Circulation: Clinical Summaries
Original Research Put Into Perspective for the Practicing Clinician
- High-Density Lipoprotein Proteomic Composition, and not Efflux Capacity, Reflects Differential Modulation of Reverse Cholesterol Transport by Saturated and Monounsaturated Fat Diets
- Long-Term Effectiveness and Safety of Pravastatin in Patients With Coronary Heart Disease: Sixteen Years of Follow-Up of the LIPID Study
- Menthol and Nonmenthol Cigarette Smoking: All-Cause Deaths, Cardiovascular Disease Deaths, and Other Causes of Death Among Blacks and Whites
- Impact of Nurse-Led, Multidisciplinary Home-Based Intervention on Event-Free Survival Across the Spectrum of Chronic Heart Disease: Composite Analysis of Health Outcomes in 1226 Patients From 3 Randomized Trials
- Effects of Age and Sex on Clinical Outcomes After Percutaneous Coronary Intervention Relative to Coronary Artery Bypass Grafting in Patients With Triple-Vessel Coronary Artery Disease
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High-Density Lipoprotein Proteomic Composition, and not Efflux Capacity, Reflects Differential Modulation of Reverse Cholesterol Transport by Saturated and Monounsaturated Fat Diets
Reverse cholesterol transport (RCT) is the process by which cholesterol from peripheral cells is effluxed onto circulating high-density lipoprotein (HDL) particles to be returned to the liver for excretion. Promotion of RCT is thought to reduce cardiovascular disease risk; however, raising high-density lipoprotein cholesterol (HDL-C) levels by using cholesteryl ester transfer protein inhibitors failed to have clinical benefit. HDL particles carry a large cargo of proteins, in particular, immune modulatory proteins that likely alter the atheroprotective functions of HDL. This study demonstrates that saturated fatty acid (SFA)–induced obesity increased HDL-C and macrophage-to-plasma RCT in vivo; however, liver-to-feces RCT was impaired coupled with increased hepatic inflammation and downregulation of hepatic transporter expression in comparison with lean controls. Replacement of SFA with monounsaturated fatty acid within obesogenic diets increased all steps of macrophage-to-feces RCT with lower levels of hepatic inflammation evident in comparison with SFA–high-fat diet. The proteome of HDL particles was enriched with proinflammatory hepatic-derived acute-phase proteins after SFA–high-fat diet in comparison with monounsaturated fatty acid–high-fat diet reflecting differential modulation of liver-to-feces RCT by SFA- and monounsaturated fatty acid–high-fat diets. Recent meta-analysis has suggested that high-SFA intake is not associated with cardiovascular disease. Furthermore, high carbohydrate consumption lowers HDL-C, whereas high fat consumption raises HDL-C. Although dietary replacement of carbohydrate for fat may normalize lipid profiles in obesity, our study warrants caution over the fat quality used in such an approach. Dietary replacement of carbohydrate with SFA may increase levels of proinflammatory HDL particles and increase cardiovascular disease risk despite elevating HDL-C. By contrast, dietary replacement of carbohydrate for monounsaturated fatty acid may raise HDL-C, preserve the anti-inflammatory proteomic composition of HDL particles, and increase RCT. See p 1838.
Long-Term Effectiveness and Safety of Pravastatin in Patients With Coronary Heart Disease: Sixteen Years of Follow-Up of the LIPID Study
An ever-increasing number of patients are being prescribed statin therapy, so it has become more important to ensure that this drug class is very safe. After 16 years of follow-up, the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study provides clear evidence that an initial 6 years of pravastatin treatment results in sustained overall survival benefit for patients with a history of coronary heart disease and average cholesterol levels. The survival benefit was primarily related to deaths from cardiovascular disease. The results will also reassure clinicians on the long-term safety of statins in relation to noncardiovascular causes of death, cancer incidence, and cancer mortality. The LIPID study found no evidence that pravastatin treatment affected cancer incidence during the 10-year extended follow-up period when any delayed effect might emerge. This finding was emphasized by the accompanying meta-analysis of long-term data from other statin trials. The high levels of adherence to pravastatin therapy also indicate that treatment is likely to be well tolerated by typical patients. These results strengthen the evidence supporting long-term continued use of statin therapy in patients who are at risk of further cardiovascular events. See p 1851.
Menthol and Nonmenthol Cigarette Smoking: All-Cause Deaths, Cardiovascular Disease Deaths, and Other Causes of Death Among Blacks and Whites
An 8-year mean follow-up of a cohort of >65 000 black and white adults in the southeastern United States revealed no higher mortality overall or from cardiovascular disease among smokers of menthol versus nonmenthol cigarettes. Prior evidence for differential associations between menthol versus nonmenthol cigarettes and cardiovascular disease risk was limited and inconsistent. Our findings confirm that smoking of any cigarette type is hazardous to health but suggest that the much higher preference for menthols among blacks than whites does not account for the higher rates of cardiovascular disease or all-cause mortality among blacks. Continued and sustained efforts are needed to assist smokers in quitting and to prevent nonsmokers from smoking initiation. See p 1861.
Impact of Nurse-Led, Multidisciplinary Home-Based Intervention on Event-Free Survival Across the Spectrum of Chronic Heart Disease: Composite Analysis of Health Outcomes in 1226 Patients From 3 Randomized Trials
These data have important clinical implications for the application of disease management across the full spectrum of heart disease to prolong survival without provoking the competing risk of recurrent hospitalization. In combining 3 contiguous trials of the same form of management adapted to clinical profile (from younger individuals surviving an acute coronary event to older individuals hospitalized with more advanced forms of atrial fibrillation and chronic heart failure), we were able to tackle an important gap in the evidence base. Overall, we demonstrated that, in comparison with high levels of standard management, a nurse-led, multidisciplinary, home-based intervention was associated with both prolonged survival and reduced hospital stay over the longer term. Given that in clinical practice disease management programs are typically applied according to a single cardiac diagnosis (most notably chronic heart failure), overall, these data support the wider application of this approach to any patient discharged home from the hospital with a form of chronic heart disease; particularly in older individuals with multimorbidity. On this basis, there is scope to extend preexisting health services applying this kind of approach to the full spectrum of heart disease on a cost-effective basis. This would involve modifications in screening and referral protocols (to identify eligible patients), more health resources to accommodate an increased case load, and critical adjustments to patient profiling and needs assessments to adapt this strategy on an individual basis. See p 1867.
Effects of Age and Sex on Clinical Outcomes After Percutaneous Coronary Intervention Relative to Coronary Artery Bypass Grafting in Patients With Triple-Vessel Coronary Artery Disease
The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) registry is a multicenter registry enrolling consecutive patients undergoing a first coronary revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). In a pooled population of the Cohort-1 (conducted in 2000–2002, n=9877) and Cohort-2 (2005–2007, N=15,939), a total of 5651 patients had a triple-vessel coronary artery disease who were considered to be pertinent in comparisons of PCI with CABG (PCI, n=3165; CABG, n=2486). PCI compared with CABG was associated with higher long-term adjusted risk for all-cause death, myocardial infarction, heart failure hospitalization, and any coronary revascularization but with lower risk for stroke. The excess adjusted mortality risk of PCI relative to CABG was significant in patients ≥74 years of age (n=1859; hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.10–1.79; P=0.006), whereas the risks were neutral in patients ≤65 years of age (n=1972; HR, 1.05; 95% CI, 0.73–1.53; P=0.78) and in patients 66 to 73 years of age (n=1820; HR, 1.03; 95% CI, 0.78–1.36; P=0.85; Pinteraction=0.003). The excess mortality risk of PCI relative to CABG was significant in men (n=3998; HR, 1.24; 95% CI, 1.03–1.50; P=0.02) and trended to be significant in women (n=1653; HR, 1.34; 95% CI, 0.98–1.84; P=0.07), without significant interaction between sex and the mortality risk of PCI relative to CABG (Pinteraction=0.40). See p 1878.
- © 2016 American Heart Association, Inc.
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