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Lipoprotein

CRP–Mediated Low Density Lipoprotein Uptake by Macrophages – (03-22-01)

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CRP–Mediated Low Density Lipoprotein Uptake by Macrophages

I may need to clarify what this article is talking about. First, it is current theory that macrophages become foam cells once they take up LDL cholesterol from the bloodstream. These foam cells are what lead to the buildup of plaque on the arteries. This article is suggesting that CRP (a marker of chronic inflammation) increases the attraction (“opsonizes”) between the LDL and the macrophages. Low level chronic inflammation can come from so many different sources; and can in turn lead to a multitude of chronic diseases.

Circulation — Abstracts: Zwaka et al. 103 (9): 1194

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Diet Low in Animal Protein Improves Blood Glucose in Type 2 Diabetics – (07-02-01)

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Diet Low in Animal Protein Improves Blood Glucose in Type 2 Diabetics

Here’s another one of those “how much did we spend on THIS study” studies. Almost any condition known to man will improve with a more plant-based diet, and diabetes is no exception. Westernized societies are typically “meat and potatoes” cultures, with very little veggies on the dinner plate compared to animal products. Other cultures generally accepted as healthier are more plant and grain based, with rice and/or beans as the central portion of the meal. Also note in this study that sugars were removed from the diet–of course this would lower insulin and glucose levels.

83rd annual meeting of the Endocrine Society The researchers studied 51 patients with type 2 diabetes who had not benefited from large doses of oral hypoglycemics and/or insulin. They were assigned to reduce their dietary animal protein intake from 2 to 3 times a day to once every other day for 6 months, replacing it with equal amounts of vegetable protein. Sugars were eliminated, but caloric content remained the same to prevent weight loss. Among the 31 patients who stayed on the diet, the HbA1c value was decreased by a significant 30%, from an average of about 10 to about 7. Other significant improvements were that total cholesterol decreased by 32%, triglycerides by 60%, and low-density lipoprotein cholesterol by 35%, and high-density lipoprotein cholesterol increased by 10%. “Patients liked the new diet and the fact that they did not have to fast, adhere to low-calorie diets or take appetite suppressants,” the researchers commented in a meeting abstract. They noted that of the 20 patients who did not follow the diet, 6 followed a low-calorie diet and lost weight, and 14 switched from red meat to fish and poultry, but their metabolic profile did not improve. Three of the patients who did follow the prescribed diet reduced their insulin dose by 50%, two patients discontinued insulin, four patients stopped taking oral hypoglycemics and six discontinued one or two of their hypolipemics. “We were not really surprised by these findings,” says Dr. Arsenis. “We know that animal protein contains essential amino acids which stimulate pancreatic insulin secretion.” The increased insulin increases adrenaline levels, which is thought to induce insulin resistance, he explained. Dr. Arsenis suggested that this type of diet might even help prevent the development of type 2 diabetes.

 

Apo e2 Allele and Anti-atherogenic Lipoprotein Profile in Children – (10-05-00)

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Apo e2 Allele and Anti-atherogenic Lipoprotein Profile in Children

This is another example of “new” markers that can affect our cardiovascular health. Running an isolated cholesterol level without the other markers such as homocysteine, apolipoprotein e2, lipoprotein a, fibrinogen and CRP. The interesting note about this article is that we are starting to release that cardiovascular disease begins in childhood.

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Use of Niacin in the Prevention and management of Hyperlipidemia – (05-17-01)

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Use of Niacin in the Prevention and management of Hyperlipidemia

With the use of niacin dating back long before the use of many of today’s common meds for high cholesterol levels, it is disappointing that it is not more widely used. This review article address the efficacy and safety of this time-tested treatment for hyperlipidemia. One side effect of niacin therapy, however, is the flushing that comes from the doses needed to achieve a clinical response (usually 1500-3000 mg). I have read that using one baby aspirin 1/2 hour before taking the niacin can de-activate the histamine release and prevent the flushing.

Prog Cardiovasc Nurs 6(1):14-20, 2001 Niacin is an inexpensive drug useful in treating various forms of hyperlipidemia. Cardiac doses of niacin are effective in lowering serum triglyceride, low density lipoprotein, and lipoprotein-a levels and in elevating high density lipoprotein levels. Adverse reactions to niacin are varied and dose-dependent and range from annoying cutaneous flushing to hepatic toxicity. Patients advised to use the drug should be carefully screened and monitored. This paper reviews the pathologic and pharmacologic basis for niacin as an antilipemic agent. The biochemical and physiologic effects of the drug and its mechanisms of action are discussed. Emphasis is placed on the importance of aggressive management of serum lipids and the therapeutic uses of niacin. The use of niacin in primary and secondary prevention of heart disease is stressed. A patient education guide is included. T he current decline in coronary heart disease (CHD) in the U.S. may be attributed more to the prolongation of life among those with existing disease than to a decrease in the absolute number of deaths. Further decline in the CHD death rate will most likely depend upon successful secondary prevention of heart disease. Single or combined drug therapies together with maintenance of a healthy lifestyle are central to successful prevention of recurrent thrombotic events in coronary arteries. Ultimate success in decreasing the incidence of CHD will depend upon primary prevention of new onset of the disease.The combination of lifestyle changes and drug therapy has been shown to be effective in both primary and secondary prevention of CHD. One of the oldest drugs in the CHD armamentarium is nicotinic acid, commonly known as niacin. First used as a hyperlipidemic agent in 1955, niacin is a readily available, inexpensive mainstay of adjunctive therapy for prevention and treatment of CHD. This paper briefly reviews the pathology of hyperlipidemia and discusses the use of plain and immediate-release niacin as well as a new, extended-release form of niacin in secondary and primary prevention of CHD. Emphasis is placed on the clinical impact of the adverse effects of niacin as well as the role of the primary care provider in recommending its use.

Lipoprotein(a) Level and Heart Attacks – (03-11-01)

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Lipoprotein(a) Level Linked to Coronary Events in Middle-Aged Men

I really hate to beat a dead horse, but checking only cholesterol levels with the copious amounts of research on other blood-related risk factors is outdated and a disservice. What is interesting about this study is that the degree of risk from lipoprotein(a) is related to the presence of other risk factors. More support of a global approach to disease management.

J Am Coll Cardiol 2001;37:434-439 – Perhaps ending a longstanding controversy, a new population-based study connects elevated levels of lipoprotein(a) with increased coronary risk in middle-aged men, especially those with high LDL cholesterol levels, low HDL cholesterol levels, hypertension and/or other risk factors. Dr. Arnold von Eckardstein, from the Westfalische Wilhelms-Universitat Munster, Germany, and colleagues collected data on 788 men, 35 to 65 years of age, who participated in the Prospective Cardiovascular Munster study. Over 10 years of follow-up, the researchers evaluated levels of lipoprotein(a) as well as traditional cardiovascular risk factors. During that period, 44 men experienced myocardial infarctions, while the remaining 744 subjects survived without a major coronary event or stroke, according to the research team’s report in the Journal of the American College of Cardiology for February. Dr. von Eckardstein’s group found a 2.7 times increased risk for coronary events among men whose lipoprotein(a) levels were 0.2 g/L or more, compared with subjects with lower levels. The risk was especially prominent in men with LDL cholesterol levels of 4.1 mmol/L or more (relative risk 2.6), and men with HDL cholesterol of 0.9 mmol/L or less (relative risk 8.3). The risk was also strongly associated with hypertension (relative risk 3.2). “Because lipoprotein(a) increases the risk of coronary events strongly depending on the presence of additional coronary risk factors, it is imperative to strictly control additional risk factors in individuals with elevated lipoprotein(a),” Dr. von Eckardstein and colleagues conclude.

 

GLUCOSE LEVELS IN BLOODSTREAM CAN IRREVERSIBLY DAMAGE PROTEINS – (10-13-04)

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High Levels of Dietary Advanced Glycation End Products Transform Low-Density Lipoprotein Into a Potent Redox-Sensitive Mitogen-Activated Protein Kinase Stimulant in Diabetic Patients

Okay, so maybe I’m on a kick for long titles detailing biochemistry for this Update… Actually, I couldn’t figure out how to shorten the title. When elevated glucose levels are present in the bloodstream they can irreversibly damage protein. Muscle, heart, heme…any protein. This is the idea behind checking hemoglobin A1C/glycosylated hemoglobin–it checks the damage occurring over the course of the 3-month lifespan of a RBC. So, it is becoming of concern that glycosylated proteins from our diet may have a negative impact on our health as well.

Circulation — Abstracts: Cai et al. 110 (3): 285 –

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CARDIAC STENT VS OPEN HEART SURGERY – (07-16-04)

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Percutaneous Coronary Intervention Results in Acute Increases in Oxidized Phospholipids and Lipoprotein(a)

While there is no question that, should I have a choice between PCI and open heart surgery, I would pick PCI anyday. But this procedure is done on many patients as a screening tool with chest pain. Many negative tests are done without thought to the long term consequences other than healing of the incision.

This study finds that there is a long term elevation of oxidized LDL (remember–LDL cannot damage our vessels until it gets damaged via oxidation) after PCI. This might be a willing trade off to the patient that avoided open heart surgery. But to the patient that was scoped to “rule out” obstructive lesions, this is not a good trade off. Maybe these findings will push a greater use of the non-invasive ultra fast CT, which does a nice job of ruling out cardiac involvement in patients with chest pain. Circulation — Abstracts: Tsimikas et al. 109 (25): 3164 –

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ERRORS FROM TC/HDL C RATIO RISKS VASCULAR DISEASE – (07-17-06)

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Errors that result from using the TC/HDL C ratio rather than the apoB/apoA-I ratio to identify the lipoprotein-related risk of vascular disease

Wow. Sometimes we really hit articles that remind us how far we can fall behind in the research. Most physicians are still blissfully making clinical decisions based entirely on total cholesterol. Some even take HDL into account. Smaller still are the physicians recognizing the risk that triglycerides/HDL ratio play. So, while most physicians are decades behind using tri/HDL ratios, research is finding that apoB/apo A-1 ratios are much, much stronger at predicting CVD risk. Just when mainstream medicine might have been catching up…

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