Aim: The Japan Diet nutritional education program effects on serum fatty acid compositions for prevention of atherosclerotic cardiovascular disease in middle-aged men brought up in the westernized dietary environment of modern Japan were examined.
Methods: Thirty-three men, 30–49 years of age, attended a nutrition education class and were recommended to consume Japan Diet volumes (more fish, soybeans and soy products, vegetables, seaweed, konjak, mushrooms, and unrefined cereals and less animal fat, meat and poultry with fat, sweets, desserts and snacks, and alcoholic drinks) for 6 weeks. Three-day weighted dietary records were kept, and fatty acid intakes were calculated. Serum phospholipid fatty acid compositions were examined.
Results: During the 6 weeks, fish, soy, and seaweed and/or mushrooms and/or konjak were consumed 1.0, 1.1, and 1.0 times daily on average, whereas daily fatty meat and poultry and sweet consumptions were 0.3 and 0.3, respectively. These changes were attributed to increased intake of n-3 polyunsaturated fatty acids (PUFAs) such as C20:5(n-3), C22:6(n-3), C18:4(n-3), and C20:4(n-3) and decreased intakes of all saturated fatty acids and unsaturated fatty acids such as C18:1 and C18:2(n-6). As to the phospholipid fatty acid composition, C18:0 decreased, whereas C15:0, C17:0, and C20:0 increased. Marked increases in C20:5(n-3) and C22:6(n-3) raised total n-3 PUFA from 10.30% to 13.20% along with n-6 PUFA decreasing from 33.92% to 31.16%. Despite decreases in C20:4(n-6) and C20:3(n-6), the C20:4(n-6)/C20:3(n-6) ratio used as an estimate of delta-5 desaturase activities increased and correlated positively with fish intake at completion of the intervention.
Conclusions: The Japan Diet is effective for changing the fatty acids to an anti-atherosclerotic profile.
The clinical trial registration number: UMIN000020639.
Aim: No meta-analysis has examined the effect of regular aquatic endurance exercise on lipid and lipoprotein levels. The purpose of the current work was to perform a meta-analysis to evaluate the effects of regular aquatic endurance exercise on lipid and lipoprotein levels.
Methods: The inclusion criteria of the randomized controlled trials were healthy adults in an exercise group performing regular aquatic exercise and a control group not exercising, with a description of the serum high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, or triglyceride levels provided. The net change in the lipid and lipoprotein levels was calculated from each trial, and the changes in the lipid and lipoprotein levels were pooled using a random effects model.
Results: The meta-analysis examined 10 trials involving aquatic endurance exercise and 327 subjects. The pooled net changes in HDL-C, LDL-C, and total cholesterol improved significantly (HDL-C, 4.6 mg/dL; LDL-C, －10.1 mg/dL; total cholesterol, －8.5 mg/dL). When trials were limited to those involving only women, the pooled net changes in HDL-C, LDL-C, and total cholesterol improved significantly. When trials were limited to those involving subjects with a mean age ＜60 years, the pooled net changes in HDL-C, total cholesterol, and triglyceride improved significantly. When trials were limited to those with dyslipidemia, the pooled net changes in HDL-C, LDL-C, total cholesterol, and triglyceride improved significantly.
Conclusions: Aquatic endurance exercise improved the lipid and lipoprotein levels and benefited women, middle-aged subjects, and patients with dyslipidemia in particular.
Aims: Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide and one of the greatest threats to public health. Tenascin C (TNC) is an extracellular matrix glycoprotein that is found in low concentrations in normal tissues and is enhanced by a range of cardiovascular pathologies. This study aimed to evaluate the value of TNC in assessing the severity of atherosclerosis measured by the Gensini score.
Methods: A total of 157 patients with chest pains who underwent selective coronary angiography for suspected coronary atherosclerosis were enrolled. The patients were divided into the CAD group and non-CAD group according to symptoms and angiography. Demographic data and laboratory analyses were collected.
Results: The mean TNC level was significantly higher in the CAD group than in the non-CAD group (p＜0.001). A significant positive correlation between TNC levels and Gensini score (p＜0.01, r=0.672) was found. ROC curve analysis demonstrated that the cutoff value for TNC at 89.48 ng/mL was well differentiated in the CAD and non-CAD groups. Furthermore, TNC was also a good predictor for a higher Gensini score (the third tertile) in the ROC curve analysis. When the cutoff was accepted as 100.91 ng/mL, the sensitivity and specificity were 82.7% and 79%, respectively.
Conclusion: A significant relationship was found between the Gensini score and serum TNC level. TNC levels can be considered in risk assessments for CAD before angiography.
Aim: This study aimed to evaluate the effect of diet on serum lipids and to assess the effectiveness of long-term dietary therapy for hypertriglyceridemia.
Methods: Seventy-nine patients (34 males and 45 females) with hypertriglyceridemia were enrolled and underwent dietary counseling for 12 months based on the following three recommendations: (1) reduce carbohydrate intake, (2) increase n-3 polyunsaturated fatty acid (PUFA) intake, and (3) limit alcohol drinking. We examined the effect of dietary therapy for 6 months on serum triglyceride (TG) levels and also compared the effectiveness of dietary and combined drug therapies on preventing arteriosclerotic disease from 7 to 12 months.
Results: We observed that serum TG levels of the patients receiving dietary counseling were decreased compared with baseline at 6 months. Body weight and serum TG levels were decreased, and serum high-density lipoprotein levels were increased in the dietary therapy alone group, whereas BW, body mass index, and abdominal circumference were decreased in the combined drug treatment group compared with baselines at 6 and 12 months. Furthermore, the dietary therapy alone group demonstrated reductions in intake of total energy, carbohydrate, and saturated fatty acids, as well as n-6/n-3 PUFA ratio compared with baselines, but only n-6/n-3 PUFA ratio was decreased in the combined drug treatment group.
Conclusion: This study demonstrated a decrease in serum TG level after 12 months of dietary therapy similar to drug therapy, which suggests that it is an effective treatment for hypertriglyceridemia, and heightened awareness should be made to encourage its use.
The clinical trial registration number: UMIN000028860.
Aims: There is limited knowledge about the association of lipoprotein particles and markers of coronary atherosclerosis such as coronary artery calcification (CAC) in relatively young high-risk persons. This study examines the association of lipoprotein subfractions and CAC in high cardiometabolic risk individuals.
Methods: The study presents analysis from baseline data of a randomized trial targeted at high-risk workers. Employees of Baptist Health South Florida with metabolic syndrome or diabetes were recruited. At baseline, all 182 participants had lipoprotein subfraction analysis using the ion mobility technique and participants above 35 years (N=170) had CAC test done. Principal components (PC) were computed for the combination of lipoprotein subclasses. Multiple bootstrapped regression analyses (BSA) were conducted to assess the relationship between lipoprotein subfractions and CAC.
Results: The study population (N=170) was largely female (84%) with a mean age of 58 years. Three PCs accounted for 88% variation in the sample. PC2, with main contributions from VLDL particles in the positive direction and large LDL particles in the negative direction was associated with a 22% increase in CAC odds (P value ＜0.05 in 100% of BSA). PC3, with main contributions from HDL lipoprotein particles in the positive direction and small/medium LDL and large IDL particles in the negative direction, was associated with a 9% reduction in CAC odds (P＜0.05 in 88% of BSA). PC1, which had approximately even contributions from HDL, LDL, IDL and VLDL lipoprotein subfractions in the positive direction, was not associated with CAC.
Conclusion: In a relatively young but high-risk population, a lipoprotein profile predominated by triglyceride-rich lipoproteins was associated with increased risk of CAC, while one predominated by HDL lipoproteins offered modest protection. Lipoprotein sub-fraction analysis may help to further discriminate patients who require more intensive cardiovascular work-up and treatment.
Aim: We investigated whether indoxyl sulfate (IS), a protein-bound uremic toxin, predicts prognosis after acute coronary syndrome (ACS).
Methods: Serum IS level was determined prospectively in 98 patients who underwent successful primary percutaneous coronary intervention for ACS. Patients on hemodialysis were excluded. The endpoint of this study was six-month composite events including death, nonfatal myocardial infarction, heart failure requiring hospitalization, and adverse bleeding events.
Results: During the mean follow-up period of 168 days, composite events occurred in 13.3% of cases. Serum IS level was significantly higher in subjects who developed composite events than in those without events (0.14±0.11 mg/dl vs. 0.06±0.04 mg/dl; p＜0.001). After adjusting for confounding factors, a Cox proportional hazard analysis revealed that the IS level (hazard ratio (HR): 10.6; 95% confidence interval (CI): 1.63–69.3, p=0.01), hemoglobin level (HR: 0.61; 95% CI: 0.43–0.87; p＜0.01), and left ventricular ejection fraction (LVEF) (HR: 0.95; 95% CI: 0.91–0.99; p=0.03) were independent predictive factors of composite events. Furthermore, IS level significantly conferred additional value to the combined established risks of LVEF and hemoglobin level for predicting the incidence of composite events (area under the curve: 0.82 vs. 0.88, p=0.01; net reclassification improvement: 0.67, p=0.01; and integrated discrimination improvement: 0.15, p＜0.01).
Conclusions: The assessment of serum IS level has prognostic utility for the management of ACS.
Aim: Lomitapide is an oral inhibitor of the microsomal triglyceride transfer protein used to treat homozygous familial hypercholesterolemia (HoFH); patients require a low-fat diet to minimize gastrointestinal adverse effects and dietary supplements to prevent nutrient deficiencies. We investigated the diet and nutritional status during lomitapide treatment.
Methods: Japanese patients with HoFH, who were in a phase 3 trial of lomitapide, were instructed to start low-fat diets with supplements of vitamin E and essential fatty acids 6 weeks before starting lomitapide treatment. Dietary education was conducted by registered dietitians 16 times during the study period, which included a pre-treatment run-in phase (Weeks －6–0), a lomitapide treatment efficacy phase (Weeks 0–26) and a safety phase (Weeks 26–56). Two-day dietary records were collected at each dietary counseling session. Anthropometric and biochemical parameters were measured at Weeks 0, 26 and 56.
Results: Eight patients completed the 56 weeks of lomitapide treatment. Their median energy intakes derived from lipids were 19.2% and 17.9% during the efficacy and safety phases, respectively. “Fats and oils” intakes, and “Fatty meat and poultry” intakes in two patients, were successfully reduced to achieve low-fat diets. Although intakes of energy, fatty acids and fat-soluble vitamins did not differ significantly among phases, body weight, serum fatty acid levels and vitamin E concentrations were decreased at Week 26 as compared with Week 0.
Conclusion: HoFH patients can adhere to low-fat diets with ongoing dietary counseling. Instructions about intakes of energy, fatty acids and fat-soluble vitamins, as well as periodic evaluations of nutritional status, are necessary.
Aims: ST-segment elevation myocardial infarction (STEMI) is an acute inflammatory and thrombotic disease due to coronary artery atherosclerotic lesions. Studies have established the correlation of serum sulfatides with inflammation, thrombogenesis, and atherosclerosis. We observed that serum sulfatides level significantly increased in STEMI patients. In this study, we try to identify the relationship of serum sulfatides level on clinical outcomes of patients in STEMI.
Methods: Serum sulfatides level was monitored in 370 inpatients within 24 h of STEMI onset. On the basis of the level of serum sulfatides that was below 10 µmol/L in the normal population, the patients were divided into two groups with the median value of 15.2 µmol/L; low sulfatide group [serum sulfatides level ≤ 15.2 µmol/L (n=200)] and high sulfatide group [serum sulfatides level ＞ 15.2 µmol/L (n=170)]. Patients’ baseline characteristics, in-hospital outcomes, and late major adverse cardiovascular events (MACE) were analyzed. Independent incident for in-hospital death and late adverse events were modeled by multivariate logistic and Cox regression analysis.
Results: Between the two groups, there were no differences in the angiographic characteristics, percutaneous coronary intervention (PCI) results, and in-hospital recovery. However, high serum sulfatides level is positively correlated with increased rate of in-hospital death (OR 0.971; 95% CI 0.926–0.990, p=0.019). In addition, this group of patients has more cumulative incidences of target vessel revascularization (TVR) (23% vs. 8%, p＜0.05) and increased overall MACE (28% vs. 10%, p ＜0.05). Cox regression analysis indicated that high serum sulfatides level contributes to TVR and overall MACE.
Conclusions: Elevated serum sulfatides level positively correlate with in-hospital death and complications (TVR and MACE) in STEMI patients.