Diet and Cardiovascular Disease

This paper describes the importance of diet in cardiovascular disease prevention. Different aspects of diet are discussed: nutrients, single foods/food groups and dietary patterns. The evidence regarding the impact of diet on intermediate risk factors (such as blood pressure and cholesterol levels) and the impact on cardiovascular endpoints are discussed.     

Long-Term Changes in Gut Microbial Metabolite Trimethylamine N-Oxide and Coronary Heart Disease Risk

BackgroundA gut-microbial metabolite, trimethylamine N-oxide (TMAO), has been associated with coronary atherosclerotic burden. No previous prospective study has addressed associations of long-term changes in TMAO with coronary heart disease (CHD) incidence.ObjectivesThe purpose of this study was to investigate whether 10-year changes in plasma TMAO levels were significantly associated with CHD incidence.MethodsThis prospective nested case-control study included 760 healthy women at baseline. Plasma TMAO levels were measured both at the first (1989 to 1990) and the second (2000 to 2002) blood collections; 10-year changes (Δ) in TMAO were calculated. Incident cases of CHD (n = 380) were identified after the second blood collection through 2016 and were matched to controls (n = 380).ResultsRegardless of the initial TMAO levels, 10-year increases in TMAO from the first to second blood collection were significantly associated with an increased risk of CHD (relative risk [RR] in the top tertile: 1.58 [95% confidence interval (CI): 1.05 to 2.38]; RR per 1-SD increment: 1.33 [95% CI: 1.06 to 1.67]). Participants with elevated TMAO levels (the top tertile) at both time points showed the highest RR of 1.79 (95% CI: 1.08 to 2.96) for CHD as compared with those with consistently low TMAO levels. Further, we found that the ΔTMAO-CHD relationship was strengthened by unhealthy dietary patterns (assessed by the Alternate Healthy Eating Index) and was attenuated by healthy dietary patterns (p interaction = 0.008).ConclusionsLong-term increases in TMAO were associated with higher CHD risk, and repeated assessment of TMAO over 10 years improved the identification of people with a higher risk of CHD. Diet may modify the associations of ΔTMAO with CHD risk.     

Cholesterol-Lowering Nutraceuticals Affecting Vascular Function and Cardiovascular Disease Risk

Purpose of Review

The aim of this review is to provide an update on the effects of the dietary supplementation with cholesterol-lowering nutraceuticals and nutraceutical combinations affecting vascular function and CV risk in clinical interventional studies.

Recent Findings

Current evidence supports the mild-to-moderate cholesterol-lowering efficacy of red yeast rice, berberine, plant sterols, fibers, and some nutraceutical combinations whereas data on the individual cholesterol-lowering action of other nutraceuticals are either less striking or even inconclusive. There is also promising evidence on the vascular protective effects of some of the aforementioned nutraceuticals. However, except for red yeast rice, clinical interventional studies have not investigated their impact on CV outcomes.

Summary

Evidence of both cholesterol-lowering and vascular protection is a prerogative of few single nutraceuticals and nutraceutical combinations, which may support their clinical use; however, caution on their uncontrolled adoption is necessary as they are freely available on the market and, therefore, subject to potential misuse.

     

Long-Term Renal Function and Cardiovascular Disease Risk in Obese Kidney Donors

Background and objectives: Increasing demand for live-donor kidneys has encouraged the use of obese donors despite the absence of long-term outcome data and evidence that obesity can adversely affect renal function. We wished to determine whether obesity increased the risk for renal dysfunction and other medical comorbidities in donors several years after donation.Design, setting, participants, & measurements: Ninety-eight patients who donated a kidney 5 to 40 years previously were stratified according to body mass index (BMI) at donation and evaluated for renal dysfunction and risk factors for cardiovascular disease. Patients who were from the 2005 through 2006 National Health and Nutrition Examination Survey database; did not have renal disease; and were matched for age, gender, race, and BMI served as two-kidney control subjects.Results: Renal function in obese (BMI ≥30) and nonobese (BMI <30) donors was similar, and both donor groups had reduced renal function compared with BMI-matched two-kidney control subjects. Obesity was associated with more hypertension and dyslipidemias in both donors and two-kidney control subjects; however, there were no significant differences between the two groups within each BMI category.Conclusions: These results indicate that obese donors are not at higher risk for long-term reduced renal function compared with nonobese donors and that the increased incidence of hypertension and other cardiovascular disease risk factors in obese donors is due to their obesity and is not further exacerbated by nephrectomy. These findings support the current practice of using otherwise healthy overweight and obese donors but emphasize the need for more intensive preoperative education and postoperative health care maintenance in this donor group.Live-donor kidney transplantation is generally considered the best choice for patients who have renal failure and are awaiting transplantation, because these kidneys function better than kidneys from deceased donors, and waiting times for deceased-donor transplants are long (1). Although several studies have shown that kidney donation has low short-term morbidity and mortality, the data on long-term outcomes are much less complete (2,3). This is particularly true of donor groups with medical comorbidities that are now being used with greater frequency. One such patient group is the obese donor. There is increasing evidence that obese patients are more susceptible to the development of renal disease either as a direct result of their weight or as a consequence of their obesity-related comorbidities, such as hypertension and diabetes. Conversely, even mild renal dysfunction is thought to increase the risk for developing cardiovascular disease (CVD), an important concern in overweight patients who are already prone to developing this complication (4–6). Despite these findings in the general population, little is known about the effects of obesity on long-term outcomes in kidney donors. This study addressed this issue by examining long-term outcomes in nonobese (body mass index [BMI] <30) and obese (BMI ≥30) patients who donated a kidney at the University of California, San Francisco (UCSF), between 1967 and 2003.     

Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study

1. Download : Download high-res image (191KB)
2. Download : Download full-size image

     

Cardiovascular Disease Risk and Statin Use Among Adults with Metabolic Dysfunction Associated Fatty Liver Disease

BackgroundA leading cause of mortality in fatty liver disease is cardiovascular disease. Metabolic dysfunction-associated fatty liver disease (MAFLD) is new terminology that classifies fatty liver due to metabolic dysfunction attributable to obesity and associated complications. We evaluated atherosclerotic cardiovascular disease (ASCVD) risk and statin use in adults with MAFLD.MethodsThis was a retrospective study of the 2011-2018 National Health and Nutrition Examination Survey. Adults with MAFLD were identified using established criteria: presence of hepatic steatosis (US Fatty Liver Index>30) plus ≥1 of the following: 1) body mass index >25 kg/m² in non-Asians or >23 kg/m² in Asians, 2) diabetes mellitus, and 3) ≥2 metabolic risk factors. Cardiovascular disease risk was estimated using the validated 10-year ASCVD risk score. Statin use was assessed in intermediate and high 10-year ASCVD risk groups.ResultsPrevalence of MAFLD was 34.8% (95% confidence interval [CI], 33.9%-35.8%), comprising 54.4% males, 27.9% aged 65 years and older, and 38.2% non-Hispanic white. Among adults with MAFLD, 23.3% and 23.0% had intermediate and high 10-year ASCVD risk, respectively. Compared with females, males were more likely to have high 10-year ASCVD risk (28.7% vs 16.1%, adjusted odds ratio 5.24, 95% CI, 3.87-7.10, P < .01). In intermediate and high ASCVD risk groups, overall statin use was 48.3% (95% CI, 46.1-51.3).ConclusionsOver 46% of adults with MAFLD had intermediate or high 10-year ASCVD risk. Statin use was underutilized at 48.3% in those meeting statin criteria. These findings are alarming given the high cardiovascular disease risk and low statin use in this cohort.     

饮食对心血管疾病的预防和保护

心血管疾病作为目前危害人类健康和生命的常见病与多发病,受到广泛关注。长期暴露于具有某种危险因素的饮食模式,会加大心血管疾病的发生概率。合理的饮食习惯对保护心血管的健康、预防心血管的发病及阻止病程进展都有帮助。现结合当前文献,综述饮食对心血管疾病的预防和保护,对各种有利于心血管疾病防治的饮食进行阐述。     

Metabolic Abnormalities,Cardiovascular Disease Risk Factors,and GFR Decline in Children with Chronic Kidney Disease

Summary

Background and objectives

Metabolic abnormalities and cardiovascular disease (CVD) risk factors have rarely been systematically assessed in children with chronic kidney disease (CKD). We examined the prevalence of various CKD sequelae across the GFR spectrum.

Design, setting, participants, & measurements

Data were used from 586 children participating in the Chronic Kidney Disease in Children (CKiD) study (United States and Canada) with GFR measured by iohexol plasma disappearance. Laboratory values and CVD risk factors were compared across GFR categories and with an age-, gender-, and race-matched community sample.

Results

CKiD participants were 62% male, 66% Caucasian, 23% African American, and 15% Hispanic with a median age of 11 years and a median GFR of 44 ml/min per 1.73 m². Compared with those with a GFR ≥ 50 ml/min per 1.73 m², having a GFR < 30 ml/min per 1.73 m² was associated with a three-fold higher risk of acidosis and growth failure and a four- to five-fold higher risk of anemia and elevated potassium and phosphate. Median GFR change was −4.3 ml/min per 1.73 m² and −1.5 ml/min per 1.73 m² per year in children with glomerular and nonglomerular diagnoses, respectively. Despite medication and access to nephrology care, uncontrolled systolic hypertension was present in 14%, and 16% had left ventricular hypertrophy. Children with CKD frequently were also shorter and had lower birth weight, on average, compared with norms.

Conclusions

Growth failure, metabolic abnormalities, and CVD risk factors are present at GFR >50 ml/min per 1.73 m² in children with CKD and, despite therapy, increase in prevalence two- to four-fold with decreasing GFR.     

Markers of Gut Barrier Function and Microbial Translocation Associate with Lower Gut Microbial Diversity in People with HIV

People with human immunodeficiency virus (HIV) (PWH) have reduced gut barrier integrity (“leaky gut”) that permits diffusion of microbial antigens (microbial translocation) such as lipopolysaccharide (LPS) into the circulation, stimulating inflammation. A potential source of this disturbance, in addition to gut lymphoid tissue CD4+ T-cell depletion, is the interaction between the gut barrier and gut microbes themselves. We evaluated the relationship of gut barrier integrity, as indexed by plasma occludin levels (higher levels corresponding to greater loss of occludin from the gut barrier), to gut microbial diversity. PWH and people without HIV (PWoH) participants were recruited from community sources and provided stool, and 16S rRNA amplicon sequencing was used to characterize the gut microbiome. Microbial diversity was indexed by Faith’s phylogenetic diversity (PD). Participants were 50 PWH and 52 PWoH individuals, mean ± SD age 45.6 ± 14.5 years, 28 (27.5%) women, 50 (49.0%) non-white race/ethnicity. PWH had higher gut microbial diversity (Faith’s PD 14.2 ± 4.06 versus 11.7 ± 3.27; p = 0.0007), but occludin levels were not different (1.84 ± 0.311 versus 1.85 ± 0.274; p = 0.843). Lower gut microbial diversity was associated with higher plasma occludin levels in PWH (r = −0.251; p = 0.0111), but not in PWoH. A multivariable model demonstrated an interaction (p = 0.0459) such that the correlation between Faith’s PD and plasma occludin held only for PWH (r = −0.434; p = 0.0017), but not for PWoH individuals (r = −0.0227; p = 0.873). The pattern was similar for Shannon alpha diversity. Antiretroviral treatment and viral suppression status were not associated with gut microbial diversity (ps > 0.10). Plasma occludin levels were not significantly related to age, sex or ethnicity, nor to current or nadir CD4 or plasma viral load. Higher occludin levels were associated with higher plasma sCD14 and LPS, both markers of microbial translocation. Together, the findings suggest that damage to the gut epithelial barrier is an important mediator of microbial translocation and inflammation in PWH, and that reduced gut microbiome diversity may have an important role.     

血清脂联素水平与我国青少年代谢综合征及心血管疾病危险因素的相关关系

目的探讨脂联素水平与我国青少年代谢综合征及相关心血管疾病危险因素之间的关系。方法分层整群抽取辽阳市初中和高中青少年学生933人,进行体格检查,测定各项生化指标,酶联免疫法(ELISA)检测脂联素,评估脂联素水平与代谢综合征及各心血管疾病相关危险因素之间的关系;907人统计资料完整(11～16岁,男性53.3%)。代谢综合征依据2007年国际糖尿病联盟(IDF)制定的儿童青少年标准。结果脂联素与腰围、体质指数、舒张压、甘油三酯、糖化血红蛋白、空腹血清胰岛素等多种代谢性指标及稳态模型胰岛素抵抗指数(HOMA-IR)之间呈显著负相关(P<0.05);校正全部影响因素后,脂联素水平下降仍是代谢综合征患病的独立危险因素(OR=5.83,95%CI 1.98～17.18);与脂联素水平下降关系最密切的代谢综合征组份为中心型肥胖(OR=3.48,95%CI 1.84～6.59)和高密度脂蛋白胆固醇降低(HDLC,OR=1.57,95%CI 1.09～2.26)。结论脂联素水平是青少年代谢综合征的独立危险因素,与心血管疾病危险因素存在相关关系。     

Fibrotic Burden Determines Cardiovascular Risk among Subjects with Metabolic Dysfunction-Associated Fatty Liver Disease

Background/AimsMetabolic dysfunction associated fatty liver disease (MAFLD) has recently been introduced to compensate for the conventional concept of nonalcoholic fatty liver disease (NAFLD). We explored whether fibrotic burden determines the risk of atherosclerotic cardiovascular disease (ASCVD) among subjects with MAFLD.MethodsWe recruited 9,444 participants from the Korea National Health and Nutrition Examination Survey (2008 to 2011). Liver fibrosis was identified using the fibrosis-4 (FIB-4) index and NAFLD fibrosis score. The 10-year ASCVD risk score (>10%) was used to determine a high probability ASCVD risk. For sensitivity analysis, propensity score matching was assessed to subjects with aged 40 to 75 years free from ASCVD.ResultsThe prevalence of MAFLD was 38.0% (n=3,592). The ASCVD risk scores stratified in quartile were positively correlated to MAFLD and FIB-4 defined-significant liver fibrosis (p for trend <0.001). Individuals with both MAFLD and FIB-4 defined-significant liver fibrosis had a greater chance of high probability ASCVD risk (odds ratio [OR]=2.40; p<0.001) than those without MAFLD. The impact of MAFLD on high probability ASCVD risk was greater than that of significant liver fibrosis (OR=4.72 for MAFLD vs OR=1.88 for FIB-4 defined-significant liver fibrosis; all p<0.001). Among participants with MAFLD, low muscle mass enhanced the risk of significant liver fibrosis (OR=1.56 to 2.43; p<0.001). When NAFLD fibrosis score was applied to define significant liver fibrosis, similar findings were observed.ConclusionsIndividuals with MAFLD had a substantial ASCVD risk compared to those without MAFLD. Accompanying significant liver fibrosis further enhanced the risk of ASCVD among subjects with MAFLD.     

Non-alcoholic Fatty Liver Disease and Cardiovascular Disease Risk

Non-alcoholic fatty liver disease (NAFLD) is an increasingly recognized cause of liver disease in the United States and worldwide. Increasing recognition of the importance of NAFLD and its strong relationship with the metabolic syndrome has stimulated an interest in the possible role of NAFLD in the development and progression of cardiovascular disease (CVD). Recent prospective studies demonstrated that NAFLD, especially in its necroinflammatory form (NASH), is linked to an increased risk of CVD, independently of obesity and other shared cardiometabolic risk factors. This suggests that NAFLD/NASH is not merely a marker of CVD, but may also be actively involved in its pathogenesis, possibly through the systemic release of proinflammatory/proatherogenic factors from the inflamed/steatotic liver as well as the contribution of NAFLD per se to whole-body insulin resistance and atherogenic dyslipidemia. Health care providers managing NAFLD patients should recognize this increased CVD risk and undertake early, aggressive risk factor modification.     

Evolving Cardiovascular Disease Prevalence,Mortality, Risk Factors,and the Metabolic Syndrome in China

The rapid growth transformation of China from a rural agrarian society to an industrial society with increased wealth has impacted the cardiovascular health of the entire population. The increasing prevalence of cardiovascular disease (CVD) and CVD risk factors mirror in some regards the disease prevalence in western industrialized countries and in other areas present unique public health issues. This article reviewed recent population surveys, reports, and clinical trials conducted in China. It was found that the prevalence of CVD and many of the risk factors such as hypertension, obesity, and diabetes contributing to disease mortality are increasing in China. However, compared with the United States, disease mortality is lower. Also, cerebrovascular disease is far more common than ischemic heart disease in China. The low prevalence of disease may suggest a reduced role of diagnostic imaging studies as compared with the US, while the increased percentage of strokes may point to the need for widely available emergent computed tomography (CT) imaging in hospitals in China. This article also discusses the occurrence of metabolic syndrome, obesity, glucose intolerance, diabetes, and their unique features in the Chinese population. Of interest, compared with the Caucasian cohort of the same body mass index (BMI), the Chinese had a higher percentage of body fat. Metabolic syndrome was found to be associated with increased cardiovascular mortality rate. With one fifth of the world's population, China can anticipate a dramatic rise, in absolute numbers, of CVD. It is imperative that national and regional programs are initiated to detect and treat the disease. Copyright © 2009 Wiley Periodicals, Inc.     

Risk Factors for Cardiovascular Disease,Metabolic Syndrome and Sleepiness in Truck Drivers

Background

Truck driver sleepiness is a primary cause of vehicle accidents. Several causes are associated with sleepiness in truck drivers. Obesity and metabolic syndrome (MetS) are associated with sleep disorders and with primary risk factors for cardiovascular diseases (CVD). We analyzed the relationship between these conditions and prevalence of sleepiness in truck drivers.

Methods

We analyzed the major risk factors for CVD, anthropometric data and sleep disorders in 2228 male truck drivers from 148 road stops made by the Federal Highway Police from 2006 to 2011. Alcohol consumption, illicit drugs and overtime working hours were also analyzed. Sleepiness was assessed using the Epworth Sleepiness Scale.

Results

Mean age was 43.1 ± 10.8 years. From 2006 to 2011, an increase in neck (p = 0.011) and abdominal circumference (p < 0.001), total cholesterol (p < 0.001), triglyceride plasma levels (p = 0.014), and sleepiness was observed (p < 0.001). In addition, a reduction in hypertension (39.6% to 25.9%, p < 0.001), alcohol consumption (32% to 23%, p = 0.033) and overtime hours (52.2% to 42.8%, p < 0.001) was found. Linear regression analysis showed that sleepiness correlated closely with body mass index (β = 0.19, Raj2 = 0.659, p = 0.031), abdominal circumference (β = 0.24, Raj2 = 0.826, p = 0.021), hypertension (β = -0.62, Raj2 = 0.901, p = 0.002), and triglycerides (β = 0.34, Raj2 = 0.936, p = 0.022). Linear multiple regression indicated that hypertension (p = 0.008) and abdominal circumference (p = 0.025) are independent variables for sleepiness.

Conclusions

Increased prevalence of sleepiness was associated with major components of the MetS.     

Metabolic Dysfunction-Associated Fatty Liver Disease Predicts Long-term Mortality and Cardiovascular Disease

Background/AimsWe investigated the effect of metabolic dysfunction-associated fatty liver disease (MAFLD) on future mortality and cardiovascular disease (CVD) using a prospective community-based cohort study.MethodsIndividuals from two community-based cohorts who were 40 to 70 years old were prospectively followed for 16 years. MAFLD was defined as a high fatty liver index (FLI ≥60) plus one of the following conditions overweight/obesity (body mass index ≥23 kg/m²), type 2 diabetes mellitus, or ≥2 metabolic risk abnormalities. Nonalcoholic fatty liver disease (NAFLD) was defined as FLI ≥60 without any secondary cause of hepatic steatosis.ResultsAmong 8,919 subjects (age 52.2±8.9 years, 47.7% of males), 1,509 (16.9%) had MAFLD. During the median follow-up of 15.7 years, MAFLD independently predicted overall mortality after adjustment for confounders (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.05 to 1.69) but NAFLD did not (HR, 1.20; 95% CI, 0.94 to 1.53). MAFLD also predicted CVD after adjustment for age, sex, and body mass index (HR, 1.35; 95% CI, 1.13 to 1.62), which lost its statistical significance by further adjustments. Stratified analysis indicated that metabolic dysfunction contributed to mortality (HR, 1.51; 95% CI, 1.21 to 1.89) and CVD (HR, 1.27; 95% CI, 1.02 to 1.59). Among metabolic dysfunctions used for defining MAFLD, type 2 diabetes mellitus in MAFLD increased the risk of both mortality (HR, 2.07; 95% CI, 1.52 to 2.81) and CVD (HR, 1.42; 95% CI, 1.09 to 1.85).ConclusionsMAFLD independently increased overall mortality. Heterogeneity in mortality and CVD risk of subjects with MAFLD may be determined by the accompanying metabolic dysfunctions.     

脂联素在代谢综合征及心血管疾病中的研究进展

脂联素(APN)由脂肪细胞分泌产生,在代谢综合征和心血管疾病中起重要的保护作用。在肥胖、糖尿病、高血压、冠状动脉硬化性疾病的患者中,APN水平显著降低。APN具有增加胰岛素敏感性、抗炎、抗动脉粥样硬化及保护心肌等作用。本文将对APN及其受体在糖尿病、胰岛素抵抗、代谢综合征及心血管疾病中的作用进行总结概括。