scholarly journals The Lipid Paradox as a Metabolic Checkpoint and Its Therapeutic Significance in Ameliorating the Associated Cardiovascular Risks in Rheumatoid Arthritis Patients

2020 ◽  
Vol 21 (24) ◽  
pp. 9505
Author(s):  
Tapan Behl ◽  
Ishnoor Kaur ◽  
Aayush Sehgal ◽  
Gokhan Zengin ◽  
Ciprian Brisc ◽  
...  

While the most common manifestations associated with rheumatoid arthritis (RA) are synovial damage and inflammation, the systemic effects of this autoimmune disorder are life-threatening, and are prevalent in 0.5–1% of the population, mainly associated with cardiovascular disorders (CVDs). Such effects have been instigated by an altered lipid profile in RA patients, which has been reported to correlate with CV risks. Altered lipid paradox is related to inflammatory burden in RA patients. The review highlights general lipid pathways (exogenous and endogenous), along with the changes in different forms of lipids and lipoproteins in RA conditions, which further contribute to elevated risks of CVDs like ischemic heart disease, atherosclerosis, myocardial infarction etc. The authors provide a deep insight on altered levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) in RA patients and their consequence on the cardiovascular health of the patient. This is followed by a detailed description of the impact of anti-rheumatoid therapy on the lipid profile in RA patients, comprising DMARDs, corticosteroids, anti-TNF agents, anti-IL-6 agents, JAK inhibitors and statins. Furthermore, this review elaborates on the prospects to be considered to optimize future investigation on management of RA and treatment therapies targeting altered lipid paradigms in patients.

2018 ◽  
Vol 47 (1) ◽  
pp. 265-270 ◽  
Author(s):  
Sinan Sarsam ◽  
Abeer Berry ◽  
George Degheim ◽  
Robby Singh ◽  
Marcel Zughaib

Objective Hyperlipidemia is an important risk factor for atherosclerotic cardiovascular disease. Many patients are intolerant to or have limited benefit from statins. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been approved for treating hyperlipidemia in these patients. We sought to investigate the impact of these medications in a real-world cardiology practice. Methods This was a retrospective study of 17 patients with either heterozygous familial hypercholesterolemia or established atherosclerotic cardiovascular disease with low-density lipoprotein cholesterol (LDL-C) levels above the treatment target despite maximally tolerated statins. Baseline lipid profile was compared with a repeat lipid profile obtained 4 to 6 weeks after initiating treatment with a PCSK9 inhibitor. Results The average duration of PCSK9 inhibitor treatment was 10.7 months. Lipid profile comparison showed that total cholesterol decreased from 243 ± 72 to 148 ± 39 (mg/dL) (39% reduction), triglycerides decreased from 185 ± 86 to 149 ± 62 (mg/dL) (19.5% reduction), high-density lipoprotein cholesterol increased from 56 ± 20 to 62 ± 26 (mg/dL) (10.7% increase), and LDL-C decreased from 154 ± 30 to 57 ± 32 (mg/dL) (63% reduction) from baseline. Conclusions PCSK9 inhibitors as add-on therapy to maximally tolerated statins resulted in an approximately 63% reduction in LDL-C.


Author(s):  
Jana Kopčeková ◽  
Mária Holovičová ◽  
Martina Gažarová ◽  
Jana Mrázová ◽  
Marta Habánová ◽  
...  

This study evaluated the associations between selected dietary habits and lipid profiles in a group of 800 randomly selected patients hospitalized in the Nitra Cardio Center, Slovakia. Patients were aged 20–101 years (only men, the average age was 61.13 ± 10.47 years). The data necessary for the detection of dietary habits were obtained by a questionnaire method in closed-ended format. Data collection was carried out simultaneously with the somatometric and biochemical examinations of the respondents ensured by the Nitra Cardio Center. The following parameters were evaluated: total cholesterol (T-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and blood glucose. Statistical comparisons between groups were performed using one-way analysis of variance (one-way ANOVA), followed by Tukey’s post hoc test. We detected significant differences (p < 0.05) in the influence of the number of daily meals on T-C and LDL-C, which were higher in men who consumed 1–2 meals compared with 3–4 or 5–6 meals. In the consumption of meat, eggs, and fish, there was no significant effect on the biochemical parameters of blood (p > 0.05). We recorded a significant effect (p < 0.001) on T-C and LDL-C levels between low-fat and whole-fat milk consumption. Except for the impact of fruit consumption on the HDL-C level (p < 0.001), the different frequencies of fruit consumption showed non-significant changes for the lipid profile levels. We detected a significant effect (p = 0.017) of the consumption of vegetables 1–2 times/week on LDL-C in favor of daily consumption. Our results support that monitoring the lipid profile is an important determinant in the prevention and treatment of cardiovascular disease. The conducted research emphasizes the importance of diet dependence on the improvement of the quality of treatment and nutrition of people with this type of disease.


2020 ◽  
Vol 9 (2) ◽  
pp. 313
Author(s):  
Roberta Lupoli ◽  
Paola Ciciola ◽  
Giuseppina Costabile ◽  
Rosalba Giacco ◽  
Matteo Nicola Dario Di Minno ◽  
...  

Background: Growing evidence shows that grape polyphenols can improve cardiovascular risk factors. Although there are clear data supporting a beneficial effect of grape supplementation on blood pressure and glucose metabolism, the effects of grape polyphenols on lipid metabolism are still controversial. Objective: We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of grape products on lipid profile. Design: A systematic search was performed in the PubMed, Web of Science, Scopus, and EMBASE databases without any language or publication year restriction. The reference lists of all retrieved articles were manually reviewed. RCTs evaluating the impact of grape products/juice/extracts on lipid profile were included. Difference in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), oxidized low-density lipoprotein cholesterol (oxLDL-C), apolipoprotein (apo) A, apo B before and after administration of grape products or placebo were expressed as mean differences (MD) with pertinent 95% confidence intervals (95% CI). The impact of clinical and demographic features on effect size was assessed by meta-regression. Results: The administration of grape products is associated with a significant improvement of lipid profile, as evidenced by changes in TC (MD: −7.6 mg/dL (−0.2 mmol/L); 95% CI: −10.8, −4.4; p < 0.001), HDL-C (MD: 1.4 mg/dL (0.04 mmol/L); 95% CI: 0.8, 1.9; p < 0.001, I2 = 74.7%, p < 0.001), LDL-C (−6.3 mg/dL (−0.16 mmol/L); 95% CI: −9.5, −3.0; p < 0.001), oxLDL-C (MD: −4.5 U/L; 95% CI: −7.5, −1.5; p = 0.003, I2 = 90.6%, p < 0.001), apo B (MD: −2.4 mg/dL (−0.05 µmol/L); 95% CI: −4.5, −0.3; p = 0.026), and TG (MD: −14.5 mg/dL (−0.16 mmol/L); 95% CI: −17.7, −11.2; p < 0.001) levels in subjects receiving grape products compared to placebo. With regard to the extent of the lipid-lowering effect, compared to baseline values, the highest reduction was reported for LDL-C (MD: −5.6 mg/dL (−0.14 mmol/L); 95% CI: −9.5, −1.7; p = 0.005) and for oxLDL-C (MD: −5.0 U/L; 95% CI: −8.8, −1.2; p = 0.010, I2 = 0%, p = 0.470). Conclusions: Grape polyphenols exert a favorable effect on lipid profile in humans by significantly reducing plasma levels of LDL-C and oxLDL-C.


2014 ◽  
Vol 2 (3) ◽  
pp. 122-130
Author(s):  
Prajakta Nande

Increasing prevalence of hypertension is a major health concern.Dietary habits and food choices play an important role in maintaining lipid levels.The aim of this study was to investigate the impact of dietary habits on lipid profile of young adult hypertensive males. Two hundred vegetarians (V) and two hundred non vegetarians (NV) stage I hypertensive young adult men from age group 25-35 yrs. Anthropometric indices like weight, height, waist circumference (WC), hip circumference (HC) and mid-upper-arm circumference (MUAC) were measured. Body mass index (BMI) and waist hip ratio (WHR) were computed using standard equations. 24 hour’s food intake data for each subject was collected for consecutive 3 days and energy and energy yielding nutrients were computed. Total cholesterol (T-C), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels were estimated. Very low density lipoprotein cholesterol (VLDL-C) was computed using standard equation.Insignificant difference was noticed between V and NV for BMI, WC and HC. In contrast, MUAC of NV was found to be significantly higher than V. NV had higher mean daily intake of energy, protein and fat but low mean daily consumption of carbohydrate as compared to V.NV had higher mean values of systolic blood pressure (SBP) (p>0.05) and diastolic blood pressure (DBP) (0.01<p<0.05) than V. 30% NV were obese grade II. TC and LDL-C of NV were greater than V but HDL-C and TG of V were greater than NV (p>0.05). TC, LDL-C and VLDL-C among NV correlated positively (p<0.01) with body weight (r 0.5340, 0.4841 and 0.5921, respectively). Stronger relationships existed between HDL-C and body weight among both groups. BP, BMI and MUAC were more among NV than V. V showed better lipid profile than NV. This could be attributed to higher intake of energy and fat among NV.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Efosa Godwin Ewere ◽  
Ngozi Paulinus Okolie ◽  
Erhunmwunsee Dalton Avan ◽  
Patience Edet Umoh

Abstract Background Exposure to arsenic orchestrates a myriad of noxious health effects, including cancer. Different parts of Irvingia gabonensis are used as herbal remedies in traditional medicine. In this study, the comparative effects of the ethanol leaf (ELEIG) and stem bark extracts (ESEIG) of Irvingia gabonensis on sodium arsenite (SA)-induced lipid profile disturbances in Wistar rats were investigated. Methods Fifty five Wistar rats weighing between 100 g and 179 g were distributed into eleven groups (n=5). Group 1 (control) received feed and water ad libitum. Group 2 received SA at a dose of 4.1 mg/kg body weight (kgbw) for 14 days. Groups 3–11 were treated with the extracts with or without SA. Treatment was done by oral intubation for 14 days. Serum concentrations of total cholesterol (TC), triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), total lipids (TL) and atherogenic index of plasma (AIP) were used to determine the lipid profile effects of the extracts. Results Exposure to SA caused significant (p ˂ 0.05) increases in all assayed parameters, relative to control. Post-treatment and simultaneous treatment with ELEIG and ESEIG mitigated the effects of SA. In addition, ELEIG alone at various doses produced results comparable with control values. However, ESEIG alone caused significant (p ˂ 0.05) increases in all assayed parameters, relative to control. Conclusion These results show that ELEIG and ESEIG ameliorate SA-induced lipid profile disturbances in Wistar rats. However, long-term administration of ESEIG alone may be discouraged.


2018 ◽  
Vol 74 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Joanna J. Samulak ◽  
Angelika K. Sawicka ◽  
Dace Hartmane ◽  
Solveiga Grinberga ◽  
Osvalds Pugovics ◽  
...  

Background: L-carnitine can be metabolized to trimethylamine N-oxide (TMAO), a molecule that promotes atherogenesis through its interaction with macrophages and lipid metabolism. Objective: The aim of the present study was to assess whether L-carnitine supplementation may promote changes in selected serum biomarkers of atherosclerosis. Methods: Before the start, in the mid-point and after completing the 24-weeks supplementation protocol, fasting blood samples were taken from the antecubital vein. Plasma free L-carnitine and TMAO were determined by the UPLC/MS/MS method. Serum proteins were determined by the enzyme immunoassay method using commercially available kits. Total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and triglycerides have been determined using standard automatic analyzer. Results: L-carnitine supplementation elevated fasting plasma carnitine in the mid-point of our study and it remained increased until the end of supplementation period. Moreover, it induced tenfold increase in plasma TMAO concentration but did not affect serum C-reactive protein, interleukin-6, tumour necrosis factor-α, L-selectin, P-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 or lipid profile markers. Conclusion: We demonstrated that ­although oral L-carnitine supplementation significantly ­increased plasma TMAO concentration, no lipid profile changes or other markers of adverse cardiovascular events were detected in healthy aged women over the period of 24 weeks.


2014 ◽  
Vol 41 (5) ◽  
pp. 902-908 ◽  
Author(s):  
Michail P. Migkos ◽  
Theodora E. Markatseli ◽  
Chrisoula Iliou ◽  
Paraskevi V. Voulgari ◽  
Alexandros A. Drosos

Objective.Many studies have highlighted the hypolipidemic action of hydroxychloroquine (HCQ). We investigated the effect of HCQ on the lipid profile of patients with Sjögren syndrome (SS).Methods.The present retrospective observational study included 71 female patients with SS treated with HCQ. The levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol, triglycerides (TG), and atherogenic index (TC/HDL) were measured at baseline, after 6 months, and 1, 3, and 5 years after initiation of HCQ treatment. Analysis to investigate changes over time was performed in the entire patient group and in the separate subgroups: those receiving (21 patients) and those not receiving (50 patients) hypolipidemic treatment.Results.For the entire group of patients a statistically significant decrease in TC was noted (levels before treatment 220 ± 41 mg/dl, and at 5 yrs 206 ± 32 mg/dl, p = 0.006). A statistically significant difference was observed in the levels of HDL (57 ± 14 mg/dl vs 67 ± 17 mg/dl, p < 0.001) and in atherogenic index (4.0 ± 1.3 vs 3.3 ± 0.9, p < 0.001). Patients not receiving a hypolipidemic agent during the same period demonstrated a decrease in TC (214 ± 40 mg/dl vs 208 ± 34 mg/dl, p = 0.049), an increase in HDL levels (55 ± 15 mg/dl vs 67 ± 18 mg/dl, p < 0.001), and a decrease in atherogenic index (4.0 ± 1.4 vs 3.3 ± 0.9, p < 0.001). In the subgroup of patients receiving hypolipidemic treatment, the respective changes in their lipid profile were not significant in the first years but became significant in the long term.Conclusion.Use of HCQ in patients with SS was related to a statistically significant decrease in TC, an increase in HDL, and improvement in the atherogenic index.


2013 ◽  
Vol 12 (5) ◽  
pp. 29-33
Author(s):  
S. A. Matveeva

Aim.To study the associations between blood lipid profile and blood glucose levels in men with coronary heart disease (CHD), stable effort angina (SEA), metabolic syndrome (MS), and Type 2 diabetes mellitus (DM-2).Material and methods.The study included 82 men (mean age 50,5±0,9 years) with CHD, Functional Class I–III SEA, MS, and DM-2. The following lipid profile parameters were assessed: total cholesterol (TCH), triglycerides (TG), low-density lipoprotein cholesterol (LDL–CH), very low-density lipoprotein cholesterol (VLDL–CH), high-density lipoprotein cholesterol (HDL–CH), atherogenic index (AI), and triglyceride index (TGI), together with fasting blood glucose.Results.There were positive (direct) associations between higher levels (>90th percentile) of lipid profile parameters (TCH, TG, LDL–CH, VLDL– CH, HDL–CH, AI, TGI) and blood glucose, as well as between lower levels (≤10th percentile) of lipid profile parameters (TCH, TG, LDL–CH, VLDL– CH, AI, TGI) and blood glucose. At the same time, there were negative (inverse) associations between lower lipid levels (≤10th percentile of TCH, TG, LDL–CH, VLDL–CH, HDL–CH, AI, TGI) and higher glucose levels (>90th percentile), as well as between higher lipid levels (>90th percentile of TCH, TG, LDL–CH, VLDL–CH, HDL–CH, AI, TGI) and lower glucose levels (≤10th percentile).Conclusion.Dyslipidemia and hyperglycemia demonstrate synergetic proatherogenic effects in patients with CHD, SEA, MS, and DM-2, as suggested by significant heterogeneous (direct and inverse) associations between lipid profile parameters and fasting blood glucose. The results obtained provide an opportunity for the assessment of risk levels, prognosis, and need for pharmacological prevention and treatment in patients with combined cardiovascular pathology. 


2018 ◽  
Vol 5 (5) ◽  
pp. 1245
Author(s):  
Sushama Bhatta ◽  
Samir Singh

Background: Gallbladder disease is one of the most common gastrointestinal diseases. Various studies have shown association between gallstone and alteration in serum lipids. The objective of this study was to evaluate histological patterns of cholecystectomy specimens and compare serum lipid profile of gallstone patients with controls.Methods: This study was conducted over a period of two years (April 2016 to April 2018). Records of 287 specimens who underwent cholecystectomy were analysed in which gallstones were found only in 186 patients. Out of 186 patients with gallstones, records of serum lipid profile were available in 32 patients which were compared with 32 control of similar age. Independent t- test was used to compare the data between cases and control.Results: Out of 287 cases, 68 were male and 219 were female with male to female ratio of 1:3.2. The predominant histopathological lesion was chronic cholecystitis (73.17%). Malignancy was observed in 0.7% cases. Serum total cholesterol, triglycerides and low density lipoprotein cholesterol were found to be higher and statistically significant in patients with gallstone compared to controls (p value 0.024, <0.001and 0.016 respectively). Serum High density lipoprotein cholesterol was lower in gallstone patient than in control but not statistically significant (p value 0.23).Conclusions: Chronic cholecystitis was the most common histopathological lesion. Serum total cholesterol, triglyceride and low density lipoprotein cholesterol level were elevated and statistically significant in patients with gallstone.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jui-Ting Hsiung ◽  
Maria Marroquin ◽  
Kamyar Kalantar-Zadeh

Background: Studies suggests that in the general population, hyperlipidemia may confer higher risk of developing chronic kidney disease (CKD). But, there is conflicting data as to whether statins can protect renal function or slow renal degradation. We sought to examine the impact of statins on the association of low-density lipoprotein cholesterol (LDL) and risk of incident CKD. Methods: Our cohort included 1,439,756 US veterans without chronic kidney disease (CKD), but with LDL measured between 2004-2006, who were followed until 2014. Incident CKD was defined as over 3 estimated glomerular filtration rate (eGFR) measurements <60 mL/min/1.73m 2 at least 90 days apart. Patients with a statin prescription at the time of LDL measurement were identified. Cox models were used to estimate the associations between LDL with incident CKD. Model adjustments include demographics, comorbidities, smoking status, prescription of fibrate or niacin, body mass index, albumin, high-density lipoprotein cholesterol, and triglycerides. Results: The cohort included 5% females, 16% African Americans, 26% diabetics, and 30% statin-users, with a mean age of 60±13 years. The median [IQR] of LDL and eGFR were 109 [88,133] mg/dL and 83 [72,94] mL/min/1.73m 2 , respectively. A J-shaped association between LDL and incident CKD were observed in both those on statin and not on a statin after adjustment. Low LDL (<70 mg/dL) was associated with a higher risk of incident CKD compared to the reference (LDL 70-<100 mg/dL) regardless of statin use. High LDL ≥160 mg/dL was associated with the highest of risks of incident CKD (HR: 1.08, 95% CI: 1.04, 1.13, and HR: 1.10, 95% CI: 1.07, 1.12, for statin use and no statin use, respectively). Conclusion: Both high and low LDL were associated with higher incident CKD risk independent of statin use in this US veteran cohort. Further studies are needed to understand how to manage cardiovascular disease risk by lowering LDL while simultaneously reducing risk of CKD.


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