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Polycystic ovary syndrome (PCOS) is associated with increased cardiometabolic risk in young women of reproductive age. There are limited studies on atherogenic dyslipidemia, inclusive of triglycerides (TG), Apolipoprotein (apo) B-lipoproteins and remnant-cholesterol (C), atherosclerotic cardiovascular disease (ACVD), cardiac function and remodeling in young women with and without PCOS. The aim of this pilot study was to investigate the relationship of atherogenic dyslipidemia and other cardiometabolic risk factors with ACVD, cardiac function-remodeling in high-risk young overweight-obese PCOS women compared to non-PCOS and healthy-weight controls. Women with and without PCOS (non-PCOS control) aged 18 - 45 years who were overweight and obese (>25kg/m PCOS (n=48) and non-PCOS control overweight-obese age-BMI matched groups (n=19) were shown to have significantly higher fasting and non-fasting lipids including TG, remnant-C, total ApoB and ApoB48, compared to healthy-weight non-PCOS controls (n=10). PCOS and non-PCOS control overweight-obese groups had significantly higher SBP, DBP, cIMT and evidence of cardiac dysfunction and remodeling, with reduced Mitral E/A ratio, intraventricular (IV) relaxation time and increased Left ventricle (LV) end diastolic and systolic diameter, LV posterior wall thickness and IV septal thickness, compared to healthy-weight non-PCOS controls. Individuals with PCOS had significantly higher fasting plasma TG and remnant-C compared to the non-PCOS overweight-obese control group. The PCOS group tended to have 25% higher carotid plaque height, although this was not significant, compared to the non-PCOS overweight-obese control group. DBP, HOMA-IR and ApoB predicted 40% of the variability in cIMT and ApoB was shown to predict 14% of the variability in carotid plaque height, independent of age and BMI. A 1mg/ml increase in ApoB was associated with a 0.041mm increase in cIMT and a 0.75mm increase in carotid plaque height in all young women. Our pilot results supports the potential of apoB-dyslipidemia, cIMT, carotid plaque height and left ventricular diastolic dysfunction and remodeling to be used in screening for CVD risk in high-risk populations such as overweight-obese women with and without PCOS. ApoB may be useful to predict atherosclerotic vascular burden and progression of cIMT and carotid plaque, and could be used to develop a female specific algorithm for ACVD risk in high-risk young women with and without PCOS. Show less

Oxidized phospholipids (OxPLs) are bound to apolipoprotein B-100 (OxPL-apoB) and apolipoprotein(a) [OxPL-apo(a)] and are present freely within the phospholipid shell of apoB-containing lipoproteins. OxPLs have been linked with the pro-inflammatory properties of lipoprotein(a) [Lp(a)]. OxPLs carried on plasminogen (OxPL-PLG) may extend the time to fibrinolysis. To evaluate the effect of lipid-lowering medications on OxPLs levels in individuals with elevated Lp(a) concentrations. In this prospective study, patients (n = 70) with Lp(a) levels ≥75 nmol/L were assigned to 3 treatment regimens according to current guidelines: high-intensity statin monotherapy (n = 28), ezetimibe added to high-intensity statin (n = 31) and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) added to high-intensity statin plus ezetimibe (n = 11). Follow-up duration was 3 months. Patients had a mean age of 51 ± 15 years, 40 % were male, 39 % were diagnosed with familial hypercholesterolemia, 16 % had atherosclerotic cardiovascular disease, and 36 %, 33 % and 15 % were at very high, high, and moderate cardiovascular risk, respectively. Lp(a) levels did not change significantly with high-intensity statin and add-on ezetimibe but significantly decreased with add-on PCSK9i treatment. OxPL-apoB and OxPL-apo(a) significantly increased, while OxPL-PLG significantly decreased with both high-intensity statin and add-on ezetimibe. Add-on PCSK9i treatment was associated with no significant changes in OxPL-apoB, OxPL-apo(a) and OxPL-PLG levels. Among patients with elevated Lp(a), both high-intensity statin and add-on ezetimibe significantly increased OxPL-apoB and OxPL-apo(a) levels, while significantly decreased OxPL-PLG levels. Add-on PCSK9i had no significant effect on OxPLs levels. The clinical implications of these findings should be further explored. Show less

Metabolic-associated fatty liver disease (MAFLD) is closely associated with insulin resistance (IR) and systemic inflammation. Apolipoprotein A1 (ApoA1) and Apolipoprotein B (ApoB), as notable non-traditional lipid markers, have demonstrated distinct advantages in identifying risks related to metabolic syndrome and coronary atherosclerosis, yet its association with MAFLD and the mediating roles of IR/inflammation remain unclear. This retrospective investigation involved 1061 participants, categorized into a non-MAFLD group ( The MAFLD group exhibited markedly elevated levels of neutrophils/lymphocytes, neutrophils/platelets, systemic immune inflammation index, systemic inflammation response index, pan-immune-inflammation value and triglyceride-glucose index (TyG), TyG body mass index (TyGBMI), and metabolic score for insulin resistance (METS-IR) compared to the non-MAFLD group. Logistic regression analysis revealed that ApoB/ApoA1, TyG, TyGBMI, and METS-IR were markedly linked to MAFLD risk. Spearman's correlation analysis identified substantial positive links between ApoB/ApoA1 and TyG ( Our findings clarify the complex interrelationships between ApoB/ApoA1, MAFLD risk, inflammation, and IR, and for the first time, demonstrate that IR may act as a key potential mediator in the link between ApoB/ApoA1 and MAFLD, rather than systemic inflammation. This suggests that IR may serve a more prominent role than chronic systemic inflammation in the association between lipid metabolism and MAFLD risk, and intervening in IR may be more effective than anti-inflammatory therapy in blocking the progression from lipid metabolism disorders to MAFLD. Show less

Traditional risk reduction strategies like diet, exercise, and existing lipid- lowering medications have minimal impact on Lp(a) levels. Recent therapies targeting Lp(a) at the level of mRNA transcription of apo(a) or binding of apo(a) to apoB-100 have demonstrated substantial reductions of Lp(a). Lepodisiran is a GalNAc-conjugated small interfering RNA (siRNA) developed to inhibit LPA transcription, reducing apo(a) synthesis and circulating Lp(a) levels. This is an updated review of the mechanism of action, pharmacokinetics, clinical efficacy, and safety of Lepodisiran, as well as its effects on lipoprotein(a), with potential applications in treating patients with elevated cardiovascular risk. We conducted a literature search on PubMed, Google Scholar, and Scopus using keywords such as "Lepodisiran," "small interfering RNA therapies," and "lipoprotein(a)". Lepodisiran demonstrated a dose-dependent and sustained reduction in Lp(a) levels, achieving a maximum reduction of up to 97% at the highest dose in a Phase 1 trial. A Phase 2 placebo-controlled trial similarly showed robust and durable decline in Lp(a) with a favorable safety profile. Lepodisiran is a promising therapy, with sustained Lp(a) reduction and good safety. Ongoing phase 3 trials are poised to provide robust data on its long-term safety, clinical efficacy, and impact on Atherosclerotic Cardiovascular Disease (ASCVD) outcomes. Lepodisiran demonstrates potent and sustained reductions in Lp(a) levels with a favorable safety profile, making it a promising therapeutic candidate for Lp(a)-mediated cardiovascular risk. Ongoing long-term outcome studies are essential to confirm its clinical benefit. Show less

Lipids are a principal component of drusen and are involved in the pathobiology of age-related macular degeneration (AMD). Nonhuman primates (NHPs) develop macular drusen and may provide insight into circulating or local lipids in AMD. We evaluated aged rhesus macaques by fundus photography, optical coherence tomography (OCT), and fundus autofluorescence, as well as measured fasting plasma glucose, total cholesterol, high- and low-density lipoproteins, triglycerides, and apolipoprotein (Apo) A1, B, CIII, and E. Retinal tissues were collected for electron microscopy and immunostained for oil red O, ApoE, and ApoB. Among 203 adult macaques (mean age 19.1 ± 3.1 years), 25 animals (12.1%) exhibited soft drusen with sub-RPE deposits, while 59 (28.6%) had yellow punctate dots that were mostly hyperautofluorescent without RPE elevation on OCT. Drusen prevalence increased with older age (P = 0.001) but not with plasma lipids (P > 0.05 for all), while the punctate dot phenotype was associated with older age (P = 0.014), higher fasting glucose (P = 0.023), low-density lipoprotein cholesterol (P = 0.022), and ApoB (P = 0.017). Ultrastructure revealed NHP drusen consisting of extracellular sub-RPE lipid particles, whereas punctate dots appeared to correspond to individual RPE cells with intracellular lipid vacuoles. Both sub-RPE and intra-RPE lipids of the two phenotypes contained neutral lipids and ApoE, while ApoE and ApoB appeared to be expressed in RPE. In rhesus macaques, soft drusen are extracellular lipid deposits associated with older age, while punctate dots are intracellular lipids linked to age, hyperglycemia, and hyperlipidemia, suggesting differential dysregulation of lipid transport in these NHP models of AMD. Show less

Abnormal circulating lipid levels have been suggested in relation to lymphoid malignancy (LM) risk. We studied UK Biobank participants (n = 403,625) with serum data for cholesterol (total [TC], high-density lipoprotein [HDL], direct low-density lipoprotein [LDL]), triglycerides (TG), and apolipoproteins A1 and B (ApoA1, ApoB). We conducted principal component (PC) analysis and multivariate Cox regression models to estimate hazard ratio (HR) overall, by lipid-lowering drug use and follow-up interval. During an average of 10.5 years of follow-up, 3006 incident LMs occurred (including 667 multiple myelomas [MM], 2193 non-Hodgkin lymphomas [NHL]). Among medication non-users, most lipid levels were inversely associated with risk of most endpoints (HR Lipid depletion closer to LM diagnosis might reflect cancer cell metabolism and warrants further work examining individuals with precursor conditions. The MM-specific long-term risk might reflect the known MM-obesity association. Show less

With the increasing prevalence of premature coronary artery disease (CAD), early detection and risk stratification are crucial. While physical inactivity is linked to CAD risk, its impact in the early stages remains underexplored. This study aims to identify biomarkers for early CAD diagnosis and their association with physical activity (PA), ultimately reducing morbidity and mortality rates. This case-control study enrolled 300 subjects aged 18-45 years. They were subdivided into three categories. Additionally, the 200 subjects in groups I and II were classified into active, moderate, and sedentary categories based on World Health Organization (WHO) criteria. Serum levels of high-sensitivity C-reactive protein (hs-CRP), lipoprotein (a) [Lp(a)], apolipoprotein A1 (Apo-A1), apolipoprotein B100 (Apo-B100), and oxidized low-density lipoprotein (oxidized LDL) were analyzed, whereas non-high-density lipoprotein cholesterol (non-HDL-C) was calculated. The comparison of these biochemical parameters was done in terms of mean ± standard error of the mean (SEM) and area under the receiver operating characteristic curve (AUROC), and their significance with PA was determined using one-way analysis of variance (ANOVA) and Bonferroni test. Significant differences in hs-CRP, Apo-B100, Lp(a), non-HDL-C, and oxidized LDL were observed across groups. AUROC analysis confirmed their strong association with CAD risk. Additionally, the findings highlight that an active lifestyle is linked to a more favorable biochemical profile, which may help mitigate the risk of premature CAD. The study suggests including hs-CRP, Apo-B, Lp(a), non-HDL-C, and oxidized LDL in routine screening for early CAD detection. Despite their proven effectiveness, these biomarkers are not widely used. Therefore, integrating early biomarker screening with lifestyle modifications can enhance risk assessment and improve treatment outcomes. Show less

Coronary artery disease (CAD) is showing a trend toward earlier onset. Premature CAD (PCAD) is clinically defined as CAD with onset before the age of 55 in males and 65 in females. Notably, many young patients subsequently hospitalized with acute cardiovascular events had undergone annual physical examinations before hospitalization, yet were not identified as high-risk by current risk stratification guidelines or traditional risk assessment tools. This study aims to investigate the diagnostic capacity of novel inflammatory biomarkers (including the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), apolipoprotein B to apolipoprotein A-1 ratio (apoB/apoA-1), and low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (LDL-c/HDL-c)) for PCAD, thereby providing the evidence-based foundation for PCAD screening. A total of 1,012 young subjects (male<55 years, female<65 years) undergoing diagnostic coronary angiography (CAG) at the Third Affiliated Hospital of Zunyi Medical University (from January 2022 to February 2023) were retrospectively analyzed. We stratified 1,012 eligible participants into two groups: 521 angiographically confirmed PCAD cases and 491 controls with normal coronary arteries. Comprehensive baseline characteristics, including cardiovascular risk profiles and core laboratory-measured inflammatory markers, were recorded. The Mann-Whitney U test and binary logistic regression analysis were employed to assess the associations between inflammatory biomarkers and PCAD. The areas under the receiver operating characteristic (ROC) curves (AUCs) were calculated to evaluate their diagnostic performance for PCAD. The odds ratio (OR) values for MHR, NLR, LDL-c/HDL-c, and apoB/apoA-1 were 5.592 (95% CI: 2.886-7.836), 1.671 (95% CI: 1.500-1.861), 1.663 (95% CI: 1.419-1.950), and 6.268 (95% CI: 2.765-8.213), respectively (all The apoB/apoA-1 outperformed MHR, NLR, and LDL-c/HDL-c as an inflammatory biomarker in PCAD. Its diagnostic capacity was notably enhanced in ACS subgroups. A comprehensive model combining apoB/apoA-1 with traditional risk factors demonstrated exceptional accuracy. Incorporating this biomarker into routine screening protocols could significantly strengthen preventive strategies. Show less

Leukocyte telomere length is considered a promising prognostic marker associated with COVID-19 severity, adverse outcomes (hospital admission, need for critical care, and respiratory support), and mortality. However, the contribution of telomere length to post-COVID-19 syndrome (PCS) development is unclear. This study aimed to evaluate the association between telomere shortening and the course of PCS in patients with type 2 diabetes (T2D) and to determine whether telomere length is linked to clinical phenotype, gender, and biological age. In this cross-sectional study, 66 T2D patients who had recovered from COVID-19 were enrolled. Patients were divided into two groups depending on PCS development: the PCS group ( We observed a significantly lower mean of telomere length in T2D patients with PCS as compared to those without it (1.09 ± 0.19 and 1.28 ± 0.24; Shorter telomere length and higher HbA1c levels were significantly associated with the presence of PCS in our cohort of individuals with T2D. These factors may represent potential biomarkers that warrant further investigation. Show less

While the benefits of almond consumption in reducing levels of TC and LDL-C are well established, the effects on additional lipids that have emerged as important predictors of cardiovascular disease, such as ApoB and the ratio of ApoB:ApoA, are not well characterized. In this systematic review and meta-analysis, the effects of almond consumption on blood lipids were comprehensively assessed. On 12 May 2025, ProQuest Dialog™ was used to search ten literature databases (AdisInsight: Trials; Allied & Complementary Medicine™; BIOSIS Previews 36 publications (48 almond-control datasets) representing 2485 participants were included. Almond consumption significantly reduced LDL-C (-0.132 mmol/L; 95% CI: -0.190, -0.075 mmol/L; Almond consumption improves levels of LDL-C, TC, non-HDL-C, TC:HDL-C, LDL-C:HDL-C, ApoB, and ApoB:ApoA, though dedicated clinical trials are needed to better understand effects on TG levels. Show less

Exposure to persistent organic pollutants such as 2,3,7,8-tetrachlorodibenzodioxin (TCDD) increases metabolic disorder risk. In this study, we show that a single intraperitoneal injection of TCDD (10 μg/kg) in C57BL/6J mice induced body weight gain, lipid accumulation in the liver and adipose tissue, macrophage infiltration, and elevated hepatic and serum triglyceride levels after 12 weeks. Despite serum aryl hydrocarbon receptor (AhR) ligand levels normalizing by 12 weeks, the persistent effects suggest TCDD sequestration in fat tissue. TCDD inhibited the expression of mitochondrial proteins (COX1, TOM20, TFAM, H2AX) and reduced mitochondrial oxygen consumption. Liver-specific AhR knockout ameliorated TCDD-induced mitochondrial dysfunction, lipid accumulation, and macrophage infiltration. Mechanistically, TCDD-induced hepatic plasminogen activator inhibitor-1 (PAI-1) promoted adipocyte hypertrophy. In the liver, PAI-1 disrupted the interaction between tissue-type plasminogen activator (tPA) and apolipoprotein B (ApoB), thereby enhancing very-low-density lipoprotein (VLDL) assembly. These findings reveal that hepatocyte-derived circulating PAI-1, upregulated via hepatic AhR activation, contributes to adipocyte hypertrophy and hepatosteatosis through the intracellular modulation of the tPA-PAI-1 axis. Thus, hepatic AhR activation drives mitochondrial dysfunction and obesity, even after a single TCDD exposure. Show less

Cardiovascular and metabolic disorders, particularly diabetes and obesity, are highly prevalent in the Middle East and North Africa (MENA) region, exhibiting some of the highest global incidence rates. These conditions significantly increase the severity of infectious diseases, notably COVID-19, leading to a rise in long-COVID cases among affected individuals. Furthermore, the MENA region's extreme temperatures exacerbate cardiovascular issues by elevating heart rates and blood pressure, increasing dehydration and blood viscosity. Extracorporeal therapies, such as apheresis, effectively reduces plasma lipids and inflammatory markers. Furthermore, apheresis has shown promise in reducing autoantibodies associated to long-COVID. Our previous research indicated that apheresis alleviates symptoms in patients with long-COVID and chronic fatigue syndrome. In this study, we treated 24 male patients from the MENA region suffering from chronic fatigue and/or different metabolic diseases such as diabetes, dyslipidemia, or obesity, using double filtration plasmapheresis. Comprehensive plasma analyses were performed before and after apheresis to assess lipid profiles, inflammatory markers, and autoantibodies, revealing significant changes following the procedure. Genetic analyses on a subgroup of the patients showed no mutations in the LDLR, APOB, APOE, PCSK9, LIPA, and LDLRAP1 genes known to be associated with predispositions to monogenic lipid disorders. However, all patients in this subgroup demonstrated an intermediate to high likelihood that their elevated lipid levels have a polygenic basis. These findings suggest that implementing apheresis in the MENA region could significantly improve health outcomes and life expectancy for affected individuals. Show less

Familial hypercholesterolemia (FH) is a prevalent hereditary disorder, with its monogenic form linked to an elevated risk of early-onset ischemic heart disease. Evaluating the prevalence and penetrance of pathogenic and likely pathogenic variants associated with this disorder would provide valuable information supporting routine FH screening of the general population. Such informed screening would facilitate early identification of at-risk individuals, enabling timely intervention and management. We analyzed genetic data from 4,856 individuals with various cardiovascular conditions for pathogenic and likely pathogenic variants in the PCSK9, APOB, and LDLR genes. The evaluation included comprehensive clinical assessments, instrumental examinations, and laboratory tests. All genetic data were obtained through the whole-genome sequencing of blood leukocytes. A total of 1.77% of participants carried pathogenic or likely pathogenic variants in the LDLR or APOB genes, and none in the PCSK9 gene. After adjusting for sex and age, the risk of ischemic heart disease was 1.3 times higher in carriers of pathogenic or likely pathogenic variants [95% CI 1.18-1.46; FH remains significantly underdiagnosed. Only 10.5% of carriers of pathogenic or likely pathogenic variants in the LDLR and APOB genes had a prior diagnosis of FH. Our findings suggest low diagnostic rates for this disorder in Eastern European populations and highlight the need for routine genetic screening of younger individuals. However, further research is needed to assess the clinical applicability and cost-effectiveness of such screening programs. Show less

Pulmonary Hypertension (PH) is a significant contributor to cardiac mortality in Dilated Cardiomyopathy (DCM) patients. Inflammatory processes and oxidative stress play pivotal roles in the advancement of Pulmonary Hypertension (PH). The Monocyte-to-High-- Density-Lipoprotein Cholesterol Ratio (MHR), a newly identified biomarker indicative of inflammatory and oxidative stress, has not been extensively researched in the context of pulmonary hypertension, especially within the scope of dilated cardiomyopathy. Given the reason mentioned above, our research explores the correlation between the MHR and the severity of PH in patients suffering from DCM. In this study, we conducted a retrospective review of medical data from 107 individuals diagnosed with non-ischemic DCM, evaluating their clinical profiles, biochemical indicators, MHR, and echocardiographic parameters. We analyzed the relationships between Pulmonary Arterial Systolic Pressure (PASP) and the Ejection Fraction of the Left Ventricle (LVEF). Utilizing logistic regression analysis, we determined the predictors of PH. Findings indicated that the DCM-PH group exhibited a significantly larger male population and elevated New York Heart Association (NYHA) classification scores (both with p-values <0.001 and 0.01, respectively) compared to the DCM-only group. A positive association was observed between the PASP and parameters, such as the Dimensions of the Left Atrium (LAD) and Left Ventricle in Systole (LVDs), Monocyte (M) levels, Direct Bilirubin (DB), and MHR. Conversely, an inverse relationship was noted with serum lipid profiles, including Total Cholesterol (TC), HDL Cholesterol (HDL-c), and apolipoprotein A1. LVEF demonstrated positive linkage with the same lipid profiles and the Left Ventricular Posterior Wall Thickness (LVPWT) yet showed negative correlations with the NYHA classification, Red Blood Cell Distribution Width Standard Deviation (RDW-SD), Total Bilirubin (TB), Direct Bilirubin (DB), and dimensions of the left ventricle in diastole and systole, as well as MHR. Through logistic regression analysis, several factors were recognized as significant predictors for the severity of PH within the DCM cohort, with weight (OR1.20, CI 1.022-1.409, p=0.026), RDW-SD (OR1.988, CI 1.015-3.895, p=0.045), LVPW (OR3.577, CI 1.307-9.792, p=0.013), LVDd (OR1.333, CI 1.058-1.680, p=0.015), MHR (OR3.575, CI 1.502-8.506, p=0.032), and TB (OR1.416, CI 1.014-1.979, p=0.041) showing positive associations, while apoB (OR0.001 CI0.001-0.824, p=0.045) exhibiting negative associations, all with p-values <0.05. Higher MHR and LVD correlate with increased PASP and reduced LVEF in DCMPH patients. MHR and LVPW are independent predictors of PH severity, indicating their potential as novel severity markers in DCM-related PH. Show less

Atherosclerosis has an auto-immune component driven by self-reactive T and B cells. Identifying their antigenic drivers may lead to new diagnosis and treatment approaches. Here, we aim to identify immunogenic T cell epitopes derived from atherosclerosis-relevant proteins such as ApoB100 by studying the repertoire of peptides presented by HLA in human plaques. We used immunopeptidomics to identify peptides presented by HLA-DR molecules from plaques of patients that underwent endarterectomy surgery. We selected a set of 20 peptides derived from ApoB100 and studied the presence and cytokine profile of ApoB100-specific CD4 revealed significant CD4 We show that immunopeptidomics can be a valid approach to new discover antigens in atherosclerosis. Show less

Gene-environment (GxE) interactions crucially contribute to complex phenotypes. The statistical power of a GxE interaction study is limited mainly due to weak GxE interaction effect sizes. Joint tests of the main genetic and GxE effects for a univariate phenotype were proposed to utilize the individually weak GxE effects to improve the discovery of associated genetic loci. We develop a testing procedure to evaluate combined genetic and GxE effects on multiple related phenotypes to enhance the power by merging pleiotropy in the main genetic and GxE effects. We base the approach on a general linear hypothesis testing framework for multivariate regression of continuous phenotypes. We implement the generalized estimating equations (GEE) technique under the seemingly unrelated regressions (SUR) setup for binary or mixed phenotypes. We use extensive simulations to show that the test for joint multi-phenotype genetic and GxE effects outperforms the univariate joint test of genetic and GxE effects and the test for multi-phenotype GxE effect concerning power when there is pleiotropy. The test produces a higher power than the test for the multi-phenotype marginal genetic effect for a weak genetic and substantial GxE effect. For more prominent genetic effects, the latter performs better with a limited increase in power. Overall, the multi-phenotype joint approach offers robust, high power across diverse simulation scenarios. We apply the methods to lipid phenotypes with sleep duration as an environmental factor in the UK Biobank. The proposed approach identified ten independent associated genetic loci missed by other competing methods. In a multi-phenotype analysis of apolipoproteins, ApoA1, and ApoB, our approach discovered two distinct loci considering sleep duration as the environmental factor. Show less

Cardiovascular disease remains a major global health challenge, with dyslipidaemia being a key modifiable risk factor. While low density lipoprotein cholesterol (LDL-C) is the primary target for lipid-lowering therapies, recent evidence highlights the importance of triglycerides, apolipoprotein B (apoB), and lipoprotein(a) [Lp(a)] for residual cardiovascular risk. Current lipid-lowering therapies target key enzymes and proteins involved in cholesterol and lipid metabolism. Statins inhibit HMG-CoA reductase, reducing cholesterol biosynthesis and increasing LDL receptor (LDLR) expression in the liver. Bempedoic acid inhibits ATP citrate lyase, the enzyme upstream of HMG-CoA reductase in the mevalonate pathway, offering an alternative to statins by selectively acting in the liver, minimizing muscle-related side effects. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors [evolocumab, alirocumab, inclisiran, lerodalcibep, and enlicitide decanoate (MK0616)] prevent LDLR degradation, while ezetimibe limits intestinal cholesterol absorption. Emerging lipid-lowering targets include angiopoietin-like 3 protein (ANGPTL3) and apolipoprotein C-III (apoC-III). Inhibiting ANGPTL3 reduces both triglycerides and LDL-C independently of LDL receptor. Inhibition of apoC-III unleashes lipoprotein lipase (LPL) activity, promoting triglyceride-rich particle catabolism, even in complete LPL deficiency. Cholesteryl ester transfer protein (CETP) inhibition also increases the catabolism of apoB-containing lipoproteins. Ongoing research into strategies to reduce Lp(a), primarily but not exclusively through antisense therapies, aims to demonstrate the cardiovascular benefits of targeting this lipoprotein. In summary, the field of targets for lipid and lipoprotein lowering is constantly evolving and offers new strategies for patients resistant to current therapies or with specific lipid profile abnormalities. Show less

An increasing body of research indicates an association between lipid-lowering medications and sensorineural hearing loss (SNHL), although there is still controversy. Therefore, the aim of this study is to investigate the genetic correlation between different lipid-lowering therapeutic gene targets and SNHL. The genetic association between lipids, lipid-lowering drug target genes, and SNHL was analyzed using a 2-sample Mendelian randomization approach. The exposures included 5 circulating lipid levels (triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein A-I, and apolipoprotein B) and 10 target genes simulating the effects of lipid-lowering drugs (HMGCR, PCSK9, Niemann-Pick C1-like 1 [NPC1L1], LDLR, APOB, CETP, LPL, ANGPTL3, APOC3, and PPARA). Summary data from a large-scale genome-wide association study on SNHL from the Finnish database were used as the outcome. The inverse variance-weighted method was employed as the primary approach, with sensitivity tests conducted to evaluate heterogeneity and pleiotropy in the results. The genetic prediction of lipid levels was not significantly associated with SSNL. However, genetic proxies for lowering low-density lipoprotein cholesterol, specifically variants in NPC1L1 (OR = 1.943 [95% CI 1.116-3.383]; P = .018) and LDL receptor (LDLR) (OR = 1.279 [95% CI 1.107-1.477]; P < .001), were associated with an increased risk of SNHL. Similarly, a genetic proxy for lowering triglycerides, the apoprotein C-III (APOC3) variant (OR = 1.174 [95% CI 1.054-1.307]; P = .003), was associated with an increased risk of SNHL. After Bonferroni correction, the genetic variants for LDLR and APOC3 remained significantly associated with an increased risk of SNHL, while the association with the NPC1L1 lipid-lowering variant was no longer significant. This study suggests that lipid-lowering medications potentially have a causal impact on increasing the risk of SNHL through the LDLR and APOC3 pathways. LDLR and APOC3 show potential as candidate drug targets for the prevention of SNHL. However, the results of the study and the potential mechanism of action require further experimental validation and evaluation. Show less

As inflammatory processes may be involved in the pathogenesis of diabetic distal sensorimotor polyneuropathy (DSPN), the first aim of the present study was to determine the clinical characteristics of type 2 diabetes mellitus (T2DM) with distal sensorimotor polyneuorpathy (DSPN). Next goal was to investigate inflammatory biomarkers, insulin-like growth factor- 1 and lipid profile in these patients. Finally, we aimed to compare the renal function in these patients. In a cross-sectional study, we included 160 patients diagnosed with T2DM. The control group was included 22 non-diabetic healthy subjects (HC). The patients with diabetes were divided into four groups, absent (n = 74), mild (n = 38), moderate (n = 24), and severe (n = 24) using a nomogram based on the MNSI features for a DSPN severity grading probability. Patients with moderate and severe DSPN were a little older and had longer duration of diabetes compared to patients with absent and mild DSPNS (p < 0.05). Serum levels of interferon-gamma (INF-γ), interleukin (IL)-1β, IL-4, IL- 6 levels in patients with severe DSPN were significantly higher than HC, absent, mild and moderate of DSPN (p < 0.05). The circulating levels of insulin-like growth factor-1 (IGF-1) were significantly lower in patients with severe DSPN (p < 0.05) compared to absent, mild and moderate of DSPN and HC. Diabetic patients with moderate DSPN showed increased circulating levels of TC, LDL-C, APOB (p < 0.05) compared to HC and patients with absent, mild and severe DSPN. Moreover, APO-A1/APOB was significantly lower in patients with diabetes compared to HC. In addition, patients with severe DSPN showed increased Cystatin C (p < 0.05) compared to HC and absent, mild, and moderate DSPN. Multivariate ordered logistic regression analysis showed that the levels of IL-6 (OR = 3.166, 95%CI 1.461-6.860, p = 0.003, IL-1β(OR = 1.148, 95%CI 1.070-2.232; p = 0.000), TC (OR = 1.174, 95%CI 1.011-1.364; p = 0.035), LDL-C (OR = 1.246, 95%CI 1.098-3.618; p = 0.003), Cystatin C (OR = 1.867, 95%CI 1.245-3.434; p = 0.004), ages (OR = 1.043, 95%CI 1.009-1.078; p = 0.012), and duration of diabetes (OR = 1.157, 95%CI 1.049-1.277; p = 0.004) were positively associated with increasing the odds ration of DSPN in T2DM. Conversely, the level of IGF-1 (OR = 0.922, 95%CI 0.961-0.982; p = 0.000) and ratio of APO-A1/APOB (OR = 0.212, 95%CI 0.078-0.567; p = 0.002) were significantly associated with decreasing the odds ratio of DSPN in T2DM. The levels of inflammatory biomarkers such as INF-γ, IL-1β, IL-4, IL- 6 were increased in patients with severe DSPN in T2DM. Ages, duration of diabetes as well as high circulating levels of IL-6, IL-1β, TC, LDL-C and Cystatin C were positively associated with DSPN in T2DM. Conversely, the level of IGF-1 and the ratio of APOA1/APOB were independent protective factors for DSPN in T2DM. Our results emphasize the importance of addressing issues related to inflammatory biomarkers, lipids and early impaired renal function in T2DM with DSPN, as these may be of potential relevance for deteriorating DSPN. Show less

Plant-derived compounds have recently gained attention owing to their better safety profile and multi-targeted actions. Charantin, a plant-based natural compound known for its diverse pharmacological properties, was investigated for its anti-hyperlipdemic activity using both in-silico and in-vivo approaches. A detailed network pharmacology analysis was used to predict charantin-related targets, cross-referenced with hyperlipidemia-associated genes from GeneCards, DisGeNET, and CTD. Shared targets were subjected to protein-protein interaction analysis and functional enrichment using STRING, Cytoscape, and ShinyGO. Molecular docking studies assessed charantin's binding interactions with key lipid-regulating proteins (HMGCR, PCSK9, LDLR, PPAR-α, PI3K). In-vivo efficacy of charantin (100 and 200 mg/kg) was evaluated in Sprague-Dawley rats fed with high-lipid diet (HLD) for 12 days. Lipid profiles, liver enzymes and transcript levels of lipid-regulating genes were analyzed. A total of 242 overlapping genes were identified between charantin targets and hyperlipidemia-associated genes, with enrichment analyses highlighting key lipid metabolic and inflammatory pathways. Molecular docking revealed that charantin exhibited stronger binding affinities than simvastatin across multiple targets. In HLD animal model, charantin significantly reduced total cholesterol, triglycerides, LDL, and VLDL, while increasing HDL levels in a dose-dependent manner. Liver function remained preserved, accompanied by downregulation of HMGCR, PCSK9, and APOB, and upregulation of LDLR and PPAR-α at both gene and protein levels. Charantin exerts potent lipid-lowering effects through modulation of multiple pathways, including cholesterol biosynthesis, lipoprotein metabolism, and nuclear receptor activation. Its efficacy and hepatoprotective properties reiterate its potential as a safe, effective alternative or adjunct to conventional therapies for hyperlipidemia. Show less

The cholesteryl ester transfer protein inhibitor obicetrapib decreases levels of atherogenic lipids and raises high-density lipoprotein cholesterol (HDL-C). In this study, we sought to determine the effect of obicetrapib on cardiovascular events. The effects of 10 mg obicetrapib and placebo daily on major adverse cardiovascular event (MACE) rates were investigated in a pooled analysis of 354 patients with heterozygous familial hypercholesterolemia (HeFH) and 2,530 patients with atherosclerotic cardiovascular disease (ASCVD) over 365 days. The association between on-treatment lipids and MACE were also investigated. The cohort (mean age 66 years, 36% female, ASCVD 82%, HeFH 27%, diabetes 35%) had median baseline levels of low-density lipoprotein cholesterol (LDL-C) 92 mg/dL, HDL-C 48 mg/dL, apolipoprotein B (ApoB) 88 mg/dL, non-HDL-C 116 mg/dL, and lipoprotein(a) (Lp(a)) 40.5 nmol/L. Obicetrapib produced greater reductions in LDL-C (-34.0 vs -4.0 mg/dL, -37.8% vs -4.6%), ApoB (-19.0 vs -3.0 mg/dL, -21.7% vs -3.6%), non-HDL-C (-36.0 vs -4.0 mg/dL, -32.4% vs -3.7%), and Lp(a) (-9.8 vs 0 nmol/L, -32.5% vs 0%) and increased HDL-C (+68.0 vs +1.0 mg/dL, +140.0% vs +1.5%). The rate of coronary heart disease death, myocardial infarction, ischemic stroke, or coronary revascularization was lower with obicetrapib (3.9% vs 5.0%; HR: 0.77; 95% CI: 0.54-1.11; P = 0.16), with a risk reduction in the second 6 months (HR: 0.60; 95% CI: 0.37-0.99; P = 0.04). The rate of coronary heart disease death, myocardial infarction, or coronary revascularization was lower with obicetrapib (3.2% vs 4.7%; HR: 0.68; 95% CI: 0.46-1.00; P = 0.048), with a risk reduction in the second 6 months (HR: 0.45; 95% CI: 0.26-0.77; P = 0.003). Achieved levels of LDL-C (P = 0.003), ApoB (P = 0.007), non-HDL-C (P = 0.01), Lp(a) (P = 0.003), and HDL-C (P = 0.0001) were associated with event rates. Obicetrapib treatment associated with a reduction in coronary events, evident beyond 6 months of treatment. Show less

When Apolipoprotein B (ApoB) is discordant with either LDL cholesterol (LDL-C) or non-high-density lipoprotein cholesterol (non-HDL-C), ApoB is a stronger predictor of atherosclerotic cardiovascular disease (ASCVD). It is unclear whether ApoB also provides better risk stratification when ApoB and LDL particle number (LDL-P) are discordant. Here we examine the relationship between ApoB and LDL-P in the UK Biobank to determine which biomarker provides more accurate risk prediction when ApoB and LDL-P are discordant. The UK Biobank is a prospective observational study of 500,000 adults. Analyses were restricted to 41,099 participants (mean age 57 years, 49.7% female, 95.1% white) with at least 10 years of data following enrollment, three or more recorded ICD codes, plasma lipoprotein and apolipoprotein measurements, and available baseline characteristics. Major adverse cardiovascular events (MACE) and coronary artery disease (CAD) events were plotted against LDL-P and ApoB for all participants. Concordance was defined as the linear regression line with y-intercept forced to zero. Discordant subpopulations were defined as populations 2, 4, 6, 8, 10, 20, and 30% above or below the regression line. The hazard ratio (HR) of cases to controls was determined for the discordant subpopulations and the concordant control group. A HR>1 means that the risk is greater in the discordant group than the reference group, whereas a HR<1 suggests that the cases are less common in the discordant group. Over 10 years of follow-up, 9,663 MACE and 1,754 CAD events occurred. There was no significant increase in HR for CAD events or MACE for the subpopulations with discordant LDL-P vs ApoB. In contrast, among subpopulations with discordant ApoB, the HR for both MACE and CAD events increased as discordance increased and was statistically significant at all percentage discordance cutoffs. At only 2% ApoB discordance, HRs were already elevated for both MACE (HR 1.1, P<0.0001) and CAD (HR 1.1, P<0.0001). Risk increased progressively, reaching HR 1.4 for MACE and HR 2.5 for CAD at 30% discordance. This study suggests that ApoB is a more accurate marker for cardiovascular risk than LDL-P when discordant, as marked by ApoB levels in excess of LDL-P. Notably, risk was already elevated at as little as 2% discordance, suggesting that even modest mismatches between ApoB and LDL-P may be clinically relevant. In keeping with prior data examining discordance between ApoB and LDL-C or non-HDL-C, this data reinforces the utility of ApoB in guiding lipid-lowering strategies and cardiovascular risk assessment. Show less

Thrombosis is a life-threatening complication in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. This study aims to conduct a statistical analysis of the incidence of blood clots and lipid concentrations, and to examine the networks of oxylipins in hospitalised patients with SARS-CoV-2. Serum samples of 1731 hospitalised patients with SARS-COV-2 were used to measure six lipid parameters: total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A (apoA), and apolipoprotein B (apoB). Additionally, the lipid profiles and oxidative lipidomics characteristics were examined via liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-MS/MS) in SARS-COV-2-positive patients with and without thrombosis. The mortality rate in the SARS-COV-2 thrombosis group was significantly higher at 29.6% compared to the SARS-COV-2 non-thrombosis group at 12.1% (P < 0.0001). The levels of the lipid parameters were closely associated with both thrombosis and SARS-COV-2 severity. Patients with SARS-COV-2 admitted to the hospital exhibited significant changes in oxidative lipid metabolites, specifically in the arachidonic acid (ARA) and docosahexaenoic acid (DHA) classes, compared with those in the control group. Among the thrombus group, 28 oxidative lipid metabolites were found to be differentially expressed compared to the non-thrombus group, and with the most notable variations observed in 20-hydroxyPGF2α and 14(15)-EpETE. Enrichment analysis using KEGG revealed that differential oxidized lipid metabolites mainly concentrated in the ARA and serotonergic synapses metabolism signaling pathway. Our findings indicate a close association between lipid mediators and both SARS-COV-2 and thrombi. Specifically, ARA and serotonergic synapses metabolism signaling pathway may be an important pathogenic factor for thrombosis caused by SARS-COV-2. Furthermore, 20-hydroxyPGF2α and 14(15)-EpETE show promise as potential biomarkers for SARS-CoV-2-induced thrombosis. Show less