Adiponectin concentration data improve the estimation of atherosclerotic risk in normal and in overweight subjects

BACKGROUND: The combinations of adipokines and body mass parameters to estimate carotid atherosclerotic disease have not been completely delineated. OBJECTIVE: To test the combinations of well-established, easily accessible body mass indices and circulating biomarkers to identify increased carotid intima-media thickness (cIMT) in a primary prevention setting. DESIGN AND PATIENTS: In a cross-sectional analysis of 339 asymptomatic individuals with no history of cardiovascular events, inflammatory and insulin sensitivity biomarkers as well as adipokine levels were measured and combined with body mass parameters to evaluate the best marker for increased cIMT.RESULTS: As isolated parameters, body mass index (BMI) and adiponectin best identified abnormal cIMT (P = .04). Adiponectin levels were also linked to the relationship between BMI and cIMT (β = 0.0371; P = .01). Twenty-nine individuals with increased cIMT were missed by BMI alone but detected by combining BMI and adiponectin measurements. When compared with BMI alone, the combination of adiponectin plus BMI improved the c-statistic (0.549-0.567) and the integrated discrimination improvement index (0.01725; P = .021). Segregation of individuals by the combined use of BMI + adiponectin is associated with significant differences in insulin sensitivity, glomerular filtration rate, systemic inflammatory activity, dyslipidaemia and cIMT.

Statin-associated muscle symptoms: position paper from the Luso-Latin American Consortium

In the last two decades, statin therapy has proved to be the most potent isolated therapy for attenuation of cardiovascular risk. Its frequent use has been seen as one of the most important elements for the reduction of cardiovascular mortality in developed countries. However, the recurrent incidence of muscle symptoms in statin users raised the possibility of causal association, leading to a disease entity known as statin associated muscle symptoms (SAMS). Mechanistic studies and clinical trials, specifically designed for the study of SAMS have allowed a deeper understanding of the natural history and accurate incidence. This set of information becomes essential to avoid an unnecessary risk of severe forms of SAMS. At the same time, this concrete understanding of SAMS prevents overdiagnosis and an inadequate suspension of one of the most powerful prevention strategies of our times. In this context, the Luso-Latin American Consortium gathered all available information on the subject and presents them in detail in this document as the basis for the identification and management of SAMS...

Impact of 3'UTR genetic variants in PCSK9 and LDLR genes on plasma lipid traits and response to atorvastatin in Brazilian subjects: a pilot study

BACKGROUND:Hypercholesterolemia is a complex trait, resulting from a genetic interaction with lifestyle habits. Polymorphisms are a major source of genetic heterogeneity, and variations in 2 key cholesterol homeostasis genes; low-density lipoprotein receptor (LDLR) and proprotein convertase subtilisin/kexin type-9 (PCSK9), lead to dyslipidemia. So, we investigated the relation of 2 variants located in the 3'-UTR (3'-untranslated region) of LDLR (rs14158, G>A) and PCSK9 (rs17111557, C>T) with lipid profile and atorvastatin response.METHODS:SNP influence on lipid profile was assessed in hypercholesterolemic patients (HC; n = 89) using atorvastatin (10 mg/day/4 weeks) and in normolipidemic subjects (NL; n = 171). Genotyping was completed through real-time PCR using TaqMan assays.RESULTS:rs14158 G allele was higher in HC than in NL group (P = 0.043). NL subjects carrying the T allele of the PCSK9 variant had lower high-density lipoprotein cholesterol (HDL-c) than C allele carriers (P = 0.009). There was no association between LDLR and PCSK9 SNPs and atorvastatin response. Additionally, the PCSK9 variant creates a microRNA interaction site, which could implicate an epigenetic mechanism in PCSK9-dependent HDL-C regulation.CONCLUSIONS:The rs14158 SNP contributes to hypercholesterolemia. Also, a putative microRNA regulation may influence HDL-C variability observed in rs17111557 carriers. Cholesterol-lowering response to atorvastatin is not influenced by LDLR and PCSK9 variants.

Influence of PCSK9 polymorphisms on plasma lipids and response to atorvastatin treatment in Brazilian subjects

BackgroundThe proprotein convertase subtilisin/kexin type 9 (PCSK9) has a key role in the regulation of plasma low-density lipoprotein (LDL) cholesterol by enhancing the degradation of LDL receptor. Functional variants in PCSK9 have been associated with differences in plasma lipids and may contribute to the variability of the response to cholesterol-lowering drugs.ObjectiveTo investigate the influence of PCSK9 variants on plasma lipid profile and response to atorvastatin in Brazilian subjects.MethodsPCSK9 E670G, I474V, and R46L single nucleotide polymorphisms (SNPs) and plasma lipids were evaluated in 163 hypercholesterolemics (HC) and 171 normolipidemics (NL). HC patients with indication for cholesterol-lowering drug therapy (n = 128) were treated with atorvastatin (10 mg/d/4 wk). PCSK9 SNPs were analyzed by real time polymerase chain reaction.ResultsFrequencies of the PCSK9 SNPs were similar between the HC and NL groups. Logistic regression analysis showed a trend of association between PCSK9 E670G and hypercholesterolemia after adjustment for covariates (P = .059). The 670G allele was associated with high basal levels of LDL cholesterol (P = .03) in HC patients using the extreme discordant phenotype method. No association tests were performed for R46L variant because of its very low frequency, whereas the I474V polymorphism and PCSK9 haplotypes were not related to hypercholesterolemia or variability on plasma lipids in both NL and HC groups (P > .05). LDL cholesterol reduction in response to atorvastatin was not influenced by PCSK9 genotypes or haplotypes.

Influence of PCSK9 polymorphisms on plasma lipids and response to atorvastatin treatment in Brazilian subjects

BACKGROUND: The proprotein convertase subtilisin/kexin type 9 (PCSK9) has a key role in theregulation of plasma low-density lipoprotein (LDL) cholesterol by enhancing the degradation ofLDL receptor. Functional variants in PCSK9 have been associated with differences in plasma lipidsand may contribute to the variability of the response to cholesterol-lowering drugs.OBJECTIVE: To investigate the influence of PCSK9 variants on plasma lipid profile and response toatorvastatin in Brazilian subjects.METHODS: PCSK9 E670G, I474V, and R46L single nucleotide polymorphisms (SNPs) and plasmalipids were evaluated in 163 hypercholesterolemics (HC) and 171 normolipidemics (NL). HC patientswith indication for cholesterol-lowering drug therapy (n 5 128) were treated with atorvastatin (10 mg/d/4 wk). PCSK9 SNPs were analyzed by real time polymerase chain reaction.RESULTS: Frequencies of the PCSK9 SNPs were similar between the HC and NL groups. Logisticregression analysis showed a trend of association between PCSK9 E670G and hypercholesterolemiaafter adjustment for covariates (P 5 .059). The 670G allele was associated with high basal levels ofLDL cholesterol (P 5 .03) in HC patients using the extreme discordant phenotype method. Noassociation tests were performed for R46L variant because of its very low frequency, whereas theI474V polymorphism and PCSK9 haplotypes were not related to hypercholesterolemia or variabilityon plasma lipids in both NL and HC groups (P ..05). LDL cholesterol reduction in response to atorvastatinwas not influenced by PCSK9 genotypes or haplotypes.CONCLUSIONS: PCSK9 E670G polymorphism but not I474V contributes to the variability onplasma LDL cholesterol levels in hypercholesterolemic subjects. Both PCSK9 variants have no influenceon cholesterol-lowering response to atorvastatin. 2014 National Lipid Association. All rights reserved.

Differentiation of african components of ancestry to stratify groups in a Case–control study of a brazilian urban population

Background: Balancing the subject composition of case and control groups to create homogenous ancestries between each group is essential for medical association studies. Methods: We explored the applicability of single-tube 34-plex ancestry informative markers (AIM) single nucleotide polymorphisms (SNPs) to estimate the African Component of Ancestry (ACA) to design a future case-control association study of a Brazilian urban sample. Results: One hundred eighty individuals (107 case group; 73 control group) self-described as white, brown-intermediate or black were selected. The proportions of the relative contribution of a variable number of ancestral population components were similar between case and control groups. Moreover, the case and control groups demonstrated similar distributions for ACA 0.50 categories. Notably a high number of outlier values (23 samples) were observed among individuals with ACA <0.25. These individuals presented a high probability of Native American and East Asian ancestral components; however, no individuals originally giving these self-described ancestries were observed in this study. Conclusions: The strategy proposed for the assessment of ancestry and adjustment of case and control groups for an association study is an important step for the proper construction of the study, particularly when subjects are taken from a complex urban population. This can be achieved using a straight forward multiplexed AIM-SNPs assay of highly discriminatory ancestry markers.

Atorvastatin and hormone therapy effects on APOE mRNA expression in hypercholesterolemic postmenopausal women

Menopause is associated with changes in lipid levels resulting in increased risk of atherosclerosis andcardiovascular events. Hormone therapy (HT) and atorvastatin have been used to improve lipid profilein postmenopausal women.Effects of HT, atorvastatin and APOE polymorphisms on serum lipids and APOE and LXRA expressionwere evaluated in 87 hypercholesterolemic postmenopausal women, randomly selected for treatmentwith atorvastatin (AT, n = 17), estrogen or estrogen plus progestagen (HT, n = 34) and estrogen or estrogenplus progestagen associated with atorvastatin (HT + AT, n = 36). RNA was extracted from peripheralblood mononuclear cells (PBMC) and mRNA expression was measured by TaqMan® PCR. APOE 2/ 3/ 4genotyping was performed using PCR-RFLP.Total cholesterol (TC), LDL-c and apoB were reduced after each treatment (p < 0.001). Triglycerides,VLDL-c and apoAI were reduced only after atorvastatin (p < 0.05), whereas triglycerides and VLDL-c wereincreased after HT (p = 0.01). HT women had lower reduction on TC, LDL-c and apoB than AT and HT + ATgroups (p < 0.05). APOE mRNA expression was reduced after atorvastatin treatment (p = 0.03). AlthoughLXRA gene expression was not modified by atorvastatin, it was correlated with APOE mRNA before andafter treatments. Basal APOE mRNA expression was not influenced by gene polymorphisms, however thereduction on APOE expression was more pronounced in 3 3 than in 3 4 carriers.Atorvastatin down-regulates APOE mRNA expression and it is modified by APOE genotypes in PBMCfrom postmenopausal women.

Tumor necrosis factor-á and interleukin-6 expression in leukocytes and their association with polymorphisms and bone markers in diabetic individuals treated with pioglitazone

BACKGROUND: Pioglitazone is a peroxisome proliferator-activated receptor gamma (PPARã) activator used in the treatment of type 2 diabetes (DM2) patients and it has been suggested that can induce bone loss. Tumor necrosis factor-á (TNFá) and interleukin-6 (IL-6) mRNA expression in blood leukocytes and the relationship with polymorphisms and bone markers in DM2 treated with pioglitazone were investigated.METHODS: DM2 (n=53) and normoglycemic (NG, n=52) individuals were included. DM2 patients were treated with pioglitazone (45 mg/day/16 weeks). mRNA expression was evaluated by real-time polymerase chain reaction (PCR). TNFA -308G>A and IL6 -174G>C polymorphisms were detected by PCR-RFLP and high resolution melting polymerase chain reaction (HRM-PCR).RESULTS: Pioglitazone reduced bone specific alkaline phosphatase (bALP) and increased TNFá in DM2 group (p0.05). TNFA -308A allele was associated with reduced basal TNFá mRNA levels in NG and DM2 and reduced alkaline phosphatase (tALP) after treatment (pA polymorphism appear to be involved in regulation of gene expression independently of hyperglycemia and its interaction with pioglitazone may modify tALP, a important bone marker. IL6 -174G>C variant is related with reduced risk of postprandial hyperglycemia but not with mRNA expression or bone markers.

Pharmacogenetics of OATP Transporters Reveals That SLCO1B1 c.388A>G Variant Is Determinant of Increased Atorvastatin Response

Aims: The relationship between variants in SLCO1B1 and SLCO2B1 genes and lipid-lowering response to atorvastatin was investigated. Material and Methods: One-hundred-thirty-six unrelated individuals with hypercholesterolemia were selected andOPEN ACCESStreated with atorvastatin (10 mg/day/4 weeks). They were genotyped with a panel of ancestry informative markers for individual African component of ancestry (ACA) estimation by SNaPshot® and SLCO1B1 (c.388A>G, c.463C>A and c.521T>C) and SLCO2B1 (−71T>C) gene polymorphisms were identified by TaqMan® Real-time PCR. Results: Subjects carrying SLCO1B1 c.388GG genotype exhibited significantly high low-density lipoprotein (LDL) cholesterol reduction relative to c.388AA+c.388AG carriers (41 vs. 37%, p = 0.034). Haplotype analysis revealed that homozygous of SLCO1B1*15 (c.521C and c.388G) variant had similar response to statin relative to heterozygous and non-carriers. A multivariate logistic regression analysis confirmed that c.388GG genotype was associated with higher LDL cholesterol reduction in the study population (OR: 3.2, CI95%:1.3–8.0, p G polymorphism causes significant increase in atorvastatin response and may be an important marker for predicting efficacy of lipid-lowering therapy.

Pleiotropic Effects With Equivalent Low-density Lipoprotein Cholesterol Reduction: Comparative Study Pleiotropic Effects With Equivalent Low-density

Background: Coadministration of any statin with ezetimibe is as effective as using high doses of the same statin in the reduction of low-density lipoprotein cholesterol (LDL-c). There may be other effects called pleiotropics. Objective: To compare the effectiveness of 2 different treatments that obtain equivalent LDL-c reductions (80 mg of simvastatin, once a day and coadministration of 10 mg of simvastatin and 10 mg of ezetimibe, once a day) over endothelial function and inflammation. Methods: Twenty-three randomized patients with hypercholesterolemia in a 2 3 2 crossover protocol were studied. Endothelial function was analyzed by ultrasound assessment of endothelial dependent flow-mediated vasodilation of the brachial artery, and inflammation was estimated by high-sensitivity C-reactive protein (hs-CRP). Results: LDL-c reduction was similar between the 2 treatments with simvastatin/ezetimibe and with simvastatin (P , 0.001); no difference between treatments was found (P = 0.968). Both treatments improved significantly the endothelial function [3.61% with simvastatin/

ezetimibe (P = 0.003) and 5.08% with simvastatin (P , 0.001)]; no difference was found between the 2 treatments (P = 0.291). hs-CRP had a 23% reduction with simvastatin/ezetimibe (P = 0.004) and a 30% reduction with simvastatin alone (P = 0.01), with no significant difference between the 2 treatments (P = 0.380).

Perfil lipídico e efeitos da orientação nutricional em adolescentes com história familiar de doença arterial coronariana prematura / Lipid profile and nutrition counseling effects in adolescents with family history of premature coronary artery disease

OBJETIVO: Examinar o perfil lipídico e parâmetros nutricionais de adolescentes com história familiar de doença arterial coronariana (DAC) prematura e avaliar os efeitos da orientação nutricional. MÉTODOS: O estudo incluiu 48 adolescentes de ambos os sexos e idades entre 10 e 19 anos (grupo caso, n=18; grupo controle, n=30). RESULTADOS: Os filhos de coronarianos jovens apresentaram valores mais elevados de colesterol total (189 ± 30 vs. 167 ± 26 mg/dl, p<0,01), LDL-C (144 ± 20 vs. 100 ± 27 mg/dl, p<0,001) e Apo B (80 ± 15 vs. 61 ± 18 mg/dl, p=0,001) e valores mais baixos de HDL-C (45 ± 9 vs. 51 ± 13 mg/dl, p<0,02) que os jovens controles. Não se observaram diferenças para os triglicérides e Apo A-I. Com a orientação dietoterápica obteve-se redução no consumo alimentar de ácidos graxos saturados (pré: 15,5 ± 4,7 por cento vs. pós: 6,6 ± 3,7 por cento, p=0,003) e melhora no perfil lipídico: CT (-8 por cento, p=0,033), LDL-C (-18,2 por cento, p=0,001), TG (-53 por cento, p=0,002) nos filhos de pacientes com DAC prematura que apresentavam hiperlipidemia. CONCLUSÃO: A presença de dislipidemia foi mais prevalente em adolescentes filhos de portadores de DAC prematura, mas foi responsiva à intervenção nutricional.

Hiper-homocisteinemia como fator de risco para doença aterosclerótica coronariana em idosos / Hyperhomocysteinemia as a risk factor for coronary atherosclerotic diseases in the elderly

OBJETIVO: Investigar se a hiper-homocisteinemia é fator de risco independente para doença aterosclerótica coronariana em idosos. MÉTODOS: Estudo caso-controle com 172 idosos, 88 pertencentes ao grupo controle e 84 ao grupo caso, que apresentavam cineangiocoronariografia solicitada por indicações clínicas. Angiografia coronariana quantitativa foi realizada em 91 por cento dos pacientes. Homocisteinemia foi avaliada sob forma contínua e categorizada, por análise univariada e multivariada. RESULTADOS: Quando analisada sob forma contínua, verificou-se que, na análise univariada, os idosos do grupo caso apresentaram média de níveis de homocisteinemia significativamente mais elevada que a dos idosos do grupo controle (14,33±4,59 æmol/l versus 11,99± 4,59 æmol/l , p=0,015). Na análise multivariada, a homocisteinemia sob forma contínua associou-se a razão de risco para doença arterial coronariana de 1,07 a cada aumento de 1 æmol/l de nível de homocisteína. Aumento de 5 æmol/l correspondeu a razão de risco de 1,40. Quando analisada sob forma categorizada, definiu-se como hiper-homocisteinemia os valores encontrados acima do percentil 75 do grupo controle (14 æmol/l ). Hiper-homocisteinemia foi encontrada em 34 por cento dos idosos, sendo 37,3 por cento no grupo controle e 62,7 por cento no grupo caso (p=0,009). Na análise multivariada, a hiperhomocisteinemia constituiu fator de risco independente para doença aterosclerótica coronariana em idosos, com razão de risco para doença arterial coronariana de 2,03, intervalo de confiança 95 por cento, 1,02-4,03. CONCLUSAO: Hiper-homocisteinemia foi fator de risco independente para doença arterial coronariana em idosos.

Atorvastatin reduces proinflammatory markers in hypercholesterolemic patients

Background: Reduction in cardiovascular events with statins has been in part attributed to their anti-inflammatory properties.Objective: Evaluate the effects of atorvastatin on levels of inflammatory markers, such as tumor necrosis factor- (TNF), interleukins (IL-1 and IL-6), soluble intercellular adhesion molecule-1 (sICAM-1) and C-reactive protein (CRP) in hypercholesterolemic patients (LDL-cholesterol >160 mg/dL).Methods and results: Two lipid-lowering regimens were taken for 8 weeks. One set of patients (n = 45, 26 men, average 50 ± 2 years of age) was subjected to atorvastatin treatment (20–40 mg/day), plus diet recommendation. Another set of patients (n = 23, 12 men, average 53 ± 3 years of age) went through diet recommendation alone. Both groups were recommended to perform standard physical activity. Plasma samples were collected after overnight fasting at baseline and after 8 weeks for ELISA. The use of atorvastatin when compared to diet alone, resulted in significant (P 3 mg/dL in the atorvastatin group fell from 25.0 to 6.7% (P < 0.0001) while in the diet group the reduction was not significant.Conclusion: In hypercholesterolemic patients, atorvastatin, compared to diet alone resulted in significant reductions in levels of proinflammatorycytokines (TNF, IL-1 and IL-6) as well as in sICAM-1 and CRP. Thus, statin-induced inhibition of inflammatory markers may play an important role in the pharmacological and clinical effects of statins seen in cardiovascular diseases.

Antioxidant effect of simvastatin is not enhanced by its association with a-Tocopherol in hypercholesterolemic patient

Among the pleiotropic effects of statins, their antioxidant action may be involved in their protective effects.Thus, we investigated the antioxidant effect of simvastatin, associated or not with a-tocopherol, on levels ofelectronegative low-density lipoprotein (LDL ), nitrotyrosine, thiols (homocysteine, glutathione, cysteine, methionine),and lipid-soluble antioxidants in blood plasma of hypercholesterolemic subjects. In this study, 25 hypercholesterolemicsubjects were treated for 2 months with simvastatin (20 mg/day) and with simvastatin (20 mg/day) + a-tocopherol (400IU/day). Concentrations of thiols were determined by high-performance capillary electrophoresis–laser-inducedfluorescene. Lipid-soluble antioxidants were determined by HPLC, and LDL , and nitrotyrosine by ELISA. Simvastatin,independent of its association with a-tocopherol, reduced plasma concentrations of LDL , nitrotyrosine, totalcholesterol, and LDL cholesterol and the LDL cholesterol/HDL cholesterol ratio. Neither simvastatin nor simvastatinplus a-tocopherol altered plasma levels of the thiols analyzed. a-Tocopherol did not change the antioxidant effect ofsimvastatin on the levels of LDL and nitrotyrosine in hypercholesterolemic subjects. The reduction of LDL andnitrotyrosine by simvastatin seems to be related to the pleiotropic effects of this statin, and it may have an importantprotective effect against endothelial dysfunction and atherosclerosis.

Effects of Simvastatin and L-arginine on vasodilation, nitric oxide metabolics and endogenous NOS Inhibitors in hypercholesterolemic subjects

The statins have lipid-lowering and pleiotropic properties, which could exert protective effects on the endothelium in hypercholesterolemia. The association of L-arginine with simvastatin could promote a further improvement on endothelial function in this condition. Thus, we investigated whether simvastatin, with or without supplementation with L-arginine, could improve endothelium-dependent vasodilation. In this study, 25 hypercholesterolemic subjects were treated according to the following protocol: washout period of 1 month; simvastatin (20 mg/day) for 2 months; simvastatin (20 mg/day) þ L-arginine (7 g/day) for 2 months. From these patients, 10 were chosen at random for evaluation of vascular function by high resolution ultrassonography of the brachial artery. In subjects treated with simvastatin plus L-arginine, an increase of L-arginine levels (68%) and L-arginine/asymmetric dimethylarginine (ADMA) ratio (67%) were observed. Simvastatin reduced the plasma concentrations of NO metabolites nitrite þ nitrate (NOx: 34%), S-nitrosothiols (RSNO: 42%), total cholesterol (25%),low density lipoprotein (LDL)-cholesterol (36%) and the LDL-cholesterol/high density lipoprotein (HDL)-cholesterol ratio (34%). Simvastatin, associated or not to L-arginine, did not affect ADMA levels and endotheliumdependent vasodilation. Our data showed that simvastatin reduced the plasma concentrations of NOx and RSNO without affecting either the levels of ADMA or endothelium- dependent vasodilation in hypercholesterolemia...

Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention

Context Percutaneous coronary intervention (PCI) is associated with excellent short-term improvements in ischemic symptoms, yet only three fifths of PCI patients at 5 years and one third of patients at 10 years remain free of major adverse cardiac events (MACE).Objective To determine whether treatment with fluvastatin reduces MACE in patients who have undergone PCI.Design and Setting Randomized, double-blind, placebo-controlled trial conductedat 77 referral centers in Europe, Canada, and Brazil. Patients A total of 1677 patients (aged 18-80 years) recruited between April 1996 and October 1998 with stable or unstable angina or silent ischemia following successful completion of their first PCI who had baseline total cholesterol levels between 135 and 270 mg/dL (3.5-7.0 mmol/L), with fasting triglyceride levels of less than 400 mg/dL (4.5 mmol/L).Interventions Patients were randomly assigned to receive treatment with fluvastatin, 80 mg/d (n = 844), or matching placebo (n = 833) at hospital discharge for 3 to 4 years. Main Outcome Measure Survival time free of MACE, defined as cardiac death,nonfatal myocardial infarction, or reintervention procedure, compared between the treatment and placebo groups. Results Median time between PCI and first dose of study medication was 2.0 days, and median follow-up was 3.9 years. MACE-free survival time was significantly longer in the fluvastatin group (P = .01). One hundred eighty-one (21.4%) of 844 patients in the fluvastatin group and 222 (26.7%) of 833 patients in the placebo group had at least 1 MACE (relative risk [RR], 0.78; 95% confidence interval [CI], 0.64-0.95; P = .01)...