Nutrition Metabolism and Cardiovascular Diseases最新文献

Background and aims: Familial dyslipidemias are associated with increased cardiovascular risk. Increased lipoprotein(a) [Lp(a)] is considered as the most prevalent monogenic lipid disorder. The objective of the study was to identify the cardiovascular prognosis of patients with familial dyslipidemias (heterozygous familial hypercholesterolemia (FH) or familial combined hyperlipidemia (FCH)), without cardiovascular disease at baseline, investigating in parallel the effect of Lp(a).

Methods and results: 909 patients with FH (n = 433, mean age 44.2 ± 12.8 years) or FCH (n = 476, mean age 49.0 ± 11.1 years) were evaluated during a mean period of 10 years. The main endpoint was the composite of major cardiovascular events. The incidence of major cardiovascular events in the total population was 6.6 %, while greater in patients with FH compared to patients with FCH (8.1 % vs 5.5 %, p = 0.03). Multiple Cox regression analysis revealed that FH patients had greater cardiovascular risk compared to FCH patients (HR 2.17, 95 % CI 1.10-4.26, p = 0.02). In FH patients, increased baseline Lp(a) (≥30 mg/dl) was an independent predictor of adverse cardiovascular events (HR 2.37 95 % CI 1.41-4.90, p = 0.02), whereas in FCH patients was not. In FCH patients the presence of diabetes at baseline was a strong independent prognosticator of adverse cardiovascular events (HR 3.56 95 % CI 1.19-11.33, p = 0.03), after adjustment for confounders.

Conclusions: FH patients demonstrate double cardiovascular risk compared to FCH patients. In FH patients increased Lp(a) doubles the cardiovascular risk, beyond low density lipoprotein cholesterol. In FCH patients the presence of diabetes triples the cardiovascular risk, beyond Lp(a) which does not seem to convey an independent prognostic value.

Background and aims: Low whole grain food consumption is the leading cause of coronary artery disease (CAD) burden in middle-East countries. However, investigations examining the association of whole and refined grain foods and CAD are scarce in this region. We aimed to investigate the association of whole and refined grain foods with CAD in Iranians with different ethnicities.

Methods and results: This was a multi-center case-control study among Iranian ethnicities consisting of Fars, Azari, Kurd, Arab, Lor, Gilak, Qashqaei, and Bakhtiari within the framework of the Iran premature coronary artery disease (IPAD) project. The data were collected from hospitals with catheterization laboratories. Cases were 2099 patients with a stenosis ≥75 % in at least one vessel or ≥50 % in the left main artery. Control group were 1168 individuals with normal angiography test. Grains intake was assessed using a validated semi-quantitative food frequency questionnaire. Compared with those with the lowest intake of whole grain foods, subjects in the top quartile had lower risk of CAD (OR = 0.54, 95 % CI: 0.40, 0.72; P < 0.001) after full adjustment. However, a significant direct link was found between higher refined grain foods consumption and the risk of CAD (OR = 1.43, 95 % CI: 0.91-1.84; P = 0.013).

Conclusion: Our findings support dietary recommendations to increase whole grain foods and mitigating refined grain food consumption to reduce the risk of CAD and its severity.

Background and aims: Cardiometabolic multi-morbidity (CMM) has emerged as a global healthcare challenge with a high mortality risk. This study aimed to explore the association between serum uric acid to high-density lipoprotein cholesterol ratio (UHR) and the incidence of CMM.

Methods and results: We enrolled 8188 individuals in the CHARLS database. Multivariable cox proportional hazards regression, logistic regression, and restricted cubic splines (RCS) analysis were conducted to evaluate the association between UHR and CMM. During a median 109 months of follow-up, 858 (10.5 %) participants were identified with new-onset CMM. The incidences of CMM among participants in quartiles (Q) 1-4 of UHR were 7.57 %, 9.18 %, 10.75 %, and 14.41 %, respectively. A fully adjusted Cox model showed a higher UHR was significantly associated with an increased risk of CMM. Compared to participants in Q1 of UHR, the hazard ratios (HRs) (95 % confidence intervals [CIs]) using cox proportional hazards regression analysis for those in Q2-4 were 1.33 (1.05-1.68), 1.62 (1.29-2.04), and 2.14 (1.71-2.68), respectively. Additionally, the odds ratios (ORs) (95 % CIs) using multivariate logistic regression analysis for participants in quartiles 2 to 4 were 1.38 (1.07-1.78), 1.69 (1.32-2.16), and 2.34 (1.82-3.00), respectively, when compared to participants in Q1 of UHR. RCS analysis revealed a significant nonlinear association between UHR and CMM (nonlinear P < 0.05).

Conclusion: A higher UHR was closely associated with an increased risk of CMM. Further studies on UHR could be beneficial for preventing and treating CMM.

Background and aim: The advanced glycation end products-receptor for advanced glycation end products (AGE-RAGE) axis is a pro-inflammatory pathway promoting endothelial dysfunction and vascular remodelling. The soluble RAGE form (sRAGE), by blocking circulating AGE, protects against AGE-induced detrimental effects. We investigated the role of sRAGE as a marker of high blood pressure and hypertension risk in children.

Methods and results: sRAGE was quantified in 284 children/adolescents (mean age (SD) 11.1 (2.5); 52.1 % male) referred for high-normal blood pressure (systolic and/or diastolic values ≥ 90th, but both <95th percentile) or hypertension (systolic and/or diastolic blood pressure ≥95th percentile) and/or other cardiovascular risk factors (excess weight, dyslipidaemia and insulin resistance). In 22.2 % of the sample, systolic and/or diastolic blood pressure values were above the 90th percentile. The prevalence of excess weight (overweight/obesity), central obesity (waist-to-height-ratio >50%), and insulin resistance (HOMA-index ≥90th percentile) was high (82.7 %, 70.8 %, and 70.5 %, respectively). Few children had altered LDL cholesterol, triglyceride, and HDL cholesterol values (15.7 %, 15.4 %, and 13.6 %, respectively). The lowest sRAGE tertile was associated with the highest risk of having hypertension (p = 0.028), obesity (p < 0.001), central obesity (p = 0.007), and insulin resistance (p < 0.001). sRAGE levels were inversely associated with systolic blood pressure (p < 0.01) and BMI (p = 0.022) z-scores and waist-to-height-ratio (p = 0.001). sRAGE values were inversely associated with the presence of hypertension (p = 0.036) and obesity (p = 0.038).

Conclusions: The independent relationship between sRAGE, systolic blood pressure, and hypertension in children suggests that the AGE-RAGE axis may be altered early in life, and that sRAGE could be a compelling marker for pediatric cardiovascular risk stratification.

Background and aims: Type 1 diabetes and diabetic ketoacidosis (DKA) have a significant impact on individuals and society across a wide spectrum. Our objective was to utilize machine learning techniques to predict DKA and HbA1c>7 %.

Methods and results: Nine different models were implemented and model performance evaluated via the Area under the Curve (AUC). These models were applied to a large multi-centre dataset of 13761 type 1 diabetes individuals prospectively recruited from Australia and New Zealand. Predictive features included a number of clinical demographic and socio-economic measures collected at previous visits. In our study, 2.9 % reported at least one episode of DKA since their last clinic visit. A number of features were significantly associated with DKA. Our results showed that Deep Learning (DL) model performed well in predicting DKA with an AUC of 0.887. The DL also provided the lowest classification error rate of 0.9 %, highest sensitivity of 99.9 % and F-measure of 99.6 %. As for HbA1c >7 %, the optimal Support Vector Machine provided a good AUC of 0.884.

Conclusion: Machine learning models can be effectively implemented on real-life large clinical datasets and they perform well in terms of identifying individuals with type 1 diabetes at risk of adverse outcomes.

Background and aims: Type 2 diabetes is associated with a heightened risk of cardiovascular complications, including myocardial steatosis. Fasting-mimicking diets (FMDs) may mimic the metabolic benefits of fasting, while being less intensive than fasting. This study aims to investigate the effect of following an FMD program on myocardial triglyceride content (MTGC), as assessed by Magnetic Resonance Spectroscopy (MRS), in patients with type 2 diabetes.

Methods and results: 100 patients with type 2 diabetes, who used metformin as the only glucose-lowering drug or no medication were randomly assigned to either an FMD group or a control group. The FMD group received the FMD program for 5 consecutive days a month alongside usual care, while the control group received usual care only. Both groups underwent baseline, 6-months and 12-months examinations, including single voxel cardiac 1H-MRS to assess MTGC. N = 13 participants of the FMD and n = 13 of the control group had complete data at baseline and twelve month follow-up. The FMD group exhibited a significant reduction in MTGC over the twelve month period (-0.235 % MTGC, p = 0.027), while the control group saw no significant change (0.143 % MTGC, p = 0.236). The decrease of MTGC in the FMD group was statistically different (p = 0.018) from control.

Conclusion: Following an FMD program reduces MTGC, which indicates a favorable effect on cardiac metabolism and thereby may be an effective strategy to reduce the cardiovascular risk in patients with type 2 diabetes.

Clinical trials registration number: NCT03811587.

Trial registration: ClinicalTrials.gov; NCT03811587, submitted January 13th, 2019.

Background and aims: The burden of cardiometabolic multimorbidity (CMM) in hypertensive patients is substantial, and obesity may play an important role in progression of CMM. We aim to explore associations of obesity with the transition patterns from hypertension to first cardiometabolic disease (FCMD), CMM, and death.

Methods and results: 21 286 hypertensive patients over 40 were enrolled in Yinzhou Health Information System from 2010 to 2015, followed until June 30, 2022. CMM was defined as the coexistence of stroke, diabetes, and coronary heart disease. Two indices of obesity including body mass index (BMI) and waist circumference (WC) were assessed at baseline. We used multi-state models to evaluate associations of BMI and WC between risk of CMM trajectories in hypertensive patients. During a median follow-up of 8.06 years, 13 289 hypertensive patients developed CMD, 6401 further developed CMM, and 1648 died. WC in every 1 cm increase was positively associated with risk of transitions from hypertension to FCMD (HR = 1.01, 95 % CI: 1.00-1.01) and from FCMD to CMM (HR = 1.01, 95 % CI: 1.01-1.02). Underweight participants had a 17 % elevated risk of transition from FCMD to CMM, while overweight participants had a 5 % elevated risk of transition from hypertension to FCMD. U-shape curves were observed for the association of WC with transitions from FCMD or CMM to death.

Conclusions: Underweight and abnormal WC were associated with an increased risk of CMM and death in hypertensive patients. Our findings emphasize the role of healthy body shape in hypertensive management.

Aim: Current evidence on the effects of parathyroidectomy (PTX) on myocardial deformation in patients with primary hyperparathyroidism (PHPT) is scanty and based on a few studies. The aim of this meta-analysis was to provide a comprehensive and updated information on this issue.

Data synthesis: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to September 30th, 2024. Searches were limited to clinical investigations published in English reporting data on LV mechanics (i.e. global longitudinal strain, GLS) in patients with PHPT before and after PTX. The statistical difference of the echocardiographic variables of interest collected at baseline and after PTX, such as left ventricular ejection fraction (LVEF) and GLS was calculated by standardized mean difference (SMD) with 95 % confidence interval (CI) by using random-effects models. Four studies including 126 patients with PHPT undergoing PTX, in whom LV mechanics had been assessed by speckle tracking echocardiography before and after six months from surgery, were considered. Baseline pooled average LVEF values were 59.5 ± 1.7 % and corresponding values after PTX 60.3 ± 1.2 %, (SMD: 0.16 ± 0.09, CI: -0.01/0.34, p = 0.07). Baseline and after surgical procedure values for GLS were -18.9 ± 0.28 % and -20.4 + 0.28 %, (SMD: 0.55 ± 0.10, CI: 0.37/0.74, p < 0.001). Meta-regression analysis showed a significant relationship between changes in serum PTH and GLS (p = 0.004).

Conclusions: Our findings suggest that PTX impacts favourably on LV mechanics, and, more importantly, the assessment of LV changes in this setting should include GLS and no longer rely on conventional echocardiographic parameters such as LVEF.

Aims: This research delved into a comprehensive examination and detailed analysis of the effects of whey protein (WP) supplementation on lipid profile in adults.

Data synthesis: Data used in this research was obtained from diverse clinical trials. Thorough searches were carried out on multiple electronic platforms including PubMed, Embase, Web of Science, Scopus, Google Scholar, and the Cochrane Library from their inception until May 2024. Random effects models were assessed and pooled data were determined as weighted mean differences (WMDs) with a 95 % confidence interval (CI).

Results: Overall, 20 randomized clinical trials (n = 1638 participants) met our inclusion criteria. The current meta-analysis demonstrates a significant reduction in TG (WMD: -12.21 mg/dL; %95CI: -20.16, -4.26; P = 0.003). Pooled analysis of 19 studies on HDL-c indicated a significant increase (WMD: 2.59 mg/dL; %95CI: 1.11, 4.07; P = 0.001).

Conclusions: We found that WP intake can improve TG and HDL-c significantly without significant effects on TC, and LDL-c levels. However, future well-designed with long duration RCTs is required on diverse populations to understand better the effects of these natural compounds and their constituents on lipid profile in adults.