scholarly journals Relationship between lipoproteins, thrombosis, and atrial fibrillation

2021 ◽  
Author(s):  
Wern Yew Ding ◽  
Majd B Protty ◽  
Ian G Davies ◽  
Gregory Y H Lip
Keyword(s):  
Atrial Fibrillation ◽  
Low Density Lipoprotein ◽  
Blood Stasis ◽  
Density Lipoprotein ◽  
Potential Contribution ◽  
Low Density ◽  
Traditional Role ◽  
Lipid Species ◽  
Structural Abnormalities ◽  
Myocardial Membranes

Abstract The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow’s triad of hypercoagulability, structural abnormalities, and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review, we provide an overview of the various lipoproteins and explore the association between lipoproteins and AF, the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF. There are several types of lipoproteins based on size, lipid composition, and apolipoprotein category, namely: chylomicrons, very low-density lipoprotein, low-density lipoprotein (LDL), intermediate-density lipoprotein, and high-density lipoprotein. Each of these lipoproteins may contain numerous lipid species and proteins with a variety of different functions. Furthermore, the lipoprotein particles may be oxidized causing an alteration in their structure and content. Of note, there is a paradoxical inverse relationship between total cholesterol and LDL cholesterol (LDL-C) levels, and incident AF. The mechanism by which this occurs may be related to the stabilizing effect of cholesterol on myocardial membranes, along with its role in inflammation. Overall, specific lipoproteins may interact with haemostatic pathways to promote excess platelet activation and thrombin generation, as well as inhibiting fibrinolysis. In this regard, LDL-C has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research with an aim to improve our knowledge base and contribute to our overall understanding of lipoprotein-mediated thrombosis.

scholarly journals The role of postprandial very-low-density lipoprotein in the development of atrial remodeling in metabolic syndrome

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Hsiang-Chun Lee ◽  
Shyi-Jang Shin ◽  
Jih-Kai Huang ◽  
Ming-Yen Lin ◽  
Yu-Hsun Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Atrial Remodeling ◽  
Very Low Density Lipoprotein ◽  
Low Density ◽  
Hip Circumference

Abstract Background Negatively charged very-low-density lipoprotein (VLDL-χ) in metabolic syndrome (MetS) patients exerts cytotoxic effects on endothelial cells and atrial myocytes. Atrial cardiomyopathy, manifested by atrial remodeling with a dilated diameter, contributes to atrial fibrillation pathogenesis and predicts atrial fibrillation development. The correlation of VLDL-χ with atrial remodeling is unknown. This study investigated the association between VLDL-χ and remodeling of left atrium. Methods Consecutively, 87 MetS and 80 non-MetS individuals between 23 and 74 years old (50.6% men) without overt cardiovascular diseases were included in the prospective cohort study. Blood samples were collected while fasting and postprandially (at 0.5, 1, 2, and 4 h after a unified meal). VLDL was isolated by ultracentrifugation; the percentile concentration of VLDL-χ (%) was determined by ultra-performance liquid chromatography. The correlations of left atrium diameter (LAD) with variables including VLDL-χ, LDL-C, HDL-C, triglycerides, glucose, and blood pressure, were analyzed by multiple linear regression models. A hierarchical linear model was conducted to test the independencies of each variable’s correlation with LAD. Results The mean LAD was 3.4 ± 0.5 cm in non-MetS subjects and 3.9 ± 0.5 cm in MetS patients (P < 0.01). None of the fasting lipid profiles were associated with LAD. VLDL-χ, BMI, waist circumference, hip circumference, and blood pressure were positively correlated with LAD (all P < 0.05) after adjustment for age and sex. Significant interactions between VLDL-χ and blood pressure, waist circumference, and hip circumference were observed. When adjusted for obesity- and blood pressure-related variables, 2-h postprandial VLDL-χ (mean 1.30 ± 0.61%) showed a positive correlation with LAD in MetS patients. Each 1% VLDL-χ increase was estimated to increase LAD by 0.23 cm. Conclusions Postprandial VLDL-χ is associated with atrial remodeling particularly in the MetS group. VLDL-χ is a novel biomarker and may be a therapeutic target for atrial cardiomyopathy in MetS patients. Trial registration ISRCTN 69295295. Retrospectively registered 9 June 2020.

scholarly journals Relationship between Plasma Lipidomics and Carotid Atherosclerotic Plaque

2020 ◽  
Author(s):  
Gaoqiang Xie ◽  
Phyo Kyaw Myint ◽  
Zhongze Fang ◽  
Ying Yang ◽  
Wenyao Ma ◽  
...  
Keyword(s):  
Vegetable Intake ◽  
Wide Spectrum ◽  
Low Density Lipoprotein ◽  
Plasma Lipid ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Lipid Species ◽  
Lipid Components

Abstract Background: The rapidly growing discipline of lipidomics allows the study of a wide spectrum of lipid species in human plasma and provides new insights into the pathogenesis of atherosclerosis. Objective: To explore the roles of plasma lipid components in relation to atherosclerotic plaques.Methods: Ten non-symptomatic persons (age 62.42±3.45) with 2 or more carotid plaques (soft or mixed) and ten apparently healthy controls without any carotid plaque (age 62.82±4.38), were randomly selected as cases and controls from a community-based sample of 1312 persons. Ultra-performance liquid chromatography coupled with electrospray ionization quadrupole mass spectrometry (UPLC-ESI-QTOF MS)-based lipidomics was used to measure lipid components. The difference of lipid species between cases and controls was analyzed by t-test and general linear regression. Results: Among 53 lipid components, significantly elevated plasma levels of one novel individual ceramide species (ceramide 22: 0) were observed in cases compared to the controls (0.59±0.18 versus 0.41±0.10μg/mL, p values<0.05). After adjusting for confounding factors, such as total cholesterol and low-density lipoprotein cholesterol, the results remained significant (p<0.05). 22:0 ceramide was significantly negatively correlated with vegetable intake (r=-0.74, p=0.014).Conclusion: High level of plasma ceramide 22:0 may be a novel risk factor for carotid atherosclerosis in human which independent of cholesterol and low-density lipoprotein cholesterol, it deserves future studies with larger sample size to confirm.

scholarly journals The Role of Postprandial Very-Low-Density Lipoprotein ­in the Development of Atrial Remodeling in Metabolic Syndrome

2020 ◽  
Author(s):  
Hsiang-Chun Lee ◽  
Shyi-Jang Shin ◽  
Jih-Kai Huang ◽  
Ming-Yen Lin ◽  
Yu-Hsun Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Waist Circumference ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Atrial Remodeling ◽  
Very Low Density Lipoprotein ◽  
Low Density ◽  
Linear Regression Models

Abstract Background: Negatively charged very-low-density lipoprotein (VLDL-χ) in metabolic syndrome (MetS) patients exerts cytotoxic effects on endothelial cells and atrial myocytes. Atrial cardiomyopathy, manifested by atrial remodeling with a dilated diameter, contributes to atrial fibrillation pathogenesis and predicts atrial fibrillation development. The correlation of VLDL-χ with atrial remodeling is unknown. This study investigated the association between VLDL-χ and the remodeling of left atrium.Methods: Consecutively, 87 MetS and 80 non-MetS individuals between 23 and 74 years old (50.6% men) without overt cardiovascular diseases were included in the prospective cohort study. Blood samples were collected while fasting and postprandially (at 0.5, 1, 2, and 4 hours after a unified meal). VLDL was isolated by ultracentrifugation; the percentile concentration of VLDL-χ (%) was determined by ultra-performance liquid chromatography. The correlations of left atrial diameter (LAD) with variables including VLDL-χ, LDL-C, HDL-C, triglycerides, glucose, and blood pressure, were analyzed by multiple linear regression models. A hierarchicallinear model was conducted to test the independencies of each variable’s correlation with LAD.Results: The mean LAD was 3.4 ± 0.5 cm in non-MetS subjects and 3.9 ± 0.5 cm in MetS patients (P< 0.01). None of the fasting lipid profiles were associated with LAD. VLDL-χ, BMI, waist circumference, hip circumference, and blood pressure were positively correlated with LAD (all P<0.05) after adjustment for age and sex. Significant interactions between VLDL-χ and blood pressure, waist circumference, and hipcircumference were observed. When adjusted for obesity- and blood pressure-related variables, 2-hour postprandial VLDL-χ (mean 1.30 ± 0.61%) showed a positive correlation with LAD in MetS patients. Each 1% VLDL-χ increase was estimated to increase LAD by 0.23 cm.Conclusions: Postprandial VLDL-χ is associated with atrial remodeling particularly in the MetS group. VLDL-χ is a novel biomarker and may be a therapeutic target for atrial cardiomyopathy in MetS patients.Trial registration: ISRCTN 69295295. Retrospectively registered 9 June 2020.

scholarly journals The Pleiotropic Effects of Statins – From Coronary Artery Disease and Stroke to Atrial Fibrillation and Ventricular Tachyarrhythmia

2019 ◽  
Vol 17 (3) ◽  
pp. 222-232 ◽  
Author(s):  
Adam Oesterle ◽  
James K. Liao
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Low Density Lipoprotein ◽  
Ventricular Tachyarrhythmia ◽  
Nicotinamide Adenine Dinucleotide Phosphate ◽  
Density Lipoprotein ◽  
Pleiotropic Effects ◽  
Low Density ◽  
Artery Disease

Statins, 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors, have been used for decades for the prevention of coronary artery disease and stroke. They act primarily by lowering serum cholesterol through the inhibition of cholesterol synthesis in the liver, which results in the upregulation of low-density lipoprotein receptors in the liver. This results in the removal of low-density lipoproteincholesterol. Studies have suggested that statins may demonstrate additional effects that are independent of their effects on low-density lipoprotein-cholesterol. These have been termed “pleiotropic” effects. Pleiotropic effects may be due to the inhibition of isoprenoid intermediates by statins. Isoprenoid inhibition has effects on the small guanosine triphosphate binding proteins Rac and Rho which in turn effects nicotinamide adenine dinucleotide phosphate oxidases. Therefore, there are changes in endothelial nitric oxide synthase expression, atherosclerotic plaque stability, pro-inflammatory cytokines and reactive oxygen species production, platelet reactivity, and cardiac fibrosis and hypetrophy development. Recently, statins have been compared to the ezetimibe and the recently published outcomes data on the proprotein convertase subtilisin kexin type 9 inhibitors has allowed for a reexamination of statin pleiotropy. As a result of these diverse effects, it has been suggested that statins also have anti-arrhythmic effects. This review focuses on the mechanisms of statin pleiotropy and discusses evidence from the statin clinical trials as well as examining the possible anti-arrhythmic effects atrial fibrillation and ventricular tachyarrhythmias.

scholarly journals The association of stroke rate with low density lipoprotein and statin exposure in patients with atrial fibrillation (AF)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Shweikialrefaee ◽  
H Abdel-Qadir ◽  
A Pang ◽  
P Austin ◽  
S Singh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Administrative Databases ◽  
P Value ◽  
Profile Measurement ◽  
Low Density ◽  
Stroke Rate ◽  
Statin Use

Abstract Background There are limited data on the association between cholesterol levels and stroke risk in atrial fibrillation (AF). Objective To quantify the association of stroke rate in AF with low-density lipoprotein (LDL) levels and statin use. Methods Using linked administrative databases in Ontario, Canada, we conducted a population-based retrospective cohort study of patients aged ≥66 years, diagnosed with AF between 2009–2019. We used cause-specific hazard regression to determine the association of statin use with stroke rate. We developed a second cause-specific regression model for patients with at least one lipid profile measurement in the year before AF diagnosis to study the association of LDL levels with stroke rate, while adjusting for statin use. LDL levels were modeled using restricted cubic splines (RCS). Both models were adjusted for age, sex, heart failure, hypertension, diabetes, stroke or transient ischemic attack, and vascular disease at baseline, plus anticoagulation as a time-varying covariate. Results We studied 261,659 qualifying patients (median age 78 years, 49% female), of whom 3,954 (1.5%) developed a stroke during one-year follow-up. A total of 142,834 (54.6%) patients were treated with statins and 145,775 (55.7%) had lipid measurements before AF diagnosis. The adjusted RCS analyses (see Figure) indicated increasing hazard ratios (HRs) for stroke with increasing low-density lipoprotein (LDL) values above 1.5mmol/L. Statin use was associated with a lower stroke rate relative to non-users (hazard ratio 0.87, 95% confidence interval 0.81–0.93, p-value &lt;0.0001). Conclusion LDL levels above 1.5mmol/L were independently associated with higher stroke rates in patients with AF, while statins were associated with lower stroke rates independent of anticoagulation. This suggests that LDL measurements may improve stroke risk stratification in AF, while statins may offer an underutilized pathway to lower stroke risk in AF. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): 1) Heart and stroke foundation of Canada HR for Stroke and LDL level

Abstract WP372: Quality Improvement in Acute Ischemic Stroke Care in Taiwan: the Breakthrough Collaborative in Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jiann-Shing Jeng ◽  
Li-Ming Lien ◽  
Tsong-Hai Lee ◽  
Chang-Ming Chern ◽  
Hung-Yi Chiou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Quality Improvement ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Guideline Adherence ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Intravenous Thrombolysis ◽  
Lipid Lowering ◽  
Low Density

Background and Purpose: Guideline adherence for acute ischemic stroke (AIS) management is often suboptimal, particularly in thrombolytic therapy and anticoagulants for atrial fibrillation. We sought to achieve quality improvement of AIS patients via a collaborative learning model, the Breakthrough Series (BTS)-Stroke, in a nationwide, multi-center activity in Taiwan. Methods: A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance AIS care quality. There were 24 teaching and community hospitals participating in and submitting data for this stroke quality improvement campaign from August 2010 to June 2011. The Get With The Guideline (GWTG)-Stroke measures were adopted to evaluate the performance and outcome of the AIS patients. The results of this study were compared to those of the previous Taiwan Stroke Registry (TSR, 22642 AIS patients from 39 hospitals, 2006-08). Results: Data from 24 hospitals with 13181 AIS patients during a 1-year period were analyzed. The BTS-Stroke (2010-11) had better performance as compared to the TSR (2006-08): intravenous thrombolysis frequency for all AIS patients (4.1% vs 1.5%), symptomatic hemorrhage after intravenous thrombolysis (6.0% vs 8.2%), early antithrombotics (96.6% vs 94.1%), anticoagulation for atrial fibrillation (57.1% vs 28.3%), lipid lowering drugs for low-density lipoprotein >100 mg/dL (63.4% vs 38.7%), antithrombotics at discharge (94.0% vs 85.5%), and one-month mortality (3.5% vs 4.0%). Temporal improvement was noted in 7 of 14 performance measures when the fourth BTS-Stroke quarter compared with the first quarter: intravenous thrombolysis frequency for all AIS patients (4.1% vs 3.7%), symptomatic hemorrhage after intravenous thrombolysis (3.4% vs 5.5%), lipid lowering drugs for low-density lipoprotein >100 mg/dL (67.3% vs 60.5%), antithrombotics at discharge (95.5% vs 91.4%), dysphagia screening (81.9% vs 63.4%), early rehabilitation (71.7% vs 63.6%), stroke education before discharge (95.6% vs 83.4%). Conclusions: A BTS collaborative learning and campaign model can improve the guideline adherence of stroke. The GWTG-Stroke can be successfully applied to other countries outside the United States.

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