EAS Member
Just a mechanical engineer with expertise in piping, with a passion for lipids
The selection of any quote is always biased. Please, read the papers
If you find people who are sincerely re-evaluating their opinion, you have a treasure close by. Usually you only see people who just want to reassert themselves. Ego rules
"Atherosclerosis regressed in patients with the greatest reduction in CRP levels, but not in those with the greatest reduction in LDL cholesterol levels".
"We estimate that the atherogenicity of LP(A) IS AROUND 6-FOLD GREATER THAN THAT OF LDL ON A PER PARTICLE BASIS.
We conclude that the atherogenicity of Lp(a) (per unit increase in particle number) is substantially greater than that of LDL"
"In the present study, we found that the amount of LDL-C lowering does not predict the clinical outcomes of ASCVD. The BENEFITS of ASCVD risk REDUCTION after statin therapy MAY NOT RELATED to LDL-C LOWERING or LDL-C goal based treatment"
"Plaque burden, not stenosis per se, is the main predictor of risk for CVD events and death. Thus, patients with a comparable calcified atherosclerosis burden generally carry a similar risk for CVD events regardless of whether they have nonobstructive or obstructive CAD."
"PCSK9 is a risk factor for adverse cardiovascular events in AF patients independent of their lipid profile.
PCSK9-mediated platelet activation might represent a novel mechanism responsible for the increased cardiovascular risk in this population"
ARE REMNANTS MORE ATHEROGENIC THAN LDLS?
🟢 TRL/remnant-C was a STRONG predictor of CHD RISK INDEPENDENT of apoB and LDL-C.
➡️ Results support remnants being more atherogenic
🤔 How much more atherogenic?
👁️ "Our study found that the presence of CAC was ▶️ varying statin impact
☺️ Patients CAC=0 had no benefit from statin therapy in mean follow-up of nearly 10 years.
🤨Calcium scoring shows significant potential to help select patients most likely to benefit from statin therapy"
"In DIABETIC individuals, it has been observed that ATHEROSCLEROSIS is distributed more UNIFORMLY in arteries, not following the typical association with regions of low shear or disturbed flow near bifurcations and curvatures" Tarbell et al. 2016
👁️ "Statins thus emerge as the class with the largest anti-inflammatory effect, leading to an additional −0.65 mg/L absolute decrease of CRP concentrations
👌We FAILED to find an ASSOCIATION between REDUCTIONS in LDL-C and CHANGES IN CRP levels with this drug class"
"Hence, circulating levels of LDL cholesterol may change for nonpathological reasons. Accordingly, an SFA-induced raise in LDL cholesterol in healthy individuals could represent a NORMAL RATHER THAN A PATHOLOGIC RESPONSE". IN LOVE WITH THIS PAPER
@realDaveFeldman
@DudzLightLime
👁️"sd-LDL-C was associated with ⬆️ odds for prevalent baseline CAC, independent of other CVRF including estimated total LDL-C
🤔 Recently, a study of 10357 men and women ▶️ LDL-C/apoB ratio, proxy for sd-LDL-C, was a superior predictor for CAC compared with total apoB alone"
👁️"Atherosclerosis is also an
inflammatory degenerative disease
👌PCSK9 affects the atherosclerotic process NOT ONLY VIA LIPID METABOLISM but also through its effects on the COAGULATION fibrinolytic system, INFLAMMATION, platelets and endothelial cells and function"
*CHANGE in the LDL-C were NOT REFLECTED by the CHANGE
in the CORONARY PLAQUE volume among the Japanese subjects, and
many cases showed PLAQUE REGRESSION WITHOUT ANY MARKED ⬇️ in LDL-C LEVEL. Change in the LDL-C level
was not correlated with the plaque regression in these studies*
👁️ 39 098 individuals follow‐up time of 11.8 years, with 4466 ASCVD events.
🤔 HIGH LDL‐C and LOW VLDL‐C experienced THE LOWEST CRUDE ASCVD rate (7.7 per 1000 person‐years)
🤔 LOW LDL‐C and HIGH VLDL‐C experienced the highest crude ASCVD rate (16.9 per 1000 person‐years).
"Importantly, 50% of the cholesterol found in atherosclerotic plaque comes from TRLs cholesterol. Even though, in most patients, TRL-C levels are much lower than calculated LDL-C", Castillo-Núñez et al. 2021 & Davidson,2018
👁️ "LDL‐TG showing THE STRONGEST ASSOCIATION among all participants and among those with normolipidemia
👌Copenhagen General Population Study,FINRISK,UKBiobank, ARICA,MESA,and CKB,have also demonstrated a significant association of LDL‐TG with incident CVD"
"The incremental long-term cardiovascular risk associated with a 10-mg/dl increment in triglycerides was similar to that for a 10-mg/dl increment in LDL-C and was evident in subgroups either above or below the median LDL-C of 73 mg/dl"
🟢"ApoB-100 was present in only 25% of foamy macrophages
🟠 By contrast, OxPLs and apo(a) were present in 100% of foamy macrophages and were approximately ten times more frequent in the shoulder region, fibrous cap and necrotic core than apoB-100"
👁️"LDL-C was NEARLY EXCLUSIVELY associated with MI & ASCVD events in patients with CAC>0
🫣HIGH LDL-C LEVEL(≥193 MG/DL versus <116 mg/dL) was associated with a substantial increased risk of MI & ASCVD in those with CAC>0, whereas NO ASSOCIATION WAS FOUND FOR THOSE WITH CAC=0"
Claims for history.
What will be said in 50 years?
Smith (1985); It is really the lesion which determines the amount of LDL rather than the LDL that creates the lesion. The role of LDL is secondary, it does not initiate lesions, but causes their progression
(1/25)
" Though it may seem SURPRISING, A SUBSTANTIAL PROPORTION of individuals (37%) presented with a CAC SCORE OF ZERO at a mean age of 63(±9) years, a prevalence of subclinical atherosclerosis comparable to the overall MESA cohort, DESPITE THE VERY HIGH LDL-C LEVELS"
👁️ High-purity EPA seems to have anti-inflammatory, anti-oxidative, anti-platelet, and anti-thrombotic properties, leading to plaque-stabilization
❤️ Or even plaque-reduction as shown with multidetector computed tomography and intravascular ultrasound studies.
As an engineer, I love the attempts at mathematical approaches to cardiovascular disease.
Risk map for plaque development:
Region I high risk;
Region II low risk;
Region III no risk.
STRENGTH TRAINING - "We SUGGEST that the acute decrease in TC in the present study represents the diversion of cholesterol for SYNTHESIS of NEW CELL MEMBRANES"
"Patients with cardiovascular disease who have elevated levels of pro-inflammatory oxidized phospholipids on apoB-containing lipoproteins are a high risk of ischemic events. High-dose statin therapy, but not low-dose therapy, reduces the risk mediated by oxidized phospholipids"
"Lack of association between change in carotid plaque height & achievement of LDLc goal in the RORA-AS study suggests it MAY BE HIGH-DOSE STATIN treatment that INDUCES ATHEROMA REGRESSION in patients with inflammatory joint disease RATHER THAN ACHIEVEMENT recommended LDLc goal"
"Results suggest that LP[A] ACCUMULATES PREFERENTIALLY to LDL in plaques, and that plaque apo[a] is directly associated with plasma apo[a] levels and is in a form that is less easily removable than most of the apoB.
NO SIGNIFICANT CORRELATIONS any of the tissue fractions & APOB"
"Among men aged 45 to 70 years old without CV RF, lifelong endurance athletes (≥8h/week cycling or ≥6h/week running, started before the age of 30 years) have a ⬆️ coronary plaque burden compared to who exercise for up to 3 hours a week, irrespective of the plaque type".
🥳 Compared with other lipid parameters including TG, LDL-C, HDL-C, non-HDL-C, and APOB
🟢 THE PROGNOSTIC VALUE of LDL-TG WAS MORE SIGNIFICANT
😍 LDL-TG for MACEs was superior to traditional lipid parameters including TG, LDL-C, non-HDL-C and APOB
"One-half of young persons with metabolic disorders and elevated LDL-C had discordantly normal ApoB and a low burden of carotid atherosclerosis over 13 years, suggesting that ApoB better represents the atherogenic lipid burden compared to LDL-C in this patient population".
"The endothelial glycocalyx is profoundly reduced in FH patients, which may contribute to increased atherogenic vulnerability. This perturbation is partially restored upon short-term statin therapy"
"In conclusion, we have shown that the strength of association of apoB with CHD risk is not uniform; rather, it depends on which particle the apoB resides; TRL/remnant particles appear to have an inherent atherogenicity that is substantially greater than that of LDL"
👁️"LARGER HDLs exert cardioprotective effects by acting on the endothelium, PREVENTING TRANSCYTOSIS of LDL and perhaps small VLDL or VLDL remnants
👉 Balance between APOB lipoproteins and LARGER HDL-Ps governs lesion APOB accumulation"
👁️"We did not detect ANY ASSOCIATIONS BETWEEN TRADITIONAL LIPID MEASUREMENTS AND CORONARY LIPID CONTENT
🤔 Lp(a) and free cholesterol in HDL-4 were the lipoprotein subfractions most strongly associated with coronary lipid content in our study"
👁️ "PCSK9 IMPAIRS the capacity of HDL to stimulate ENDOTHELIAL cells migration, as well as to protect endothelial cells from ROS production
👉 Observed effect of PCSK9 may affect the functionality of HDL against atheroprotection"
"There was a monotonic relationship between lower achieved LDL-C levels, down to very low LDL-C levels
<20 mg/dL (or <0.5 mmol/L) and even into the single digits, and a lower risk of cardiovascular outcomes in
the long term."
"COLCHICINE ➡️ fibrous cap thickening and collagen deposition ➡️ protective ACTA2+ myofibroblast-like cells, in a NOTCH3 DEPENDENT MANNER
🟢 EFFECT INDEPENDENT of its other beneficial ANTI-INFLAMMATORY properties"
🟢 Colchicine ACTIVATES both TGFβ and Notch3 signaling.
Was the
#Oreo
trial the first time?
Year 1982,....they concluded that carbohydrate-rich diets could be a safe and effective adjunct in the treatment of HFH
LDL= 676 mg/dl
⬇️
HIGH GLUCOSE DIET
⬇️
LDL= 277 mg/dl ➡️ regression of xanthomatous
#FXR
@DudzLightLime
@Clint_OMeley
"In normal weight volunteers, we observed that 1 WK OF
FASTING ⬆️cholesterol without affecting the triacylglycerol. The INCREASE in serum CHOLESTEROL
was ASSOCIATED with the AMOUNT of WEIGHT LOSS. LDL,which
carries a major part of circulating cho, ⬆️,
whereas HDL was unaffected"
"Lp(a) and LDL-C are independently associated with CVD risk. At LDL-C levels below <2.5 mmol/L, the risk associated with elevated Lp(a) attenuates in a primary prevention setting". Verbeek et al. 2018
"That hsCRP today remains a powerful predictor of risk likely reflects adverse secular trends over time in the prevalence of obesity, insulin resistance, and metabolic syndrome, factors that promote low-grade vascular inflammation"
"Analysis using MR revealed that BODY FAT percentage
was CAUSAL of but not LDL-C and the inflammatory marker, CRP, had no causal relationship with neither
ApoB nor LDL-C. This is the FIRST STUDY where a CAUSAL role
between ADIPOSITY and APOB has been demonstrated."
"Oxidized ApoB (oxLDL) and oxidized ApoA-I (oxHDL) have different relationships and prognostic values for high-risk coronary plaque characteristics and ⬆️ in CVD patients, as compared to healthy subjects"
"sLOX-1, ARE SIGNIFICANTLY associated with VULNERABLE PLAQUE PHENOTYPE"
Normal endothelium to diseased endothelium. "Action of risk factors in the normal endothelium leading to endothelial dysfunction and development of
atherothrombosis".
Fascinating, so much to know. HUMILITY "HDL increases PCSK9 activity and may link PCSK9 activity to circulating lipids levels. Further elucidation of the interactions between circulating lipoproteins and PCSK9 might reveal new avenues of therapeutic targeting of PCSK9"
"Our findings suggested that Lp(a) should be
considered as an influential factor in determining CAC burden. Specifically, data of our analysis demonstrated that the plasma level of Lp(a) between 20-38 mg/dl was a better predictor of subclinical CAC compared with Lp(a)≥50 mg/dl"
"LDL-TG was associated with atherosclerosis independently of well-known factors .In Bayesian analysis, LDL-TG was directly linked to atherosclerosis in over 95% of the ensembles. "
"Atherogenesis is initiated by subendothelial accumulation of atherogenic lipoproteins. Mediated by ionic interactions ➕ apoB100, and ➖ charged artery wall proteoglycans. ApoC-III facilitates this interaction by increasing the affinity of LDL for the artery wall proteoglycans"
"Protein standardized, STRONG DIRECT ASSOCIATION of DIETARY CHOLESTEROL to the magnitude of LEAN MASS GAINS that was consistent with the association of SERUM CHOLESTEROL to lean mass gains. Supported by a significant association of dietary cholesterol and change in STRENGTH."
Cholesterol is essential for life, ergo high cholesterol is not bad. Blood pressure is essential for life, ergo high blood pressure is not bad. It all starts to make sense now.
"Importantly, the observation that some people continue to experience plaque progression even at very low achieved LDL-C levels while other people
cease plaque progression and may even achieve plaque REGRESSION AT HIGHER LDL-C levels", Ference et al.2018
👁️"Patients with chronic coronary disease, long-term low-dose COLCHICINE produced a consistent reduction in major cardiovascular events year by year during 5 YEARS OF FOLLOW-UP
💚 The benefit of colchicine continues to accumulate during long-term follow-up"
"PCSK9 inhibitors; in both the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk) and the SPIRE trials, hsCRP remained a common and strong predictor of future cardiovascular risk, despite LDLC levels as low as 20 to 30 mg/dl"
👉"Plaque rupture with ST-segment elevation
MI.
🟠 TG, sd-LDL-C, and TRL-C levels were associated with PR but not LDL-C.
🟢 ONLY SD-LDL-C levels
were an INDEPENDENT RISK FACTOR for PR.
🔥 Non-HDL-C,
APOB, and apoC3 levels were NOT IDENTIFIED TO BE ASSOCIATED
WITH PR"
💝 EXTREME LONGEVITY ▶️ RESISTANCE TO LIPID PEROXIDATION of MEMBRANE
🤗 "Extreme longevity is significantly associated with a HIGHER average chain length and SATURATED FATTY ACID CONTENT, and a LOWER content of UNSATURATED FATTY ACIDS, particularly polyunsaturated fatty acids"
Obstructive CAD in those without CAC associated with a significantly
⬆️ risk of MI and death,
with an adjusted HR of 1.80 (1.02-3.19) in
< 60 years of age who followed median of 4.3 years. Results highlighted the relevance of noncalcified plaque
and stenosis in younger patient
"Although hs-CRP has been a useful marker of
⬆️ risk, Mendelian randomization studies investigating the association of genetic variants in the CRP
gene with risk for CHD suggest that CRP concentration
itself is unlikely to be a causal factor in CHD"
"Aspirin use was associated with a significant reduction in CHD events in participants with elevated Lp(a) without baseline CVD. These results are hypothesis generating and require confirmation in studies with randomization of aspirin use". MESA
"MENDELIAN RANDOMIZATION analysis suggested that the observational relationship between HIGHER levels of HIGH-DENSITY LIPOPROTEIN CHOLESTEROL and REDUCED RISK of hospitalization for INFECTIOUS DISEASE could be CAUSAL in nature"
"Using the cutoff of 71 mg/dL for HDL-C, we proved that patients with HDL-C ranging between 71 and 101 mg/dL had significantly better endothelial function than those with HDL-C ≤ 71 mg/dL, and this also was evident across the HDL-C tertiles"
"In patients with AS, Lp(a) and OxPL drive valve calcification and disease progression. These findings suggest lowering Lp(a) or inactivating OxPL may slow AS progression and provide a rationale for clinical trials to test this hypothesis"
"274 babies examined at 1 year 24 had serum cholesterol of 240 mg/100 ml or ⬆️ .
These observations were carried out on average seven weeks after
the "one year" blood sample had been taken."
"VLDL remnants are a better target for disease prevention than LDL-C, which cannot be easily reduced by a modulation of exercise or food intake"
Inspired by a conversation with
@LowCarbEyeDoc
"More than 40% of statin eligible individuals with baseline CAC = 0 had long-term healthy arterial aging. Statin eligible candidates with persistent CAC = 0 had a very low 15-year ASCVD risk,suggesting that statin therapy may be of limited benefit among this group of individuals"
💝 "Physiological adaption to an inherently LOW OXIDATIVE STRESS present in centenarians
🤗 Ether lipid profile predominant in centenarians suggest a greater resistance to oxidation based on the ⬆️ alkyl forms and the ⬇️ CONTENT IN PUFAS & ⬆️ for MONOUNSATURATED fatty acid"
"Increased plasma concentrations of Lp(a) are detectable in about 30–50% of patients with FH and consistent evidence supports the notion that they may significantly affect CVD risk in the FH population"
"Colchicine reduced CV events and inflammatory markers, high-sensitivity C-reactive protein and IL-6, in patients with coronary disease compared to controls. Its impact on cardiovascular and all-cause mortality requires further investigation"
👁️" DYSREGULATED cholesterol metabolism in macrophages ▶️ atherosclerosis
💚 ASCVD has evolved beyond the SIMPLISTIC NOTION of lipid accumulation
▶️ ...Complex links metabolic pathways,cellular activities & cell differentiation within the plaque microenvironment is ESSENTIAL"
"AGE, HBA1C, TOTAL CHOLESTEROL to HDL RATIO, LEUKOCYTE volume, and HEMOGLOBIN are the top 5 predictors of generalized SA in the PESA study. Despite the small sample size (AWHS), all predictors except LDL were independent predictors of generalized SA"
"In this population-based study of the indigenous Tsimane population of Bolivia, we observed a very low prevalence of coronary atherosclerosis, as measured by CAC scoring"
ApoB =min. 86,4-max. 109,4 mg/dl
See percentil
"Results presented in Table 2 suggest that among all variables of interest, elevated FASTING PLASMA INSULIN concentrations, irrespective of the PRESENCE OR ABSENCE of other LIPOPROTEIN ABNORMALITIES, were associated with the GREATEST RELATIVE INCREASE in the RISK of IHD.".
"In fact,most FDG avidity occurred in plaque-free arterial segments,suggesting active arterial inflammation precedes the development of atherosclerosis.
Study suggests inflammation actually precedes the development of plaque,definitive proof ➡️ follow-up imaging of the PESA"
🔵 Beneficial for resisting fatal stress
🟢 LDL-C protective effect multiple pathogens, and extremely low may increase susceptibility to life-threatening diseases
⚪ Low circulating concentrations may have adverse effects on survival
"Alirocumab produced the greatest reduction of coronary revascularization in patients with baseline Lp(a) in the top quartile (≥59.6 mg/dL) (HR, 0.6), but no apparent reduction in the bottom quartile (HR, 1.00). Findings similar for the effect of aliro on any revascularization"
Ezetimibe and Lp(a)
"The results of this meta-analysis suggest that ezetimibe treatment does NOT reduce plasma lipoprotein(a) levels and therefore Lp(a) reduction does not contribute to its therapeutic efect in cardiovascular prevention".
👁️"This study has detected the expression DIFFERENCES OF 115 GENES in FH samples compared to the controls
👉ZEB2, JAK3 and PLCG2 genes as the key hub genes ▶️ connects cardiovascular and immune response
👌IMMUNE DYSREGULATION MECHANISMS underlying the athero AMONG FH PATIENTS"
"Statin therapy is associated with regression of coronary atherosclerosis when LDL-C is substantially reduced and HDL-C is increased by more than 7.5%"
👁️"Atherosclerosis is now considered a NON-RESOLVING CHRONIC INFLAMMATORY condition in which the MACROPHAGE IS THE CENTRAL PLAYER
🥳 Robust attenuation of macrophages within the atherosclerotic plaques of our Dj1-deficient mice ▶️ STRONG LINK BETWEEN ATHERO AND INFLAMMATION"
🤔 "Genetic evidences CONFIRMED the overall INVERSE ASSOCIATION between LDL-C and the risk of STOMACH CANCER
🧐 LDL-C≥4.1 mmol/L respectively served as a CAUSAL PROTECTIVE ROLE for the risk of stomach cancer among female participants and participants aged 60 years or older,.."
"Lower fasting triglyceride levels are associated with better ENDOTHELIAL FUNCTION.
From the aspect of endothelial function, the OPTIMAL target for TRIGLYCERIDE LEVELS may be 30 MG/DL, a level that is similar to that in neonatal triglyceride"
"Statin-naïve participants by LDL-C levels and a combined group of statin-naïve with LDL-C≥190 and statin users with LDL-C≥130 (“high LDL-C”). LDL-C≥190, 54% CAC=0, 40% no plaque. Similar numbers were observed among participants with “high LDL-C”, 45% CAC=0 and 35% no plaque"
MR "The PROTECTIVE EFFECT of HDLc was STILL SIGNIFICANT in our study even AFTER ADJUSTING for LDLc and TG. As the genetically predicted HDLc is not causally associated with CVD, the relationship between HDLc and LONGEVITY is unexpected and the underlying mechanism is not clear"
"Triglyceride-lowering LPL alleles were STRONGLY and CONSISTENTLY associated WITH PROTECTION from coronary disease and diabetes in subgroups of people ABOVE or BELOW the median of the population DISTRIBUTION OF THE 58 LDL-C–lowering alleles"
🫣 "Stroke patients had a ⬆️ proportion of LDL(−), independently of other lipid-related molecules and of treatment with high-dose statins
👉 LDL(−), BUT NOT OXLDL, was independently associated with the degree of carotid stenosis,....., all of features of plaque vulnerability"
"Despite chronic and presumably life-long levels of LDL-C typically less than 40 mg/dl, the patient presented here was found to have mild atherosclerosis.
On admission the patient's standard lipid panel showed a serum LDL-C of 32 mg/dl"