slightly attenuated after multivariate adjustments for established CHD risk factors. Subgroup analyses showed that the relation between cystathionine and all-cause mortality in SAP patients was stronger among nonsmokers and those with lower plasma concentration of pyridoxal-5'-phosphate (P-interaction ≤ 0.01 for both). CONCLUSIONS Elevated plasma cystathionine is associated with both cardiovascular and noncardiovascular mortality among patients with suspected or established CHD. The joint risk associations of high plasma cystathionine with lifestyle factors and impaired vitamin B-6 status on mortality need further investigation. This trial was registered at clinicaltrials.gov as NCT00354081 and NCT00266487.
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Affiliation(s)
- Indu Dhar
- Department of Clinical Science, KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
| | - Vegard Lysne
- Department of Clinical Science, KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Per M Ueland
- Department of Clinical Science, KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.,Bevital AS, Bergen, Norway
| | - Jesse F Gregory
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL
| | - Kaare H Bønaa
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ottar K Nygård
- Department of Clinical Science, KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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17
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Bjørndal B, Bruheim I, Lysne V, Ramsvik MS, Ueland PM, Nordrehaug JE, Nygård OK, Berge RK. Plasma choline, homocysteine and vitamin status in healthy adults supplemented with krill oil: a pilot study. Scand J Clin Lab Invest 2018; 78:527-532. [PMID: 30261756 DOI: 10.1080/00365513.2018.1512716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Plasma concentrations of metabolites along the choline oxidation and tryptophan degradation pathways have been linked to lifestyle diseases and dietary habits. This study aimed to investigate how krill oil, a source of ω-3 polyunsaturated fatty acids (PUFAs) with a high phosphatidylcholine content, affected these parameters. The pilot study was conducted as a 28 days intervention in 17 healthy volunteers (18-36 years), who received a supplement of 4.5 g krill oil per day, providing 833 mg ω-3 PUFAs, and 1750 mg phosphatidylcholine. Krill oil supplementation increased fasting plasma choline (+28.4%, p < .001), betaine (+26.6%, p < .001), dimethylglycine (+33.7%, p < .001) and sarcosine (+16.8%, p < .001), whereas no statistically significant changes were seen for plasma glycine, serine, methionine, total homocysteine, cysteine, cystathionine, methionine sulfoxide, folate, cobalamin, B2-, B3-, and B6 vitamers, tryptophan, kynurenines, nicotinamide, vitamin A and vitamin E. In summary, krill oil supplementation influenced choline metabolite levels, but not plasma metabolites of the tryptophan-kynurenine-nicotinamide pathways and vitamins. These observations should be confirmed in a placebo-controlled trial, including an ω-3 PUFA supplement without phospholipids to explore the potential additive effects of the different active ingredients.
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Affiliation(s)
- Bodil Bjørndal
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Inge Bruheim
- b Rimfrost AS , Fosnavåg , Norway.,c Møreforskning AS , Ålesund , Norway
| | - Vegard Lysne
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Marie S Ramsvik
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Per M Ueland
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Jan E Nordrehaug
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Ottar K Nygård
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,d Department of Heart Disease , Haukeland University Hospital , Bergen , Norway.,e KG Jebsen Centre for Diabetes Research, University of Bergen , Bergen , Norway
| | - Rolf K Berge
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,d Department of Heart Disease , Haukeland University Hospital , Bergen , Norway
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18
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Dhar I, Svingen GF, Ueland PM, Lysne V, Svenningsson MM, Tell GS, Nygård OK. Plasma Cystathionine and Risk of Incident Stroke in Patients With Suspected Stable Angina Pectoris. J Am Heart Assoc 2018; 7:e008824. [PMID: 30371177 PMCID: PMC6201441 DOI: 10.1161/jaha.118.008824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/20/2018] [Indexed: 12/14/2022]
Abstract
Background Cystathionine is an intermediate product in the transsulfuration pathway and formed during the B6-dependent conversion of methionine to cysteine. Elevated plasma cystathionine has been related to atherosclerosis, which is a major etiological factor for ischemic stroke. However, the role of cystathionine in stroke development is unknown. Therefore, we prospectively assessed the association of circulating levels of cystathionine with risk of total and ischemic stroke. Methods and Results Two-thousand thirty-six patients (64% men; median age, 62 years) undergoing coronary angiography for suspected stable angina pectoris were included. Stroke cases were identified by linkage to the CVDNOR (Cardiovascular Disease in Norway) project. Hazard ratios with confidence intervals (95% confidence interval) were estimated by using Cox-regression analyses. During 7.3 years of median follow-up, 124 (6.1%) incident strokes were ascertained, which comprised 100 cases of ischemic stroke. There was a positive association of plasma cystathionine with risk of total stroke and ischemic stroke. Comparing the fourth versus the first cystathionine quartiles, age- and sex-adjusted hazard ratios (95% confidence interval) were 2.11 (1.19-3.75) and 2.56 (1.31-4.99) for total and ischemic stroke, respectively. Additional adjustment for major stroke risk factors only slightly attenuated the associations, which tended to be stronger in patients without previous or existing atrial fibrillation at baseline (hazard ratio [95% confidence interval], 2.43 [1.27-4.65] and 2.88 [1.39-5.98] for total and ischemic stroke, respectively). Conclusions In patients with suspected stable angina pectoris, plasma cystathionine was independently related to increased risk of total stroke and, in particular, ischemic stroke. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00354081.
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Affiliation(s)
- Indu Dhar
- Department of Clinical ScienceUniversity of BergenNorway
- KG Jebsen Centre for Diabetes ResearchUniversity of BergenNorway
| | - Gard F.T. Svingen
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
| | - Per M. Ueland
- Department of Clinical ScienceUniversity of BergenNorway
- Bevital ASBergenNorway
| | - Vegard Lysne
- Department of Clinical ScienceUniversity of BergenNorway
| | | | - Grethe S. Tell
- Department of Global Public Health and Primary CareUniversity of BergenNorway
- Norwegian Institute of Public HealthBergenNorway
| | - Ottar K. Nygård
- Department of Clinical ScienceUniversity of BergenNorway
- KG Jebsen Centre for Diabetes ResearchUniversity of BergenNorway
- Department of Heart DiseaseHaukeland University HospitalBergenNorway
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19
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Olsen T, Vinknes KJ, Svingen GFT, Pedersen ER, Dhar I, Tell GS, Blomhoff R, Ueland PM, Midttun Ø, Refsum H, Nygård OK. The risk association of plasma total homocysteine with acute myocardial infarction is modified by serum vitamin A. Eur J Prev Cardiol 2018; 25:1612-1620. [DOI: 10.1177/2047487318788587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Plasma total homocysteine (tHcy) has been implicated in the development of cardiovascular disease, but the mechanisms remain unclear. Vitamin A (Vit-A) is involved in homocysteine metabolism and we therefore explored the potential interaction between plasma tHcy and serum Vit-A in relation to incident acute myocardial infarction. Methods Cox proportional hazards models were used to assess the prospective relationships between tHcy and acute myocardial infarction in 2205 patients from Western Norway undergoing elective coronary angiography for suspected stable angina pectoris. Results are reported as hazard ratio per standard deviation increase in log-transformed tHcy. An interaction term for tHcy × Vit-A was added to multivariate models including age, sex, smoking, apolipoprotein B fasting, statin and aspirin prescription and estimated glomerular filtration rate. Results Geometric mean (geometric standard deviation) age of the participants (64.3% men) was 62.3 (1.24) years. Plasma tHcy was higher among participants in the upper versus lower Vit-A tertile. During 7 (2.4) years of follow-up, 15.1% suffered an AMI. A significant association of plasma tHcy with AMI in the total study population was observed. When we stratified the population according to Vit-A tertiles, plasma tHcy was associated with acute myocardial infarction only in the upper Vit-A tertile (hazard ratio per SD: 1.25, 95% confidence interval: 1.04–1.53, pinteraction = 0.03). Conclusions The risk relationship between plasma tHcy and acute myocardial infarction was modified by serum concentrations of Vit-A in patients with suspected stable angina pectoris. This finding may clarify the relationship between tHcy and cardiovascular disease.
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Affiliation(s)
- Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Kathrine J Vinknes
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Gard FT Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Centre for Diabetes Research, University of Bergen, Norway
| | - Indu Dhar
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Norway
| | - Per M Ueland
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
- Bevital AS, Bergen, Norway
| | | | - Helga Refsum
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Ottar K Nygård
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Centre for Diabetes Research, University of Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway
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20
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Dhar I, Svingen GFT, Pedersen ER, DeRatt B, Ulvik A, Strand E, Ueland PM, Bønaa KH, Gregory JF, Nygård OK. Plasma cystathionine and risk of acute myocardial infarction among patients with coronary heart disease: Results from two independent cohorts. Int J Cardiol 2018; 266:24-30. [PMID: 29728335 DOI: 10.1016/j.ijcard.2018.04.083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/06/2018] [Accepted: 04/18/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cystathionine is a thio-ether and a metabolite formed from homocysteine during transsulfuration. Elevated plasma cystathionine levels are reported in patients with cardiovascular disease; however prospective relationships with acute myocardial infarction (AMI) are unknown. We investigated associations between plasma cystathionine and AMI among patients with suspected and/or verified coronary heart disease (CHD). METHODS Subjects from two independent cohort studies, the Western Norway Coronary Angiography Cohort (WECAC) (3033 patients with stable angina pectoris; 263 events within 4.8 years of median follow-up) and the Norwegian Vitamin Trial (NORVIT) (3670 patients with AMI; 683 events within 3.2 years of median follow-up) were included. RESULTS In both cohorts, plasma cystathionine was associated with several traditional CHD risk factors (P < 0.001). Comparing the cystathionine quartile 4 to 1, age and gender adjusted hazard ratios (95% confidence intervals) for AMI were 2.08 (1.43-3.03) and 1.41 (1.12-1.76) in WECAC and NORVIT, respectively. Additional adjustment for traditional risk factors slightly attenuated the risk estimates, which were generally stronger in both cohorts among non-smokers, patients with higher age, and lower BMI or PLP status (P-interaction ≤ 0.04). Risk associations also tended to be stronger in patients not treated with B-vitamins. Additionally, in a subset of 80 WECAC patients, plasma cystathionine associated strongly negatively with glutathione, an important antioxidant and positively with lanthionine, a marker of H2S production (P < 0.001). CONCLUSIONS Plasma cystathionine is associated with increased risk of AMI among patients with either suspected or verified coronary heart disease, and is possibly related to altered redox homeostasis.
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Affiliation(s)
- Indu Dhar
- Department of Clinical Science, University of Bergen, Bergen, Norway; KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Barbara DeRatt
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL
| | | | - Elin Strand
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per M Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway; Bevital AS, Bergen, Norway
| | - Kaare H Bønaa
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jesse F Gregory
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL
| | - Ottar K Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway; KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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21
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Rosendahl-Riise H, Karlsson T, Drevon CA, Apalset EM, Nygård OK, Tell GS, Dierkes J. Total and lean fish intake is positively associated with bone mineral density in older women in the community-based Hordaland Health Study. Eur J Nutr 2018. [PMID: 29541909 DOI: 10.1007/s00394-018-1665-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Fish is a source of various nutrients beneficial for bone health, but few studies have investigated the association between bone mineral density (BMD) and fish consumption. Thus, the aim was to investigate the relationship between total fish intake and BMD and between both lean and fatty fish intake and BMD. METHOD These cross-sectional analyses include 4656 participants in the Hordaland Health Study, a community-based study conducted in 1997-1999. The study includes two birth cohorts of men and women from Hordaland county (Norway) born in 1950-1951 and 1925-1927. BMD was measured by dual-energy X-ray absorptiometry and dietary intake was obtained from a semi-quantitative food-frequency questionnaire. RESULTS The average total fish intake was 33 ± 18 g/1000 kcal and was primarily lean fish. Older women had significantly lower BMD than older men and middle-aged men and women. In older women, total and lean fish intake (50 g/1000 kcal) was significantly and positively associated with BMD also after multivariate adjustments (β-coefficient 0.018, p = 0.017 and 0.026, p = 0.021). CONCLUSION A high intake of fish, in particular lean fish, was positively associated with BMD in older women. No association between intake of fatty fish and BMD was found in either of the age and sex groups.
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Affiliation(s)
- Hanne Rosendahl-Riise
- Department of Clinical Science, Faculty of Medicine, University of Bergen, P.O. Box 7804, Laboratory Building 8th Floor, 5020, Bergen, Norway.
| | - Therese Karlsson
- Department of Clinical Science, Faculty of Medicine, University of Bergen, P.O. Box 7804, Laboratory Building 8th Floor, 5020, Bergen, Norway
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen M Apalset
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ottar K Nygård
- Department of Clinical Science, Faculty of Medicine, University of Bergen, P.O. Box 7804, Laboratory Building 8th Floor, 5020, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jutta Dierkes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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22
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Christensen MHE, Fadnes DJ, Røst TH, Pedersen ER, Andersen JR, Våge V, Ulvik A, Midttun Ø, Ueland PM, Nygård OK, Mellgren G. Inflammatory markers, the tryptophan-kynurenine pathway, and vitamin B status after bariatric surgery. PLoS One 2018; 13:e0192169. [PMID: 29401505 PMCID: PMC5798786 DOI: 10.1371/journal.pone.0192169] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/17/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Obesity is associated with increased inflammation and insulin resistance. In conditions with chronic immune activation, low plasma vitamin B6-levels are described, as well as an increased kynurenine:tryptophan-ratio (KTR). We investigated circulating tryptophan, kynurenine and its metabolites, neopterin, B-vitamins, CRP, and HbA1c in individuals with obesity before and after bariatric surgery. METHODS This longitudinal study included 37 patients with severe obesity, scheduled for bariatric surgery. Blood samples were taken at inclusion and at three months and one year postoperatively. RESULTS We observed significant positive correlations between HbA1c and both 3-hydroxy-kynurenine and 3-hydroxyanthranilic acid at inclusion. After surgery, fasting glucose, HbA1C and triglycerides decreased, whereas HDL-cholesterol increased. Tryptophan, kynurenine and its metabolites, except for anthranilic acid, decreased during weight loss. The KTR and CRP decreased while vitamin B6 increased during the year following operation, indicating reduced inflammation (all p<0.05). CONCLUSIONS In patients with obesity subjected to bariatric surgery, levels of 3-hydroxykynurenine and 3-hydroxyanthranilic acid seemed to be positively correlated to impaired glucose tolerance. One year following surgery, plasma levels of the kynurenine metabolites were substantially decreased, along with a metabolic improvement. The relation of circulating kynurenine pathway metabolites with biomarkers of metabolic impairment in patients with obesity needs further evaluation.
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Affiliation(s)
- Monika H. E. Christensen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Dag J. Fadnes
- Medical Department, Førde Hospital Trust, Førde, Norway
| | - Therese H. Røst
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eva R. Pedersen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John R. Andersen
- Sogn og Fjordane University College, Førde, Norway
- Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Villy Våge
- Center of Health Research, Førde Hospital Trust, Førde, Norway
- Department of Surgery, Voss Hospital, Bergen Health Trust, Voss, Norway
| | | | | | - Per M. Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Ottar K. Nygård
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- KG Jebsen Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- * E-mail:
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23
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Rebnord EW, Strand E, Midttun Ø, Svingen GFT, Christensen MHE, Ueland PM, Mellgren G, Njølstad PR, Tell GS, Nygård OK, Pedersen ER. The kynurenine:tryptophan ratio as a predictor of incident type 2 diabetes mellitus in individuals with coronary artery disease. Diabetologia 2017; 60:1712-1721. [PMID: 28612106 PMCID: PMC5552838 DOI: 10.1007/s00125-017-4329-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/15/2017] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The tryptophan metabolite kynurenine has potent immune modulatory and vasoactive properties. Experimental data implicate kynurenine in obesity-related morbidities. Epidemiological studies are, however, sparse. We evaluated associations of the plasma and urine kynurenine:tryptophan ratio (KTR) to incident type 2 diabetes. METHODS We followed 2519 individuals with coronary artery disease (CAD; 73.1% men) without diabetes at baseline for a median of 7.6 years, during which 173 (6.9%) new incidences of type 2 diabetes were identified. Multivariate Cox regression analyses were applied to investigate the prospective relationships of plasma and urine KTR with new onset type 2 diabetes. RESULTS At inclusion, mean (SD) age was 61.3 (10.4) years, BMI was 25.9 (3.71) kg/m2 and median (interquartile range) HbA1c was 5.6% (5.0%-6.0%) (38 [31-42] mmol/mol). Plasma KTR was not significantly related to type 2 diabetes risk. By contrast, urine KTR showed a strong positive association. Comparing quartile 4 with quartile 1, the HRs (95% CIs) were 2.59 (1.56, 4.30) and 2.35 (1.39, 3.96) in the age- and sex-adjusted and multivariate models, respectively. CONCLUSIONS/INTERPRETATION Urine KTR is a strong predictor of incident type 2 diabetes in individuals with CAD. Potential clinical implications and possible pathogenic roles of renal kynurenine excretion in type 2 diabetes development should be further elucidated.
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Affiliation(s)
- Eirik W Rebnord
- Department of Clinical Science, University of Bergen, Bergen, Norway.
- KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway.
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
| | - Elin Strand
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Monika H E Christensen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Per M Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Department of Clinical Science, University of Bergen, Bergen, Norway
- KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Pål R Njølstad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ottar K Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway
- KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Eva R Pedersen
- KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
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24
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Ulvik A, Hustad S, McCann A, Midttun Ø, Nygård OK, Ueland PM. Ratios of One-Carbon Metabolites Are Functional Markers of B-Vitamin Status in a Norwegian Coronary Angiography Screening Cohort. J Nutr 2017; 147:1167-1173. [PMID: 28381531 DOI: 10.3945/jn.116.244657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/03/2017] [Accepted: 03/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Functional (metabolic) markers of B-vitamin status, including plasma total homocysteine (tHcy) for folate and plasma methylmalonic acid (MMA) for vitamin B-12, suffer from moderate sensitivity and poor specificity. Ratios of metabolites belonging to the same pathway may have better performance characteristics.Objective: We evaluated the ratios of tHcy to total cysteine (tCys; Hcy:Cys), tHcy to creatinine (Hcy:Cre), and tHcy to tCys to creatinine (Hcy:Cys:Cre) as functional markers of B-vitamin status represented by a summary score composed of folate, cobalamin, betaine, pyridoxal 5'-phosphate (PLP), and riboflavin concentrations measured in plasma.Methods: Cross-sectional data were obtained from a cohort of patients with stable angina pectoris (2994 men and 1167 women) aged 21-88 y. The relative contribution of the B-vitamin score, age, sex, smoking, body mass index, and markers of renal function and inflammation to the variance of the functional B-vitamin markers was calculated by using multiple linear regression.Results: Compared with tHcy alone, Hcy:Cys, Hcy:Cre, and Hcy:Cys:Cre all showed improved sensitivity and specificity for detecting plasma B-vitamin status. Improvements in overall performance ranged from 4-fold for Hcy:Cys to ∼8-fold for Hcy:Cys:Cre and were particularly strong in subjects with the common 5,10-methylenetetrahydrofolate reductase (MTHFR) 677CC genotype.Conclusions: Ratios of tHcy to tCys and/or creatinine showed a severalfold improvement over tHcy alone as functional markers of B-vitamin status in Norwegian coronary angiography screenees. The biological rationale for these ratios is discussed in terms of known properties of enzymes involved in the catabolism of homocysteine and synthesis of creatine and creatinine.
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Affiliation(s)
| | - Steinar Hustad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | - Ottar K Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; and
| | - Per M Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
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25
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Haugsgjerd TR, Dierkes J, Vollset SE, Vinknes KJ, Nygård OK, Seifert R, Sulo G, Tell GS. Association between Weight Change and Mortality in Community Living Older People Followed for Up to 14 Years. The Hordaland Health Study (HUSK). J Nutr Health Aging 2017; 21:909-917. [PMID: 28972244 DOI: 10.1007/s12603-016-0866-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To study the importance of weight change with regard to mortality in older people. DESIGN Prospective cohort study. PARTICIPANTS The cohort includes participants in the Hordaland Health Study, Norway, 1997-99 (N=2935, age 71-74 years) who had previously participated in a survey in 1992-93. MEASUREMENTS Participants with weight measured at both surveys were followed for mortality through 2012. Cox proportional hazards models were used to calculate risk of death according to changes in weight. Hazard ratios (HR) with 95% confidence intervals (CIs) for people with stable weight (± <5% weight change) were compared to people who lost (≥5%) or gained (≥5%) weight. Cox regression with penalized spline was used to evaluate the association between weight change (in kg) and mortality. Analyses were adjusted for age, sex, physical activity, smoking, diabetes, hypertension, and previous myocardial infarction or stroke. Participants with cancer were excluded. RESULTS Compared to those with stable weight, participants who lost ≥5% weight had an increased mortality risk (HR 1.59 [95% CI: 1.35-1.89]) while the group with weight gain ≥5% did not (HR 1.07 [95% CI 0.90-1.28]). Penalized spline identified those who lost more than about three kg or gained more than about 12 kg as having increased risk of death. CONCLUSION Even a minor weight loss of ≥5% or >3 kg were significantly associated with increased risk of mortality. Thus, weight should be routinely measured in older adults.
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Affiliation(s)
- T R Haugsgjerd
- Teresa Risan Haugsgjerd, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway; , Tel: +47 40634711
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26
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Veum VL, Laupsa-Borge J, Eng Ø, Rostrup E, Larsen TH, Nordrehaug JE, Nygård OK, Sagen JV, Gudbrandsen OA, Dankel SN, Mellgren G. Visceral adiposity and metabolic syndrome after very high-fat and low-fat isocaloric diets: a randomized controlled trial. Am J Clin Nutr 2017; 105:85-99. [PMID: 27903520 DOI: 10.3945/ajcn.115.123463] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/28/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Different aspects of dietary pattern, including macronutrient and food profiles, may affect visceral fat mass and metabolic syndrome. OBJECTIVE We hypothesized that consuming energy primarily from carbohydrate or fat in diets with similar food profiles would differentially affect the ability to reverse visceral adiposity and metabolic syndrome. DESIGN Forty-six men (aged 30-50 y) with body mass index (in kg/m2) >29 and waist circumference >98 cm were randomly assigned to a very high-fat, low-carbohydrate (VHFLC; 73% of energy fat and 10% of energy carbohydrate) or low-fat, high-carbohydrate (LFHC; 30% of energy fat and 53% of energy carbohydrate) diet for 12 wk. The diets were equal in energy (8750 kJ/d), protein (17% of energy), and food profile, emphasizing low-processed, lower-glycemic foods. Fat mass was quantified with computed tomography imaging. RESULTS Recorded intake of carbohydrate and total and saturated fat in the LFHC and VHFLC groups were 51% and 11% of energy, 29% and 71% of energy, and 12% and 34% of energy, respectively, with no difference in protein and polyunsaturated fatty acids. Mean energy intake decreased by 22% and 14% in the LFHC and VHFLC groups. The diets similarly reduced waist circumference (11-13 cm), abdominal subcutaneous fat mass (1650-1850 cm3), visceral fat mass (1350-1650 cm3), and total body weight (11-12 kg). Both groups improved dyslipidemia, with reduced circulating triglycerides, but showed differential responses in total and low-density lipoprotein cholesterol (decreased in LFHC group only), and high-density lipoprotein cholesterol (increased in VHFLC group only). The groups showed similar reductions in insulin, insulin C-peptide, glycated hemoglobin, and homeostasis model assessment of insulin resistance. Notably, improvements in circulating metabolic markers in the VHFLC group mainly were observed first after 8 wk, in contrast to more acute and gradual effects in the LFHC group. CONCLUSIONS Consuming energy primarily as carbohydrate or fat for 3 mo did not differentially influence visceral fat and metabolic syndrome in a low-processed, lower-glycemic dietary context. Our data do not support the idea that dietary fat per se promotes ectopic adiposity and cardiometabolic syndrome in humans. This study was registered at clinicaltrials.gov as NCT01750021.
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Affiliation(s)
- Vivian L Veum
- Department of Clinical Science.,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
| | - Johnny Laupsa-Borge
- Department of Clinical Science.,Hormone Laboratory and.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Espen Rostrup
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Terje H Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Ottar K Nygård
- Department of Clinical Science.,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jørn V Sagen
- Department of Clinical Science.,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
| | | | - Simon N Dankel
- Department of Clinical Science, .,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
| | - Gunnar Mellgren
- Department of Clinical Science, .,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
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27
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Ding Y, Pedersen ER, Svingen GF, Helgeland Ø, Gregory JF, Løland KH, Meyer K, Tell GS, Ueland PM, Nygård OK. Methylenetetrahydrofolate Dehydrogenase 1 Polymorphisms Modify the Associations of Plasma Glycine and Serine With Risk of Acute Myocardial Infarction in Patients With Stable Angina Pectoris in WENBIT (Western Norway B Vitamin Intervention Trial). ACTA ACUST UNITED AC 2016; 9:541-547. [DOI: 10.1161/circgenetics.116.001483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 10/21/2016] [Indexed: 02/07/2023]
Abstract
Background—
Serine and glycine interconversion and methylenetetrahydrofolate dehydrogenase 1 (MTHFD1)–mediated 1-carbon transfer are the major sources of methyl groups for 1-carbon metabolism. Recently, plasma glycine and a common polymorphism in MTHFD1 have been associated with risk of acute myocardial infarction (AMI). It is, therefore, of interest to explore if these 2 pathways interact in relation to AMI.
Methods and Results—
A total of 2571 participants in the WENBIT (Western Norway B Vitamin Intervention Trial) undergoing coronary angiography for stable angina pectoris were studied. Associations of plasma serine and glycine concentrations with risk of AMI across 2 common and functional MTHFD1 polymorphisms (
rs2236225
and
rs1076991
) were explored in Cox regression models. During a median follow-up of 4.7 years, 212 patients (8.2%) experienced an AMI. In age- and sex-adjusted analyses, plasma glycine (
P
<0.01), but not serine (
P
=0.52), showed an overall association with AMI. However, interactions of MTHFD1
rs2236225
polymorphism with both plasma serine and glycine were observed (
P
interaction
=0.03 for both). Low plasma serine and glycine were associated with an increased risk of AMI among patients carrying the
rs2236225
minor A allele. Similarly, low plasma glycine showed stronger risk relationship with AMI in the
rs1076991
CC genotype carriers but weaker associations in patients carrying the minor T allele (
P
interaction
=0.02).
Conclusions—
Our results showed that 2 common and functional polymorphisms in the
MTHFD1
gene modulate the risk associations of plasma serine and glycine with AMI. These findings emphasize the possible role of the MTHFD1 in regulating serine and glycine metabolism in relation to atherosclerotic complications.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique Identifier: NCT00354081.
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Affiliation(s)
- Yunpeng Ding
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Eva R. Pedersen
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Gard F.T. Svingen
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Øyvind Helgeland
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Jesse F. Gregory
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Kjetil H. Løland
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Klaus Meyer
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Grethe S. Tell
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Per M. Ueland
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
| | - Ottar K. Nygård
- From the Department of Clinical Science (Y.D., E.R.P., P.M.U., O.K.N.), KG Jebsen Center for Diabetes Research, Department of Clinical Science (Ø.H., O.K.N.), and Department of Global Public Health and Primary Care (G.S.T.), University of Bergen, Norway; Department of Heart Disease (G.F.T.S., K.H.L., O.K.N.) and Department of Pediatrics (Ø.H.), Haukeland University Hospital, Bergen, Norway; Laboratory of Clinical Biochemistry, Bergen, Norway (P.M.U.); Food Science and Human Nutrition Department,
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28
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Ding YP, Pedersen EKR, Johansson S, Gregory JF, Ueland PM, Svingen GFT, Helgeland Ø, Meyer K, Fredriksen Å, Nygård OK. B vitamin treatments modify the risk of myocardial infarction associated with a MTHFD1 polymorphism in patients with stable angina pectoris. Nutr Metab Cardiovasc Dis 2016; 26:495-501. [PMID: 26803590 DOI: 10.1016/j.numecd.2015.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/24/2015] [Accepted: 12/15/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Methylenetetrahydrofolate dehydrogenase (MTHFD1) catalyzes three sequential reactions that metabolize derivatives of tetrahydrofolate (THF) in folate-dependent one-carbon metabolism. Impaired MTHFD1 flux has been linked to disturbed lipid metabolism and oxidative stress. However, limited information is available on its relation to the development of atherothrombotic cardiovascular disease. METHODS AND RESULTS We explored the association between a MTHFD1 polymorphism (rs1076991 C > T) and acute myocardial infarction (AMI), and potential effect modifications by folic acid/B12 and/or vitamin B6 treatment in suspected stable angina pectoris patients (n = 2381) participating in the randomized Western Norway B Vitamin Intervention Trial (WENBIT). During the median follow-up of 4.9 years 204 participants (8.6%) suffered an AMI. After adjusting for established CVD risk factors, the MTHFD1 polymorphism was significantly associated with AMI (HR: 1.49; 95% CI, 1.23-1.81). A similar association was observed among patients allocated to treatment with vitamin B6 alone (HR: 1.53; 95% CI, 1.01-2.31), and an even stronger relationship was seen in patients treated with both vitamin B6 and folic acid/B12 (HR: 2.35; 95% CI, 1.55-3.57). However, no risk association between the MTHFD1 polymorphism and AMI was seen in patients treated with placebo (HR: 1.29; 95% CI, 0.86-1.93) or folic acid/B12 (1.17; 95% CI, 0.83-1.65). CONCLUSION A common and functional MTHFD1 polymorphism is associated with increased risk of AMI, although the risk seems to be dependent on specific B vitamin treatment. Further studies are warranted to elucidate the possible mechanisms, also in order to explore potential effect modifications by nutritional factors.
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Affiliation(s)
- Y P Ding
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway.
| | - E K R Pedersen
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - S Johansson
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway; Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen 5021, Norway
| | - J F Gregory
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - P M Ueland
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway; Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen 5021, Norway
| | - G F T Svingen
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - Ø Helgeland
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - K Meyer
- Bevital AS, Bergen 5020, Norway
| | - Å Fredriksen
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway
| | - O K Nygård
- Department of Clinical Science, University of Bergen, Bergen 5021, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen 5021, Norway; KG Jebsen Center for Diabetes Research, Haukeland University Hospital, Bergen 5021, Norway
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29
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Ding Y, Svingen GFT, Pedersen ER, Gregory JF, Ueland PM, Tell GS, Nygård OK. Plasma Glycine and Risk of Acute Myocardial Infarction in Patients With Suspected Stable Angina Pectoris. J Am Heart Assoc 2015; 5:JAHA.115.002621. [PMID: 26722126 PMCID: PMC4859380 DOI: 10.1161/jaha.115.002621] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Glycine is an amino acid involved in antioxidative reactions, purine synthesis, and collagen formation. Several studies demonstrate inverse associations of glycine with obesity, hypertension, and diabetes mellitus. Recently, glycine‐dependent reactions have also been linked to lipid metabolism and cholesterol transport. However, little evidence is available on the association between glycine and coronary heart disease. Therefore, we assessed the association between plasma glycine and acute myocardial infarction (AMI). Methods and Results A total of 4109 participants undergoing coronary angiography for suspected stable angina pectoris were studied. Cox regression was used to estimate the association between plasma glycine and AMI, obtained via linkage to the CVDNOR project. During a median follow‐up of 7.4 years, 616 patients (15.0%) experienced an AMI. Plasma glycine was higher in women than in men and was associated with a more favorable baseline lipid profile and lower prevalence of obesity, hypertension, and diabetes mellitus (all P<0.001). After multivariate adjustment for traditional coronary heart disease risk factors, plasma glycine was inversely associated with risk of AMI (hazard ratio per SD: 0.89; 95% CI, 0.82–0.98; P=0.017). The inverse association was generally stronger in those with apolipoprotein B, low‐density lipoprotein cholesterol, or apolipoprotein A‐1 above the median (all Pinteraction≤0.037). Conclusions Plasma glycine was inversely associated with risk of AMI in patients with suspected stable angina pectoris. The associations were stronger in patients with apolipoprotein B, low‐density lipoprotein cholesterol, or apolipoprotein A‐1 levels above the median. These results motivate further studies to elucidate the relationship between glycine and lipid metabolism, in particular in relation to cholesterol transport and atherosclerosis. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00354081.
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Affiliation(s)
- Yunpeng Ding
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.)
| | - Gard F T Svingen
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.)
| | - Eva R Pedersen
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.)
| | - Jesse F Gregory
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL (J.F.G.)
| | - Per M Ueland
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.) Bevital AS, Bergen, Norway (P.M.U.)
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway (G.S.T.) Norwegian Institute of Public Health, Bergen, Norway (G.S.T.)
| | - Ottar K Nygård
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.) Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.K.N.) KG Jebsen Center for Diabetes Research, Haukeland University Hospital, Bergen, Norway (O.K.N.)
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Øyen J, Svingen GFT, Gjesdal CG, Tell GS, Ueland PM, Lysne V, Apalset EM, Meyer K, Vollset SE, Nygård OK. Plasma dimethylglycine, nicotine exposure and risk of low bone mineral density and hip fracture: the Hordaland Health Study. Osteoporos Int 2015; 26:1573-83. [PMID: 25616506 DOI: 10.1007/s00198-015-3030-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/05/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED In the large community-based Hordaland Health Study, low plasma dimethylglycine was associated with low bone mineral density in both middle-aged and elderly subjects and to an increased risk of subsequent hip fracture among the elderly. These associations seemed to be particularly strong among subjects exposed to nicotine. INTRODUCTION Dimethylglycine (DMG) is a product of the choline oxidation pathway and formed from betaine during the folate-independent remethylation of homocysteine (Hcy) to methionine. Elevated plasma DMG levels are associated with atherosclerotic cardiovascular disease and inflammation, which in turn are related to osteoporosis. High plasma total Hcy and low plasma choline are associated with low bone mineral density (BMD) and hip fractures, but the role of plasma DMG in bone health is unknown. METHODS We studied the associations of plasma DMG with BMD among 5315 participants (46-49 and 71-74 years old) and with hip fracture among 3310 participants (71-74 years old) enrolled in the Hordaland Health Study. RESULTS In age and sex-adjusted logistic regression models, subjects in the lowest versus highest DMG tertile were more likely to have low BMD (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.43-1.99). The association was stronger in participants exposed compared to those unexposed to nicotine (OR 2.31, 95% CI 1.73-3.07 and OR 1.43, 95% CI 1.16-1.75, respectively, p interaction = 0.008). In the older cohort, Cox regression analyses adjusted for sex showed that low plasma DMG was associated with an increased risk of hip fracture (hazard ratio [HR] 1.70, 95% CI 1.28-2.26). A trend toward an even higher risk was found among women exposed to nicotine (HR 3.41, 95% CI 1.40-8.28). CONCLUSION Low plasma DMG was associated with low BMD and increased risk of hip fractures. A potential effect modification by nicotine exposure merits particular attention.
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Affiliation(s)
- J Øyen
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway,
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Igland J, Vollset SE, Nygård OK, Sulo G, Ebbing M, Tell GS. Educational inequalities in acute myocardial infarction incidence in Norway: a nationwide cohort study. PLoS One 2014; 9:e106898. [PMID: 25188248 PMCID: PMC4154768 DOI: 10.1371/journal.pone.0106898] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Increasing differences in cardiovascular disease (CVD) mortality across levels of education have been reported in Norway. The aim of the study was to investigate educational inequalities in acute myocardial infarction (AMI) incidence and whether such inequalities have changed during the past decade using a nationwide longitudinal study design. METHODS Data on 141 332 incident (first) AMIs in Norway during 2001-2009 were obtained through the Cardiovascular Disease in Norway (CVDNOR) project. Educational inequalities in AMI incidence were assessed in terms of age-standardised incidence rates stratified on educational level, incidence rate ratios (IRR), relative index of inequality (RII) and slope index of inequality (SII). All calculations were conducted in four gender and age strata: Men and women aged 35-69 and 70-94 years. RESULTS AMI Incidence rates decreased during 2001-2009 for all educational levels except in women aged 35-69 among whom only those with basic education had a significant decrease. In all gender and age groups; those with the highest educational level had the lowest rates. The strongest relative difference was found among women aged 35-69, with IRR (95% CI) for basic versus tertiary education 3.04 (2.85-3.24)) and RII (95% CI) equal to 4.36 (4.03-4.71). The relative differences did not change during 2001-2009 in any of the four gender and age groups, but absolute inequalities measured as SII decreased among the oldest men and women. CONCLUSIONS There are substantial educational inequalities in AMI incidence in Norway, especially for women aged 35-69. Relative inequalities did not change from 2001 to 2009.
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Affiliation(s)
- Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Ottar K. Nygård
- Section for Cardiology, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Gerhard Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marta Ebbing
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
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Vik R, Busnelli M, Parolini C, Bjørndal B, Holm S, Bohov P, Halvorsen B, Brattelid T, Manzini S, Ganzetti GS, Dellera F, Nygård OK, Aukrust P, Sirtori CR, Chiesa G, Berge RK. An immunomodulating fatty acid analogue targeting mitochondria exerts anti-atherosclerotic effect beyond plasma cholesterol-lowering activity in apoe(-/-) mice. PLoS One 2013; 8:e81963. [PMID: 24324736 PMCID: PMC3852987 DOI: 10.1371/journal.pone.0081963] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/18/2013] [Indexed: 11/18/2022] Open
Abstract
Tetradecylthioacetic acid (TTA) is a hypolipidemic antioxidant with immunomodulating properties involving activation of peroxisome proliferator-activated receptors (PPARs) and proliferation of mitochondria. This study aimed to penetrate the effect of TTA on the development of atherosclerotic lesions in apolipoprotein (apo)-E-/- mice fed a high-fat diet containing 0.3% TTA for 12 weeks. These mice displayed a significantly less atherosclerotic development vs control. Plasma cholesterol was increased by TTA administration and triacylglycerol (TAG) levels in plasma and liver were decreased by TTA supplementation, the latter, probably due to increased mitochondrial fatty acid oxidation and reduced lipogenesis. TTA administration also changed the fatty acid composition in the heart, and the amount of arachidonic acid (ARA) and eicosapentaenoic acid (EPA) was reduced and increased, respectively. The heart mRNA expression of inducible nitric oxidase (NOS)-2 was decreased in TTA-treated mice, whereas the mRNA level of catalase was increased. Finally, reduced plasma levels of inflammatory mediators as IL-1α, IL-6, IL-17, TNF-α and IFN-γ were detected in TTA-treated mice. These data show that TTA reduces atherosclerosis in apoE-/- mice and modulates risk factors related to atherosclerotic disorders. TTA probably acts at both systemic and vascular levels in a manner independent of changes in plasma cholesterol, and triggers TAG catabolism through improved mitochondrial function.
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Affiliation(s)
- Rita Vik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- * E-mail:
| | - Marco Busnelli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Cinzia Parolini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sverre Holm
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - Pavol Bohov
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trond Brattelid
- National Institute of Nutrition and Seafood Research, NIFES, Bergen, Norway
| | - Stefano Manzini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giulia S. Ganzetti
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Federica Dellera
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Ottar K. Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- K.G. Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway
| | - Cesare R. Sirtori
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giulia Chiesa
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Rolf K. Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Christensen MHE, Pedersen EKR, Nordbø Y, Varhaug JE, Midttun Ø, Ueland PM, Nygård OK, Mellgren G, Lien EA. Vitamin B6 status and interferon-γ-mediated immune activation in primary hyperparathyroidism. J Intern Med 2012; 272:583-91. [PMID: 22757621 DOI: 10.1111/j.1365-2796.2012.02570.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Primary hyperparathyroidism (PHPT) has been associated with low-grade inflammation and elevated risk of cardiovascular disease (CVD). In inflammatory conditions, interferon-γ (IFN-γ) activity is enhanced and a decreased circulating concentration of vitamin B6 is often observed. Such changes in IFN-γ activity or vitamin B6 levels have been associated with increased incidence of CVD. The aim of the study was to investigate systemic markers of IFN-γ-mediated immune activation, such as neopterin, the kynurenine-to-tryptophan ratio (KTR) and kynurenine pathway metabolites, as well as B6 vitamers in patients with PHPT. DESIGN/SUBJECTS A total of 57 patients with PHPT and a control group of 20 healthy blood donors were included in this study. PHPT patients who responded positively to parathyroidectomy were followed for 6 months. Forty-three patients participated in the longitudinal study in which blood samples were taken at inclusion and 1, 3 and 6 months after surgery. RESULTS Plasma concentrations of the B6 vitamers pyridoxal 5'-phosphate (PLP) (P = 0.007) and pyridoxal (P = 0.013) were significantly lower in the patient group compared to healthy control subjects. An increase in the KTR indicated that the kynurenine pathway of tryptophan metabolism was altered in PHPT patients (P = 0.015). During the initial 6 months after surgery, levels of PLP (P < 0.001) and anthranilic acid (P < 0.001) increased significantly, whereas neopterin decreased (P = 0.018). CONCLUSIONS The results of this study demonstrate altered levels of vitamin B6 and the KTR in PHPT patients, both of which may reflect cellular immune activation. These abnormalities should be considered in relation to the increased risk of CVD previously observed in patients with PHPT.
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Lønnebakken MT, Staal EM, Bleie Ø, Strand E, Nygård OK, Gerdts E. Quantitative contrast stress echocardiography in assessment of restenosis after percutaneous coronary intervention in stable coronary artery disease. Eur J Echocardiogr 2009; 10:858-64. [PMID: 19549699 DOI: 10.1093/ejechocard/jep090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Quantitative contrast stress echocardiography (CSE) can assess regional myocardial perfusion. The aim of this study was to evaluate the performance of quantitative CSE in the detection of restenosis after percutaneous coronary intervention (PCI). METHODS AND RESULTS Thirty-three patients with stable coronary artery disease, scheduled for PCI, underwent CSE and quantitative coronary angiography (QCA) before and 9 months after PCI. Regional myocardial perfusion was analysed blinded to QCA results. QCA identified 38 significant stenoses (> or =50% diameter reduction). Before PCI, perfusion during stress was significantly reduced in regions supplied by stenotic arteries; blood flow velocity (Deltabeta) -3.9 (-9.0 to 0.5) s(-1), perfusion rate (DeltaA x beta) -175.0 (-518.0 to 58.5) s(-1), and refilling time (Deltart) 210 (-22 to 452)ms, compared with the perfusion increase seen in regions supplied by non-stenotic arteries; Deltabeta 1.6 (-0.7 to 4.4) s(-1), DeltaA x beta 151.7 (-67.0 to 300.5) s(-1), and Deltart -47 (-195 to 89) ms, all P < 0.05. At follow-up, regional stress-induced perfusion improved in 29 regions with successful PCI; Deltabeta 0.1 (-2.7 to 3.6), DeltaA x beta 30.5 (-133.3 to 232.1), and Deltart -99 (-247 to 125), all P < or = 0.01, although there was no improvement in nine regions with restenosis; Deltabeta 0.9 (-1.5 to 5.3), DeltaAxbeta 65.7 (-40.8 to 412.6), and Deltart -79 (-268 to 163), P = NS. CONCLUSION Quantitative CSE has the potential to detect angiographically significant coronary artery stenoses as well as angiographic success after PCI.
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Affiliation(s)
- Mai Tone Lønnebakken
- Department of Heart Disease, Institute of Medicine, Haukeland University Hospital, University of Bergen, Bergen 5021, Norway.
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Lønnebakken MT, Bleie Ø, Strand E, Staal EM, Nygård OK, Gerdts E. Myocardial Contrast Echocardiography in Assessment of Stable Coronary Artery Disease at Intermediate Dobutamine-Induced Stress Level. Echocardiography 2009; 26:52-60. [DOI: 10.1111/j.1540-8175.2008.00738.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bleie Ø, Semb AG, Grundt H, Nordrehaug JE, Vollset SE, Ueland PM, Nilsen DWT, Bakken AM, Refsum H, Nygård OK. Homocysteine-lowering therapy does not affect inflammatory markers of atherosclerosis in patients with stable coronary artery disease. J Intern Med 2007; 262:244-53. [PMID: 17645592 DOI: 10.1111/j.1365-2796.2007.01810.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A high level of total homocysteine (tHcy) is a risk marker for cardiovascular disease (CVD), and is related to inflammation. We wanted to test the effect of homocysteine-lowering B-vitamin therapy, as used in the Western Norway B-vitamin Intervention Trial (WENBIT), on inflammatory markers associated with atherosclerosis. DESIGN Single centre, prospective double-blind clinical interventional study, randomised in a 2 x 2 factorial design. SUBJECTS AND METHODS Ninety patients (21 female) with suspected coronary artery disease (CAD), aged 38-80 years, were blindly randomised into one of four groups of daily oral treatment with (A) folic acid (0.8 mg)/vitamin B12 (0.4 mg)/vitamin B6 (40 mg), (B) folic acid/vitamin B12, (C) vitamin B6 alone or (D) placebo. Blood samples were collected before and after 6 months of treatment. RESULTS Before intervention, median levels of the analytes were: tHcy 11.0 micromol L(-1), neopterin 8.1 nmol L(-1), soluble CD40 ligand (sCD40L) 3.9 ng mL(-1), interleukin (IL)-6 1.9 pg mL(-1), C-reactive protein (CRP) 1.9 mg L(-1) and low-density lipoprotein (LDL) cholesterol 3.3 mmol L(-1). tHcy was significantly associated with neopterin (r = 0.49, P < 0.001) and with IL-6 (r = 0.29, P = 0.01), but not with CRP or sCD40L. Neither treatment with folic acid/B12 nor with B6 induced significant changes in any of these inflammatory biomarkers (P >or= 0.14). In patients receiving folic acid/B12 (groups A and B), tHcy was reduced with 33% (P < 0.001). CONCLUSIONS In patients with stable CAD, homocysteine-lowering therapy with B-vitamins does not affect levels of inflammatory markers associated with atherogenesis. Failure to reverse inflammatory processes, may partly explain the negative results in clinical secondary B-vitamin intervention trials.
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Affiliation(s)
- Ø Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
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Halsted CH, Wong DH, Peerson JM, Warden CH, Refsum H, Smith AD, Nygård OK, Ueland PM, Vollset SE, Tell GS. Relations of glutamate carboxypeptidase II (GCPII) polymorphisms to folate and homocysteine concentrations and to scores of cognition, anxiety, and depression in a homogeneous Norwegian population: the Hordaland Homocysteine Study. Am J Clin Nutr 2007; 86:514-21. [PMID: 17684227 DOI: 10.1093/ajcn/86.2.514] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Glutamate carboxypeptidase II (GCPII) encodes for intestinal folate hydrolase and brain N-acetylated alpha-linked acidic dipeptidase. Previous studies provided conflicting results on the effect of the GCPII 1561C-->T polymorphism on folate and total homocysteine (tHcy) concentrations. OBJECTIVE We aimed to determine the potential effects of 2 polymorphisms of GCPII on plasma folate and tHcy concentrations, cognition, anxiety, and depression in a large aging cohort of Norwegians enrolled in the Hordaland Homocysteine Study. DESIGN DNA samples were genotyped for the GCPII 1561C-->T and 484A-->G polymorphisms, and the results were linked to plasma folate and tHcy concentrations and to scores for cognition, anxiety, and depression. RESULTS The 2 polymorphisms were in linkage disequilibrium and were associated with concentrations of tHcy. After adjustment for covariates, persons in the CT or combined CT and TT groups of the 1561C-->T polymorphism had higher plasma folate concentrations and lower tHcy concentrations than did those in the CC group. Subjects with the TT genotype had lower Symbol Digit Modalities Test (SDMT) scores than did subjects with the CC genotype. Compared with abstainers, moderate alcohol drinkers had higher plasma folate concentrations and higher scores on the Mini Mental State Examination. However, women abstainers with the CT genotype had lower SDMT scores than did abstainers with the CC genotype or moderate drinkers with the CT genotype. CONCLUSIONS The 1561C-->T polymorphism is associated with higher plasma folate and lower tHcy concentrations and with lower SDMT cognitive scores in women who abstain from alcohol.
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Affiliation(s)
- Charles H Halsted
- Genome and Biomedical Sciences Facility, University of California Davis, Davis, CA 95616, USA.
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Ulvik B, Wentzel-Larsen T, Hanestad BR, Omenaas E, Nygård OK. Relationship between provider-based measures of physical function and self-reported health-related quality of life in patients admitted for elective coronary angiography. Heart Lung 2006; 35:90-100. [PMID: 16543037 DOI: 10.1016/j.hrtlng.2005.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Improving health-related quality of life (HRQOL) is important for patients with coronary artery disease (CAD). However, few clinicians measure HRQOL in clinical practice. More commonly used are two provider-based measures of CAD, the Canadian Cardiovascular Society (CCS) and the New York Heart Association (NYHA). We explored the relationship of these two provider-based measures with two self-reported HRQOL questionnaires, the Seattle Angina Questionnaire (SAQ) and the Short Form 36 (SF-36). METHODS Included were 753 outpatients (74% were men) admitted for elective cardiac catheterization. HRQOL, CCS class, and NYHA status were measured. RESULTS We found significant associations of CCS and NYHA with HRQOL concerning physical dimensions, but weaker associations for other important dimensions. We also observed weaker associations in women than men, not being previously reported. CONCLUSIONS HRQOL instruments add broader information in patients with CAD and should supplement provider-based measures. Further research is needed on possible implications of the observed sex differences.
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Affiliation(s)
- Bjorg Ulvik
- University of Bergen Norway, Department of Public Health and Primary Health Care, and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Abstract
BACKGROUND The Keito machine offers automatic measurements of blood pressure (BP), height and weight on insertion of coins and has been introduced in pharmacies. DESIGN Cross-sectional study comparing automatic BP measurements by the Keito machine to office BP measurements by physicians. METHODS Patients scheduled for pre-catheterisation screening participated in the study. Their BP was first measured using the Keito machine, then by physicians. Office BP was recorded as the last of three consecutive BP measurements recorded with one-min intervals after a five-min rest in the sitting position. In a sub-study BP was measured simultaneously during the Keito measurement by a physician. RESULTS In 390 consecutive patients average BP was significantly lower with the Keito machine compared to office BP measurements made by the physicians (136/75+/-19/8 mmHg versus 141/79+/-21/10 mmHg, both p<0.001). The correlation coefficient (r) was 0.56 (p<0.001) for systolic BP (SBP) and 0.53 (p<0.001) for diastolic BP (DBP). Bland-Altman analysis showed a mean difference (+/-2 SD) for SBP and DBP of -5 (+/-37) and -4 (+/-17) mmHg, respectively. When defining hypertension (HT) as office SBP> or =140 and/or DBP> or =90 mmHg, the Keito method diagnosed 83% of the systolic and 62% of the diastolic hypertensive population correctly. The classification of systolic and diastolic normotensive was correct in 61% and 86%, respectively. CONCLUSION Agreement between office and Keito BP is poor. The Keito machine underestimates SBP on average by 5 mmHg and DBP by 4 mmHg, which may be of significance for diagnosing HT and starting anti-hypertensive therapy. However, the difference can be much larger in individual patients. Therefore, the Keito machine cannot be recommended for medical screening of HT or as a replacement for follow-up by physicians.
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Affiliation(s)
- Eva M Staal
- Department of Heart Disease; Institute of Medicine, Haukeland University Hospital, Bergen, Norway
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Nygård OK, von der Lippe G, Seim S. [Cholesterol determination at conscription. A method to identify persons with high risk of developing cardiovascular disease]. Tidsskr Nor Laegeforen 1995; 115:3249-53. [PMID: 7482452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In the adult population, serum cholesterol level and risk of cardiovascular disease are related to some extent to habits and lifestyle established at an early age. We have estimated serum total cholesterol levels by means of a dry chemical method and have collected information on established cardiovascular risk factors among 1,203 young Norwegian men at conscription. 30 of the recruits with the highest serum cholesterol levels were later examined in the hospital's out-patient clinic. A total of 30.8% of the recruits were daily smokers. Mean serum total cholesterol was 4.05 mmol/l with a 97.5 percentile value of 6.31 mmol/l. The prevalence of coronary heart disease among parents was significantly higher among recruits from the upper cholesterol quintile (4.2%) compared with those in the lowest quintile (0.8%) (p = 0.02). These findings show that cholesterol screening at conscription is feasible and can be used to identify a group of men at high risk of subsequently developing cardiovascular disease.
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Affiliation(s)
- O K Nygård
- Hjerteavdelingen, Haukeland Sykehus, Bergen
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