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The ratio of uric acid to high-density lipoprotein cholesterol (UHR) is a novel comprehensive indicator related to dyslipidemia. However, the association between UHR and coronary artery disease (CAD) risk in patients with chronic kidney disease (CKD) remains unclear. After matching based on age and gender propensity scores, 2124 subjects were included and divided into the CKD group (708 cases) and the non-CKD group (1416 cases). The predictive performance of UHR for CAD was evaluated by the area under the curve (AUC), and the independent association between UHR and the risk of CAD onset was analyzed using a multivariate logistic regression model. The correlation and dose-response relationship between the ratio of uric acid to high-density lipoprotein cholesterol (UHR) and the risk of CAD were analyzed using LOESS fitting and restricted cubic spline (RCS) analysis. After matching, the multiple lipid-related indices (Triglycerides (TG), Remnant Cholesterol (RC), Atherogenic Index (AI), Atherogenic Index of Plasma (AIP), Triglyceride Glucose Index (TyG), Lipoprotein Composite Index (LCI), Triglyceride to High-Density Lipoprotein Cholesterol Ratio (TG/HDL-C), Total Cholesterol to High-Density Lipoprotein Cholesterol Ratio (TC/HDL-C), Low-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (LDL-C/HDL-C), UHR) in the CKD group were significantly higher than those in the non-CKD group. The AUC analysis showed that HDL-C, AIP, TG/HDL-C, and UHR had strong predictive performance in the overall cohort and the non-CKD group, while in the CKD group, HDL-C, AI, and TC/HDL-C are better predictive indicators. After adjusting for all confounding factors, multivariate regression analysis revealed that HDL-C, apolipoprotein A-1 (APOA-1), and the APOA-1/APOB ratio were independent protective factors for CAD in the entire cohort. Among them, the protective effect of HDL-C was the most stable (overall population aOR = 0.26, 95% CI: 0.17-0.39, p < 0.001), and it was significantly in both the CKD (aOR = 0.18, 95% CI: 0.09-0.40, p < 0.001) and non-CKD subgroups (aOR = 0.31, 95% CI: 0.18-0.52, p < 0.001). In CKD, UHR is significantly correlated with CAD (aOR = 6.23, 95% CI: 1.89-20.60, p = 0.003), and the association was more significant in the non-CKD group (aOR = 15.15, 95% CI: 4.20-54.72, p < 0.001). CKD status significantly modified the association between UHR and CAD (P for interaction = 0.015). LOESS fitting suggested that UHR was positively correlated with the probability of CAD occurrence (the correlation was more significant at low UHR, and it slowed down when UHR > 0.5, r = 0.2, p < 0.001), and negatively correlated with eGFR (r = -0.38, p < 0.001). RCS analysis confirmed a significant nonlinear association between UHR and CAD (overall P < 0.001, nonlinear P = 0.002), and the risk of CAD increased when UHR was > 0.41 in CKD patients. UHR is an independent risk factor for coronary heart disease, with higher adjusted OR values and more significant independent risk effects in non-CKD populations. Show less

Apolipoprotein standardization in multiple calibration laboratories requires equivalent results to value assign matrix-based reference and external quality assurance materials. A multiplexed LC-MS/MS-based reference measurement procedure (RMP) has been developed for serum apolipoproteins apo(a), apoA-I, apoB, apoC-I, apoC-II, apoC-III, and apoE. This study evaluates the transferability of the RMP between 3 calibration labs and determines the between-laboratory imprecision. Six periodic ring trial surveys were held. The study protocol, calibrators, internal standards, quality controls (QCs), and clinical samples (CSs) were shared among the laboratories. Intra-laboratory imprecision and inter-peptide comparisons evaluated intra-laboratory performance, while inter-laboratory imprecision evaluated equivalence between the calibration labs. Precision of the common bilevel QC monitored the level of harmonization over time. Intra-laboratory imprecision fulfilled predefined analytical performance, defined as repeatability <50% of the maximum allowable uncertainty (MAU) at minimal criteria. Median interlaboratory variation (CVbl) was 3.71%, 3.33%, 7.38%, 6.74%, 3.88%, and 3.90% for apoA-I, apoB, apoC-I, apoC-II, apoC-III, and apoE, respectively. For apo(a), CVbl was concentration (x) dependent following 206.32×x-0.899%. In QC samples, the average imprecision for all apolipoproteins decreased from 6.0% and 18.1% for QC1 and QC2, to 5.2% and 9.5%, indicating improvement of analytical performance of the network over time. This study shows the feasibility of transferring the multiplex apo LC-MS/MS-based RMP between laboratories. Predefined performance specifications were fulfilled for all seven apolipoproteins. Ongoing round-robin studies will ensure stable performance of the calibration labs required to accomplish an accurate value-base for apolipoprotein certification of commercial reagents. Show less

Despite significant advances in the management of myocardial infarction (MI), therapeutic options targeting upstream pathogenic mechanisms remain scarce. This study introduces a novel multiomics-to-drug discovery framework to identify and validate causal therapeutic targets for MI. We conducted a systematic two-sample Mendelian randomization (MR) analysis integrating expression quantitative trait loci (eQTL) and protein quantitative trait loci (pQTL) data from the IEU OpenGWAS database, with replication in the UK Biobank cohort. Causal inference was rigorously validated using HEIDI heterogeneity tests, Bayesian colocalization, bidirectional MR, and multivariate MR (MVMR) to account for potential confounders. Downstream applications were explored via protein-protein interaction (PPI) network analysis, phenome-wide association studies (PheWAS), and molecular docking simulations. Initial screening identified four candidate genes (BMP1, APOB, FABP2, and ALDH2) associated with MI risk in both discovery and replication cohorts. However, only BMP1 demonstrated consistent causal effects at both transcriptional and proteomic levels, passing all sensitivity analyses with no evidence of horizontal pleiotropy in PheWAS. Colocalization and bidirectional MR further confirmed BMP1 as a robust, independent causal driver of MI. Molecular docking revealed that UK-383367, a selective BMP1 inhibitor, exhibits high binding affinity to the BMP1 active site. While BMP1 is traditionally associated with extracellular matrix remodeling, this study provides the first genetic evidence establishing it as an independent causal risk factor for MI, distinct from conventional traits such as hypertension. By bridging causal genetic inference with structure-based drug prediction, we propose BMP1 inhibition, specifically via agents like UK-383367, as a promising therapeutic strategy to mitigate MI-related pathological remodeling. Show less

ApoB (apolipoprotein B)-containing lipoproteins are causal risk factors for atherosclerotic coronary artery disease (CAD). Since human cathelicidin LL-37 binds to ApoB-100 in this pathological context, we investigated whether the circulating LL-37-ApoB-100 complex could serve as a biomarker for CAD. We performed surface plasmon resonance and protein-protein docking to demonstrate the direct LL-37-ApoB-100 interaction. We developed a specific polyclonal antibody against the complex and measured its levels in human atherosclerotic plaques and plasma, as well as in We identified that LL-37 directly interacted with multiple distinct binding sites on ApoB-100. Plasma levels of LL-37-ApoB-100 complex were significantly elevated in human patients with atherosclerosis. Consistently, levels of this complex were positively correlated with atherosclerotic plaque area in Circulating LL-37-ApoB-100 levels are strongly associated with angiographically documented CAD, highlighting LL-37-ApoB-100 as an independent predictor for CAD. Show less

Apolipoprotein B (apoB) is a superior marker of residual atherosclerotic cardiovascular disease risk in patients treated with lipid-lowering therapy (LLT) compared with low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). The cost-effectiveness of LDL-C, non-HDL-C, and apoB goals has not been established. To determine the relative cost-effectiveness of intensifying LLT for primary prevention based on LDL-C, non-HDL-C, and apoB goals. This economic evaluation used a computer simulation model to evaluate the cost-effectiveness of intensifying LLT with high-intensity statins or ezetimibe according to LDL-C, non-HDL-C, or apoB goals. A cohort of 250 000 statin-eligible and atherosclerotic cardiovascular disease-free US adults was constructed from 2005 to 2016 National Health and Nutrition Examination Survey participants (N = 4149). Individuals commenced the simulation after lipid screening and received statin therapy based on 2018 American Heart Association/American College of Cardiology guidelines. Model inputs were derived from national survey data, pooled longitudinal cohort studies, and published literature. Uncertainty was explored with traditional and probabilistic sensitivity analysis. Lipid-lowering therapy was intensified if individuals did not achieve treated LDL-C level less than 100 mg/dL, non-HDL-C level less than 118 mg/dL, or apoB level less than 78.7 mg/dL. Lifetime quality-adjusted life-years (QALYs) and costs (in 2025 US dollars), discounted 3.0% annually. The primary outcome was the incremental cost-effectiveness ratio. Strategies were considered cost-effective if they cost less than $120 000 per QALY gained. Compared with an LDL-C goal, 965 QALYs (95% uncertainty interval [UI], -3551 to 5341 QALYs) would be gained with a non-HDL-C goal, alongside a $2.1 million (95% UI, -$94.2 million to $92.0 million) reduction in costs. Compared with a non-HDL-C goal, 1324 QALYs (95% UI, -2602 to 5669 QALYs) would be gained with an apoB goal, alongside a $40.2 million (95% UI, -$43.6 million to $134 million) increase in costs, yielding an incremental cost-effectiveness ratio of $30 300 per QALY gained. At a willingness-to-pay threshold of $120 000 per QALY gained, an apoB goal was optimal in 65% of probabilistic analyses and a non-HDL-C goal was optimal in 25%. The cost of apoB testing was marginal; higher costs reflected longer life expectancy and prolonged preventive treatment. The results of this computer simulation study suggest that apoB can be used as a cost-effective marker to guide primary prevention LLT and improve population health. Show less

Many adults fail to achieve guideline-directed low-density lipoprotein cholesterol (LDL-C) goals on statin monotherapy, requiring additional nonstatin lipid-lowering medication. Enlicitide, an oral proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitor, lowered LDL-C by 60% compared with placebo; its efficacy compared with other oral nonstatin therapies has yet to be examined. This study assessed the efficacy of enlicitide, a novel oral PCSK9 inhibitor, vs other oral nonstatin therapies. In this phase 3, randomized, double-blind, active-comparator trial, statin-treated adults aged ≥18 years with LDL-C ≥55 mg/dL and a previous major atherosclerotic cardiovascular disease (ASCVD) event, or LDL-C ≥70 mg/dL if at intermediate to high risk for a first event, were randomized in 2:1:1:2 fashion to 20 mg enlicitide (n = 101), 180 mg bempedoic acid (n = 50), 10 mg ezetimibe (n = 50), or 180 mg bempedoic acid plus 10 mg ezetimibe (n = 100) once daily for 56 days. The primary endpoint was mean percentage change in LDL-C from baseline to day 56; secondary endpoints included mean percentage changes in apolipoprotein B (ApoB) and non-high-density lipoprotein cholesterol (nonHDL-C). Safety endpoints included overall adverse events (AEs) and discontinuations due to AEs. Among 301 randomized participants (mean age 64.4 years, 37% female, 98% receiving moderate- to high-intensity statin), 298 (99.0%) completed the trial. The mean percentage change in LDL-C from baseline to day 56 was -64.6% (95% CI: -68.3% to -60.9%) with enlicitide, -6.3% (95% CI: -13.5% to 0.8%) with bempedoic acid, -27.8% (95% CI: -32.3% to -23.4%) with ezetimibe, and -36.5% (95% CI: -40.8% to -32.2%) with bempedoic acid plus ezetimibe; enlicitide was superior to each comparator (all P < 0.001). Reductions in ApoB and nonHDL-C were also greater with enlicitide (all P < 0.001). Proportions of participants with AEs and discontinuations due to AEs were similar across treatment arms. In statin-treated adults with a history of a major ASCVD event or at increased risk for a first event, enlicitide achieved greater reductions in LDL-C, ApoB, and nonHDL-C than other oral nonstatin therapies, demonstrating its potential role as an important add-on option when LDL-C goals are not met with the use of statins alone. (A Study to Evaluate the Efficacy and Safety of Enlicitide Decanoate [MK-0616, Oral PCSK9 Inhibitor] Compared With Ezetimibe or Bempedoic Acid or Ezetimibe and Bempedoic Acid in Adults With Hypercholesterolemia [MK-0616-018] [CORALreef AddOn; NCT06450366). Show less

Hypertensive disorders of pregnancy (HDP) are associated with future cardiovascular disease but mechanisms are not well defined. We examined the association between HDP and atherosclerotic cardiovascular disease (ASCVD) biomarkers 5-10 years after childbirth. Secondary analysis of the NICHD MFMU Network Gestational Diabetes (GDM) Trial Follow-Up study. Participants were recruited and biospecimens obtained 5-10 years after the original trial of treatment for mild GDM. Patients were included if a biospecimen was available and their HDP status was known. We compared patients who experienced HDP to normotensive controls. Outcomes included unadjusted medians and mean concentrations of ASCVD serum biomarkers Apolipoprotein B (ApoB), high-sensitivity C-reactive protein (hs-CRP), and creatinine. Generalized linear models were used to compare concentrations between groups. Of 740 participants in this analysis, 78 had been diagnosed with HDP. Mean duration of follow up after delivery was 7.1 ± 1.3 years for both groups. Unadjusted means of each biomarker were not different between groups. After adjusting for obesity, mean serum creatinine was elevated in women who had been diagnosed with HDP (0.77 mg/dL 95%CI (0.72, 0.82)) compared to controls (0.71 mg/dL 95%CI (0.69, 0.72)), p = 0.02. Adjusted means for ApoB between women with HDP and controls were 64.2 mg/dL (95%CI (59.3, 69.5)) and 60.6 mg/dL (95%CI (58.9, 62.3)), (p = 0.18), and for hs-CRP mg/L were 14.6 (95%CI (11.4, 19.1)) and 14.5 mg/L (95%CI (13.3, 15.9)), (p = 0.91). In patients with HDP compared to normotensive controls, serum creatinine, but not ApoB or hs-CRP, was modestly elevated within 10 years of childbirth. Show less

Dietary intake is a primary route of exposure to polychlorinated biphenyls (PCBs). The absorption and adverse effects of pollutants are markedly influenced by sex. However, insights into sex-specific differences in PCB oral bioavailability remain limited. In this study, PCB oral bioavailability was assessed in adult female and male Balb/c mice. At different exposure doses, the oral bioavailability of PCBs in female mice (14.2-22.8%) was significantly higher than that in male mice (12.3-18.8%). Correspondingly, males excreted a greater proportion of PCBs via feces, with fecal excretion percentages of 9.50-10.4% in males compared to 6.98-8.13% in females. Mechanistic analyses revealed that the higher PCB oral bioavailability in females was associated with greater dietary lipid assimilation efficiency and elevated postprandial serum apoB-48 levels, which are key indicators of chylomicron-mediated transport of lipophilic pollutants. Gut microbiota analysis revealed a more pronounced increase in Show less

Between 1920 and 1950, cardiovascular disease (CVD) underwent a profound epidemiological shift, rising from a relatively rare and infrequently diagnosed condition to become the leading cause of death in industrialized nations. This epidemic coincided with a series of changes in the food supply, including the expanded use of refined carbohydrates, industrial seed and vegetable oils, and trans fatty acids. In response, the "Diet-Heart Hypothesis" emerged, dominated by Ancel Keys' lipid theory, which focused scientific and public health attention on saturated fat and cholesterol as the primary causes of CVD. This paradigm profoundly shaped dietary guidelines for decades, yet the sugar industry's documented influence on nutritional research during this period raises questions about how economic interests may have deflected scrutiny from other dietary factors. This review critically examines the evolution of cardiovascular risk assessment, exploring both the historical context of CVD emergence and the contemporary evidence supporting biomarkers that may be better at predicting risk than traditional cholesterol-focused approaches. Significant evidence reveals limitations in the lipid hypothesis, which oversimplified cardiovascular risk by demonizing total and LDL cholesterol. Research now demonstrates that apolipoprotein B and non‑HDL cholesterol more accurately reflect atherogenic lipoprotein burden than LDL cholesterol alone, while the triglyceride‑to‑HDL cholesterol ratio is a useful marker of insulin resistance and metabolic dysfunction. Lipoprotein(a), an independent genetic risk factor, accounts for a substantial proportion of cardiovascular events previously attributed to other causes. Furthermore, inflammatory markers like high-sensitivity C-reactive protein add prognostic value beyond traditional lipid panels. Perhaps most importantly, the historical dominance of saturated fat as a dietary "villain" is challenged by contemporary meta-analyses showing no significant association with CVD, while the roles of refined carbohydrates, industrial trans fats, and excess omega-6 fatty acids, such as those in soybean oil, warrant greater scrutiny. Contemporary cardiovascular risk assessment must move beyond LDL cholesterol-centric approaches to incorporate comprehensive metabolic and inflammatory markers. Apolipoprotein B, lipoprotein(a), triglyceride-to-HDL ratio, and high-sensitivity C-reactive protein provide more nuanced risk stratification, while dietary recommendations should acknowledge that industrial food processing, refined carbohydrates, and specific fatty acid compositions may pose greater cardiovascular threats than naturally occurring saturated fats. This paradigm shift demands updated clinical guidelines that reflect current scientific understanding rather than historical assumptions, potentially revolutionizing both prevention and treatment strategies for CVD. Show less

Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality in individuals with diabetes, partly driven by dyslipidemia. While low-density lipoprotein cholesterol (LDL-C) reduction is the primary target of lipid management, many patients with diabetes exhibit mixed dyslipidemia characterised by elevated triglycerides and increased concentrations of atherogenic remnant lipoproteins, which are more comprehensively captured by non-high-density lipoprotein cholesterol (non-HDL-C). Current guidelines from international societies, including the American Diabetes Association (ADA), the American Association of Clinical Endocrinology (AACE), and the European Society of Cardiology (ESC), recommend LDL-C and non-HDL-C targets based on individual cardiovascular risk profiles. Despite clear therapeutic algorithms, lipid target attainment remains suboptimal in routine clinical practice, necessitating more intensive and individualised treatment strategies. Lipid-lowering therapies, including statins, ezetimibe, bempedoic acid and PCSK9 inhibitors, effectively reduce LDL-C and non-HDL-C, significantly lowering cardiovascular risk. Triglyceride-lowering therapies, including omega-3 fatty acids and fibrates, have demonstrated substantial reductions in triglyceride levels, but their impact on cardiovascular outcomes remains uncertain. Given the heterogeneity of dyslipidemia in diabetes, non-HDL-C and apolipoprotein B (apoB) have emerged as superior markers for assessing atherogenic burden. While LDL-C reduction remains central, additional efforts are needed to optimise the management of residual atherogenic lipoprotein particles in diabetes. Future research should focus on refining risk stratification, improving lipid target attainment, and integrating novel lipid-modifying agents to enhance cardiovascular outcomes in this high-risk population. Show less

Sex-specific differences in serum lipids are recognized, but their relationship with cardiovascular disease (CVD) has not been reliably quantified. We examined sex-specific associations of major lipids and apolipoproteins with incident CVD. We included 432 092 UK Biobank participants without CVD at baseline (2006-2010) and with ≥1 lipid measurement. Age-adjusted risks were estimated using Poisson regression. Multivariable Cox models estimated hazard ratios (HRs) and women-to-men ratios of HRs for 1-SD higher values of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, apoB (apolipoprotein B), apoA1 (apolipoprotein A1), and Lp(a) (lipoprotein [a]). Over a mean 13.3 years of follow-up, there were 10 699 and 18 950 cases of CVD in women and men, respectively. CVD risk per 10 000 person-years was 33.4 (95% CI, 32.7-34.0) for women and 76.6 (95% CI, 75.5-77.7) for men. Low-density lipoprotein cholesterol, apoB, and log Lp(a) were associated with smaller HRs of CVD for women than men (ratio of HR, 0.94 [95% CI, 0.91-0.97], ratio of HR, 0.94 [95% CI, 0.92-0.97] and ratio of HR, 0.96 [95% CI, 0.93-0.99], respectively). Triglycerides were associated with larger HRs of CVD in women than men (ratio of HR, 1.06 [95% CI, 1.02-1.09]). The association of lower apoA1 with higher CVD risk was stronger in men than women (ratio of HR, 1.06 [95% CI, 1.03-1.10]). No sex difference was observed for high-density lipoprotein cholesterol (ratio of HR, 1.02 [95% CI, 0.98-1.06]). Men had a higher rate of CVD than women overall. Low-density lipoprotein cholesterol, apoB and Lp(a) had stronger associations with CVD risk in men, whereas triglycerides were stronger in women. ApoA1 was less protective for CVD in women than men. Show less

Postprandial metabolic impairments play a key role in the pathophysiology of cardiometabolic diseases. While liver fat content has been linked to distinct fasting metabolite profiles, its relationship with postprandial metabolite profiles remains unexplored. In this study, we aimed to (1) examine to what extent liver fat content is associated with the postprandial metabolomic profile beyond fasting metabolites; and (2) investigate whether diet-induced changes in liver fat content are associated with changes in plasma metabolites identified in objective 1. In a subpopulation (n = 1986) of an existing cohort study and a 12-week dietary intervention study (n = 80), liver fat content was measured by proton magnetic resonance spectroscopy and categorized as low (< 2.5%), middle (2.5-5.5%), or high (> 5.5%). In the cohort study, plasma metabolomic profiles were quantified by NMR spectroscopy at fasting (T High liver fat group was characterized by higher fasting and postprandial levels of triglycerides, all VLDL and the small LDL/HDL subclasses, ApoB, fatty acids, glycoprotein acetyls, and BCAAs, and lower medium/larger HDL subclasses, and acetate compared to the low liver fat group. In the high vs. low liver fat group, postprandial responses of cholesterol content of S-LDL, IDL, and S-HDL, glutamine and histidine, omega-3% and DHA % were lower. Diet-induced reductions in liver fat were associated with reductions in 40 fasting plasma metabolites, including VLDL-TG, tyrosine, isoleucine, fatty acid ratios, and most of the VLDL subclasses. Postprandial metabolomic profiling revealed additional associations between liver fat content and plasma metabolites beyond fasting measures, particularly in lipoprotein cholesterol and fatty acid composition. Diet-induced reductions in liver fat were associated with favorable changes in fasting metabolites, but not postprandial metabolite responses. Future studies with harmonized postprandial assessment are needed to further elucidate the postprandial observations and the underlying mechanisms. The trials in this study were registered at clinicaltrials.gov as NL21981.058.08/P08.109 and NCT02194504. Show less

Chronic low-grade inflammation plays a central role in cardiometabolic disease, yet the associations between lipid metabolism and inflammatory biomarkers in generally healthy individuals remain incompletely understood. This study aimed to investigate the relationship between blood lipids, high-sensitivity C-reactive protein (hsCRP), and a broad panel of inflammatory cytokines in a healthy adult population. A total of 165 healthy participants aged 18-44 years were recruited at the Falun County Hospital, Sweden. Blood samples were analyzed for a full lipid profile, blood counts, cytokines, and hsCRP. Plasma inflammatory protein levels were quantified using the Olink Proseek Multiplex Inflammation panel, including 92 cytokines. Statistical analysis included Spearman rank correlations and multiple testing correction using the Benjamini-Hochberg false discovery rate (FDR < 0.10). hsCRP showed significant correlations with several lipid parameters, particularly remnants, triglycerides, apolipoprotein B (ApoB), and non-HDL cholesterol, as well as with BMI and specific leukocyte counts. Additionally, hsCRP was significantly associated with multiple cytokines, including IL-6, TNF, IL-10, and CXCL10, highlighting a complex pro- and anti-inflammatory milieu. This study demonstrates correlations between hsCRP, lipid-related biomarkers, and inflammatory cytokines in healthy adults, underscoring the interplay between lipid metabolism and subclinical inflammation. The significant correlations between hsCRP and remnants, ApoB, and cytokines such as IL-6 support the role of these factors as early indicators of cardiometabolic risk, even in the absence of overt disease. Show less

Dietary fat absorption is among the most energy-demanding processes of nutrient uptake. Fatty acid activation, triglyceride synthesis, and the trafficking of chylomicrons through the secretory pathway - all require ATP. How enterocytes accommodate the surge in ATP consumption following fat uptake is unclear. We show that the purine biosynthesis/salvage pathway supplies necessary ATP and that Ankyrin Repeat Domain 9 (ANKRD9) couples ATP synthesis and lipoprotein trafficking. Ankrd9 regulates enzymes within the purine biosynthesis pathway to increase ATP synthesis and facilitate Golgi dynamics. Intracellular localization of ANKRD9 is lipid and ATP-dependent. Inactivation of Ankrd9 in mice reduces intestinal ATP despite intact mitochondrial and glycolytic function, alters Golgi morphology, delays ApoB/chylomicron trafficking, and causes lipid accumulation in enterocytes, along with a lean body phenotype. Taken together, the results reveal a previously unrecognized mechanism that regulates lipid absorption in enterocytes and identify ANKRD9 as a central component of this mechanism. Show less

Hepatitis C virus (HCV) has the unique characteristic of forming lipo-viro-particles (LVPs), which are lipid-rich virions containing both the viral components and host apolipoproteins such as ApoB and E. This unique composition gives to LVPs a low buoyant density, facilitates their entry into the hepatocyte, and is a hallmark of highly-infectious HCV particles. Although recent studies have shown that inhibiting NAD biosynthesis can both disrupt central carbon metabolism and thereby interfere with the replication of hepatotropic viruses such as dengue virus (DENV) and hepatitis B virus (HBV), the impact of nicotinamide biosynthesis inhibition on HCV replication and LVP formation has not yet been explored. We therefore investigated the dependance of HCV on NAD(H) biosynthesis in Huh7 cells by using the antimetabolite 6-Aminonicotinamide (6-AN) or by specifically inhibiting NAMPT, a key enzyme in the nicotinamide salvage pathway. The impact on cellular metabolism was assessed by LC-MS/MS to quantify metabolites, by confocal microscopy to analyze lipid droplets and by ELISA for ApoB/E secretion. Glycolytic activity and mitochondrial respiration were evaluated by real-time measurement of extracellular acidification rate (ECAR) and oxygen consumption rate (OCR), respectively. Consequences on viral replication were analyzed using both a subgenomic replicon (strain JFH1) and the full-length infectious virus (strain Jc1). The effect of 6-AN on the formation of double-membrane vesicles (DMVs) where the virus replicates was determined transmission electron microscopy. Finally, the secretion and specific infectivity of virions were analyzed by RT-qPCR and titration technics, either before or after separation by density-gradient centrifugation to focus on LVPs. Pharmacological inhibition of NAD(H) biosynthesis in Huh7 cells impaired HCV replication, the formation of DMVs and the production of infectious LVPs. Mechanistically, 6-AN drastically inhibited glycolysis but increased oxidative phosphorylation as compensatory mechanism. This metabolic reprogramming was associated with decreased intracellular levels of triglycerides, smaller lipid droplets and reduced secretion of Apo B and E, which altogether could explain the impact of 6-AN on HCV replication and the production of LVPs. Inhibiting NAD(H) biosynthesis disrupts central carbon metabolism, reduces intracellular triglycerides and blocks ApoB ⁺ -lipoprotein secretion-a pathway essential for HCV replication and LVP production. These results reveal, for the first time, that HCV life cycle is critically dependent on NAD(H) metabolism, reinforcing the interest of this pathway as a potential therapeutic target against hepatotropic viruses. Show less

Amyotrophic lateral sclerosis (ALS) is a heterogeneous neurodegenerative disorder. Notably, the differences in lipid metabolism between bulbar- and limb-onset subtypes of ALS remain unclear, particularly in non-Western populations. The present study investigated serum lipid profiles in a Chinese cohort of patients with ALS to explore their associations with disease severity and clinical subtypes. A retrospective, cross-sectional study was conducted, involving 158 patients with ALS and 62 matched healthy controls. Serum lipid parameters, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), small dense LDL cholesterol (sdLDL-c), apolipoprotein A-1 (ApoA1), apolipoprotein B (ApoB) and the TG/HDL ratio, were compared between the groups. Correlation analyses and multivariable linear regression models incorporating phenotype x lipid interaction terms were conducted after adjusting for age, sex, body mass index and disease duration. Patients with ALS exhibited significantly higher TC, TG, LDL, sdLDL-c, ApoA1, ApoB and TG/HDL ratios than controls. Subtype-specific analyses revealed different associations; in bulbar-onset ALS, higher sdLDL-c and TG/HDL ratios were associated with better functional status, whereas higher HDL and ApoA1 levels were negatively correlated with functional status. By contrast, in limb-onset ALS, higher sdLDL-c and ApoB levels were associated with worse function. Interaction analyses confirmed significant phenotype modification for sdLDL-c, TG/HDL ratio, HDL and ApoA1. These results suggest that lipid-severity relationships in ALS vary by subtype, indicating metabolic heterogeneity across phenotypes and supporting the potential of specific lipid parameters as exploratory markers for disease monitoring. Show less

Hypertriglyceridemia is a widely prevalent disorder of lipid metabolism that increases the risk of cardiovascular disease and pancreatitis, and it often remains difficult to control even with standard treatments. Olezarsen, an antisense oligonucleotide that targets apolipoprotein C-III (ApoC-III), offers a new and promising option for lowering triglyceride levels. A systematic search of PubMed, Scopus, Web of Science, and Cochrane was conducted through September 2025 to identify randomized controlled trials (RCTs) comparing olezarsen with placebo in adults with hypertriglyceridemia at high cardiovascular risk. Dichotomous outcomes were analysed as risk ratios (RRs) and continuous outcomes as percentage mean differences (MDs), both with 95% confidence intervals (CIs). Four RCTs (n = 1615 patients) were included. Olezarsen significantly reduced triglycerides (MD -47.71%, 95% CI -56.78 to -38.64, p < 0.0001), non-HDL-C (MD -22.11%, 95% CI -28.48 to -15.75, p < 0.0001), ApoC-III (MD -68.93%, 95% CI -77.54 to -60.31, p < 0.0001), VLDL-C (MD -48.52%, 95% CI -57.16 to -39.87, p < 0.0001), and ApoB (MD -10.67%, 95% CI -16.83 to -4.51, p = 0.0007), while increasing HDL-C (MD 35.13%, 95% CI -27.30 to -42.96, p < 0.0001). LDL-C showed no significant change. The risks of any or serious adverse events were comparable to placebo. Olezarsen was associated with fewer acute pancreatitis events (p = 0.035) but higher rates of liver enzyme elevations ≥ 3× ULN (p = 0.046). Olezarsen demonstrated consistent improvements in triglycerides and other atherogenic lipid parameters with an overall acceptable safety profile. These findings suggest that olezarsen may be a useful adjunct option for patients with persistent hypertriglyceridemia despite standard therapy. Further large-scale and long-term studies are needed to confirm its cardiovascular and safety outcomes. Show less

We investigated the associations of genetic risk score for Alzheimer's disease (GRS-AD) with cardiometabolic risk from early childhood over a 20-year follow-up. The STRIP study included 1062 children at baseline. GRS-AD was calculated for 631 participants using 22 independent genetic risk variants, including APOE ε2 and ε4 alleles, and excluding them (non-APOE-GRS-AD). We repeatedly measured waist circumference, high-density (HDL-C) and low-density (LDL-C) lipoprotein cholesterol, triglycerides, glucose, insulin, and blood pressure. The data were analysed with generalised additive mixed models. GRS-AD was directly associated with serum LDL-C (unstandardised β = 0.140, 95% CI = 0.084 to 0.195) and inversely with HDL-C (β = -0.026, 95% CI = -0.044 to -0.009). GRS-AD was inversely associated with serum HDL-C in males (β = -0.044, 95% CI = -0.070 to -0.018) but not in females (β = -0.010, 95% CI = -0.032 to 0.012). The associations were diluted when the non-APOE-GRS-AD was applied. A genetic predisposition to AD may alter lipid metabolism from early childhood. While Alzheimer's disease and cardiometabolic diseases may have shared genetic determinants, the associations between genetic susceptibility for Alzheimer's disease and increased cardiometabolic risk from childhood to young adulthood are poorly understood. We investigated the associations of genetic risk score for Alzheimer's disease with cardiometabolic risk from early childhood over a 20-year follow-up. We found that a higher genetic risk score for Alzheimer's disease was associated with higher LDL cholesterol, non-HDL cholesterol, and ApoB, and with lower serum HDL cholesterol and ApoA1. These findings suggest that a genetic predisposition to Alzheimer's disease may alter lipid metabolism from early childhood. Show less

This study aimed to evaluate the effects of phytosterols (PSs) alone and in combination with phospholipids (PLs) on blood lipid levels, erythrocyte membrane fluidity (EMF) and lipid profiles in subjects with borderline hyperlipidemia in a randomized, double-blind, placebo-controlled clinical trial. Among 144 initially screened participants, 87 were enrolled and randomly assigned to three groups receiving PSs (2 g of PSs), PSs and PLs (2 g of PSs plus 0.825 g of PLs), or placebo for 60 days, respectively. A total of 83 subjects completed the entire trial. After 60 days of intervention, the levels of total cholesterol (TC) and apolipoprotein B (ApoB) in the combined PSs and PLs group decreased by 7.8% and 6.4% ( Show less

Residual cardiovascular risk persists in type 2 diabetes mellitus (T2DM) despite intensive risk-factor management. Apolipoprotein B (apoB) and excess apoB are potentially promising biomarkers for identifying residual cardiovascular risk. We assessed apoB and excess apoB in T2DM for incremental prediction of atherosclerotic cardiovascular disease (ASCVD) risk. This prospective cohort included 11,918 UK Biobank participants (mean age 59.7 ± 6.6 years; 61% male) with T2DM and no ASCVD at baseline. Excess apoB was defined as the observed minus predicted apoB, where the predicted value was derived using a linear regression model of apoB on low-density lipoprotein cholesterol (LDL-C) fitted in a statin-naïve reference subset with triglycerides ≤ 1.0 mmol/L. The primary endpoint was incident ASCVD. Secondary endpoints included major adverse cardiovascular events (MACE) and all-cause mortality. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox models. Nonlinearity was assessed using restricted cubic splines. Incremental improvements were quantified using the C-index, net reclassification improvement (NRI). During a median 185.3-month follow-up, 2,548 ASCVD and 1,205 MACE events occurred. ApoB was linearly related to ASCVD and MACE, while excess apoB showed J-shaped associations with a nadir near - 7.5 mg/dL for ASCVD. Both apoB and excess apoB showed positive associations with ASCVD across ascending percentile categories. Versus < 50th percentile, HRs (95% CIs) for ASCVD in higher apoB categories (50-<75th, 75-<90th, ≥ 90th) were 1.31 (1.16-1.49), 1.51 (1.25-1.81), and 1.47 (1.10-1.95); corresponding HRs (95% CIs) for excess apoB were 1.50 (1.36-1.66), 1.45 (1.29-1.63), and 1.53 (1.33-1.76), respectively. Similar but weaker risk gradients were observed for MACE. Neither apoB nor excess apoB was associated with all-cause mortality. Excess apoB yielded greater prediction improvement than apoB (ΔC-index: 0.009 vs. 0.002; NRI: 0.270 vs. 0.101) and better stratified risk in statin users and those with LDL-C ≤ 100 mg/dL (P for interaction < 0.05). In T2DM, apoB is independently associated with ASCVD but adds limited discrimination over conventional lipids. Excess apoB yielded improved discrimination and reclassification, and may serve as a complementary ASCVD risk marker, particularly in statin-treated settings. However, its clinical application requires external validation and standardization. Show less

This study aimed to identify novel key targets and mechanisms for repurposing strategies and mitigating sorafenib (SFB) resistance using the GEO transcriptomic dataset GSE94550 within a systems pharmacology framework. Potential counteracting molecules against SFB were retrieved from chemical repositories, followed by molecular docking tests (MDT), Kaplan-Meier survival analysis, and density functional theory (DFT) assessments to evaluate therapeutic potential. PPI networks were constructed using STRING and R to characterize the relationships between upregulated and downregulated genes. The most relevant signalling pathways associated with major targets were determined to elucidate the upstream regulatory mechanisms. Among the differentially expressed genes, APOB emerged as a pivotal regulator (log Show less

Psoriasis patients face a significantly elevated risk of cardiovascular diseases (CVD), necessitating early and accurate risk prediction tools. This study developed and validated a machine learning model to predict CVD risk in psoriasis patients using clinical and biochemical data from 2685 individuals. After preprocessing and addressing class imbalance with SMOTE-NC, six machine learning models (Logistic Regression as baseline, XGBoost, LightGBM, CatBoost, GradientBoosting, AdaBoost) were evaluated using a completely leak-free nested cross-validation framework (outer k = 10, inner k = 3) with randomized hyperparameter search (n_iter = 50). Feature selection via the Boruta algorithm was performed separately within each training fold to prevent data leakage. The Boruta algorithm identified 21 key predictors, including age, systolic blood pressure (SBP), apolipoprotein B (apoB), fasting blood glucose (FBG), and complement C1q. CatBoost emerged as the top-performing model (OOF ROC-AUC = 0.908, 95% CI [0.892-0.924]; PR-AUC = 0.509, 95% CI [0.448-0.578]; F1 = 0.540; MCC = 0.498; Brier = 0.078), while the Logistic Regression baseline achieved ROC-AUC = 0.909 but was eliminated due to poor calibration (Brier = 0.114 > 0.10). All metrics were evaluated with 95% bootstrap confidence intervals ( Show less

Randomized controlled trials (RCTs) found no cardioprotective effects of levothyroxine therapy in older adults with subclinical hypothyroidism. To assess levothyroxine effects on cardiometabolic biomarkers, which may serve as more sensitive treatment indicators. Post hoc analysis using (baseline and 12-month) data from two double-blind randomised controlled trials in older adults (≥ 65 years) with subclinical hypothyroidism. Cardiometabolic biomarkers included seven clinically relevant lipid measures (apolipoprotein B (ApoB), total cholesterol (Total-C), non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), low-density lipoprotein cholesterol (LDL-C), HDL-C, and triglycerides (TG)) and 167 standardised metabolomic measures from nuclear magnetic resonance. Analyses were additionally stratified by baseline TSH levels. Among 286 included participants (48% women; median age 75 [70, 82] years; median baseline TSH 6.44 [5.36, 7.81] mIU/L), 142 were randomized to levothyroxine. Overall, levothyroxine showed no effects on ApoB (-0.03 [95% CI: -0.07, 0.00] g/L), Total-C (-0.17 [-0.34, 0.00] mmol/L), non-HDL-C (-0.15 [-0.31, 0.00] mmol/L), RC (-0.09 [-0.16, -0.01] mmol/L), LDL-C (-0.07 [-0.15, 0.02] mmol/L), and TG (-0.07 [-0.15, 0.01] mmol/L). In participants with baseline TSH ≥10 mIU/L (n=27), potentially beneficial changes (P-values < 0.05, but not significant after multiple-testing correction) were observed for all clinically relevant lipids except HDL-C, as well as for ApoB-containing lipoproteins, VLDL size and fatty acids. In older adults with subclinical hypothyroidism, levothyroxine treatment showed no effects on cardiometabolic biomarkers, although potentially favourable changes in lipids and lipoproteins were observed for individuals with baseline TSH ≥ 10 mIU/L. Show less

Apolipoprotein B (APOB) containing lipoproteins contribute to atherosclerosis by entering the arterial wall through the endothelial cell (EC) surface receptors scavenger receptor-BI (SR-BI) and activin receptor-like kinase 1 (ALK1). We used N-terminal fragments of APOB, molecular modeling, and site-directed mutagenesis to identify and block the binding of chylomicrons and LDL to these receptors in cells and mice. We discovered that different APOB regions interact with SR-BI and ALK1 expressed on ECs APOB48 lipoproteins were only internalized by SR-BI. A fragment of APOB, comprising 18% of the N-terminal sequence, APOB18, reduced the uptake and transport of both chylomicrons and LDL by ECs, whereas a shorter fragment, APOB12, only blocked ALK1 mediated uptake of APOB100 containing lipoproteins. Importantly, overexpressing APOB18 decreased atherosclerosis in hypercholesterolemic mice. These findings identify the N-terminal region of APOB as the cause of atherosclerosis and illustrate an approach to treating or preventing vascular disease. Show less

To investigate changes in serum lipid profile parameters combined with tumor markers in gastric cancer (GC) patients and their value in GC screening. A total of 100 patients diagnosed with GC at Renji Hospital (West) between May and September 2025 were consecutively enrolled as the GC group (54 cases in stage Ⅰ/Ⅱ and 46 cases in stage Ⅲ/Ⅳ). Additionally, 100 age- and sex-matched healthy individuals undergoing routine physical examinations were included as the healthy control (HC) group. The serum levels of nine lipid indicators (high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], triglycerides [TG], small and dense low-density lipoprotein cholesterol [sdLDL-C], apolipoprotein [Apo] A1, ApoB, ApoC2, and ApoC3) and five tumor markers (carcinoembryonic antigen [CEA], carbohydrate antigen [CA] 19-9, CA50, CA242, and CA72-4) were measured using an automatic biochemical analyzer and an electrochemiluminescence instrument. Intergroup differences were analyzed using the Mann-Whitney Compared with the HC group, the GC group showed significantly lower levels of ApoA1, ApoC3, TC, HDL-C, LDL-C, and sdLDL-C ( The combined panel of ApoA1, ApoC3, HDL-C, LDL-C, TC, sdLDL-C, CEA, CA50 and age offers a potential auxiliary tool for detecting gastric cancer. Show less

Inhibition of angiopoietin-like protein 3 (ANGPTL3) has been proposed as a promising approach to reduce residual cardiovascular risk. We conducted a meta-analysis of randomized controlled trials (RCTs) to provide a comprehensive evaluation of the metabolic effects of ANGPTL3 inhibitors. Databases (PubMed, EMBASE, Web of Science, CENTRAL, ClinicalTrials.gov) were searched from inception to July 2025. Eligible studies were RCTs comparing ANGPTL3 inhibitors against placebo. Outcomes included triglycerides (TG), LDL-C, apolipoprotein B (ApoB), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), very-low-density lipoprotein cholesterol (VLDL-C), apolipoprotein A1 (ApoA1), apolipoprotein C3 (ApoC3), lipoprotein(a) (Lp(a)), remnant cholesterol (RC), ANGPTL3 and C-reactive protein (CRP). Pooled estimates of percentage change from baseline were obtained using fixed- and random-effects models. Subgroup analysis was performed based on the mechanism of action: monoclonal antibodies (mAbs, evinacumab), antisense oligonucleotides (ASOs, vupanorsen), and small interfering RNAs (siRNA, zodasiran and solbinsiran). Nine RCTs (1,254 participants) were included. ANGPTL3 inhibition significantly reduced TG (-47.1%), LDL-C (-21.6%), ApoB (-19.9%), non-HDL-C (-31.5%), TC (-32.8%), VLDL-C (-40.6%), and RC (-72.7%). Modest but consistent reductions were also observed in Lp(a) (-11.5%), ApoA1 (-18.3%), and ApoE (-16.4%). ANGPTL3 inhibitors markedly reduced circulating ANGPTL3 protein (-70.7%), with no significant effect on high-sensitivity CRP. Subgroup analyses demonstrated greater reductions in LDL-C, ApoB, non-HDL-C, and TC with evinacumab compared to the other groups, whereas small interfering RNAs produced more pronounced VLDL-C lowering compared with vupanorsen. ANGPTL3 inhibition offers broad lipid-lowering benefits, with particularly marked reductions in TG-rich lipoproteins. Show less

This review examines whether high high-density lipoprotein cholesterol (HDL-C) is protective, harmful, or simply misleading in relation to atherosclerotic cardiovascular disease (ASCVD), with emphasis on recent mechanistic, epidemiologic, genetic, and trial evidence. HDL is biologically important and multifunctional, but HDL-C is an imperfect surrogate for HDL function. Recent cohort studies show nonlinear associations, with very high HDL-C not consistently protective and in some settings associated with increased mortality. Mendelian randomization studies do not support HDL-C as a causal protective factor, and randomized trials of HDL-C-raising strategies have generally failed to reduce ASCVD events. These findings have shifted attention from HDL quantity to HDL quality, including cholesterol efflux capacity, particle characteristics, and pathway-specific biology. At the same time, modern cholesteryl ester transfer protein (CETP) inhibition has renewed interest in whether benefit, if any, relates to Apolipoprotein B-lowering rather than HDL-C elevation itself. HDL biology remains highly relevant, but HDL-C alone should not be interpreted as a reliable marker of atheroprotection or as a therapeutic target. Very high HDL-C should not be used to downplay established causal risk factors. Future research should prioritize functional HDL metrics, deeper phenotyping, and mechanism-aligned trials to determine whether improving HDL quality, rather than simply raising HDL-C, can reduce ASCVD risk. Show less