0
selected
-
1.
Efficacy and safety of turmeric and curcumin in lowering blood lipid levels in patients with cardiovascular risk factors: a meta-analysis of randomized controlled trials.
Qin, S, Huang, L, Gong, J, Shen, S, Huang, J, Ren, H, Hu, H
Nutrition journal. 2017;(1):68
Abstract
BACKGROUND Dyslipidemia is an important and common cardiovascular risk factor in the general population. The lipid-lowering effects of turmeric and curcumin are unconfirmed. We performed a meta-analysis to assess the efficacy and safety of turmeric and curcumin in lowering blood lipids in patients at risk of cardiovascular disease (CVD). METHODS A comprehensive literature search was conducted on PubMed, Embase, Ovid, Medline and Cochrane Library databases to identify randomized controlled trials (published as of November 2016) that assessed the effect of turmeric and curcumin on blood lipid levels including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Pooled standardized mean difference (SMD) with 95% confidence interval (CI) was used to assess the effect. RESULTS The analysis included 7 eligible studies (649 patients). Turmeric and curcumin significantly reduced serum LDL-C (SMD = -0.340, 95% confidence interval [CI]: -0.530 to -0.150, P < 0.0001) and TG (SMD = -0.214, 95% CI: -0.369 to -0.059, P = 0.007) levels as compared to those in the control group. These may be effective in lowering serum TC levels in patients with metabolic syndrome (MetS, SMD = -0.934, 95% CI: -1.289 to -0.579, P < 0.0001), and turmeric extract could possibly have a greater effect on reducing serum TC levels (SMD = -0.584, 95% CI: -0.980 to -0.188, P = 0.004); however, the efficacy is yet to be confirmed. Serum HDL-C levels were not obviously improved. Turmeric and curcumin appeared safe, and no serious adverse events were reported in any of the included studies. CONCLUSIONS Turmeric and curcumin may protect patients at risk of CVD through improving serum lipid levels. Curcumin may be used as a well-tolerated dietary adjunct to conventional drugs. Further research is required to resolve uncertainties related to dosage form, dose and medication frequency of curcumin.
-
2.
Approach to identifying and managing atherogenic dyslipidemia: a metabolic consequence of obesity and diabetes.
Bosomworth, NJ
Canadian family physician Medecin de famille canadien. 2013;(11):1169-80
Abstract
OBJECTIVE To review the evidence for recognition and management of atherogenic dyslipidemia. SOURCES OF INFORMATION High-quality randomized trials and meta-analyses were available to address most questions. North American and European guidelines were reviewed. Of these, the Canadian Cardiovascular Society lipid guidelines were most congruent with current literature. MAIN MESSAGE Atherogenic dyslipidemia is characterized by low levels of high-density lipoprotein (HDL), high levels of triglycerides, and a high low-density lipoprotein (LDL) particle number. The condition is highly associated with cardiovascular disease (CVD) and is poorly reflected in Framingham risk score and LDL measurements. Obesity, glucose intolerance, diabetes, and metabolic syndrome are rapidly becoming more common, and are often associated with atherogenic dyslipidemia, affecting long-term CVD risk. Recognition in the office is best achieved by non-HDL or total cholesterol-HDL ratio testing. Treatment success lies in optimizing diet and exercise. Of available medications, statins produce the most benefit and can be titrated to patient tolerance rather than to LDL target levels, which have a poor evidence base. The addition of fenofibrate can be considered in patients with high triglyceride and low HDL levels who have responded poorly to or have not tolerated statins. CONCLUSION Growing obesity prevalence creates a CVD risk that might be missed by LDL cholesterol testing alone. Simple calculations from results of a non-fasting lipid panel produce non-HDL levels and total cholesterol-HDL ratio, both of which are superior for predicting risk in all patients. These metrics should be available in lipid panels.
-
3.
Therapeutic approaches to the regulation of metabolism of high-density lipoprotein. Novel HDL-directed pharmacological intervention and exercise.
Zhang, B, Kawachi, E, Miura, S, Uehara, Y, Matsunaga, A, Kuroki, M, Saku, K
Circulation journal : official journal of the Japanese Circulation Society. 2013;(11):2651-63
Abstract
High-density lipoprotein (HDL) and low-density lipoprotein (LDL) particles transport cholesterol in plasma and play an important role in cellular cholesterol homeostasis, which influences cell function. The risk of coronary artery disease (CAD) associated with high levels of LDL-cholesterol (LDL-C) can be reduced by treatment with statins, which reduce LDL-C levels by inhibiting cellular cholesterol synthesis. However, patients who are treated with high doses of statins, especially secondary CAD prevention, regardless of their resulting LDL-C levels, are still at high risk of CAD. Therefore, there has been growing interest in HDL-directed therapies. Inhibitors of cholesteryl ester transfer protein (CETP) substantially increase HDL-C levels (by 31-138%). However, it is still unclear whether or not CETP inhibitors can reduce the risk of CAD associated with low HDL-C levels, while reconstituted HDL or apolipoprotein A-I mimetic peptides increase the functionality of HDL. Low levels of HDL-C are often complicated with metabolic disorders, including hypertriglyceridemia, metabolic syndrome, and type 2 diabetes mellitus, and lifestyle changes are effective for correcting these conditions. Physical activity and exercise training increase HDL-C levels, especially HDL2-C levels, by multiple mechanisms. Therefore, although using HDL-directed therapies that increase HDL-C levels and/or improve the function of HDL is a reasonable approach for reducing the residual risk of CAD as a complement to LDL-C-lowering therapy, lifestyle modifications including exercise to improve metabolic disorders should be considered as the first option.
-
4.
The role of triglycerides in atherosclerosis.
Talayero, BG, Sacks, FM
Current cardiology reports. 2011;(6):544-52
-
-
Free full text
-
Abstract
Hypertriglyceridemia is a prevalent risk factor for cardiovascular disease (CVD) and increasingly important in the setting of current obesity and insulin resistance epidemics. High triglyceride (TG) levels are markers for several types of atherogenic lipoproteins. Patients who have hypertriglyceridemia may be at significant risk for CVD even if low-density lipoprotein cholesterol levels are at goal, and therefore warrant treatment that optimizes diet, reduces overweight, and promotes regular exercise. High-risk patients with hypertriglyceridemia, such as those with diabetes, CVD, or metabolic syndrome, may benefit from additional drug treatment aside from a statin to address other lipid abnormalities. In this discussion, we review the role of hypertriglyceridemia and its associated atherogenic lipoproteins in the pathogenesis of atherosclerosis, the relevance of a high TG level as a predictor of CVD, the cardiovascular outcomes from TG-lowering intervention trials, and the current guidelines for treating hypertriglyceridemia.
-
5.
Implications of the obesity epidemic for lipid-lowering therapy: non-HDL cholesterol should replace LDL cholesterol as the primary therapeutic target.
Hoenig, MR
Vascular health and risk management. 2008;(1):143-56
Abstract
Obesity, metabolic syndrome and diabetes are conditions with increasing prevalence around the world. Cardiovascular risk in diabetics is often so high as to overlap with event rates observed in those with established coronary disease and this has lead to diabetes being classified as a coronary risk equivalent. However, despite the elevated risk of cardiovascular events associated with diabetes and the metabolic syndrome, these patients often have normal low density lipoprotein (LDL) cholesterol despite frequent increases in apolipoprotein B, triglycerides and nonhigh density lipoprotein (HDL) cholesterol. In contrast to LDL cholesterol, non-HDL cholesterol represents cardiovascular risk across all patient populations but is currently only recommended as a secondary target of therapy by the ATP III report for patients with hypertriglyceridemia. This article provides an overview of the studies that shown non-HDL cholesterol to be superior to LDL cholesterol in predicting cardiovascular events and presents the case for non-HDL cholesterol being the more appropriate primary target of therapy in the context of the obesity pandemic. Adopting non-HDL cholesterol as the primary therapeutic target for all patients will conceivably lead to an appropriate intensification of therapy for high risk patients with low LDL cholesterol.
-
6.
[Effect of ethanol on metabolic syndrome].
Jelski, W, Szmitkowski, M
Polskie Archiwum Medycyny Wewnetrznej. 2007;(7):306-11
Abstract
Metabolic syndrome is characterized by a group of risk factors for cardiovascular diseases, such as abdominal obesity, low high-density lipoprotein (HDL) cholesterol, elevated triglycerides, elevated arterial blood pressure, insulin resistance or impaired glucose tolerance. A number of studies focused on the relationship between alcohol consumption and prevalence of metabolic syndrome and its individual components. Ethanol can either aggravate the syndrome or prevent it--this depends primarily on the amounts and types of alcohol beverages consumed. It is commonly believed that moderate alcohol consumption is associated with a decreased incidence of metabolic syndrome and beneficial effects on plasma lipid levels, waist circumference and fasting plasma glucose. Of all the components of metabolic syndrome, the most beneficial effect of ethanol arises from an increase in plasma HDL cholesterol levels. The relationship between alcohol consumption and incidence of metabolic syndrome is more pronounced among red wine drinkers because polyphenoles contained in red wine increase the activity of endothelial nitric oxide synthase (eNOS), which plays a key role in the pathogenesis of metabolic syndrome. Decreased activity of this enzyme contributes to the development of insulin resistance, arterial hypertension and dyslipidemia. Stimulation of eNOS activity, which participates in the transport of HDL molecules, may provide an explanation for the mechanism of the increase in plasma levels of this particular lipid fraction in response to ethanol. Endothelial nitric oxide synthase requires the presence of antioxidants, which prevent both inactivation of nitric oxide in the reaction with peroxide anions and the accumulation of peroxynitrates.
-
7.
The significance of low HDL-cholesterol levels in an ageing society at increased risk for cardiovascular disease.
Windler, E, Schöffauer, M, Zyriax, BC
Diabetes & vascular disease research. 2007;(2):136-42
-
-
Free full text
-
Abstract
In most developed and developing countries, the proportion of the population aged 60 years or more is growing faster than any other age group. Given that the vast majority of cardiovascular events occur in older individuals, new thinking is needed to reduce their risk. Epidemiological studies have shown an increasing prevalence of the metabolic syndrome with age, driven by nutrition inappropriate for a modern sedentary lifestyle. A low level of high-density lipoprotein (HDL)-cholesterol, a component of the atherogenic dyslipidaemia of the metabolic syndrome, has been shown to be an important determinant of coronary risk, which rises in prevalence with increasing age. Thus, raising HDLcholesterol, in addition to lowering the level of low-density lipoprotein (LDL)-cholesterol, seems a plausible approach to reduce cardiovascular risk in an ageing population. Clinical studies have shown that adding nicotinic acid, which raises HDL-cholesterol by 20-25%, to a statin enhances the reduction in progression of atherosclerosis. Results of the ongoing Atherothrombosis Intervention in Metabolic syndrome with low HDL/High triglyceride and Impact on Global Health Outcomes (AIM-HIGH) study are awaited with interest to see whether such theoretical benefit translates into clinical outcome.
-
8.
Metabolic syndrome: controversial but useful.
Stolar, M
Cleveland Clinic journal of medicine. 2007;(3):199-202, 205-8
Abstract
The metabolic syndrome--the cluster of obesity, impaired fasting glucose, elevated triglycerides, low high-density lipoprotein cholesterol, and hypertension--may not be a "real" syndrome in the strict sense. It can, however, still be a useful concept if it prompts a physician to look for and treat additional risk factors when a patient is found to have one risk factor, or if it helps persuade patients to undertake healthy lifestyle changes before they develop overt diabetes mellitus or coronary artery disease.
-
9.
Aging and HDL metabolism in elderly people more than 100 years old.
Arai, Y, Hirose, N
Journal of atherosclerosis and thrombosis. 2004;(5):246-52
Abstract
Epidemiological studies have enhanced the importance of high-density lipoprotein (HDL) as a risk factor for CAD, as well as disability and frailty in the oldest elderly. Therefore, HDL and molecules involved in HDL metabolism seem to be attractive candidates for longevity-promoting factors. A series of observational studies has demonstrated that the predominance of the larger, more lipid-rich HDL2 subclass is a reproducible phenotype among centenarians. This finding was recently evolved by nuclear magnetic resonance technology in quantification of lipoprotein particle size. However, results of investigations into the mechanisms underlying the lipoprotein profiles in the oldest elderly have been conflicting. Genetic variation in cholesteryl ester transfer protein (CETP), which is a carrier protein in reverse cholesterol transport, was demonstrated to have no association with longevity in one study, but to have positive impacts on large HDL particles and longevity in another. Regarding environmental factors, acute phase reactant and nutritional status are frequently associated with HDL-C levels in the oldest elderly, however, the causality of the association remains to be elucidated. Determination of the association between cognitive function and HDL in the oldest elderly is also a future task. To obtain further insight into the mechanistic roles of low HDL in the pathophysiology of geriatric syndrome, a much greater effort should be invested in this research field.
-
10.
Non-HDL cholesterol as a measure of atherosclerotic risk.
Packard, CJ, Saito, Y
Journal of atherosclerosis and thrombosis. 2004;(1):6-14
Abstract
Elevated triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) levels, hallmarks of the atherogenic lipid profile found in the metabolic syndrome and type 2 diabetes, are commonly seen in Japanese patients with coronary heart disease (CHD). In the setting of mildly to moderately elevated plasma TG (150-500 mg/dl), very-low-density lipoprotein (VLDL) accumulates and so do high levels of atherogenic TG-rich, cholesterol-enriched remnant particles. Indeed, in hypertriglyceridemia, abnormalities are seen in the quantity and quality of all lipoprotein B-containing lipoproteins. Non-HDL-C (total cholesterol minus HDL-C) provides a convenient measure of the cholesterol content of all atherogenic lipoproteins, and thus incorporates the potential risk conferred by elevated levels of atherogenic TG-rich remnants that is additional to the risk associated with low-density lipoprotein cholesterol (LDL-C). Non-HDL-C level has been found to be a strong predictor of future cardiovascular risk among patients whether or not they exhibit symptoms of vascular disease, and was recently recommended as a secondary treatment target (after LDL-C) in patients with elevated TG by the National Cholesterol Education Program Adult Treatment Panel III. Adoption of this readily available measure to assess risk and response to treatment in patients with elevated TG would improve treatment of dyslipidemia in a substantial number at risk for CHD.